Diagnosis and Treatment of Neurological Disease from Herpesvirus infection in Neonates and Children Cheryl Jones The Children s s Hospital at
|
|
- Patricia Chandler
- 6 years ago
- Views:
Transcription
1 Diagnosis and Treatment of Neurological Disease from Herpesvirus infection in Neonates and Children Cheryl Jones The Children s s Hospital at Westmead, NSW University of Sydney
2 Overview Members of herpesvirus family that cause CNS infections in infants and children Epidemiology HSV CMV Pathogenesis VZV Diagnosis EBV Therapy HHV-6,7 HHV-8
3 Herpes Simplex Virus medicineworld.org Clinical CNS Syndromes HSV Encephalitis (HSE) Recurrent benign meningitis (Mollaret s) Neonatal HSV encephalitis
4 Epidemiology: HSV Encephalitis Commonest cause sporadic encephalitis > 6 mo No seasonal or gender variation Bimodal distribution 1/3 < 20 yrs, 1/2 > 50 yrs Infrequent : 1:250,000 population per yr USA Serotype: 96-99% HSV-1, 1-4% HSV-2 2/3 due to reactivation, 1/3 primary High incidence long term sequelae in survivors Without Rx: mortality 70% and only 9% survivors normal With Rx (IV ACV) mortality 19% at 6 mos, 30% survivors normal or mild defects
5 HSE: how does the virus access the CNS After Primary infection Animals: primary infection olfactory tract or trigeminal nerves to brain. In humans, pathways less clear After HSV reactivation: Sensory ganglia From periphery (TG, olfactory n) or Latent HSV in brain? PM asymp seropositive adults: 1/3 HSV Cx & DNA from br. stem, olfact. bulbs, gyrus rectus and limbic areas.
6 HSE Pathogenesis direct damage from virus versus role of host response Neuronal apoptosis- mechanism of neuronal injury in HSE DeBiasis et al, JID 2002; 186:
7 Immunogenetics: UNC-93B TLR3 IFN pathway important for primary HSV-1 CNS in children Zhang Immunol Rev 2007 but is redundant for immunity to most other viruses.
8 Diagnosis of HSE I Altered LOC Clinical features CSF examination Fever CSF Headache pleocytosis and elevated protein HSV DNA in CSF detected by PCR Non invasive Personality studies change Neuroimaging :CT or MRI EEG Seizures: focal or general CSF viral culture: CSF WCC Dysphasia rarely usually positive lymphocytes in older children and adults HSE (4%) but higher yield in neonates (25-40%) Average pr Other 100mg/dl, CNS symptoms, increases as Ataxia, disease Brain biopsyprogressesautonomic dysfunction isolation of HSV, histopath, PCR CSF cell now count only for and atypical protein cases may or be immunocompromised normal early 5-10% CSF especially serologyin children for chronic disease or retrospective diagnosis: Maybe 4x elevated or > HSV CSF Ab Red in cell CSF count or serum to CSF to HSV IgG ratio: 20 usually after a month. Need albumin control to check integrity of blood brain barrier)
9 PCR for HSV DNA in HSE Changed understanding of symptoms/signs of HSE Monitoring of therapy Evaluate recurrence
10 HSE Clinical Manifestations and HSV DNA detection by PCR Dominigues et al, Clin Infect Dis 1997 Study of PCR with clinical presentations of HSE Grouped: Focal, Diffuse- dec LOC, neurobehavioural change, but no focal signs or imaging, Mild disease- GCS > 13 PCR Result Focal Patients n (%) Diffuse Mild Total HSV +ve 15 (52) 0 3 (25) 18 (37) HSV -ve Total (100)
11 HSE Bx-proven Vs PCR-proven Severity GSC >10 Personality 60% change Seizures Motor deficits Aphasia Bx-proven 35% 40% 33% 31% PCR-proven Milder cases ~ 80% 70-85% 50% 33% 75% Dominigues et al, Clin Infect Dis 1997
12 Duration of HSV DNA detection in HSE post onset of symptoms HSV DNA detectable for up to one week post onset of symptoms Revello et al, Clin Diag Virol 1997 False negative : V. early or late (>d 10) testing after onset of symptoms After Antiviral Rx: detection reduced by 5-7 days Rx, in most Presence of inhibitors eg blood Poor sensitivity in an individual lab
13 PCR Monitoring of Therapy Frequency HSV DNA declines after antiviral Rx: by 5-7 days Rx in most; sharp decline after two weeks. (Lakeman JID 95) Persistence HSV DNA at end 2-3 weeks Rx poor prognostic indicator (Adult studies) e.g. Wildman % 21% PCR of CSF should be considered at completion of Rx Quantitative PCR Copy no/ ml >100- poorer prognosis in adult HSE Needs standardisation Lakeman et al, JID 1995
14 Rx and outcome HSE in children Rx intravenous aciclovir 10mg/kg/dose every 8 hours i.v. for (2 to) 3 weeks RCT of valaciclovir for HSE underway (IV Rx followed by VACV or Placebo for 90 days) Outcome influenced by Age- sl. Lower mortality in children than adults, but 70% survivors have residual defects LOC at presentation Duration of encephalitis
15 Recurrent HSV Encephalitis Up to 20% will have recurrence of neurological symptoms? Role of viral reactivation or immunological phenomenon Limited data on role of antiviral Rx/ suppressive therapy Antiviral Rx: if repeat +ve HSV DNA in CSF, or if using corticosteroids
16 Neonatal HSV Encephalitis
17 Neonatal HSV in Australia Mode of Presentation APSU study 21% 18% 11% Jones, Isaacs, et al in prep. 3% 47% HSV-1 55% HSV-2 45% Skin, Eye, Mouth Disseminated alone Disseminated + CNS CNS alone Intrauterine 39% HSE Hydrancephaly, chorioretinitis, Scarring lesions at birth
18 Route of neonatal HSV infection Intrauterine 3-5% HSV entry to CNS? Encephalitis alone: neuronal entry Disseminated disease: blood borne During delivery 85% Risk transmission 30-60% with 1º genital herpes practice.html Postnatal: 10%
19 Age at Presentation? CATEGORY All cases Mean (days) 8.0 RANGE 0-47 Skin, eye, mouth CNS alone Disseminated Jones et al, unpublished observations. Neonatal APSU HSV study
20 Neonatal HSV Encephalitis Clinical signs non specific; seizures, poor feeding, irritability, lethargy, temp instability; if disseminated: shock, tachypnoea, DIC, elevated LFTs, Cutaneous vesicles may be absent (40%) HSV DNA PCR as for older children but Virus cultured from CSF more readily than in older children/adults (25-40%). CSF pleocytosis, increased protein in most, but CSF WCC/Protein may be normal Mortality usually due to brain stem involvement, un Rx 50%. Good Response to Rx. Predictors: decreased LOC, prematurity, seizures Sequelae in70% survivors: associated with seizures at presentation, HSV-2 in CNS, PCR positive at end of 21 days Rx
21 Survival APSU study? 21.6% (22/102) acute mortality Category of disease Jones et al, unpublished observations, APSU 2005 SEM *1/22 Disseminated 20/22 +/- CNS I/uterine death 1/22 CNS alone 1/22 *1 Death of preterm infant at 56 days? due to other cause
22 Recommended Antiviral Rx Neonatal HSV Disease Aciclovir 20mg/kg/dose given 8 th hourly 21 days if encephalitis/ disseminated infection or LP not performed 14 days for disease localised to skin, eye or mouth Kimberlin et al, Pediatrics 2003
23 Recurrent Herpes Post Neonatal HSV Disease Not routinely recommended. Consider: preterm, frequent HSV- 2 recurrence Role of chronic suppressive antiviral therapy to prevent long term CNS sequelae under evaluation Ph II:Kimberlin PIDJ mg/m 2 3x/d 46% neutropenia (<1000x10 3 )
24 Congenital CMV Infection
25 CNS Sequelae in Infants With Signs of Congenital CMV Infection at Birth Sensorineural hearing loss ~59% Severe Motor Deficit ~49% Mental retardation (IQ <70) ~47% Chorioretinitis ~12% Seizures ~11% Boppana et al, Pediatrics 1997
26 Early Predictors of Poor CNS Outcome? Poor cognitive outcome Microcephaly (adjusted) most specific predictor, Abnormal head CT most sensitive predictor Long term motor disability Abnormal head CT strong, sensitive predictor chorioretinitis insensitive, but specific predictor Not predictive SN hearing loss, jaundice, platelets, increased LFTs, hepatosplenomegaly, growth retardation Boppana et al, Pediatr 1997 Noyola et al, J Pediatr 2001
27 Congenital CMV Long Term CNS Outcome? If no CNS abnormality by one year, unlikely to be at increased risk for subsequent neurodevel/cns impairment Prospective mother/infant studies Sweden Ivarsson et al, Pediatr 1997; Scand Infect Dis J 1999 USA Fowler et al, NEJM 1992; Temple et al, J Dev Behav Ped 2000
28 CNS Sequelae after ASYMPTOMATIC INFECTION AS NEWBORN Sensorineural hearing loss 10-15%? Chorioretinitis Mild Late onset learning defects
29 Diagnosis CNS sequelae congenital CMV Newborn CMV isolation or PCR on specimens obtained in 1 st 3 weeks of life CMV IgM Neuroimaging Hearing screen Eye exam Dx after newborn period Retrospective dx CMV PCR on newborn screening card Neuroimaging, hearing, eye exam
30 Treatment Congenital CMV Infection Recommended for life or sightthreatening disease IV ganciclovir: dose? duration? 5mg/kg/dose IV q12h Treatment of symptomatic infant to reduce long term neurological sequelae? Kimberlin et al, Pediatrics 2003 IV Ganciclovir for 6 weeks
31 Varicella Zoster- CNS syndromes VZV vascular Acute cerebellar syndromes-large and small vessel ataxia VZV vascular Large vessel wks/months after syndromes cutaneous syndrome, VZV encephalitis Rare- mostly in elderly but isolate CNS sequelae reports in infants/children post varicella from Congenital Dx: varicella CT/MRI syndrome shows infarct Pleocytosis, VZV PCR/Ab on CSF
32 VZV Acute cerebellar ataxia Rare: about 1:4000 children with VZV < 15 yrs Usually within 1 wk of rash, has occurred prior to onset of rash Viral replication vs immune mediated? VZV DNA in 3/5 children in one series VZV Ab usually negative CSF mild changes only, MRI usually normal Recovery the norm. Rare reports of persistent cerebellar defects Role of antiviral Rx unclear: if Rx IV aciclovir 500mg/m 2 every 8 hours Connolly et al, Ann Neurol, 1994
33 CNS sequelae of congenital Varicella Skin scars ~80% Eye defects 60% Limb abnormalities ~70% Cortical atrophy, Low IQ 46% Poor sphincter control 32% Also: Prematurity, LBW 50%, Early death 29% DX; Hx varicella inmother during pregnancy. VZV PCR negative. IgG usually positive, and IgM neg
34 Summary HSV Encephalitis Immunogenetic markers in future PCR directed therapy Neonatal HSV disease High dose Rx for 3 weeks PCR directed Rx CMV Predictive factors at birth of poor CNS outcome More research needed to define use of ganciclovir to decrease CNS sequelae VZV Acute cerebellar ataxia: usually self limiting
35 Acknowledgements Neonatal HSV APSU study: Coinvestigators: D. Isaacs, A. Cunningham, S. Garland, P. McIntyre Contributors to the APSU APSU staff and sponsors
Congenital CMV infection. Infectious and Tropical Pediatric Division Department of Child Health Medical Faculty, University of Sumatera Utara
Congenital CMV infection Infectious and Tropical Pediatric Division Department of Child Health Medical Faculty, University of Sumatera Utara Congenital CMV infection Approximately 0.15 2% of live births
More informationAlphaherpesvirinae. Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV)
Alphaherpesvirinae Simplexvirus (HHV1&2/ HSV1&2) Varicellovirus (HHV3/VZV) HERPES SIMPLEX VIRUS First human herpesvirus discovered (1922) Two serotypes recognised HSV-1 & HSV-2 (1962) HSV polymorphism
More informationCongenital/Neonatal Herpes Simplex Infections
Congenital/Neonatal Herpes Simplex Infections Infectious and Tropical Pediatric Division Department of Child Health Medical Faculty University of Sumatera Utara Herpes Infections Herpes from the Greek
More informationC M V a n d t h e N e o n a t e D r M e g P r a d o N e o n a t o l o g i s t D i r e c t o r, N I C U, S t F r a n c i s M e d i c a l C e n t e r
C M V a n d t h e N e o n a t e D r M e g P r a d o N e o n a t o l o g i s t D i r e c t o r, N I C U, S t F r a n c i s M e d i c a l C e n t e r C M V S e r o - P r e v a l e n c e ( I g G p o s i t
More informationWales Neonatal Network Guideline
Guideline for the Management of Neonatal Herpes Infection Introduction: Herpes simplex virus type 1 and 2 are DNA viruses that belong to Alphaherpesviridae, a subfamily of the Herpesviridae family. Both
More informationNeonatal HSV SARA SAPORTA-KEATING 3/1/17
Neonatal HSV SARA SAPORTA-KEATING 3/1/17 Pt Sx onset Presentation Clinical Presentation HSV risk factor(s) HSV results CSF WBC 1 DOL 7 DOL 8 Vesicular rash FOC with active cold sore (DOL2), C/S 2 DOL 7
More informationCONGENITAL CMV INFECTION
CONGENITAL CMV INFECTION Pablo J. Sánchez, MD 20 th International Symposium on Neonatology.... São Paolo, Brazil 9/10-12/15 HUMAN CYTOMEGALOVIRUS DNA virus; herpesvirus family; 1881 (Ribbert) Infected
More informationNeonatal infections. Joanna Seliga-Siwecka
Neonatal infections Joanna Seliga-Siwecka Neonatal infections Early onset sepsis Late onset sepsis TORCH Early onset sepsis (EOS) Blood or cerebral fluid culture-proven infection at fewer than 7 days
More informationPEDIATRIC INFECTIOUS DISEASES UPDATE. Neonatal HSV. Recognition, Diagnosis, and Management Coleen Cunningham MD
Neonatal HSV Recognition, Diagnosis, and Management Coleen Cunningham MD Important questions Who is at risk? When do you test? What tests do you perform? When do you treat? What is appropriate therapy?
More informationVIRAL INFECTIONS OF THE CNS. Anne A. Gershon, Columbia University
VIRAL INFECTIONS OF THE CNS Anne A. Gershon, Columbia University A Patient with Aseptic Meningitis 15 yo female, previously in good health Complained of severe headache, stiff neck, fever No rash LP: 323
More informationCongenital Cytomegalovirus (CMV)
August 2011 Congenital Cytomegalovirus (CMV) Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) August 2011 August 2011 June
More informationProf Dr Najlaa Fawzi
1 Prof Dr Najlaa Fawzi is an acute highly infectious disease, characterized by vesicular rash, mild fever and mild constitutional symptoms. is a local manifestation of reactivation of latent varicella
More informationA summary of guidance related to viral rash in pregnancy
A summary of guidance related to viral rash in pregnancy Wednesday 12 th July 2017 Dr Rukhsana Hussain Introduction Viral exanthema can cause rash in pregnant women and should be considered even in countries
More informationCMV: perinatal management of infected neonates
CMV: perinatal management of infected neonates ccmv Epidemiology The prevalence of ccmv in developed countries is 04 0 0.4 0.8% In the UK, symptomatic congenital infection was estimated to be 3/1000 in
More informationMANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW 1980s: dramatically improved by aciclovir HSV encephalitis in adults Delays treatment(> 48h after hospital admission): associated with a
More informationHuman Herpes Viruses (HHV) Mazin Barry, MD, FRCPC, FACP, DTM&H Assistant Professor and Consultant Infectious Diseases KSU
Human Herpes Viruses (HHV) Mazin Barry, MD, FRCPC, FACP, DTM&H Assistant Professor and Consultant Infectious Diseases KSU HERPES VIRUS INFECTIONS objectives: ØTo know the clinically important HHVs. ØTo
More informationViruses. Poxviridae. DNA viruses: 6 families. Herpesviridae Adenoviridae. Hepadnaviridae Papovaviridae Parvoviridae
Viruses DNA viruses: 6 families Poxviridae Herpesviridae Adenoviridae Hepadnaviridae Papovaviridae Parvoviridae Human herpesviruses Three subfamilies (genome structure, tissue tropism, cytopathologic effect,
More informationThe Study of Congenital Infections. A/Prof. William Rawlinson Dr. Sian Munro
The Study of Congenital Infections A/Prof. William Rawlinson Dr. Sian Munro Current Studies SCIP Study of Cytomegalovirus (CMV) Infection in Pregnancy ASCI Amniotic Fluid Study of Congenital Infections
More informationHerpes Simplex Viruses: Disease Burden. Richard Whitley The University of Alabama at Birmingham Herpes Virus Infection and Immunity June 18-20, 2012
Herpes Simplex Viruses: Disease Burden Richard Whitley The University of Alabama at Birmingham Herpes Virus Infection and Immunity June 18-20, 2012 Mucocutaneous HSV Infections Life-Threatening HSV Diseases
More informationHerpesvirus infections in pregnancy
Herpesvirus infections in pregnancy Dr. med. Daniela Huzly Institute of Virology University Medical Center Freiburg, Germany Herpes simplex virus 1+2 Risk in pregnancy and at birth Primary infection in
More informationESCMID Postgraduate Education Course Infectious Diseases in Pregnant Women, Fetuses and Newborns Bertinoro, Italy 3 7 October 2010
ESCMID Postgraduate Education Course Infectious Diseases in Pregnant Women, Fetuses and Newborns Bertinoro, Italy 3 7 October 2010 Robert Pass University of Alabama at Birmingham School of Medicine Disclosures:
More informationVZV, EBV, and HHV-6-8
VZV, EBV, and HHV-6-8 Anne Gershon Common Features of Herpesviruses Morphology Basic mode of replication Primary infection followed by latency Ubiquitous Ability to cause recurrent infections (reactivation
More informationHerpesviruses. -Recurrence: clinically obvious disease due to reactivation. **Reactivation and recurrence are used interchangeably.
*Herpesviruses: A large group of viruses (100 strains), but we are concerned with only 8 strains as they are the only ones to infect human beings *herpesviruses groups: HSV-1 HSV-2 VZV CMV EBV HHV-6 HHV-7
More informationSample Selection- Vignettes
Sample Selection- Vignettes Rangaraj Selvarangan, BVSc, PhD, D(ABMM) Professor, UMKC School of Medicine Director, Microbiology, Virology and Molecular Infectious Diseases Laboratory Director, Laboratory
More informationPUO in the Immunocompromised Host: CMV and beyond
PUO in the Immunocompromised Host: CMV and beyond PUO in the immunocompromised host: role of viral infections Nature of host defect T cell defects Underlying disease Treatment Nature of clinical presentation
More informationLong-Term Hearing Outcomes of Symptomatic Congenital CMV Infected Children Treated with Valganciclovir
Long-Term Hearing Outcomes of Symptomatic Congenital CMV Infected Children Treated with Valganciclovir Hilary McCrary MD MPH, Xiaoming Sheng PhD, Tom Greene PhD, Albert Park MD University of Utah Disclosures:
More informationControversies in Diagnosis and Therapy of Neonatal Sepsis
Controversies in Diagnosis and Therapy of Neonatal Sepsis Sarah S. Long, M.D. Professor of Pediatrics Drexel University College of Medicine Chief, Section of Infectious Diseases St. Christopher s Hospital
More informationHuman Herpesviruses. VZV, EBV, and HHV-6-8. The rash of VZV is vesicular. MID 34
VZV, EBV, and HHV-6-8 Anne Gershon Human Herpesviruses Replication (lytic infection) occurs in a cascade Latency occurs when the cascade is interrupted Transcription of viral genome and protein synthesis
More informationVIRAL ENCEPHALITIS EASY TO MISS
TAMORISH KOLE MBBS MRCS(EDIN) FRSM(UK) SENIOR CONSULTANT & HEAD, EMERGENCY MEDICINE, MAX HEALTHCARE, NEW DELHI, INDIA ADJUNCT ASSISTANT PROFESSOR, EMERGENCY MEDICINE, GEORGE WASHINGTON UNIVERSITY, WASHINGTON
More informationDilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?
Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,
More informationKidz Medical Services Infant Exposed to Genital Herpes Simplex Virus
Kidz Medical Services Infant Exposed to Genital Herpes Simplex Virus Guideline: HSV Guideline: I. Herpes Simplex Virus (HSV): A. HSV is an enveloped, double-stranded DNA virus that enters the body via
More informationHSV Screening: Are Wesley Obstetricians Following the Guidelines? Dawn Boender, PGY4 Taylor Bertschy, PGY3
HSV Screening: Are Wesley Obstetricians Following the Guidelines? Dawn Boender, PGY4 Taylor Bertschy, PGY3 Goals To increase obstetrician knowledge regarding HSV screening Institute clinical changes at
More informationHerpes viruses. Dr.farah hazem. Classification:
Dr.farah hazem Herpes viruses Herpesviridae are a large family of viruses contains several of the most important human viral pathogens. Clinically, the herpesviruses exhibit a spectrum of diseases. Some
More informationGENITAL HERPES. 81.1% of HSV-2 infections are asymptomatic or unrecognized. Figure 14 HSV-2 seroprevalence among persons aged years by sex.
GENITAL HERPES Genital herpes is a chronic, lifelong, sexually transmitted disease caused by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV-1 typically causes small, painful, fluid-filled,
More informationWhen the drugs don t work- a case of HSV encephalitis.
When the drugs don t work- a case of HSV encephalitis. Nicky Price Consultant Virologist Public Health Wales 67 year old Caucasian Female Presenting complaint 2 day history of: Confusion Shivering Headache
More informationWales Neonatal Network Guideline
Congenital infection: Diagnosis and management Overview: Infections transmitted and acquired in utero. Most as a result of primary infection of mother during pregnancy, some organisms such as Cytomegalovirus
More informationReactivation of herpesvirus under fingolimod: A case of severe herpes simplex encephalitis
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2015 Reactivation of herpesvirus under fingolimod: A case of severe herpes
More informationNeonatal HSV. Version: 1. Governance Group. Date of Approval: Date of Ratification Signature of ratifying Group Chair
Paediatric Neonatal HSV Version: 1 Approval Committee: Date of Approval: 25-04-2018 Ratification Group (eg Clinical network): Date of Ratification Signature of ratifying Group Chair Author s and job titles
More informationPeople with genital herpes require enough information and medication (when indicated) to self-manage their condition.
Genital Herpes Summary of Guidelines Taken from: Guidelines for the Management of Genital Herpes in New Zealand 11th Edition - 2015 www.herpes.org.nz Genital Herpes Key Management Points Genital herpes
More informationMultiple Choice Questions - Paper 1
Multiple Choice Questions - Paper 1 Instructions for candidates The examination consists of 30 multiple choice questions, each divided into 5 different parts. Each part contains a statement which could
More informationHuman Herpesviruses. Varicella-zoster virus. Human Herpesvirus (VZV) phospholipid envelope, tegument, icosahedral capsid, DNA core
Common Features of Herpesviruses Morphology Basic mode of replication Primary infection followed by latency Ubiquitous Ability to cause recurrent infections (reactivation of latent virus), reinfections
More informationIntroduction to Viruses That Infect Humans: The DNA Viruses
Chapter 24 Introduction to Viruses That Infect Humans: The DNA Viruses Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 24.1 Viruses in Human Infections and Diseases
More informationCNS Infections in the Pediatric Age Group
CNS Infections in the Pediatric Age Group Introduction CNS infections are frequently life-threatening In the Philippines, bacterial meningitis is one of the top leading causes of mortality in children
More informationCommon Features of Herpesviruses
Common Features of Herpesviruses Morphology Basic mode of replication Primary infection followed by latency Ubiquitous Ability to cause recurrent infections (reactivation of latent virus), reinfections
More informationMichael Nissen Director of Infectious Diseases & Clinical Microbiologist Royal Children s Hospital-Brisbane
Michael Nissen Director of Infectious Diseases & Clinical Microbiologist Royal Children s Hospital-Brisbane Neonatal Herpes simplex Usually type 2 Vertical transmission2-5% if mother has active lesions
More informationHuman Herpesviruses. Varicella-zoster virus. Human Herpesvirus (VZV) phospholipid envelope, tegument, icosahedral capsid, DNA core
Common Features of Herpesviruses Morphology Basic mode of replication Primary infection followed by latency Ubiquitous Human Herpesvirus (VZV) phospholipid envelope, tegument, icosahedral capsid, DNA core
More informationHerpesviruses. Tools of diagnosis : what to use and when. Corinne Liesnard Laboratory of Virology Erasme Hospital - ULB
Herpesviruses Tools of diagnosis : what to use and when Corinne Liesnard Laboratory of Virology Erasme Hospital - ULB Evolution of the techniques in the virology lab Techniques : "Classic" methods Ag detection
More informationDisseminated shingles acyclovir
Disseminated shingles acyclovir The Borg System is 100 % Disseminated shingles acyclovir Two developed disseminated herpes zoster, one developed cytomegalovirus. Reduced response to acyclovir,. Disseminated
More informationCOPYRIGHT 2012 THE TRANSVERSE MYELITIS ASSOCIATION. ALL RIGHTS RESERVED
The Transverse Myelitis Association...advocating for those with acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis and transverse myelitis ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM)
More informationVARICELLA. Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara
VARICELLA (Chicken pox) Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara Definition : Varicella is a common contagious disease caused
More informationLaboratory diagnosis of congenital infections
Laboratory diagnosis of congenital infections Laboratory diagnosis of HSV Direct staining Tzanck test Immunostaining HSV isolation Serology PCR Tzanck test Cell scrape from base of the lesion smear on
More informationHerpes virus co-factors in HIV infection
Herpes virus co-factors in HIV infection Dr Jane Deayton Barts and the London Queen Mary School of Medicine Introduction Herpes viruses very common and often coexist with HIV Establish life-long latent
More informationBio-Rad Laboratories. The Best Protection Whoever You Are. Congenital and Pediatric Disease Testing
Bio-Rad Laboratories I N F E C T I O U S D I S E A S E T E S T I N G The Best Protection Whoever You Are Congenital and Pediatric Disease Testing Bio-Rad Laboratories I N F E C T I O U S D I S E A S E
More informationThe Healthcare Cost of Symptomatic Congenital CMV Disease in Privately Insured US Children: Estimates from Administrative Claims Data
National Center on Birth Defects and Developmental Disabilities The Healthcare Cost of Symptomatic Congenital CMV Disease in Privately Insured US Children: Estimates from Administrative Claims Data Scott
More informationHerpes Simplex Virus. Objectives After completing this article, readers should be able to:
Article infectious diseases Herpes Simplex Virus Linda A. Waggoner- Fountain, MD,* Leigh B. Grossman, MD Objectives After completing this article, readers should be able to: 1. Describe the epidemiology
More informationCLINICAL AUDIT SUMMARY CLINICAL AUDIT SUMMARY. Diagnosis and Recognition of Congenital Cytomegalovirus in Northern Ireland
Regional Virology Issue Date: 08/09/14 Page(s): Page 1 of 6 1.0 Name of audit Diagnosis and Recognition of Congenital Cytomegalovirus in Northern Ireland 2.0 Personnel involved Peter Coyle, Han Lu, Daryl
More informationHerpes Simplex Virus Type 1 and Alzheimer s disease:
The Neurodegenerates Herpes Simplex Virus Type 1 and Alzheimer s disease: Increasing Evidence for a major role of the virus 1 Introduction and Agenda 2 Agenda What is the HSV1 and why is it linked to AD?
More informationHepatitis and Herpes Viruses. These two virus groups are very diverse, but cause much human morbidity and mortality
Hepatitis and Herpes Viruses These two virus groups are very diverse, but cause much human morbidity and mortality Liver Functions Performs 3 major functions: Regulation: of blood composition glucose levels,
More informationFever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center
Age: 0-28 Day Pathway - Emergency Department EXCLUSION CRITERIA Toxic appearing No fever Born < 37 weeks gestational age INCLUSION CRITERIA Non-toxic with temperature > 38 C (100.4 F) < 36 C (96.5 F) measured
More informationThemes Non-Traumatic Intracranial Emergencies
Themes Non-Traumatic Intracranial Emergencies Diffuse Lesion: Infection vs Infarction Focal Lesion: Infection vs Tumor Kevin Abrams, M.D. Chief of Radiology Medical Director of Neuroradiology & MRI Baptist
More informationPersistent Infections
Persistent Infections Lecture 17 Biology 3310/4310 Virology Spring 2017 Paralyze resistance with persistence WOODY HAYES Acute vs persistent infections Acute infection - rapid and self-limiting Persistent
More informationEXANTHEMATOUS ILLNESS. IAP UG Teaching slides
EXANTHEMATOUS ILLNESS 1 DEFINITIONS Exanthema eruption of the skin Exanthema eruption of mucosae Macule flat nonpalpable lesion Papule small palpable lesion Nodule large palpable lesion Vesicle small fluid
More informationالحترمونا من خري الدعاء
الحترمونا من خري الدعاء Instructions for candidates The examination consists of 30 multiple choice questions, each divided into 5 different parts. Each part contains a statement which could be true or
More informationSWISS SOCIETY OF NEONATOLOGY. Symptomatic congenital CMV infection after recurrent maternal infection
SWISS SOCIETY OF NEONATOLOGY Symptomatic congenital CMV infection after recurrent maternal infection May 2017 Mack I, Burckhardt MA, Heininger U, Prüfer F, Wellmann S, Department of Pediatric Infectious
More informationHYPERIMMUNOGLOBULIN and CMV- DNAemia IN PREGNANT WOMEN WITH PRIMARY CYTOMEGALOVIRUS INFECTION
HYPERIMMUNOGLOBULIN and CMV- DNAemia IN PREGNANT WOMEN WITH PRIMARY CYTOMEGALOVIRUS INFECTION Giovanni Nigro, Rome, Italy Stuart P Adler, Richmond, VA, USA To avoid fetal rejection (50% allograft) an estrogeninduced
More information1. Introduction Algorithm: Infant with Fever 0-28 Days Algorithm: Infant with Fever Days...3
These guidelines are designed to assist clinicians and are not intended to supplant good clinical judgement or to establish a protocol for all patients with this condition. MANAGEMENT OF FEVER 38 C (100.4F)
More informationLab 3: Pathogenesis of Virus Infections & Pattern 450 MIC PRACTICAL PART SECTION (30397) MIC AMAL ALGHAMDI 1
Lab 3: Pathogenesis of Virus Infections & Pattern 450 MIC PRACTICAL PART SECTION (30397) 2018 450 MIC AMAL ALGHAMDI 1 Learning Outcomes The pathogenesis of viral infection The viral disease pattern Specific
More informationThe Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University
The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate
More informationNewborn screening for cytomegalovirus
Newborn screening for cytomegalovirus External review against programme appraisal criteria for the UK National Screening Committee (UK NSC) Version: Final Bazian Ltd. October 2017 This analysis has been
More informationHerpes simplex virus I and II: a therapeutic approach
Herpes simplex virus I and II: a therapeutic approach Abstract Van der Plas H Division Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town Hardie D Division of Virology,
More informationMaternal oral CMV recurrence following postnatal primary infection in infants
Maternal oral CMV recurrence following postnatal primary infection in infants I. Boucoiran, B. T. Mayer, E. Krantz, S. Boppana, A. Wald, L. Corey, C.Casper, J. T. Schiffer, S. Gantt No conflict of interest
More informationProperties of Herpesviruses
Herpesviruses Properties of Herpesviruses Structure and Composition Spherical icosahedron, 150-200 nm Double-stranded DNA, linear More than 35 proteins Enveloped Replication from nucleus (budding) Features
More informationNeonatal Herpes Simplex Infection
CLINICAL MICROBIOLOGY REVIEWS, Jan. 2004, p. 1 13 Vol. 17, No. 1 0893-8512/04/$08.00 0 DOI: 10.1128/CMR.17.1.1 13.2004 Copyright 2004, American Society for Microbiology. All Rights Reserved. Neonatal Herpes
More informationCMV. Your questions answered. Contact us on us Visit December 2013 Edition
CMV Your questions answered Contact us on 0845 467 9590 Email us info@cmvaction.org.uk Visit www.cmvaction.org.uk December 2013 Edition Your Questions Answered 02 The basics about the virus 04 Transmission
More informationWelcome to Pathogen Group 6
Welcome to Pathogen Group 6 Human herpesviruses 1 (HHV-1) and 2 (HHV-2 or HSV-2) Varicella-zoster virus (chickenpox and shingles) Neisseria gonorrhoeae Treponema pallidum Human papillomaviruses (HPV) Human
More informationZika Virus. Robert Wittler, MD
Zika Virus Robert Wittler, MD Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME
More informationZika Virus. Disclosure. Zika Virus 8/26/2016
Zika Virus Robert Wittler, MD Disclosure I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME
More informationherpesviruses dsdna, linear, enveloped, nm Large genome, codes for 75 viral proteins 50-70% similarity Cross reactivity between HSV and VZV
Herpesviridae herpesviruses dsdna, linear, enveloped, 180-200 nm Large genome, codes for 75 viral proteins 50-70% similarity Cross reactivity between HSV and VZV HSV-2 virus particle. Note that all herpesviruses
More informationMAJOR ARTICLE. congenital CMV infection; CMV kinetics of clearance; DNAemia at birth; late-onset sequelae.
MAJOR ARTICLE High Cytomegalovirus (CMV) DNAemia Predicts CMV Sequelae in Asymptomatic Congenitally Infected Newborns Born to Women With Primary Infection During Pregnancy Gabriella Forner, 1 Davide Abate,
More informationCOMMON VIRAL INFECTIONS. Dr D. Tenea Department of Dermatology University of Pretoria
COMMON VIRAL INFECTIONS Dr D. Tenea Department of Dermatology University of Pretoria GENERAL Viral infections of the skin important in immunocompromised Pts. Infection: direct inoculation ( warts ) or
More informationWOMENCARE. Herpes. Source: PDR.net Page 1 of 8. A Healthy Woman is a Powerful Woman (407)
WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 Herpes Basics: Herpes is a common viral disease characterized by painful blisters of the mouth or genitals. The herpes simplex virus (HSV) causes
More informationHuman Herpesviruses. Medical Virology, 27 Nov 2015.
Human Herpesviruses Assoc.Prof. Murat Sayan Kocaeli Üniversitesi, Rutin PCR Lab. Sorumlu Öğt.Üyesi Yakın Doğu Üniversitesi, DESAM Kurucu Öğrt. Üyesi sayanmurat@hotmail.com 0533 6479020 Medical Virology,
More informationPrognostic indicators of childhood acute viral encephalitis
ecommons@aku Community Health Sciences Department of Community Health Sciences December 1999 Prognostic indicators of childhood acute viral encephalitis E Bhutto Aga Khan University M Naim Aga Khan University
More informationThe Pediatric Approach to Infants Born with Zika and their Families
The Pediatric Approach to Infants Born with Zika and their Families Leslie Rubin MD Morehouse School of Medicine Developmental Pediatric Specialists Innovative Solutions for Disadvantage and Disability
More informationClinical Information on West Nile Virus (WNV) Infection
Clinical Information on West Nile Virus (WNV) Infection Introduction In 1999, West Nile Virus (WNV), an Old World flavivirus, producing a spectrum of disease including severe meningoencephalitis, appeared
More informationAcyclovir dose for meningitis
P ford residence southampton, ny Acyclovir dose for meningitis Aciclovir (ACV), also known as acyclovir, is an antiviral medication. It is primarily used for the treatment of herpes simplex virus infections,
More informationNegri Body and EM of Rabies Virus
Rhabdovirus Nearly 100% fatal after symptoms appear Bullet shaped virion Helical nucleocapsid Zoonotic Glycoprotein Binds to Nicotinic Ach receptors in the post-synaptic junction. Replicates in motor neurons
More informationNeonatal herpes simplex virus infections: HSV DNA in cerebrospinal fluid and serum
F24 Arch Dis Child Fetal Neonatal Ed 1999;81:F24 F29 Neonatal herpes simplex virus infections: HSV DNA in cerebrospinal fluid and serum G Malm, M Forsgren Department of Paediatrics B68 Huddinge University
More informationLaboratory Diagnosis of Central Nervous System Infections in Children
Laboratory Diagnosis of Central Nervous System Infections in Children R. Selvarangan. BVSc, PhD, D(ABMM). Professor, UMKC-SOM Director, Microbiology Laboratory Children's Mercy Hospital Kansas City, MO
More informationReducing the Sexual Transmission of Genital Herpes
CLINICAL GUIDELINE Reducing the Sexual Transmission of Genital Herpes Compiled by Adrian Mindel Introduction People diagnosed with genital herpes usually have many questions and concerns, a key one being
More informationThe problem with TORCH screening
: Beyond TORCHeS TORCH or STORCH-a helpful mnemonic? Toxoplasma Other Rubella CMV HSV (HIV) Syphilis 3 The problem with TORCH screening TORCH-first proposed by Nahmias et.al. (Pediatr Res 1971) Toxo, Rubella,
More informationNote: Syllabus notes refer to the slides for Dr. Gershon s lecture, which may be downloaded from the course website.
Anne Gershon Herpesviruses Note: Syllabus notes refer to the slides for Dr. Gershon s lecture, which may be downloaded from the course website. Slide 1 Common features of the herpesviruses are: 1. similar
More informationCongenital Zika Virus. Rebecca E. Levorson, MD Pediatric Infectious Diseases Pediatric Specialists of Virginia November 4, 2017
Congenital Zika Virus Rebecca E. Levorson, MD Pediatric Infectious Diseases Pediatric Specialists of Virginia November 4, 2017 Objectives 1. Understand Congenital Zika Virus and why evaluating for congenital
More informationSubunit adjuvanted zoster vaccine: why the fuss?
Subunit adjuvanted zoster vaccine: why the fuss? Soren Gantt, MD PhD MPH Pediatric Infectious Diseases Vaccine Evaluation Center BC Children s Hospital University of British Columbia Disclosures Research
More informationStructure of viruses
Antiviral Drugs o Viruses are obligate intracellular parasites. o lack both a cell wall and a cell membrane. o They do not carry out metabolic processes. o Viruses use much of the host s metabolic machinery.
More informationManagement of Viral Infection during Pregnancy
Vaccination Management of Viral Infection during Pregnancy JMAJ 45(2): 69 74, 2002 Takashi KAWANA Professor of Obstetrics and Gynecology, Teikyo University Mizonokuchi Hospital Abstract: Viral infection
More informationClinical Aspect and Application of Laboratory Test in Herpes Virus Infection. Masoud Mardani M.D,FIDSA
Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection Masoud Mardani M.D,FIDSA Shahidhid Bh BeheshtiMdi Medical lui Universityit Cytomegalovirus (CMV), Epstein Barr Virus(EBV), Herpes
More informationHerpes viruse. Dr. Hala Al Daghistani. HHV-1 Herpes simplex virus-1 Oral (fever blisters), ocular lesions, encephalitis
Herpes viruse Dr. Hala Al Daghistani HHV-1 Herpes simplex virus-1 Oral (fever blisters), ocular lesions, encephalitis HHV-2 Herpes simplex virus-2 Genital, anal lesions Severe neonatal infections, meningitis
More informationNeonatal sepsis INCIDENCE RISK FACTORS RISK FACTORS 5/18/2015
Angelica Floren MD.FAAP. Caring for Little Miracles 6 Th Annual Care Of the Sick Newborn Conference Neonatal sepsis Neonatal sepsis is a disease that may start with minimal or nonspecific symptoms and
More information