Makindo Medical Notes

Related Subjects: |Herpes Varicella-Zoster (Shingles) Infection |Chickenpox Varicella Infection |Varicella Cerebral Vasculopathy |Herpes Viruses |Herpes Zoster Ophthalmicus (HZO) Shingles |MonkeyPox |Mumps |Measles |Rubella (German Measles) |Epstein-Barr Virus infection |Cytomegalovirus (CMV) infections |CMV retinitis infections |Toxoplasmosis

🦠 Herpes Viruses (HHVs)

There are 8 known human herpesviruses (HHV-1 to HHV-8). They share the ability to establish **lifelong latency** and reactivate during immunosuppression or stress.

💋 HHV-1 & HHV-2 (Herpes Simplex Viruses)

• HSV-1 → orolabial ulcers (“cold sores”), HSV-2 → genital ulcers.
• Other: herpetic whitlow (fingers), eczema herpeticum, neonatal HSV, encephalitis (temporal lobe).
• 🧪 Latent in sensory ganglia → reactivation with stress/immunosuppression.
• 💊 Treatment: Aciclovir PO (first/recurrent episodes), IV aciclovir for severe/encephalitis.
• ⚠️ Neonatal HSV = high mortality without urgent IV aciclovir.

🐔 HHV-3 (Varicella-Zoster Virus)

• Causes varicella (chickenpox) & herpes zoster (shingles, dermatomal vesicles).
• Complications: pneumonitis, encephalitis, hepatitis, retinal necrosis, post-herpetic neuralgia.
• 🧪 Latent in dorsal root ganglia → reactivation with age or immunosuppression.
• 💊 Oral aciclovir (start <72 h), IV aciclovir if severe/disseminated.
• ⚠️ Ophthalmic zoster threatens vision → urgent ophthalmology review.

🤒 HHV-4 (Epstein–Barr Virus, EBV)

• Infectious mononucleosis: fever, pharyngitis, lymphadenopathy, splenomegaly.
• Other: oral hairy leukoplakia, Burkitt’s lymphoma, Hodgkin’s lymphoma, nasopharyngeal carcinoma.
• 💊 Supportive treatment only. Avoid amoxicillin/ampicillin (rash).
• ⚠️ Splenic rupture → avoid contact sports for 3–4 weeks.

👁️ HHV-5 (Cytomegalovirus, CMV)

• Opportunistic infection in immunosuppressed (HIV, transplant).
• Clinical: retinitis (“pizza-pie fundus”), oesophagitis, colitis, pneumonitis, congenital CMV (sensorineural hearing loss).
• 💊 Ganciclovir/valganciclovir; foscarnet or cidofovir if resistant.
• ⚠️ Causes neutropenia → monitor FBC and renal function.

👶 HHV-6 & HHV-7 (Roseoloviruses)

• Cause roseola infantum: high fever → sudden defervescence rash.
• Can cause febrile seizures in infants.
• Reactivation in transplant patients → encephalitis, myelosuppression.
• 💊 Supportive. Severe disease may need ganciclovir/foscarnet (specialist).

🎗️ HHV-8 (Kaposi’s Sarcoma–associated Herpesvirus)

• Associated with Kaposi’s sarcoma, primary effusion lymphoma, multicentric Castleman’s disease.
• Seen especially in immunosuppressed (e.g., HIV/AIDS).
• 💊 ART optimisation, local therapies (surgery/radiotherapy), systemic chemotherapy (liposomal doxorubicin), rituximab for MCD.
• ⚠️ Can cause visceral involvement → GI bleeding, respiratory compromise.