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Herpes virus familyHerpes simplex virus -1(Humán herpesvirus 1,
HHV-1)Herpes simplex virus -2(HHV-2)Varicella-zoster virus (HHV-3)
Cytomegalovirus (HHV-5)Human herpesvirus 6 (HHV-6A ,6B)Human herpesvirus 7 (HHV-7)
Epstein-Barr virus (HHV-4)Humán herpesvirus 8 (HHV-8)
Alfa(Neuronos)
Béta(leukocytes)
Gamma(Immunsystem, B-cells) oncogenic
HSV-1 and HSV-2 Cytolytic type DNA virusesLatent infection (sensory ganglia – trigeminus,
sacralis)Herpes labialis – HSV1Genital herpes HSV 2 and HSV1 (30%)Spread by direkt contact (saliva, sexual mucosa, urine)
Primer infection: 1-3 yrs age Fever, gingivo-stomatitis, group of vesicules on
mucosa
Trigger- reactivation
HSV-1 and HSV-2
Keratitis, keratoconjunctivitisEnchephalitis (temporal lobe)Immunocompromised
Generalised infectionVisceral manifestation: pneumonitis,
hepatitis
Connatal infection: intrapartum 90%Congenital – very rare
HSV-1 and HSV-2Congenital HSV:
Skin scars, microcephalia, ocular involvement (keratoconjunctivitis)
Intranatal infection: Keratoconjunctivitis, chorioretinitis (days
2-14)Skin vesicules (days 9-12)Haematogenic dissemination (days 9-11)
Hepatomegalia, jaundice, liver failure, pneumonitis, coagulopathy
Encephalitis (days 16-28)
HSV-1 and HSV-2DiagnosisClinical signsIsolations of virus from vesicules, antigen
detection, PCRSerology only useful in primary infection
TherapyHerpes labialis - localStomatitis – dehydration → hospitalisationAcyclovir:
During pregnancy in genital herpes Neonatal herpes infection Immunocompromised Encephalitis
Varicella-Zoster virusPrimary infection: varicella (chicken pox)VZV reactivation: herpes zoster (shingles)Spread by airSkin and mucosal vesiculesDifferent types of rashes (macule, papule,
vesicule, pustule, crust)
Incubation: 14 daysVery contagious: 2 days before symptomes
till crusts
Herpes-zosterVZV in paravertebral ganglia-latent
infectionGanglion teritory group of vesicules, painfulNo feverPostherpetic neuralgia
Varicella-Zoster virus Complications (varicella)Cellulitis, varicella phlegmone, impetigo,
necrotic fasciitis (S. aureus, S. pyogenes, H. infl.), STSSArthritisCerebellitisEnchephalitisRamsey-hunt sy.Guillan-Barre sy.PneumonitisCytopenia
Varicella-Zoster virusPregnancy and VZV infectionI. trimester (weeks 8-20) – congenital varicella
syndrome limb hypoplasia, eyes (chorioretinitis) és CNS damage
II. trimester – No severe complications
5 days before or 2 days after birth - connatal varicella syndromeNeonatal serious, progressiv varicella (VZIG, acyclovir
th.)
Varicella-Zoster virusImmunocompromised patientsNo hyperaemia around the vesiculesNo crustsOne stageHaemorrhage Visceral involvement:
Pneumonitis, ARDS Hepatitis Intestinal bleeding
Varicella-Zoster virusTherapy- acyclovir Controversial with healthy immunity Immunocompromised Serious cases, atypical varicellaNeonates ComplicationsZoster cures without treatment in
immunocompetents
Varicella-Zoster virusPreventionPassive immunization: VZIG- postexpozition
(Varitect) 72 hours Immunsuppression In pregnancy - controversial Connatal varicella
Activ immunization: live attenuated (Varilrix) > 1 yr, 2 doses, mild varicella, less zoster Zostavax USA, >60 yrs, postherpetic neuralgia ↓
EBV – Mononucleosis infectiosaAdolescence Spread by saliva, „kissing disease”Population >90% get infected <25 yrsLytic infection of pharyngeal mucosa CD-21 receptor – B cells
No B cells No mononucleosis (XLA)XLP – fulminant infection (fatal
mononucleosis)
EBV infectionClinical presentationsIncubation: 2-8 weeksProdroma : weakness, elevated tempr.FeverConfluent tonsillitisLypmhadenopathyHepato-splenomegalyMaculo-papular rash (penicillins)Chronic fatigue
EBV infectionLab testsBlood count: lymphomonocytosis,
activated lymphocytes, platelet↓Liver enzymes ↑
Serology (VCA, EA, EBNA antibody)
Heterophil agglutination -Paul-Bunnel test
EBV infectionComplications Spleen ruptureBacterial superinfections:
Necrotic tonsillitis, pneumonia, otitis, sinusitis
Haematology complications: Thrombocytopenia, haemolyticus anaemia,
neutropenia
Pericarditis, atrialfibrillation - rareHepatitis, haematuria, proteinuria- rareNeurological complications :
Periferal, central mononeuritis, Guillain-Barré sy.
EBV infectionComplicationsFatal mononucleosis- XLPBurkitt lymphoma Nasopharingeal carcinomaPolyclonalis B sejtes lymphoma – stem cell
transpl., AIDS
Therapy: symptomatic, NSAID
CMV infectionNo symptomes in healthy people
Mild disease (1%)Mononucleosis syndrome:
fever, malaise, lymphomonocytosis, liver enzymes↑
T cell deficiency - opportunisticTX: pneumonitis, colitis, hepatitisHIV: retinitis, polyradikulopathia, ulceral colitis
Primary infection, latency, reactivationNo cell proliferationIncubation: 4-12 weeks
CMV infectionComplicationsInterstitial pneumonia (improves spontanously )
Granulomar hepatitisGuilla-Barré sy. MeningoenchephalitisThrombocytopenia
CMV infectionCongenital infectionTransplacentar spreading
Intranatal
Postnatal- contaminated blood transfusion, breast feeding
CMV infectionManifest congenital CMV infectionPremature birthHepatosplenomegaly, jaundice,
petechiaThrombocytopeniaChorioretinitisMicrocephaliaSensoneural deafness (both side, progressiv)
Psychomotor retardationTeeth development problems
CMV infectionIntra- and postnatal CMV infectionRecurrent maternal infectionNo symptomes, but virus shedding for years
(urine)10% pneumonitisThrombocytopeniaHepatosplenomegaly
Therapy- gancyclovir, foscarnet, cidofovir
HHV-6,7,8HHV-6 (7): Exanthema subitum/Roseola
infantum („3 days fever”)<2 yrs, high fever for 3-5 days, no special
symptomesRash after fever stopsFever seizure, hepatitis, encephalitis
HHV-8Kaposi-sarcoma
Non-polio enterovirusesOnly human pathogenesFecal-oral spreading, summer-autumnEcho 4,6,9,11,30Coxsackie B2-5; A9,A16Enterovirus 70, 71Asymptomatic infection: 50-90 %Non specific fever syndrome
Fever, headache, muscle pain, malaise, loss of apetite, sore throat, nausea, vomiting, abdominal pain, loose stool („summer influenza” )
Non-polio enterovirusHand-foot-mouth disease
Coxsackie 16, Enterovírus 71Vesicules in the mouthPainfull vesicules on soles and palms
Herpanginafever, headache, vomitusVesicules on pharyngeal wall, tonsills
Symptomatic treatment
Non-polio enterovirusesAcut hemorrhagial conjunctivitisPharyngitis, tonsillitis, laryngitis, bronchitisPleurodynia (Bornholm-betegség)Acut gastroenteritisHepatitisAseptikus meningitis, encephalitisGuillen-Barré szindrómaPeri-, myocarditisPolymyositis
Non-polio enterovirusesNeonatal infection
Perinatal days, Coxsackie, EchoEpidemicSepsis-like syndrome, rashMeningitis, meningoencephalitisNecrotic hepatitisMyocarditis → early congestiv heartfailure
Treatment: IVIG?