Herpes Simplex Virus

Herpes Simplex Virus

Q. 1 Infection with herpes simplex virus, a common human pathogen, is best described by which of the following statements?
 A The CNS and visceral organs are usually involved
 B It rarely recurs in a host who has a high antibody titer
 C It can be reactivated by emotional disturbances or prolonged exposure to sunlight
 D Initial infection usually occurs by intestinal absorption of the virus
Q. 1 Infection with herpes simplex virus, a common human pathogen, is best described by which of the following statements?
 A The CNS and visceral organs are usually involved
 B It rarely recurs in a host who has a high antibody titer
 C It can be reactivated by emotional disturbances or prolonged exposure to sunlight
 D Initial infection usually occurs by intestinal absorption of the virus
Ans. C

Explanation:

The initial infection by herpes simplex virus is often inapparent and occurs through a break in the skin or mucous membranes, such as in the eye, throat, or genitals.Latent infection often persists at the initial site despite high antibody titers. Recurrent disease can be triggered by temperature change, emotional distress, and hormonal factors. Type 1 herpes simplex virus is usually, but not exclusively, associated with ocular and oral lesions; type 2 is usually, but not exclusively, associated with genital and anal lesions. Type 2 infection is more common. In addition to mucocutaneous infections, the CNS and occasionally visceral organs can be involved.


Q. 2

In herpes simplex encephalitis, drugs used are, EXCEPT:

 A

Acyclovir

 B

Vidarabine

 C

Ganciclovir

 D

Amantadine

Q. 2

In herpes simplex encephalitis, drugs used are, EXCEPT:

 A

Acyclovir

 B

Vidarabine

 C

Ganciclovir

 D

Amantadine

Ans. D

Explanation:

The most effective drug for herpes simplex encephalitis is acyclovir, given intravenously at a dosage of 10 to 15 mg/kg every 8 hours, with each dose given over 1 hour.

  • Ganciclovir is an analogue  of acyclovir which is active against all herpes viruses including Herpes simplex.
  • Vidarabine is a purine nucleoside analogue with activity against HSV-1, HSV-2, VZV, and EBV. Vidarabine inhibits viral DNA synthesis through its 5′-triphosphorylated metabolite
  • Amantadine is an antiviral agent whose dopaminergic properties make it effective in the treatment of Parkinson’s disease and for prophylaxis against the parkinsonian side effects of neuroleptic agents. It is not used in herpes simplex encephalitis.
Ref: Baden L.R., Dolin R. (2012). Chapter 178. Antiviral Chemotherapy, Excluding Antiretroviral Drugs. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison’s Principles of Internal Medicine, 18e.

 


Q. 3

Consider the following statements and choose the best option:

Assertion: Acicyclovir is effective for Herpes simplex and Herpes Zoster infections
 

Reason: These viruses have thymidine kinase enzyme

 A

Both A and R are true, but R is not the correct explanation of A

 B

Both A and R are true and R is the correct explanation of A

 C

A is true, but R is false

 D

A is false, but R is true

Q. 3

Consider the following statements and choose the best option:

Assertion: Acicyclovir is effective for Herpes simplex and Herpes Zoster infections
 

Reason: These viruses have thymidine kinase enzyme

 A

Both A and R are true, but R is not the correct explanation of A

 B

Both A and R are true and R is the correct explanation of A

 C

A is true, but R is false

 D

A is false, but R is true

Ans. B

Explanation:

Acyclovir is a synthetic deoxyguanosine analog and it is the prototype antiviral agent that is activated by viral thymidine kinase. The selective activity of aciclovir is due to its affinity for the thymidine kinase enzyme encoded by Herpes simplex (HSV) and Herpes Zoster (VZV).

Mechanism of action:HSV-1, HSV-2 and VZV thymidine kinase converts acyclovir to the acyclovir monophosphate, which is then converted to the diphosphate by cellular guanylate kinase, and finally to the triphosphate by phosphoglycerate kinase, phosphoenolpyruvate carboxykinase, and pyruvate kinase.

Acyclovir triphosphate competitively inhibits viral DNA polymerase and competes with the natural deoxyguanosine triphosphate, for incorporation into viral DNA. Once incorporated, aciclovir triphosphate inhibits DNA synthesis by acting as a chain terminator.

Ref: Pharmacology, By Bhattacharya, 2nd Edition, Page 439.


Q. 4

A young male presents with fever, followed by headache, confusion, focal seizures and right hemiparesis. MRI shows bilateral frontotemporal hyperintense lesion. Which of the following is the most likely diagnosis?

 A

Acute pyogenic meningitis

 B

Herpes simplex encephalitis

 C

Neurocysticercosis

 D

Carcinomatous meningitis

Q. 4

A young male presents with fever, followed by headache, confusion, focal seizures and right hemiparesis. MRI shows bilateral frontotemporal hyperintense lesion. Which of the following is the most likely diagnosis?

 A

Acute pyogenic meningitis

 B

Herpes simplex encephalitis

 C

Neurocysticercosis

 D

Carcinomatous meningitis

Ans. B

Explanation:

Patient is showing features  suggestive of herpes simplex encephalitis. Clinical manifestations in viral encephalitis includes altered level of consiousness (confusion, behavioral abnormalities), mild lethargy to coma, evidence of both focal or diffuse neurologic signs and symptoms and focal or generalized seizures.
 
Investigations: CSF shows lymphocytic leukocytosis, red blood cells due to hemorrhagic necrosis and elevated cerebrospinal fluid (CSF) protein levels. In HSV encephalitis80% will have abnormalities in temporal lobe and 10% have extra temporal abnormalities. The lesions are typically hyper intense on T2-weighted images. Brain biopsy has been the gold standard for defining HSV encephalitis, but now PCR for detection of HSV DNA in CSF has largely replaced biopsy for defining CNS infection. Acyclovir is used in the treatment.
 
Ref: Harrison‘s Internal Medicine, 18th Edition, Pages 3421, 3437, Chapters 179, 379, 381.

Q. 5

Which of the folloing virus is the commonest cause of sporadic encephalitis?

 A

Rubeola Virus

 B

Japanese B Virus

 C

Herpes Simplex Virus

 D

Human Immunodeficiency Virus

Q. 5

Which of the folloing virus is the commonest cause of sporadic encephalitis?

 A

Rubeola Virus

 B

Japanese B Virus

 C

Herpes Simplex Virus

 D

Human Immunodeficiency Virus

Ans. C

Explanation:

Herpes simplex virus is the most common cause of sporadic fatal encephalitis.
It mainly involves individuals more than 40 years of age.
Primary HSV 1 often present as stomatitis and HSV type 2 manifest as venereally transmitted genital eruption.
These virus then migrates along nerve axons to sensory ganglia, and persists in a latent form and may be reactivated later.

In adults encephalitis is caused by HSV type 1.

In neonates HSV encephalitis is caused by type 2 virus during passage through the birth canal of a mother with active genital lesions.
HSV type 2 in adults causes meningitis, rather than encephalitis.
 
Ref: Clinical Neurology By Roger P. Simon, 7th Edition,  Chapter 1

Q. 6

According to the latest evidence the latent virus infection which is responsible for the pathogenesis of the achalasia is:

 A

Herpes simplex 1

 B

Hepatitis C infection

 C

Rubella

 D

Measles

Q. 6

According to the latest evidence the latent virus infection which is responsible for the pathogenesis of the achalasia is:

 A

Herpes simplex 1

 B

Hepatitis C infection

 C

Rubella

 D

Measles

Ans. A

Explanation:

It is believed that cause of ganglion cell degeneration in achalasia is an autoimmune process attributable to a latent infection with human herpes simplex virus 1 combined with genetic susceptibility.

Ref: Harrison, Edition-18, Page-2431.


Q. 7

In which one of the following infection dendritic ulcer is seen?

 A

Herpes simplex

 B

Measles

 C

Pseudomonas

 D

Gonococcal infection

Q. 7

In which one of the following infection dendritic ulcer is seen?

 A

Herpes simplex

 B

Measles

 C

Pseudomonas

 D

Gonococcal infection

Ans. A

Explanation:

A dendritic corneal ulcer is the hallmark sign of HSV infection, accompanied by stromal keratitis in more severe infection. These ulcers may begin as nondescript punctate keratopathies but quickly coalesce to form the familiar branching patterns.

 
Because the virus invades and compromises the epithelial cells surrounding the ulcer, the leading edges (the so-called “terminal end-bulbs”) will stain with rose bengal or
lissamine green. Acyclovir 3% ointment is used as treatment.

Q. 8

Which of the following produces pocks on chorioallantoic membrane of chick embryo –

 A

Myxovirus

 B

Varicella

 C

Herpes simplex 

 D

Cytomegalovirus

Q. 8

Which of the following produces pocks on chorioallantoic membrane of chick embryo –

 A

Myxovirus

 B

Varicella

 C

Herpes simplex 

 D

Cytomegalovirus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Herpes simplex 

  • Herpes simplex virus produces small white shiny non-necrotic pocks on chick embryo chorioallontoic membrane.
  • Other viruses which produces pocks on CAM.

– Vaccinia                          – Monkey pox                     – Cow pox

– Smallpox                         – Camel pox  


Q. 9

Herpes simplex virus is –

 A

Single stranded DNA

 B

Double stranded DNA

 C

Single stranded RNA

 D

Double stranded RNA

Q. 9

Herpes simplex virus is –

 A

Single stranded DNA

 B

Double stranded DNA

 C

Single stranded RNA

 D

Double stranded RNA

Ans. B

Explanation:

Ans. is ‘b’ i.e., Double Stranded DNA 

Herpes Simplex Viruses (RSV)

.  HSV belongs to herpes virus family

.  They are enveloped DNA (ds DNA) viruses

.  There are two types of HSV HSV- 1

HSV- 2

  • HSV – 1 and HSV – 2 are distinguished by restriction endonuclease analysis or nucleic acid hybridization (DNA sequencing)

Q. 10

Herpes simplex virus causes all except –

 A

Encephalitis

 B

Pharyngitis

 C

IMN

 D

Whitlow

Q. 10

Herpes simplex virus causes all except –

 A

Encephalitis

 B

Pharyngitis

 C

IMN

 D

Whitlow

Ans. C

Explanation:

Ans. is ‘c’ i.e., IMN

CLINICAL FEATURES OF HSV INFECTION

  • Incubation period – 6-8 days
  • Primary HSV infection is more severe and associated with systemic symptoms and complications than reactivation from latent infection
  • Both HSV- 1 and 2 can cause genital and oral – facial infection but reactivation at oral – facial site is more common with HSV- 1 and at genital site with HSV-2
  • Infection with HSV-1 is acquired more frequently and earlier than HSV-2. HSV-1 is acquired in early while HSV-2 is acquired after puberty.

Q. 11

All are true about erythema multiformis except:

 A

Due to herpes simplex

 B

Due to sulphonamide

 C

Lesion are symmetrical

 D

Mucous membrane is involved in all

Q. 11

All are true about erythema multiformis except:

 A

Due to herpes simplex

 B

Due to sulphonamide

 C

Lesion are symmetrical

 D

Mucous membrane is involved in all

Ans. D

Explanation:

D. i.e. Mucous membrane is usually involved


Q. 12

Most common site of infection of herpes simplex‑

 A

Thorax

 B

Abdomen

 C

Face

 D

Extremities

Q. 12

Most common site of infection of herpes simplex‑

 A

Thorax

 B

Abdomen

 C

Face

 D

Extremities

Ans. C

Explanation:

C i.e. Face


Q. 13

Genital ulcer is/are caused by:

 A

Human papilloma virus

 B

Herpes simplex virus

 C

HIV

 D

All

Q. 13

Genital ulcer is/are caused by:

 A

Human papilloma virus

 B

Herpes simplex virus

 C

HIV

 D

All

Ans. D

Explanation:

B, C, A i.e. Herpes simplex virus, HIV, Human papilloma virus 

  • Any of the blistering (or ulcerating) disorders of skin can occur on genital (eg. vulva & vaina) and cause ulceration.

Chronic genital ulcerations may be seen in epidermolysis bullosa, Halley- Hailey diseas, Darier’s disease, nymphohymenal tears, dermatitis artefacta, radiation damage, TB, actinomycosis, LGV, Lichen planus, LS, lupus erythematosus, pyoderma gangrenosum, hidradenitis suppurativa, Crohn’s disease, and malignancy (squamous, basal cell, melanoma & Langerhans cell histocytosis)

  • Common causes of genital ulcers include syphilis (T. palladium), LGVQ, chanchoid, donovanosis & herpes genitalis (HSV-H)Q. But HIV and HPV may also 1/t genital ulcers.

Q. 14

Vertical transmission is seen in –

 A

Herpes simplex

 B

Leprosy

 C

Tetanus

 D

Whooping cough

Q. 14

Vertical transmission is seen in –

 A

Herpes simplex

 B

Leprosy

 C

Tetanus

 D

Whooping cough

Ans. A

Explanation:

Ans. is ‘a’ i.e., Herpes simplex 


Q. 15

Follicular conjunctivitis are found in all except:

 A

Herpes simplex conjunctivitis

 B

Drug induced

 C

Adult inclusion conjunctivitis

 D

Allergic conjunctivitis

Q. 15

Follicular conjunctivitis are found in all except:

 A

Herpes simplex conjunctivitis

 B

Drug induced

 C

Adult inclusion conjunctivitis

 D

Allergic conjunctivitis

Ans. D

Explanation:

D i.e. Allergic conjunctivitis

– Acute follicular conjunctivitis can be caused by adenovirus (pharyngo-conjunctival fever, epidemic kerato­conjunctivitis), herpes simplex virusQ (acute herpetic conjunctivitis), new castle virus (new castle conjunctivitis) and chlamydia trachomatis D-K serotypes (acute adult inclusion conjunctivitis or swimming pool conjunctivitis)Q. Mn – “Add Her New Adult Inclusion to Swimming pool Tract”

–  Chronic follicular conjunctivitis can be caused by molluscum contagiosum (toxins), topical drugs /chemicalsQ (IDU, adrenaline, pilocarpine, eserine, DFP) and benign / school folliculosis.

Allergic conjunctivitis (chronic) is usually papillaryQ. However, follicular pattern may also occur in contact dermoconjunctivitis.


Q. 16

Corneal sensation is lost in

 A

Herpes simplex

 B

Conjunctivitis

 C

Fungal infection

 D

Trachoma

Q. 16

Corneal sensation is lost in

 A

Herpes simplex

 B

Conjunctivitis

 C

Fungal infection

 D

Trachoma

Ans. A

Explanation:

A i.e. Herpes simplex

  • Decreased corneal sensations, dendritic and geographical ulcers are characteristic features of Herpes simplex ocular disease Q

Sensory supply of cornea is through trigeminal nerve Q. Neurotrophic keratopathy occurs due to paralysis of sensory supply of cornea. Causes of neurotrophic keratopathy or anaesthetic cornea are:


Q. 17

Which of the following statements about Mollaret meningitis is true?

 A

Caused by Herpes simplex 2 in most of the cases.

 B

Is a recurrent, benign septic meningitis

 C

Is also referred to as “Benign Recurrent Neutrophilic Meningitis”

 D

Does not resolve without treatment

Q. 17

Which of the following statements about Mollaret meningitis is true?

 A

Caused by Herpes simplex 2 in most of the cases.

 B

Is a recurrent, benign septic meningitis

 C

Is also referred to as “Benign Recurrent Neutrophilic Meningitis”

 D

Does not resolve without treatment

Ans. A

Explanation:

Answer is A (Caused by Herpes simplex 2 in most of the cases):

Mollaret’s Meningitis is a form of Self-limiting Benign Recurrent Aseptic Lymphocvtic Meningitis that is most commonly caused by HSV-2 infection of the CNS.

Several etiologies have been proposed for Mollaret’s Meningitis however recent studies suggest that most cases of Mollaret’s Meningitis result from Herpes Simplex Virus -2 (HSV-2) infection

Mollaret’s Meningitis

  • It is the name given to a Self-Limited Recurrent form of Aseptic Meningitis
  • It is also referred to as Benign Recurrent Lymphocytic Meningitis
  • Recurrent episodes (typically> 3 episodes) of meningismus and fever lasting for 2-5 days with spontaneous resolution is highly suggestive of a diagnosis of Mollaret’s Meningitis
  • CSF Examination is characterized by a cloudy spinal fluid with lymphocytic pleocytosis and normal glucose and protein.
  • Presence of large granular cells on Papanicolaou’s stain of the CSF called `Mollaret’s Cells’ is considered pathognomonic (Mollaret’s cells were once thought to be endothelial cells but are now believed to be from the monocyte/ macrophage family)
  • Several etiologies. have been proposed for Mollaret’s Meningitis however recent studies suggest that most cases of Mollaret Meningitis result from Herpes Simplex Virus -2 (HSV-2) infection Presence of HSV DNA on PCR is highly suggestive of Mollaret’s Meningitis (In most cases HSV-2 DNA is detected
  • It is not associated with genital herpetic lesions

Q. 18

Most common cause of viral encephalitis:

March 2013

 A

Herpes zoster

 B

Herpes simplex

 C

Varicella zoster

 D

Japanese encephalitis

Q. 18

Most common cause of viral encephalitis:

March 2013

 A

Herpes zoster

 B

Herpes simplex

 C

Varicella zoster

 D

Japanese encephalitis

Ans. B

Explanation:

Ans. B i.e. Herpes simplex

Herpes simplex virus land 2 (HSV-1 and HSV-2/ Human herpes virus 1 and 2(HHV-1 and -2)

  • They are two members of the herpes virus family, Herpesviridae, that infect humans.
  • Both HSV-1 (which produces most cold sores) and HSV-2 (which produces most genital herpes) are ubiquitous and contagious.
  • They can be spread when an infected person is producing and shedding the virus.
  • Symptoms of herpes simplex virus infection include watery blisters in the skin or mucous membranes of the mouth, lips or genitals
  • Lesions heal with a scab characteristic of herpetic disease.
  • However, as neurotropic and neuroinvasive viruses, HSV-1 and -2 persist in the body by becoming latent and hiding from the immune system in the cell bodies of neurons.After the initial or primary infection, some infected people experience sporadic episodes of viral reactivation or outbreaks.
  • In an outbreak, the virus in a nerve cell becomes active and is transported via the neuron’s axon to the skin, where virus replication and shedding occur and cause new sores.
  • Herpes simplex virus type 1 (HSV-1) encephalitis is the most common cause of sporadic fatal encephalitis worldwide.
  • The clinical syndrome is often characterized by the rapid onset of fever, headache, seizures, focal neurologic signs, and impaired consciousness

Q. 19

The following is responsible for causing ophthalmia neonatorum on 5-7th day after birth:

March 2013 (b)

 A

Chemical

 B

Herpes Simplex Virus II

 C

Neisseria gonorrhoea

 D

Chlamydia trachomatis

Q. 19

The following is responsible for causing ophthalmia neonatorum on 5-7th day after birth:

March 2013 (b)

 A

Chemical

 B

Herpes Simplex Virus II

 C

Neisseria gonorrhoea

 D

Chlamydia trachomatis

Ans. B

Explanation:

Ans. B i.e. Herpes simplex virus II

Ophthalmia neonatorum

  • Time frame of signs/ symptoms following birth play an important role in determining the most likely etiology and subsequent proper diagnosis and treatment
  • Within 48 hours: Chemical conjunctivitis (Typically presents within first 24 hours following birth) & Niesseria gonorrhoe
  • 48-72 hours: Staph. aureus, Strepto. Hemolyticus
  • 5-7 days: HSV-II
  • More than 1 week: C. trachomatis (D-K)

Q. 20

Important in Herpes simplex involvement of the eye are all EXCEPT:              

September 2012

 A

Type of lesion

 B

Corneal anaesthesia

 C

Iridocyclitis

 D

Purulent discharge

Q. 20

Important in Herpes simplex involvement of the eye are all EXCEPT:              

September 2012

 A

Type of lesion

 B

Corneal anaesthesia

 C

Iridocyclitis

 D

Purulent discharge

Ans. D

Explanation:

Ans. D i.e. Purulent discharge

Decreased corneal sensations, dendritic and geographical ulcers are characteristic features of Herpes simplex ocular disease



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