Herpes - HerpesvirusInfectionsin Immunocompromised Patients...

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    Herpesvirus Infections in  Immunocompromised  Patients An Overview
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Immunocompromising conditions Congenital immunodeficiencies e.g. . Di George, Wiskott- Aldrich syndrome. AIDS Haematological malignancies such as leukaemia. Organ transplant recipients Autoimmune diseases eg. SLE Iatrogenically immunosuppressed patients e.g. cancer patients receiving chemotherapy.
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Herpesvirus Enveloped DNA viruses. Set up latent infection following primary infection. Reactivation are more likely to take place during periods of immunosuppression. Both primary infection and reactivation are likely to be more serious in immunocompromised patients.
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Herpesvirus Particle HSV-2 virus particle. Note that all herpesviruses have identical morphology and cannot be distinguished from each other under electron microscopy. (Courtesy of Linda Stannard, University of Cape Town, S.A.)
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Herpes Simplex Virus Normal individuals Primary HSV infection usually occurs in childhood, the majority of infections are asymptomatic or present with a gingivostomatitis. The virus becomes latent in the craniospinal ganglia. The virus may then be reactivated from time to time by various triggers such as stress, infection, sunlight, immunosuppression.
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Herpes Simplex Virus Immunocompromised individuals Patients receiving cytotoxic therapy, organ graft recipients, and patients with AIDS are at risk of severe HSV disease. HSV disease are more frequent and severe in these patients. Severe local disease or disseminated infection may be seen. Acyclovir may be used to treat HSV infection, but resistance to acyclovir may emerge during long term therapy. Acyclovir is now routinely given as prophylaxis for those receiving organ graft transplant, and HSV has ceased to be a major problem in these patients.
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Varicella-Zoster Virus Normal individuals Primary infection (chickenpox) is one of the classical rash diseases of childhood. Following primary infection, the virus remains latent in the cranial-spinal ganglia. Reactivation leading to the appearance of shingles occurs in 10-20% of infected individuals and usually occurs after the fourth decade of life. Usually, only one episode of reactivation occurs.
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Primary infection Chickenpox is much more severe in children undergoing treatment for malignancies such as leukaemia and lymphoma. Life-threatening complications such as disseminated varicella, pneumonia, and encephalitis are much more likely to be seen. Reactivation Immunocompromised individuals are at risk of developing herpes zoster, herpes zoster may appear at an earlier age than usual in these individuals, furthermore, more than one episode may occur. Severe, disseminated disease may occur but fatality is rare.
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Herpes - HerpesvirusInfectionsin Immunocompromised Patients...

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