Dr. Gulácsy Vera Herpes virus and Enterovirus infections.

Dr. Gulácsy Vera

Herpes virus and Herpes virus and Enterovirus infectionsEnterovirus infections

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

Varicella

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?

Thank you!