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The infection with this virus is very common but, in healthy people does not produce disease. Is a member of the herpesviridae family together with herpes simplex, Epstein-Barr, varicella-zoster viruses.
Presence of "cytomegalic" cells with reddish-blue intranuclear inclusions surrounded by a clear halo to impart a peculiar owl's eye appearance, hepatocytes, bile duct epithelium, endothelial and connective tissue cells. In cases of congenital hepatitis the picture is that of a severe "neonatal hepatitis" with necrosis and formation of multinucleated giant cell without significant inflammatory cell reaction.
In cases of cytomegalovirus mononucleosis, which are rare, the liver shows a prominent diffuse lobular inflammation with lymphocytes, plasma cells and macrophages without significant necrosis. The "gold standard" for diagnosis of CMV is the conventional cell culture based on the appearance of the typical cytopathic effect (CPE) in the infected cells. Notice an area of necrosis with nuclear inclusions in hepatocytes and not much inflammatory reaction. This virus produces infectious mononucleosis in young adults throughout the world and seems to contribute to Burkitt's lymphoma and nasopharyngeal carcinoma.
Mononucleosis hepatitis is characterized by peculiar necroinflammatory changes which, at the difference of classical viral hepatitides consist of more inflammation and less necrosis. Another peculiar feature is the presence of a marked regenerative activity of hepatocytes with presence of increased number of binucleate cells, polyploid nuclei and mitotic figures. High power of previous illustration showing the signs of high regenerative activity: binucleate cells and a mitotic figure. Helpful advice for diagnosing and living (and loving) with different types of Herpes virus. Herpes simplex 1 and 2 are actually two different diseases caused by two different viruses.
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Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. There’s no cure for genital herpes, but medications can ease symptoms and reduce the risk of infecting others. The viral particles consist of a DNA core, a icosahedral capsid, adn a surrounding envelop. The infection acquired in the may present a serious illness which begins shortly after birth with jaundice, purpura, hemolytic anemia, thrmobocytopenia, brain damage, microcephaly and paravetricular calcifications. The infection may produce a chronic disease with abnormal liver function tests and recurrent fever and jaundice.
However, an average of 7-10 days is required for the CPA to develop, which in a critically ill patient is too long.
This consists in the incubation of the tissue on a glass slide with antibodies to the virus.
Unfortunately, the ubiquitous presence of the virus and the common asymptomatic type infection makes the evaluation of a single measurement of antibody level difficult to interpret.
Their accuracy, when compared with culture or histologic methods, is still being evaluated.
Type 1 produces herpes simplex infection especially recurrent blisters around the lips and generalized infections in older children and adults.


The infection in childhood is common and asymptomatic but it may rarely cause mononucleosis syndrome.
There is marked mononuclear cell infiltration of sinusoids and portal fields contrasting with mild hepatocellular necrosis.
Herpes simplex type 1, or oral herpes, often affects the mouth, lips, nose, and other parts of the face. For herpes simplex 1, the most common symptoms are recurrent cold sores on the mouth and other areas of the face.
Still contagious at this point.For both herpes simplex 1 and 2, shedding is more likely during outbreaks. After the initial infection, the virus lies dormant in your body and can reactivate several times a year. Your mind and your body form one system, and your thoughts influence the biochemistry and genetical structure of your body. Under electron microscopy there are herpes-like virions, defective viral particles and spherical particles called dense bodies. The liver presents cholestasis, fatty changes, focal necrosis with cytomegalic cells in hepatocytes and bile ducts. Some adults and older children may develop "glandular fever", the so-called Cytomegalic Mononucleosis consisting of a febrile illness of 3-6 weeks duration with lymphocytosis, abnormal lymphocytes but negative Paul-Bunnell test and absence of sore throat and lymphadenitis. Positive cases show a strong, dark-brown or red staining (depending on the counterstain) in the nucleus of the cell. Type 2 affects the genital tract and produces disseminated infection of the neonate with severe hepatic involvement.
In debilitation, pregnancy, immunosuppression it may produce a disseminated disease which is usually fatal. The sinusoids are filled and distended with mononuclear cells which are large and sometimes clustered to resemble granulomas sometimes similar to sarcoidosis. Portal tracts are healvily infiltrated by mononuclear inflammatory cells but there is mild erosion of the limiting plates. When people encounter the word herpes, they usually think of genital herpes.But there are other types of herpes. The herpes virus type 1 prefers the oral region unlike the herpes virus type 2, or genital herpes, that affects the genital as well as the anal area.Herea€™s where it gets tricky. During normal days, herpes simplex 1 can shed from 6 to 33% of days from the mouth and 5% of days from the genitals. For some people, however, it may recur more than 10 times per year.The severity of the symptoms varies from one person to another. One type of the virus - herpes simplex virus type 1 (HSV1) - can lead to cold sores or fever blisters around the mouth. Perinatal infection can be contracted in utero, from infected maternal genitalia and from breast milk.
Infected cell may become cytomegalic but since the infection may not produce morphological changes, the absence of large cells and of intranuclear inclusions do not exclude the infection. Fatality is high but some patients may recover completely or may come out with permanent brain damage. The picture is similar to that of infectious mononucleosis and can be confused with acute viral hepatitis. This assay requires the incubation of the sample submitted with a monoclonal antibody, labeled with a fluorescent tag. Disseminated herpes infection is commonly seen in immunocompromised patients (vesicular eruptions, encephalitis, esophagitis, keratitis).


The liver lesions are similar to those of herpes simplex, necrotizing with viral inclusions in hepatocytes. The difference is attributed to the exposure to a large quantity of viruses by deep kissing. The sinusoids are swollen adn the liver cell plates, in some areas, may be compressed and atrophic. After a few days, the sores form crusts and then heal.It can get very embarrassing and worrisome especially when an important event, interview, or date is coming up. For herpes simplex 2, the virus can shed from 15 to 25% of days from the genitals and 1% from the mouth.
After a period of incubation of 24 or 48 hours, positive cells display nuclear apple-green fluorescence under the microscope.
The virus is a typical member of the Herpesviridae family: DNA core, a icosahedral capsid with 162 capsomers, a surrounding envelope, 120 nm in diameter. That means that herpes simplex type 1 can affect the genital area and herpes simplex type 2 can affect the mouth area. Practically all pirmary infections are asymptomatic but the infected individuals excrete the virus in the urine and saliva for months and years and are infectious. Similar symptoms may appear in the so-called Postperfusion Syndrome which develops after massive transfusions from multiple donors in both positive and negative individuals for anti-CMV antibodies.
Groups of hepatocytes surrounding these areas contain intranuclear eosinophilic viral bodies (Cowdry type A inclusions).
It is found in lymphoid tissues and in the epithelium of the nasopharynx and probably of the cervix. Obviously, the sinusoidal infiltration reflects the mononucleosis picture of the peripheral blood. The virus may be reactivated from the latent state by decreased imune response usually induced by disease or drugs especially by immunosuppressant therapy where reactivation of a primary infection and not re-infection appears to be the norm. However, the chance of getting herpes simplex 1 on the genital area and herpes simplex 2 on the mouth is lower than getting them on their preferred body part. Both types of herpes virus are contagious and can be passed from person to person through contact with the herpes sores or blisters.
The white cells of 5% of blood donors contain CMV virus therefore infection by blood transfusion occurs in a large number (60%?) of patients.
After infection, the lymphocyte under the influence of the viral genome produce new antigens which are deposited on their surface.
Because of the wide distribution and the asymptomatic occurrence of CMV infection it is crucial to test donors for organ transplantation. T lymphocytes react to these antigens, become blastoid and form the atypical lymphocytes of the peripheral blood seen in these patients who at this piont develop the full symptoms of infectious mononucleosis which, evidently, is immunopathologically mediated. An infected organ under immunosuppressive therapy will reactivate the virus with disastrous consequences. Some individuals cannot mount this t-lymphocytic reaction will succumb to the primary EVB infection. This is the case of those suffering of X-linked lymphoprolipherative disorder, Duncan's syndrome.



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