Herpes Simplex

I and II
Dr.T.V.Rao MD
Dr.T.V.Rao MD 1
Herpesviridae
The Herpesviridae are a large family
of DNA viruses that cause diseases in
animals, including humans The family
name is derived from the Greek word
herpein ("to creep"), referring to the
latent, re-occurring infections typical
of this group of viruses. Herpesviridae
can cause latent or lytic infections.
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Herpes Viruses
DNA group
Most important Human
Pathogens
Wide Host cell range
Life Long Infection
Periodic reactivation
Immunocompromised
Large number of genes,
Some viruses
susceptible to treatment.
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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
CLASSIFICATION
(Human pathogens)
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Infecting Humans.
Herpes Simplex virus 1 and 2
Varicella Zoster Viruses
Cytomegalovirus virus
Epstein Barr virus
Human Herpes viruses 6, 7.
Kaposi's Sarcoma associated
Viruses
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Spherical in Shape
Icosahedral 150
to 200 nm in size
Genome Double
stranded DNA
Linear
Envelope contains
Glycoprotein's
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Out Standing Characteristics
Encode many
enzymes.
Cause Latent
Infections.
Indefinite
persistence.
Relation in
Immunocompromised
Relation to Cancers.


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Herpes Virus
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Classification of Human Herpes
virus
Subfamily
Alpha
Neurons
Herpes
simplex 1,2
Varicella
zoster


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Subfamily Beta
Glands and
Kidney
Cytomegalovir
us
Lymphoid
tissues
Herpes 6,7


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Subfamily - Gamma
Lymphoid tissue
( Herpes 5 )
Epstein Barr
virus
Kaposi Sarcoma
(Virus Herpes 8)
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Intranuclear infection of
infected cells

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Herpes Virus Replication
Replicates in Host Cell Nucleus
Form Cow dry A Type inclusion
bodies.
More than 50 different types proteins in
infected cell.
Large number of enzymes in DNA
synthesis
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Herpes Simplex
1 and 2
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Human Herpes Virus 1 and 2
They are also called Human Herpes Virus
1 and 2 (HHV-1 and HHV-2) and are
neurotropic and neuroinvasive viruses;
they enter and hide in the human nervous
system, accounting for their durability in
the human body. HSV-1 is commonly
associated with herpes outbreaks of the
face known as cold sores or fever blisters,
whereas HSV-2 is more often associated
with genital herpes.
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Herpes 1and 2
HSV-1 is commonly
associated with
herpes outbreaks of
the face known as
cold sores or fever
blisters, whereas
HSV-2 is more often
associated with
genital herpes.

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Infections in Humans.( Herpes
Simplex 1 and 2 )
Wide spread in Humans
Broad Host Ranges.
Replicate in Many types of Cells.
Produce cytolytic effects
Most Common Diseases.
Gingival stomatitis, Keratoconjunctivitis
Encephalitis Genital diseases,
New Born Infections, Latent Infections in Nerve
Cells,
Recurrence.
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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, one can get both the
infections
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Properties of Herpes Simplex Viruses
Type 1 and 2
Similar in Organization
Restriction Enzyme Differentiates
H S V 1 contact with Saliva.
H S V 2 Sexual
Maternal infection ( Genital Infection
spreads to New Born )
Replicates in 8-16 hours.
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Out characters of Herpes
group of viruses
Out standing characters
1 Encode many
enzymes
Latent infections are
common
Persist indefinitely in
infected hosts.
Frequent reactivation in
infected hosts
Some care cancer
causing.
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HSV 1 differs from HSV 2
HSV 1
Monoclonals differs
On CAM HSV 2 larger
pocks
Replicate well on Chick
embryo fibroblast
More neurovirulent
Type 2 strains are more
antiviral resistant
Restriction endonulease
analysis diffentiates
HSV 2
Monoclonal's differentiate
Smaller

No
Lesser

Lesser




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Virus Grows in the following.
Primary and Continues Cell lines.
Monkey and Rabbit Kidney,
Human Amnion
Syncytial formation and Giant cell
formations
Multiplies in Chorio Allontoic membrane
Monoclonal Antibodies differentiates
Type 1 and 2 types.
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Sources of infection

- Saliva
- Skin lesions
-
Oropharyngeal
lesions
- Carriers
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Most Common Human Viral Infection
Causes catalytic effect causes the
necrosis of cells.
Infects Skin and Mucous membrane
Cowdry type A inclusions are produced
Multinucleated Giant cells are
demonstrated
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Pathogenesis

Entry by skin or mucous membranes

viral multiplication sensory nerve

lysis of cells root ganglia

vesicles latency

ulcers
REACTIVATION
COLD
FEVER
SURGERY
UNKNOWN
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Transmission
Close contact
Skin and epithelial contact,
Defects in Mucosal membrane
Multiples Locally,
Enters through cutaneous nervefibers
Intraaxonally to Ganglion
Centrifugal Migration
Recurrent manifestation in Skin and Mucosa.
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Predisposition of Latent
Infection in
Ganglion
Trigeminal HSV 1
Sacral HSV 2
Immunity.
Cell Mediated ( CMI )
Predisposing Factors
Axonal Injury
Physical and Emotional stress
U V light
80% Adults harbour Antibodies to HSV


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Clinical Manifestations
Oropharyngeal Disease Buccal
Gingival Mucosa Incubation 3 to 5
days
May last for 2-3 weeks
Gingvo stomatitis Sub mandibular
lymphadenopathy
Present with painful ulcers.
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Recurrent Blisters in Herpes
simplex 1

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Herpes lesions in the oral
cavity

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Eye Infections
and Genital Infections.
Corneal ulcerations pacifications
Blindness
Vesiculo ulcerative Lesions
penis, Cervix, Vulva and Vagina.
Manifest with Painful lesions.

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Herpes simplex 1 infecting eye
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Herpes 2 producing
Genital Lesions

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Infect abrasions
Dentists, (
Herpetic
Whitlow) Health
care workers,
Eczema , Burns

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In Uterus
At Birth
After Birth.
Delivery By
Caesarean
Section
Reduces the
Infection
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Neonatal Infection
Normal delivery

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Other Manifestations.
Meningitis,
Encephalitis
Multi organ
Involvement
Increased incidence
in Immune
compromised AIDS,
Haematological
Malignancies.
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Recurrent infections in HSV 1
and 2

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Immunity

Mothers Ig G protects for 6 months.
Primarily Ig M Later Ig g produced.
Main Participants in Immunity.
C M I and Killer Cells and
Interferon play major role in
immunity
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Laboratory Diagnosis
Microscopy,
Antigen
Detection
DNA detection
PCR.
Viral Isolation.
Serology

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Microscopy,
Tzanck Smear
Intranuclear
Type A Inclusion
Bodies
Electron
Microscopy
Fluorescent
Antibody
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Specimens for Diagnosis.
Saliva.
CSF
Vesicle
fluid.

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Viral Isolation
Chick embryo
In Tissue
Cultures
Primary
Embryonic
Kidney
Human Amnion


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Serology,
ELISA Test
Neutralization
Tests
Complement
Fixation
Tests
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Chemotherapy
Idoxuridine used topically in eye and skin
infections first successful antiviral
agent.
Acyclovir and vidarabine helps in
systemic infections
Other Drugs Valaciclovir, Famiciclovir,
Orally effective
Foscarnet.
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Epidemiology.
World Wide Distribution
HSV 1 early in life 6 months to 3 years.
70% to 90% Adults have Antibodies
Poor Living Conditions
HSV 2 Sexually transmitted.
Risk to mother and foetus
Abortions < 20 weeks gestation
HSV 2 increases predisposition to HIV
infection
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Programme Created by
Dr.T.V.Rao MD for Medical and
Paramedical Students for Global
education on Infectious Diseases
Email
doctortvrao@gmail.com
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