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Herpes infection
200204022 송지근
http://pathmicro.med.sc.edu/virol/herpes.htm
Herpes Virus 소개• Very large virus · Genome encodes at least 80 proteins
• From greek – means “to creep”• Family(Subfamily) · Herpesviridae(Alphaherpesvirinae)
• Genus · Simplexvirus
• Species · HHV-1, HHV-2
• Envelope · glycoprotein 존재 , fragile• Tegument · contain virally-encoded protein and enzyme• Capsid : Icosahedral Capsid · doughnut shape (diameter : 100-200nm) · icosahedral capsid (162 capsomeres)• Genome : ds DNA Genome · Double stranded DNA
Morphology
Viral Enzyme
• DNA-dependent DNA polymerase• Thymidine kinase · dNTP 생성
• Ribonucleotide reductase · convert ribonucleotides to deoxynucleotides
• Serine-protease · convert a scaffoding protein to its final form
• Glycoprotein
HSV replication
• Binding• Fusion• Protein synthesis · early genes 만 발현시 Latency · early and late protein → lytic replication
• DNA synthesis• Assembly• Release of virus
Lytic or Latency
Herpes Simplex Virus(HSV)• HSV-1, HSV-2 · very similar characterstic · cell of mucoephithelia, enter through wounded · persistently infect macrophage and lymphocyte• HSV-1 · above the waist · oral mucosa, trigeminal ganglia • HSV-2 · below the waist · genital mucosa, sacral ganglia
Transmission• Direct contact : infected lesion or secretion · anyone who comes in contact with fluid containing infecious
virus is at risk
• HSV-1 · Mouth to mouth (kissing or use of utensils conta-minated wit
h saliva) · Hand, through the eyes
• HSV-2· Normally spread sexully· Genital area : anus, rectum, urethra, penis, vulva etc
HSV-2 and pregnancy
• 보통은 출산시 감염• Infect in utero → fatal, rare · Underdeveloped immune system → spread to many peri
pheral organ, infect central nervous system · 임신중 처음 감염시 태아로 전염될 확률이 높다
• 출산시 virus 가 활동중이면 제왕절개 시행
Immune response
• Neutralization of infectious virus : IgM, IgA, IgG
• Complement-mediated lysis of infected cells : IgM, IgG
• Interferon, CTL, lymphocyte, NK cell
HSV 가 병을 일으키는 부위
Disease caused by HSV
Oral herpes• HSV-1 or HSV-2 infection• Lips → All parts of mouth, pharynx• Reactivation : trigeminal ganglia → cold sores• Herpes pharyngitis : other viral infection 과 연관• Severe in Immunosuppressed people
Herpes keratitis• Eye infection (HSV-1)• Recurrent, blindness
Herpes whitlow• HSV-1, HSV-2• Small wound
on the hand or wrist
• Healthy care worker
Herpes gladiatorum• Wrestlers• Head and neck lesion• More often on the right side of the body• Rugby : Herpes Rugbeiorum (scrum pox)
Eczema herpeticum• Preexisting atopic dermatitis• Eczema lesion → spread over the skin• Liver, adrenal• Similar disease : eczema vaccinatum
Genital herpes 90% : HSV-2, 10% : HSV-1 Primary infection• Asymptomatic or many painful lesion on urogenital organ• Transient viremia, Fever, Myalgia, Inguinal adenitis Secondary episodes(reactivation)• Sacral ganglion• Less severe than the first episode• burning sensation → eruption• Without overt symptom → 전염 가능
HSV proctitis• Inflamation of rectum, anus
HSV meningitis• HSV-2 infection• Syptom seem to resolve spontaneously
HSV encephalitis• HSV-1 infection, fatal• Sporadic viral encephalitis• Damage to temporal lobes• Blood in the spinal fluid• Neurological symptom : seizures
Diagnosis
• Tzank smear, Histochemistry · formation of syncytia · cowdry type A inclusion body in nucleous
• Specific Ab in an immunofluorescence test · HSV-1 : gG1, HSV-2 : gG2
• In situ hybridization
HSV chemotherapy
Interferon 연고Nucleoside analog durgs• Acyclovir, Famcivlovir, Valacyclovir• Viral DNA polymerase 억제• Ineffective against latent virus• Resistant type : lack of thymidine kinase
Prevention
• Incureable• Avoid infection → Healthy care worker 에 중요• Latex comdom• 증상이 나타날 때 접촉을 피한다• HSV-2 : prodromal itching symptom or active lesion