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Human Herpes Viruses PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "HUMAN HERPES VIRUSES" by Dr. D Kalita.

This medical PowerPoint presentation talks about Human herpes viruses which are a group of viruses that belong to the family Herpesviridae. There are eight different types of human herpes viruses, which are named HHV-1 through HHV-8. Each type of herpes virus has a distinct set of symptoms and health effects.

Tags : HUMAN HERPES VIRUSES, Herpesviridae, Dermatology, Dermatology PowerPoint presentation

Published on : Mar 31, 2023 | Views : 2499 | Downloads : 6

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HUMAN HERPES VIRUSES -1 Dr. D Kalita, Associate professor, Department of Microbiology, AIIMS Rishikesh Date of Class: 26/4/2017 (4PM to 5PM, LT-4)
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01-Apr-23 2
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HERPES VIRUS 01-Apr-23 3
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Introduction to HERPES VIRUS About100 Enveloped DNA viruses affecting Humans and animals Can cause Latent infections – enabling virus to persist within infected hosts and to undergo periodic reactivation. 01-Apr-23 4
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Herpes virus morphology Icosahedral capsid - 162 capsomers - Enclosing the core with dsDNA Nucleocapsid covered by a lipid envelope (derived from modified host cell membrane) Envelope carries surface spikes Tegument (amorphous): between envelope and capsid 01-Apr-23 5
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Herpes virus morphology Enveloped virion 200 nm Naked virion  100 nm Replication takes place in the host cell nucleus Cowdry type A inclusion bodies which is also called Lipschutz bodies 01-Apr-23 6
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CLASSIFICATION 01-Apr-23 7
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Herpes simplex
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HHV 1 & HHV 2 - Morphology 01-Apr-23 9
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HHV 1 & HHV 2 - Pathogenesis 01-Apr-23 10
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Differentiation of HSV1 and HSV2 Monoclonal antibodies Pocks in CAM (HSV2 > HSV1) HSV2 more neurovirulent in lab animals HSV2 is more resistant in vitro to antivirals (e.g.Cytarabine & IUDR) DNA RE studies differentiates (upto strain level) Etc.…………….Ref to a textbook 01-Apr-23 11
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Infections HSV1 Acute gingivostomatitis Herpes labialis (cold sore) Keratoconjunctivitis Eczema herpericum Encephalitis Dendritic keratitis (above waist…………………but…) 01-Apr-23 12
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HSV2 Genital herpes (Penile, Urethral, Cervix, Vulval, Vaginal) Neonatal herpes Aseptic meningitis (Below waist…..but………….) 01-Apr-23 13
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ACUTE GINGIVOSTOMATITIS Acute gingivostomatitis is the commonest manifestation of primary herpetic infection. Pain and bleeding of the gums Ulcers with necrotic bases Neck glands are commonly enlarged accompanied by fever. Usually a self limiting disease lasting around13 days.
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HERPES LABIALIS (COLD SORE) Recurrence of oral HSV. 45% of orally infected individuals will experience reactivation. Tingling, warmth or itching at the site initially12 hours later, redness appears followed by papules and then vesicles.
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SYMPTOMS Mild or severe and may include: Sores on the inside of the cheeks or gums Fever General discomfort, uneasiness, or ill feeling Very sore mouth with no desire to eat Halitosis
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HSV – Cold Sore
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HHV 1- Clinical manifestations 01-Apr-23 19 EM of Herpes virus 1
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OCULAR HERPES Cause of corneal blindness. Include the following:- Primary HSV keratitis – Keratoconjunctivitis Dendritic ulcers Recurrent HSV keratitis HSV conjunctivitis Acute necrotising retinitis, chorioretinitis
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KERATOCONJUNCTIVITIS Inflammation of the cornea and conjunctiva. Minor damage to the epithelium (superficial punctate keratitis) to formation of dendritic ulcers.
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Keratoconjunctivitis
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HERPES SIMPLEX ENCEPHALITIS One of the most serious complications of herpes simplex disease. There are two forms:
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Neonatal – global involvement and the brain is almost liquefied mortality rate approaches 100%. Focal disease – Temporal lobe is most commonly affected. In children and adults Many arise from reactivation of virus. Mortality rate is high (70%) in untreated
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01-Apr-23 25 Early diagnosis and treatment of HSE is very essential. IV acyclovir is recommended in all cases of suspected HSE before laboratory results are available.
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Herpes Simplex Encephalitis CT Scan Autopsy
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MENINGITIS Most commonly with primary HSV-2 infection; less likely with recurrences of genital herpes Benign, self-limited (contrast with encephalitis) Usually affects sexually active young adults No neurologic sequelae
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GENITAL HERPES Genital lesions may be primary, recurrent Sites: penis, vagina, cervix, anus, vulva, bladder, the sacral nerve routes, the spinal and the meninges. Prone to secondary infection eg. Staphylococcus aureus, Streptococcus group, Trichomonas and Candida albicans.
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GENITAL HERPES Dysuria is a common complaint, Recurrences in 60% . Recurrent lesions in the perianal area  more numerous and persists longer.
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HSV – CONGENITAL/PERINATAL Perinatal infection: ¾ th are due to HSV 2 acquired during delivery Post natal infection HSV-1 acquired from maternal genital, oral or breast lesions or nosocomial infection from other infected babies
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HERPETIC WHITLOW A lesion (whitlow) on a finger or thumb caused by the herpes simplex virus. HSV-1 or HSV-2. HSV-1 whitlow is often contracted by health care workers  dental workers and medical workers exposed to oral secretions.
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Laboratory Diagnosis Direct Detection Electron microscopy of vesicle fluid - rapid result Immunofluorescence of skin scrappings - distinguish between HSV and VZV
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HHV 1& 2 Diagnosis Multinucleate Giant cells – Tzanck’s smear 01-Apr-23 35
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Laboratory Diagnosis Viral culture (gold standard) Preferred test in genital ulcers or mucocutaneous lesions Highly specific (>99%) Sensitivity declines rapidly as lesions begin to heal Positive more in primary infection (80%–90%) than with recurrences (30%)
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CPE of HSV in cell culture: ballooning of cells. IF test for HSV antigen in epithelial cell.
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Laboratory Diagnosis…cntd Polymerase Chain Reaction (PCR) More sensitive than viral culture; has been used instead of culture in some settings not widely available Preferred test for detecting HSV in spinal fluid (Routinely used in HSE)
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Serology Type-specific and nonspecific antibodies Anti HSV-2 antibody indicates anogenital infection Anti HSV-1 antibody does not distinguish anogenital from orolabial infection IgG, IgM - ELISA 39
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ANTIVIRAL Several antivirals available for treatment of the conditions: Aciclovir (acyclovir), Valaciclovir (valacyclovir), Famciclovir, Penciclovir.
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Varicella zoster
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VARICELLA Primary infection results in varicella (chickenpox) Incubation period : 14-21 days Presents fever, lymphadadenopathy. a widespread vesicular rash. Diagnosis can be made on clinical grounds alone.
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Complications are rare  occurs more frequently and with greater severity in Adults Immunocompromised persons MC complication is secondary bacterial infection. Life threatening complications Viral pneumonia, Encephalititis, Haemorrhagic chickenpox.
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NEONATAL VARICELLA VZV can cross the placenta in the late stages of pregnancy to infect the fetus congenitally. Mild disease to fatal disseminated infection. If rash in mother occurs more than 1 week before delivery  sufficient immunity is transferred to the fetus.
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LABORATORY DIAGNOSIS C/Fs of varicella or Herpes zoster are characteristic laboratory confirmation is rarely required. Laboratory diagnosis  for atypical presentations (as seen in immunocompromised patients)
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LABORATORY DIAGNOSIS….cntd Direct detection - electron microscopy (no d/d between HSV and VZV). IF on skin scrapings can distinguish the 2 VZV IgG is indicative of past infection and immunity.  IgM is indicative of recent primary infection. Virus Isolation - rarely carried  requires 2-3 weeks for a results.
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HERPES ZOSTER (Shingles) Manifestation of recurrent infection following a primary attack of chicken pox. Caused by varicella zoster Unlike herpes labialis repeated recurrences of zoster are uncommon. Infection typically affect adult of middle aged group
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Pain precedes the rash (vesicles). Severe pain, and commonly occurs on the trunk on one side. The trigeminal nerve is affected  15% of cases
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Lesions localized to one side, along distribution of nerve (e.g. any divisions of the trigeminal nerve up to the midline) Malaise can be severe. Regional lymph node are enlarged and can be life-threatening in HIV disease.
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TREATMENT Only in severe cases : Oral acyclovir 800 mg five times daily for 7-10 + analgesic.
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RAMSAY HUNT SYNDROME Involvement of facial nerve with VZV Facial nerve palsy Vesicles in external auditory meatus Vesicles on palate Symptoms :dizziness, loss of taste. Usually self limiting condition  rarely permanent facial weakness may remain.
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Clinical case scenario A 21 years old female presented with a complaint of malaise and loss of appetite X 1 month and sore throat and fever (especially in afternoon) since 5 days. O/E: Cervical lymphadenopathy+, Mild hepatosplenomegaly+. CBC showed Absolute Mononuclear lymphocytosis (mostly atypical lymphocytes). Her serum was tested by Monospot where IgM was positive. Diagnosis? 01-Apr-23 53
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Diagnosis Human Herpes Virus 4 (HHV-4) / Epstein Barr virus infection Infectious mononucleosis / Glandular fever/ Kissing’s disease 01-Apr-23 54
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HHV 4 Ebstein Barr virus - EBV 01-Apr-23 55
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EBV or HHV-4 1964 – Epstein, Barr and Achong – identified a new type of herpes virus EB virus affecting B lymphocyte lineage. CD 21 receptors necessary for acquiring EBV infection 01-Apr-23 56
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EBV EPIDEMIOLOGY Source of infection: Saliva of infected persons – Not highly contagious, droplets and aerosols not effective in disease transmission Intimate oral contact (as in kissing) – predominant mode of transmission – hence the name ‘Kissing disease’ 01-Apr-23 57
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EBV – Clinical spectrum Infectious mononucleosis EBV associated malignancies: Burkitt’s lymphoma Lymphomas in immunodeficient persons e.g. AIDS & transplant recipients Nasopharyngeal carcinoma in East Asia/China 01-Apr-23 58
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Infectious mononucleosis Glandular fever Acute self-limited illness Usually seen in non-immune young adults following primary infection with EBV Incubation period: 4-8 weeks. 01-Apr-23 59
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Infectious mononucleosis (EBV) 01-Apr-23 60
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01-Apr-23 61
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Infectious mononucleosis Ampicillin Rx may lead to develop maculopapular rash May associate sub-clinical Hepatitis Complications: Hematological, Neurological, Cardiac & Pulmonary conditions and Splenic rupture Spontaneous resolution occurs in 2-4 weeks 01-Apr-23 62
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Lab diagnosis of EBV Leukopenia followed by leukocytosis in later stages with atypical lymphocytosis (Abnormal mononuclear cells) Paul – Bunnell test: Standard diagnostic test for Heterophile antigen detection Monospot test 01-Apr-23 63
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Lab diagnosis of EBV cont.. Differential agglutination test: Differential absorption of Agglutinins with Ox red cells and Guinea pig kidney cells Immunofluorescence ELISA 01-Apr-23 64
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Lab diagnosis of EBV cont… IgM antibody to VCA (Viral Capsid Antigen) indication of primary infection EB Nuclear Antigen (EBNA) is also a useful marker of primary infection Ab to Early antigens (EA) high in EB-associated lymphomas 01-Apr-23 65
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Case scenario A 27 years old male a K/C/O HIV/AIDS presented to Ophthalmology OPD with Progressive diminution of vision X 3 months. CD4 counts<100 cells/mm3. Fundus examination: Fluffy retinal infiltrates+ Multiple hemorrhages+ Serological tests positive for IgG antibodies and PCR were positive for DNA (Herpes group). Diagnosis? Rx 01-Apr-23 66
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DIAGNOSIS CMV retinitis made Patient was started on Ganciclovir. Note: Patient did not take Anti-HIV medications regularly. …to be initiated urgently 01-Apr-23 67
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Thanks …..to be continued to next class 01-Apr-23 68