Académique Documents
Professionnel Documents
Culture Documents
Characterized by:
• Involvement of CNS: Significant defects within 2
years of life
– Severe hearing loss
– Ocular abnormalities
– Mental retardation
• Involvement of reticuloendothelial system
Laboratory diagnosis
Lab diagnosis of CMV infections depends on
7. Demonstrating seroconversion
Laboratory Diagnosis (1)
• Direct detection
– Histology of biopsy specimens for CMV inclusion
– The detection of CMV antigenaemia is now
routinely used for the rapid diagnosis of CMV
infection in immunocompromised patients
– PCR for CMV-DNA is diagnostic
• Virus Isolation
– Cell culture is regarded as gold standard but
requires up to 3-4 weeks for CPE
– Rapid culture methods such as shell vials can
reduce the time for detection to 24-48 hours
• Serology
– CMV IgG antibody indicates past infection
– CMV IgM is indicative of primary infection
Laboratory interpretations
• Congenital infection
Virus culture or viral DNA assay positive at birth or within 1-2
weeks
• Perinatal infection
Culture-negative specimens at birth but positive specimens at 4
weeks or more after birth suggest natal or early postnatal
infections
• CMV mononuclesis in non-immunocompromised patients
Serconversions and presence of IgM specific for CMV are the best
indicators of primary infections
• Immunocompromised patients
Demonstration of virus by viral antigen, DNA, or demonstration
of inclusions in diseased tissue.
Treatment
Congenital infections
Immunocompromised patients
Clinical Manifestations
• Primary HHV-6 infection is associated with Roseala
Infantum (or fourth disease), which is a classical
disease of childhood.
• Children are protected by maternal Ag until 6 months.
• A spiking fever develops over a period of 2 days
followed by a faint maculopapular rash from trunk to
extermities.
• May be complicated by encephalitis
• Reactivation is common in immuno-suppression (post-
transplantation)
Diagnosis
• Primary infection can be
documented serologically
• Active virus infection can be
documented by culture or DNA
detection (by PCR)
Treatment
Definitive therapy has not been
established, but HHV-6 is more
susceptible to ganciclovir
Roseala Infantum
HHV-7
Epidemiology
• Two epidemiological patterns are seen with EBV
• In developed countries,
• 2 peaks of infection are seen:
– 1st preschool children aged 1 - 6
– 2nd adolescents and young adults aged 14 - 20
– Eventually 80-90% of adults are infected.
• In developing countries
• Infection occurs at a much earlier age so that by
the age of two, 90% of children are seropositive.
• The virus is transmitted by contact with saliva, in
particularly through kissing.
Pathogenesis
1. Infectious Mononucleosis
2. Chronic infectious mononucleosis
3. Burkitt's lymphoma
4. Nasopharyngeal carcinoma
5. Lymphoproliferative disease and lymphoma in the
immunosuppressed.
6. X-linked lymphoproliferative syndrome
7. Oral leukoplakia in AIDS patients
8. Chronic interstitial pneumonitis in AIDS patients.
Infectious Mononuclosis (IM)
• NPC
– Histology
– The determination of the titre of anti-EBV viral
caspid antigen (VCA) IgA in screening for early
lesions of NPC
This so-called "Downy cell" is typical of lymphocytes infected by EBV
(Epstein Barr Virus) or CMV (Cytomegalovirus) in infectious
mononucleosis.
•
Vaccination
• Gammaherpesviruses
• Associated with Kaposi’s
Sarcoma (KS)
• HHV-8 DNA is found in
almost 100% of cases of
Kaposi’s sarcoma
• Most patients with KS
have antibodies against
HHV-8
•
Close-up
Human Herpesviruses
Designation Common name Disease
HHV-1 Herps simplex virus-1 Oral (fever blister), ocular lesions, encephalitis
HHV-2 Herps simplex virus-2 Genital, anal lesions, severe neonatal infections,
meningitis
HHV-3 Varicella-Zoster virus Chicken box (primary infection),. Shingles
(reactivation)
HHV-4 Epstein-Barr virus IM (primary infection). Tumors including B-cell
tumors (Burkitt’s lymphoma, immunoblastic
lymphomas of immunosuppressed), NPC
HHV-5 Cytomegalovirus Mononucleosis, severe congential infections.
Infections in immunocompromised (GIT, retinitis,
pneumonia)
HHV-6 Human herpesvirus-6 Roseola in infants (Primary Infection)
Infections in allograft recipients (pneumonia, marrow failure)
HHV-7 Human herpesvirus-7 Some cases of roseola (primary infection)