SUMMARY OF HERPESVIRUSESINFECTION

INCLUDING(HSV,HZV,CMV,EBV)

Hamad Emad H. Dhuhayr

CONTENTS

• HSV

• HZV

• CMV

• EBV

HERPES SIMPLEX VIRUS

• Etiology:

• Organism: there are 2 types HSV1 & HSV2

• Mode of transmission: by mouth and less commonly by skin. The infection may

remain

• Latent , and activated later by stress, infection or trauma

CLINICAL PICTURE

• The condition may be asymptomatic or present by

• Investigations:

1. PCR, electron microscopy and culture for

vesicle fluid

2. Serological tests to confirm primary

infection

• Treatment: acyclovir 200 mg 5 times daily

orally or iv.

HERPES ZOSTER

• Herpes zoster (or simply zoster), commonly known

as shingles and also known as zona, is a viral

disease characterized by apainful skin rash

with blisters in a limited area on one side of the body

(left or right), often in a stripe. The initial infection

with varicella zoster virus (VZV) causes the acute, short-

lived illness chickenpox which generally occurs in

children and young adults.

• Clinical picture:

1. results from reactivation of latent VZV in ganglia

2. Occurs most common in the elderly

3. Skin lesion are unilateral and are of dermatome distribution

4. Usually proceeded by sever pain of dermatome distribution (thoracic

dermatomes, ophthalmic division of trigeminal nerve)

complication

1. Post herpetic neuralgia

2. Encephalitis, myelitis

• Dx

Pcr or culture of fluid of vesicles

Treatment

Acyclovir 800mg 5 times daily orally or iv

Analgesics carbamazepine

CYTOMEGALOVIRUS

Etiology:

· Virus: DNA herpes virus

· Mode of transmission: transplacental, passage through

infected birth canal, Blood transfusion, sexual intercourse,

or organ transplantation.

Pathogenesis:

· The infected cells are 2-4 times larger than normal.

· There is severe lymphocytic reaction which is

characterized by atypical

Lymphocytes in the peripheral blood.

· Once infected, the host will have CMV indefinitely.

· The manifestations of the virus will appear when the host

is

Immunosupressed.

Clinical picture:

1. Congenital CMV infection

· CNS: microcephaly+ cerebral calcification & mental retardation

· GIT: hepatosplenomegaly, jaundice

· Petichea

2. Perinatal CMV infection

Ø mainly asymptomatic

Ø interstitial pneumonitis

Ø lymphadenopathy

Ø hepatitis

Ø rash

Ø anemia

Investigations:

1. Blood:

· Rbcs: may show hemolyytic anemia

· WBS: relative lymphocytosis(> 10% atypical lymphocytes)

· Pancytopenia

· Detection of virus by PCR

2. Liver enzymes: mild elevation in SGOT, SGPT & ALP

3. Serology: four fold increase in antibodies detected by ELISA or IF

Treatment:

Prophylaxis: screening blood donors & checking donors and recipients of organ

Transplantation for CMV

Curative: gancyclovir (the best treatment) · Acyclovir or interferon

EPSTEIN BARR VIRUS

Etiology:

· Organism: epstein-barr virus

· Mode of transmission: droplet infection

Presentations:

1. Infectious mononucleosis

2. Nasopharyngeal carcinoma

3. Burkitt’s lymphoma and other B cell lymphomas

Clinical picture:

· Incubation period: 4-8 weeks

· Clinical triad: fever, pharyngitis, lymphadenopathy:

O fever: higher in the afternoon and may reach 40 C

O pharyngitis: with sore throat & red spots

O lymphadenopathy: usually cervical but may be generalized

O others: splenomegaly (50-75% of cases), rash (which may

represent drug

Eruption when treated by ampicillin).

· Other presentations:

O neurological: peripheral neuritis(guillan-barre syndrome), bell’s palsy

O cardiac: pericarditis, myocarditis

O GIT type:

1. Hepatomegaly + jaundice(dd viral hepatitis)

2. Fever + splenomegaly (typhoid picture)

3. Oropharyngeal type: sore throat + hyperplasia of

Pharyngeal lymphoid tissue (DD follicular tonsillitis)

O cutanouse eruption : may be precipitated by ampicillin

O latent form: laboratory diagnosis only.

Investigations:

1. Cbc:

O lymphocytosis with atypical lymphocytes (larger, stains deeper & with

Vacuolated cytoplasm).

O thrombocytopenia

O auto-immune hemolytic aneamia

2. Serology:

O paul-bunnel test: hetereophil antibodies in the serum that agglutinate sheep

Rbcs

O monospot test: serum of the patient + guinea big kidney + ox rbcs on slide

→ Agglutination

O anti- EBV antibodies in the serum

3.Others:

O BM aspiration to exclude leukemia

O LN biopsy to exclude lymphoma

O throat swab to exclude other causes of sore throat

REFERENCES

• CECIEL

• WEBSITE