Herpesvirida

e &
Adenoviridae

By: Mj Briones
BSN-II

HERPESVIRIDAE

Herpesviridae

is a largefamilyofDNA
virusesthat cause diseases in
animals, including
humans.The members of this
family are also known
asherpesviruses.

HERPES VIRUSES

Herpes means that some of the lesions

are creeping in nature

Infect both warm and cold blooded

animals

Infections include - trivial

mucocutaneous infection
Have become successful pathogens due
to latency and reactivation

Herpesviruses are bad

news for reasons
1) Some infect crucial target tissues e.g. the brain and
maternal placenta.
2) All become latent (as circular DNA in the nucleii of
ganglia of lymphocytes) of recovered animals. Subsequent
reactivation during stress causes disease or tumours.
3) All are cell-associated and can spread between cells
by cell fusion. Inactivated vaccines which induce
circulating antibody therefore do not work well and safe
strong live vaccines which stimulate long term cytotoxic T
cells are difficult to make.

CLASSIFICATION
(Human pathogens)

DNA VIRUSES
Icosahedral
Large baggy envelope
DNA polymerase
Replication in nucleus of host cell

Herpes viruses have a similar

morphology

Share common antigens

Can differentiate by their

genome and by serological
tests

CLASSIFICATION
(Human pathogens)

Alphaherpesvirinae
Herpes simplex virus type 1
HSV-1
Herpes simplex virus type 2
HSV-2
Varicella-zoster virus VZV
Betaherpesvirinae
cytomegalovirus CMV
Human herpesvirus type 6 HHV-6
Human herpesvirus type 7 HHV-7
Gammaherpesvirinae
Epstein-Barr virus
EBV

HERPES SIMPLEX VIRUS

(HSV)

HSV 1 infect the upper part of the

body
- mouth and the face
HSV 2 infect the lower part of the
body
- genital infections
There is little cross protection
Therefore, you can get both the
infections

Man is the only natural host

Primary infection occurs

- skin
- Oral mucous membrane - eyes

Sources of infection
- Saliva
- Skin lesions
- Oropharyngeal
lesions
- Carriers

Viral DNA may get integrated in

to the host genome or virus may
just remain in the ganglia

Primary infection usually due to

type 1 happens at 6 months to 3
yrs of age

Only 10-15% of children show

acute gingivostomatitis OTHERS
ARE ASYMTOMATIC

About 75% of the adults show

+ve for HSV 1 infection
HSV 1 infections include
-i. Oropharyngeal
. Children - very painful
. due to kissing of elders
. acute gingivostomatitis
. problem of feeding

ii. Dermal - mainly among the

health care workers
- Herpetic whitlow
- painful
- heals without
treatment
- no pus
- Herpes gladiatorum - among
wrestlers
- eczema herpeticum

ECZEMA HERPETICUM

Iii. Ophthalmic - Keratoconjunctivitis

with dendritic ulcers
- Repeated attacks can
lead to blindness
1V. Meningitis and encephalitis
HSV 2 infections include
Genital - male and
female

Male - metaus with dysuria

- hepatic proctitis

Females - infection of the

labia/vulva/perineus
- cervicitis
Neonatal infections
At what stage ?

During the delivery

What are the other

infections acquired by
this mode

Candida can super infect, So what ?

High antibody titres do not prevent

latent infections

Latent infections
- recurrent herpes labialis
- acute keratoconjunctivitis
Recurrent lesions may lead to
- dendritic ulcers
- corneal ulcers

Treatment

Treatment

Acyclovir - is an antiviral drug. It

slows the growth and spread of the
herpes virus in the body. It will not
cure herpes, but it can lessen the
symptoms of the infection.
Acyclovir is used to treat infections
caused by herpes viruses, such
asgenital herpes, cold
sores,shingles, andchicken pox.

Idoxuridineophthalmic is an
antiviral medication. It prevents the
replication (reproduction) of the
herpes simplex virus. Thus, it reduces
the amount of active virus in your
system.Idoxuridineophthalmic is
used to treat eye infections caused by
the herpes virus

HERPES VARICELLA ZOSTER

HVZ

Causes chicken pox -fever + characteristic

rash
usually mild in children and more severe in
adults
complications
secondary infection - uncommon
varicella pneumonia

post-infectious encephalitis
generalized varicella (in immunocompromised
patients)
congenital and neonatal varicella

HERPES ZOSTER

Reactivation of HVZ
dermatomal distribution
may recur
can disseminate in immunocompromised
patients
complications

post herpetic pain

ophthalmic zoster -corneal scarring and loss of
vision

CLINICAL
DIAGNOSIS
EM of vesicle fluid
SEROLOGY
IgM detection

People can bet varicella from

zoster

Therefore, having
immunocompromised patients in
the hospital is a problem

These patients should be looked

after by the staff who are immune
to chickenpox

Pain and hyperaesthesia

Pain and hyperaesthesia

Pain and hyperaesthesia

Pain and hyperaesthesia

Prevention of
Chickenpox

Do nothing

Susceptible population
Immunize
children
live attenuated
dults living in close proximity
vaccine

Protect if contact with patient with chickenp

and at risk of severe disease
Zoster Immune Globulin (ZIG)

EPSTEIN BARR VIRUS

EBV

Discovered in 1964 by Epstein &

colleagues
Definite association with malignancy
is able to transform cells resulting
in immortalization of cell
2 types of virus A & B which may coexist in same person

Infectious
mononucleosis

Affects adolescents and young adults

worldwide distribution
called kissing disease
presents with fever,
sore throat, rash & lymph nodes
COMPLICATIONS
COMPLICATIONS
ampicillin
ampicillinrash
rash
guillain
guillainbarre
barresyndrome
syndrome
rupture
ruptureof
ofspleen
spleen

AMPICILLIN RASH

Syndromes caused by
EBV
Burkitts lymphoma

Nasopharyngeal carcinoma

children 4-12 years

subsaharan Africa and New Guinea
adults 20-50 years old
southern China

B cell lymphome

children and adults

primary immunodeficiency
patients with AIDS

Cytomegalovirus
infections

Ubiquitous virus
most populations -infections in
early childhood
often asymtomatic
Latency
Clinical disease increasing due
to increasing number of
immunocompromised patients

Cytomegalovirus
Foetus
infections

transmission from mother via placenta

clinically normal 80%
causes congenital CMV
death 1%
Cytomegalic inclusion disease %
late onset hearing defect / mental
retardardation 15%

Infant

transmission during birth or breast feeding

usually asymptomatic

Cytomegalovirus

Young
children
infections

adolescent/adult

transmission from other children

usually asymptomatic
transmission during kissing, sexual
intercourse or blood transfusion
occasionally IM like syndrome

immunocompromised

Exogenous
PRIMARY INFECTION
Endogenous REACTIVATION
pneumonitis, GI infection

Cytomegalovirus
Diagnosis
infections
DIFFICULT

presence of virus or antibody to CMV does not

indicate
that current disease is due to CMV
Different strategies used in different clinical
situations

isolation of virus from urine

within CMV
30 days of birth
Congenital
* antigen detection in
buffy coat indicates
viraemia
mmunocompromised

patient
* CMV specific Ig G positive indicates past

Treatment and
prevention
Congenital CMV

prevention not possible

treatment ?

CMV in transplant recipients

prevention
treatment

Early diagnosis
Reduce immunosuppression
Ganciclovir

Test IgG before transplant

If seronegative - use only
seronegative donors

CMV retinitis

CMV
retiniti
s

CMV
retinitis

CMV
encephalopat
hy

OTHER HUMAN HERPES

VIRUSES
HHV6

Discovered in 1988
Worldwide
virus replicates in T and B cells
infection occurs in first 3 years of life
Clinical
Exanthem subitum (roseola infantosum )

mild acute febrile illness

incubation period of 2 weeks

fever lasts several days

macular papular rash appears within 2 days of

fever
85% of adults carry virus in saliva

Exanthem subitum
(roseola infantosum)

OTHER HUMAN HERPES

VIRUSES

HHV7

isolated from CD4 positive cells

virus present in saliva of >75% of
adults
role in disease unclear
Evidence of infection present

HHV8

detected in epithelial cells of Kaposi

sarcoma
also present in semen
postulated as cause of Kaposi sarcoma

At least five species of

Herpesviridae
HSV-1and HSV-2 (both of which can
causeorolabial herpesandgenital herpes),
Varicella zoster virus(which
causeschicken-poxandshingles),
Epstein-Barr virus(which causes
mononucleosis),

ADENOVIRUSES

Human Adenoviruses

Human Adenoviruses

Adenoviruses were first isolated in 1935

from human adenoid tissues.

Since then, at least 49 distinct antigenic

types have been isolated from humans and
many other types from animals.

All human serotypes are included in a

single genus within the family Adenoviridae.

Morphology

ds-DNA viruses,
media sized in diameter,
icosahedral
Nonenveloped

Antigenic structure
All human Adenoviruses share a common
group-specific antigen.

Type specific antigens are important in

serotyping.

Classification
Adenoviruses are divided into six groups (A to F)
based on:

physical,
chemical
biological properties

Antigenic structure divides adenoviruses into:

- 49 serotypes:
- About 1/3 of the 49 known human serotypes are
responsible for most cases of Adenovirus disease.

Pathogenesis:

Adenoviruses spread by:

direct contact,
respiratory droplets
feco-oral route.

Pathogenesis:

Adenoviruses infect and replicate in the

epithelial cells of the:
pharynx,
conjunctiva,
urinary bladder
small intestine.
They usually do not spread beyond the
regional lymph nodes EXCEPT IN THE
IMMUNE COMPROMIZED HOST.

Pathogenesis:

The virus has a tendency to become

latent in lymphoid tissue,

The virus can be reactivated by

immunosuppression.

Clinical Syndromes:

Adenoviruses cause primary infection

in:

children
less commonly adults.

Several distinct clinical syndromes are

associated with Adenovirus infection.

CLINICAL SYNDROMES
A. Respiratory diseases:
B. Eye infections:
C. Gastrointestinal disease
D. Other diseases:
E. Adenoviral infections of the immune
compromised host

A. Respiratory
diseases:

The most important etiological association of

adenoviruses is with the respiratory diseases.

They are responsible for 5% of acute

respiratory diseases in:

young children
and much less in adults.

A. Respiratory
diseases:

Four different syndromes of respiratory infection have

been linked to Adenoviruses.

Acute febrile pharyngitis:

most commonly seen in infants and young children,
symptoms include cough, stuffy nose, fever and sore throat.

Pharyngo conjunctival fever:

symptoms are similar to those of acute febrile pharyngitis but
conjunctivitis is also present.
It tends to occur in outbreaks such as at children's
summer camps (swimming pool conjunctivitis).

A. Respiratory
diseases:

Acute respiratory disease:

is characterized by pharyngitis, fever,

cough and malaise.
It occurs in an epidemic form among
young recruits under conditions of
fatigue and overcrowding

Pneumonia: a complication of acute

respiratory disease in both children and
adults.

NOTE
Outbreaks & epidemic
adenovirus
infections
Pharyngo conjunctival
fever:

Acute respiratory disease:

outbreaks
in children's summer camps (swimming pool
conjunctivitis).

occurs in an epidemic form

among young recruits

Epidemic keratoconjunctivitis:

B. Eye infections:

Mild conjunctivitis:

can occur as a part of respiratory pharyngeal

syndromes.
Can occur sporadically or in outbreaks.

Epidemic keratoconjunctivitis:

a highly contagious and a more serious disease

occurring mainly in adults.

Corneal involvement may be followed

by various degrees of visual disability.

1.

C. Gastrointestinal
disease:
No disease association
1.

2.

Many Adenoviruses replicate in intestinal cells and

are present in the stools without being
associated with GIT disease.

Infantile gastroenteritis
1.

Two serotypes (40, 41) have been etiologically

associated with infantile gastroenteritis.

NOTE
1.

2.

The enteric Adenoviruses are

very difficult to cultivate.
Lab diagnosis depend on direct
detection

D. Other diseases:

Acute haemorrhagic cystitis:

types 11, 21 may cause acute haemorrhagic

cystitis in children especially boys.

E. Adenoviral infections of
the immune compromised
host

The most common clinical manifestations

are:
pneumonia,

hepatitis

gastroenteritis.

Laboratory Diagnosis

Direct detection:

Isolation

Serology

Laboratory
Diagnosis
Isolation
Isolation depending on the
clinical disease, the virus
may be recovered from
throat, or conjunctival
swabs or and urine.
Isolation is much more
difficult from the stool
or rectal swabs

Laboratory Diagnosis
Serology
Haemagglutination inhibition
&
Neutralization tests can be used to
detect specific antibodies following
Adenovirus infection.

Prevention and control

Careful hand washing is the easiest way to

prevent infection.

Disinfection of Environmental surfaces with

hypochlorites.

The risk of water borne outbreaks of

conjunctivitis can be minimized by
chlorination of swimming pools.

Epidemic keratoconjunctivitis can be

controlled by strict asepsis during eye
examination.