infection disease by herpes virus

1. SUMMARY OF HERPESVIRUSES
INFECTION
INCLUDING(HSV,HZV,CMV,EBV)
Hamad Emad H. Dhuhayr

2. CONTENTS
• HSV
• HZV
• CMV
• EBV

3. 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

4. CLINICAL PICTURE
• The condition may be asymptomatic or present by

5. • 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.

6. 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.

7. • 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

8. • Dx
Pcr or culture of fluid of vesicles
Treatment
Acyclovir 800mg 5 times daily orally or iv
Analgesics carbamazepine

9. CYTOMEGALOVIRUS
Etiology:
· Virus: DNA herpes virus
· Mode of transmission: transplacental, passage through
infected birth canal, Blood transfusion, sexual intercourse,
or organ transplantation.

10. 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.

11. 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

12. 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

13. 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

14. 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).

15. · 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.

16. 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

17. REFERENCES
• CECIEL
• WEBSITE