Human Herpes Viruses

Latent Viruses

Introduction
Herpes Viruses are a leading cause of human

viral diseases, second only to influenza and cold viruses. Are capable of causing overt disease or remaining silent for many years only to be reactivated. Name Herpes comes from the Latin herpes which, in turn, comes from the Greek word herpein which means to creep.

Classification
There are 25 families in the
Herpeotoviridae but only 6 of them infect man with any regularity.
Herpes Simplex virus Type 1 (HSV-1) Herpes Simplex virus Type 2 (HSV-2) Epstein Barr virus (EBV) Cytomegalovirus (CMV) Varicella Zoster virus (VZV) Human Herpes virus 6 Human Herpes virus 8

Herpes Simplex Virus (HSV)

These are very large viruses and their
genome encodes at least 80 proteins. Half are not directly involved in the virus structure. Almost any human cell type can be affected by HSV.

Epidemiology
HSV-1 and 2 infections are life-long. The virus is found in the lesions on the
skin but can be present in body fluids including saliva and vaginal secretions. As a result of poor hygiene in underdeveloped countries, HSV-1 antibodies are found in more than 90% of children.

Epidemiology 2
HSV-2 is normally spread sexually and is found

in the anus, rectum and upper alimentary tract as well as the genital area. An infant can be infected at birth by a genitallyinfected mother. The infant can also be infected in utero if the mothers infection spreads. Because of the infants underdeveloped immune system, the resulting infection can be very severe and sometimes be deadly.

Disease caused by Herpes Simplex Viruses

Oral Herpes - Cold sores

Herpetic gingiovostomatitis, the infection, often initially on the lips spreads to all parts of the mouth and pharynx.

Disease caused by Herpes Simplex Viruses

Eczema Herpeticum
This is found in children with active eczema. The virus can spread to other organs such as the liver and adrenals.

Disease caused by Herpes Simplex Viruses

Genital Herpes
Is usually the result of HSV-2. Primary infection is often asymptomatic but many painful lesions can be developed on the shaft of the penis and vulva, vagina, cervix and perianal region of women.

Genital Herpes

Genital Herpes
In both sexes, the urethra can be
involved. Genital Herpes infections can be accompanied by a variety of symptoms including fever, myalgia, glandular inflammation of the groin area (inguinal). Some patients have only infrequent recurrences but others experience recurrences as often as every 14-21 days.

Diagnosis of HSV Infections

Cells may be obtained from the base of
the lesion (called a Tzank smear) and histochemistry performed. These can be seen in the smears as multinucleated giant cells and contain Cowdry type A inclusion bodies.

Diagnosis of HSV Infections

Diagnosis of HSV Infections

The cells can also be stained with specific
antibodies in an immunofluorescence test. It can also be detected by viral DNA by in situ hybridization. Type-specific antibodies can distinguish between HSV-1 and HSV-2.

Treatment
Acyclovir
A Safe and extremely well-tolerated drug. More than 35 million patients have been consistent and reassuring. Some authorities have proposed making acyclovir available as a non-prescription drug. Adverse effects, usually mild, include nausea, vomiting, rash and headache.

Treatment
Valacyclovir
New antiviral agent Is the 1-valine ester prodrug of acyclovir. It has an oral bioavailability three to five times greater than that of acyclovir. Several large trials have shown that it is safe and well tolerated.

Treatment
Famciclovir
Another new antiviral medication Is the oral form of penciclovir, a purine analog similar to acyclovir. Oral bioavailability is 77% and the drug is quickly converted to its active form. Famciclovirs intracellular half-life is 10 times longer than acyclovirs. Dosing less frequently than twice daily is not recommended.