Patient 20 year-old female presented at ER with 4-day history of fever, chills,
ID: 148678 • Letter: P
Question
Patient
20 year-old female presented at ER with 4-day history of fever, chills, myalgia. Two days earlier she noted painful genital lesions. On the day of admission she developed headache, photophobia, and a stiff neck. Previously, she had been in good health. She admitted to being sexually active, but had no history of sexually transmitted diseases (STDs).
Physical exam showed patient alert and oriented with normal vital signs except for a temperature of 101.3F. Throat was clear with no lymphadenopathy. Pelvic exam revealed extensive vesicular and ulcerative lesions on the left labia minora and majora with marked edema. The cervix had exophytic (outward-growing) necrotic ulcerations.
Diagnostic
General laboratory tests were unremarkable. VDRL was negative. Lumbar puncture was performed and showed a mild pleocytosis (increased cell count) with a leukocyte count of 41 per µl with 21% polymorphonuclear leukocytes and 79% mononuclear cells. CSF glucose was 41 mg/dl (normal 50-80 ml/dl) and protein of 68 mg/dl (normal 15-60 mg/dl).
Cultures from the genital lesions and CSF were received 2 days later. The patient had received 2 days of intravenous therapy by then and her condition had improved.
Which of the following could cause her symptoms (circle most probable; Hint: virology course)?
Human papillomavirus
Treponema pallidium
Herpes simplex virus Type 2
Chlamydia trachomatis
Haemophilus ducreyi
Which of the above organisms would be most likely to have caused her symptoms and why (which cultures were positive/why)?
Which complication of her underlying illness did she develop?
If she had been pregnant at the time of her infection, for what would her fetus be at risk?
Briefly describe the natural cycle of this infection.
Briefly describe the 2 serotypes of this infection (name, where infection occurs, how usually contracted).
please can you answer all the questions.
Explanation / Answer
.In the list of organisms given only 2 viruses are there HSV2 and papillomavirus, rest of them are bacteria. Now out of HPV and HSV, the female in question is probably suffering from Herpes simplex virus Type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Genital lesions are also the diagnostic signs of this infection. Whereas in HPV infection warts are the main sign which is not present in this female.
she developed HSV-2–associated meningitis too along with the primary infection causing a type of genital herpes. At that time due to a prior infection from this virus, she became immunocompromised too and thus viral meningitis also resulted. The diagnosis of HSV-induced meningitis relies on the detection of HSV DNA in the CSF by PCR.
If she had been pregnant at the time of infection with herpes simplex virus, that (HSV) can be spread to an infant, causing neonatal herpes, a serious and sometimes fatal condition. In the fetus it causes damage to the central nervous system, mental retardation, or death.
Infection cycle- Transcription, genome replication, and capsid assembly occur in the host cell nucleus. Genes are replicated in a specific order: (1) immediate-early genes, which encode regulatory proteins; (2) early genes, which encode enzymes for replicating viral DNA; and (3) late genes, which encode structural proteins. Transmission of herpes from an infected male to a female partner is a common cause of infection. Thus a female who is sexually active may acquire HSV2 infection easily.
HSV 1 and HSV 2 are the most common types of serotypes.
HSV-1 more commonly causes infections around the mouth while HSV-2 more commonly causes genital infections. They are transmitted by direct contact with body fluids or lesions of an infected individual