Chapter 6 : Herpes Simplex Virus and Varicella-Zoster Virus

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Herpes simplex viruses (HSV) are enveloped large DNA viruses (approximately 152,250 to 154,750 base pairs, depending on HSV type, and 90 transcriptional units). HSVs are α-herpesviruses (family Herpesviridae) and are divided into three major clades. There are two HSV types (HSV 1 and 2) that are genetically distinct but that are colinear and share roughly 83% genomic homology ( ). HSV from mucocutaneous lesions, or from asymptomatic shedding in the oral or genital secretions from an infected contact, enters the skin/mucosa of a new host through minor breaks or abrasions to infect the underlying epithelium. Infection at the dermal–epidermal junction produces characteristic skin lesions. These begin as macules and papules that culminate in vesicles that contain infectious virus ( Fig. 1A ). These form pustules that rupture after 2 days; the resulting ulcers and crusts form within 96 hours. Vesicles and pustules are most likely to contain infectious virus, whereas ulcers and crusts reliably contain HSV DNA. Local vesicle formation is the hallmark of HSV infection, but vesicles may not be appreciated on mucosal surfaces because they rupture shortly after forming ( Fig. 1B ). An essential characteristic of α-herpesviruses during primary infection is entry into a permanent latent relationship with sensory neurons, with the potential for subsequent reactivation to cause recurrent local infections ( ).

Citation: Levin M, Weinberg A, Schmid D. 2016. Herpes Simplex Virus and Varicella-Zoster Virus, p 135-156. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0017-2015
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Figure 1

First-episode HSV in an HIV-infected patient. Genital HSV in a renal transplant recipient. Typical recurrent HSV. Atypical chronic recurrent HSV in a bone marrow transplant recipient.

Citation: Levin M, Weinberg A, Schmid D. 2016. Herpes Simplex Virus and Varicella-Zoster Virus, p 135-156. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0017-2015
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Generic image for table
Table 1

Laboratory methods for the diagnosis of HSV infection

Citation: Levin M, Weinberg A, Schmid D. 2016. Herpes Simplex Virus and Varicella-Zoster Virus, p 135-156. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0017-2015
Generic image for table
Table 2

Laboratory methods for the diagnosis of VZV infection

Citation: Levin M, Weinberg A, Schmid D. 2016. Herpes Simplex Virus and Varicella-Zoster Virus, p 135-156. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0017-2015

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