State institution

«Dnepropetrovsk state Medical academy of the Ministry of Health of Ukraine»

Department of infectious diseases

APPROVED
At the methodical meeting
« » 2019

Chief of the department ,professor L. R. Shostakovich-Koretskaya

METHODICAL RECOMMENDATIONS

For the students to organize the classroom work

For students of the students 5-th course of medical faculties

practical seminar on infectious diseases

(IX - X semester)
3 hours

TOPIC 8 : HERPESVIRAL DISEASES.

Dnipro 2019
 1. Actuality of theme:
During long time role of herpes viruses, as causative agents of infection of human underestimated. A lot
of generations of doctors behaved to the herpetic infections, as to easy indisposition which is accompanied
only with the short lasting rash on lips. However, as far as development of processes of urbanization, growth
of the psychical loading and stresses in everyday life, worsening of ecological environment, expansion of
clinical application of immune depressive drugs and as a result of distribution of HIV-infection, role of
herpes viruses in pathology of human was revised. Development of our concept on herpetic infections in a
great deal rendered assistance to appearance of modern methods of diagnostics of viral diseases.
Herpetic infection is characterized with different localization of process and various clinical forms
and caused by viruses from Herpesviridae family, that contain DNA and characterized by long persistence in
human population, taking 3rd place after cardiovascular and oncological pathology. Diseases caused by
herpes viruses 1st and 2nd type taking 2nd place (15,8%) after influenza (35,8%) as cause of death after viral
infections by data of WHO. Herpes simplex and cytomegaloviral infection belongs to TORCH – complex and
causes pre-natal infections. НSV- infection takes part (in an association with papiloma viruses, СМV,
Chlamydia and mycoplasma), such as cancer of uterus and tumors of prostste. Also herpesviruses take part in
aterosclerotic process and severe affection of internal organs and formation of psychological problems. In
70% of cases infection is results from asymptomatic carriers.
Most unfavorably course of herpetic infection observed in children of early age and patients with
immunodeficiency of different origin, in which the most severe generalized forms of infections, are observed.
Moreover, relapsing course and generalized forms of herpetic infection are AIDS-indicated diseases.
Herpetic infections are AIDS-indicating states because at the damage of T- helpers and macrophages,
course of the disease acquires the severe clinical form. Herpetic infection often meets in patients with AIDS
(in 17% of patients, registered in Ukraine). It should be noted that herpetic infections can be not only
opportunistic «indicator» infections, but cofactor of activating and progress of HIV-infection and AIDS.
Etiologic role in pathology of human take part 8 types of herpesviridae, that by biological properties
and genetic likeness divided on 3 subfamilies:
α- herpesviridae: Poikilovirus (Herpes zoster - VZV or HHV-3) and genus of Simplex virus (virus
simple herpes 1 type НSV-1 and 2 type - НSV-2). α-herpes viruses have least long cycle of replication and
cause a strong cytopathogenic effect in cellular cultures and are affined to the epithelium and cells of a central
nervous system.
β - herpesviridae is included genus of Cytomegalovirus (cytomegalovirus or СМV, or ННV-4). This
group of viruses circulates in the organism of human and are affined to lymphatic tissue. Herpes viruses 6 and
7 types last years were obtained from a human organism, their clinical value now is unclear. It is known that
ННV-6 causes the syndrome of sudden exanthema in children, and HHV-7 has a pathogenetic value in
development of syndrome of chronic fatigue.
γ – herpesviridae, genus Rhadinivirus. Genus Lymphoscyptovirus is also belongs to γ- viruses, like a
4 type virus of human or Epsteyn-Barr virus (HHV-5, EBV).
Character of clinical course of infectious process, probability of development of manifest or latent
forms of disease, possibility and frequency of his relapses is determined by the state of unspecific
mechanisms of immune defense and immune activeness of organism, mainly - by the factors of cellular
immunity, and also antigen type of virus.

2. Tasks of the lesson (with pointing of level of mastering which is planned):

2.1. A student must know: а-1

•to know: about the place of herpetic infection in the structure of infectious diseases, history of its study,
scientific role of domestic scientists, including employees of department of infectious diseases of KNMU, in
history of scientific researches in this area.
•to get to know: with modern statistical information in relation to prevalence of herpetic infection, mortality,
frequencies of complications in Ukraine and in the world.

2.2. A student gets to know: а-2

•etiology of herpetic infection, pathogenic factors of causative agents;
•epidemiology of herpetic infection;
•pathogenesis of herpetic infection;
•clinical symptoms of herpetic infection depending on type of agent and gravity;
•clinical and epidemical features of herpetic infection;
•pathogenesis, incubation period and clinical symptoms of complications of herpetic infection;
•laboratory diagnostics of herpetic infection;
•principles of treatment of herpetic infection;
•principles of prophylaxis of herpetic infection;
•tactic of conduct of patients in the case of a urgent states;
•prognosis of disease depending on gravity and form of herpetic infection;
•rules of discharge of convalescents from a hospital;
•rules of a outpatient system for convalescents.

23. Student must be able: а-3

•to adhere to the basic rules of work bedside of patient with a herpetic infection, chicken pox and herpes
zoster;
•to collect anamnesis of illness with the estimation of epidemiology information;
•to examine a patient and find out basic symptoms and syndromes of herpetic infection, chicken pox and
herpes zoster, to ground a clinical diagnosis for timely direction of patient in a hospital;
•to conduct differential diagnostics of herpetic infection, chicken pox and herpes zoster;
•to make a plan of laboratory and instrumental diagnostics;
•to interpret results of laboratory and instrumental diagnostics.
•to work out an individual plan of treatment taking into account epidemiological information, clinical form,
stage of illness, presence of complications, condition of a patient, allergic anamnesis, accompanied
pathology; to give the first aid on the outpatient level;
•to work out a plan of anti epidemic and prophylactic measures in the pesthole of infection;
•to give recommendations about bed regimen, diet, diagnostic measures and supervision in the period of
convalescence.

2.4. Creative level (for the most capable students): а-4

•to develop the creative capabilities of students in the process of conducting of clinical researches, analysis of
scientific sources;
•to bring over students to work in the student scientific circle of department;
•to offer themes for UDRS and NDRS on most actual questions, for example: «Problems of prophylaxis of
relapses of herpetic infection», etc..

3. Educate tasks (for development of personality):

•To develop deontological presentations in the process of study of theme; to be able to adhere to the rules of
conduct bedside of patient, principles of medical deontology; to capture ability to set a psychological contact
with by a patient and his family.
•To develop the picture of influencing of socially-sanitary factors on prevalence of herpetic infection.
•On material of theme to develop sense of responsibility for a timeliness and rightness of professional actions.

4. Inter subject integration:

Discipline To know To be able

Previous disciplines
Microbiology Properties of Herpes simplex І To estimate the results of
and the II types; methods of specific methods of diagnostics
specific diagnostics of herpetic of herpetic infection.
infection
Physiology Parameters of physiological norm To estimate information of
of organs and systems of human; laboratory tests
indexes of normal values of
laboratory tests (general analysis
of blood, urine, CSF, biochemical
blood test, parameters of acid-
alkaline balance, electrolytes,
etc.).

Pathophysiology Mechanism of disturbance of To assay pathological changes by

functions of different organs and results of laboratory tests at
systems in pathological states of disturbances of functions of organs
different origin. and systems of different origin.

Immunology Basic concepts of the object, role To estimate data of

and allergology of the immune system in immunological tests.
infectious process, influencing for
the term of elimination of
pathogen from the human
organism. Immunological aspects
of relapsing course of herpetic
infection.
Epidemiology Epidemic process (source, To collect epidemiological anamnesis,
mechanism and ways of conduct anti epidemic and prophylactic
transmission) of herpetic measures in a pesthole of infection.
infection; prevalence of
pathology in Ukraine and in the
world.
Dermatology Pathogenesis, clinical To recognize rash in patient with
characteristic of exanthema and herpetic infection.
enanthema

Neurology Pathogenesis and clinical signs of To conduct a clinical examination of

meningitis, meningoencephalitis patient with affection of nervous
and edema of brain. system.

Ophthalmology Pathogenesis and clinical signs To conduct a clinical examination of

of keratitis, conjunctivitis, patient with affection of eyes.
iridocyclitis, choreorithinitis,
uveitis and neuritis of n.
ophtalmicus
Propaedeutics of Methods and basic stages of To collect anamnesis, conduct the
therapy clinical examination of clinical examination of patient, show
patient. pathological symptoms and
syndromes. To analyze findings.

Clinical pharmacology Pharmacokinetics and To prescribe treatment depending on

pharmacodynamics, side age, individual features of patient, to
effects of antiviral and choose the optimum mode of
supportive drugs. reception and dose of drug, write
recipes.

Reanimation and intensive Urgent stages: brain To diagnose in good time and give
therapy edema. the first aid.
Next disciplines
Family medicine Pathogenesis, epidemiology, To conduct differential diagnostics
dynamics of clinical symptoms, of illnesses of different genesis
possible complications of herpetic with a herpetic infection. To
infection. Features of clinical recognize a herpetic infection, its
course of herpetic infection. complications; to estimate
Principles of prophylaxis and information of laboratory
treatment. diagnostics. To hospitalize a
patient in good time in infectious
hospital. To fill an urgent report.
To render the first aid in the case
of necessity.
Interdisciplinary integration
Infectious diseases Features of infectious diseases. To conduct differential diagnostics
Principles of diagnostics, treatment of herpetic infection with other
and prophylaxis of infectious infectious diseases. To recognize
diseases. Pathogenesis, herpetic infection, its
epidemiology, dynamics of clinical complications; to estimate
symptoms, laboratory diagnostics, information of laboratory
possible complications of herpetic diagnostics. To prescribe
infection. Features of clinical treatment. To give the first aid on
course of herpetic infection. outpatient stage.
Principles of prophylaxis and
treatment.
 Etiology

pathogenesis
Epidemiology

Clinical classification
Inoculation

Localized form
Inoculation of Fusion of envelop Replication of virus in
virus into sensitive of virus with epithelial epidermal and
Skin affection or vegetative cellular membrane dermal cells
nerve-endings
Herpetic dermatitis
Extraction of Assembling of
nucleocapsid in nucleocapsid
Herpetiform eczema cytoplasm of cell
5. Content of topic of lesson*

Herpes simplex (HSV-1, HSV-2).

Herpetic infection

Kaposi Spreading of virus Covering of

by nerve trunks to nucleocapsid with
High sensitivity.

cells of nerve envelop

Ulcerous necrotic ganglions Disintegration of
dermatitis
nucleocapsid Moving through
endoplasmic
reticulum to
Exit of viral RNA
droplet, contact, sexual, transplacental, intranatal.
Host – infected human. Routs of transmission – air-

cellular surface
 Ulcerous necrotic dermatitis

Affection of mucosal Gingivostomatitis (aphthous,

layer of mouth ulcerous, necrotic)

Affection of mucosal nasopharyngitis

layer of respiratory
tract
laryngitis
Affection of eyes keratitis

conjunctivitis

iridocyclitis

chorioretinitis

uveitis

Neuritis of ophthalmic nerve

Affection of genital uretritis
organs
balanoposthitis

vulvovaginitis

cervicitis

disseminated (generalized) form

Affection of encephalitis
nervous system
meningoencephalitis

neuritis

Affection of other hepatitis

internal organs or
systems pneumonia

esophagitis

enterocolitis

nephritis

Mixed from
 Clinic
Herpetic affection of Herpetic affection of skin
mouth cavity

Herpetic pharyngitis: Herpetic stomatitis: ↑tºС, Rash on lips, around mouth, Acquired herpetic infection: Inborn herpetic infection –
↑tºС, weakness, weakness, headache`язів, sides of nose, less frequent More early infection – more transplacental route
headache, sore throat, discomfort and pain in on eyelids, hands, trunk. severe course; Early term of gravidity –
neck lymphadenitis plases of affection, hyperemia→papule→vesicle Late infection gives milder death с of fetus/defects of
hypersalivation, neck →erosion→crust forms/ asymptomatic; development (mycrocephalia,
lymphadenitis Primary herpetic infection microphtalm,
Rash on mucosal layer of has more severe course, choreoretinitis);
pharynx, tonsils: toxicosis, spreading of Late stage / delivery – death
Rash on mucosal layer of Plentiful elements→t=37,5- affection and longer course of infant/development of
vesicles→erosions
cheeks, pharynx, tongue; 38,5ºС, chill, headache generalized herpetic infection
little vesicles, erosions, (often with fatal outcome)
aphthosis
Skin and internal organs

Latent form

Without clinical focuses of affection

 Herpetic affection of Herpetic affection of Herpetic affection of Gerpetic affection of
internal organs nervous system eyes genital organs

Herpetic pneumonia Herpetic esophagitis: Herpetic Herpetic encephalitis: Retinitis: keratitis/keratoconjuncti ↑tºС, weakness,
(nidal character of dysphagia, retrasternal meningitis: ↑tºС, ↑tºС, chill, , fever, inflammatory vitis: pain in eye, myalgias, hyperemia
inflammation) pain weakness, nousea, vomiting, granuloms on deterioration of vision, and edema of tissues,
headache, catarrhal headache, focal retina edema of conjunctives, local pain, itching,
syndrome, affection (paresis, affection of cornea painful urination,
meningeal signs coma, plegia, inguinal lymphadenitis
pathologic reflexes, Relapses: deep
hyperkinesis); keratoiritis, Rash on penis, uretritis,
disturbances of prostatitis: in women on
parenchimatous uveitis,
consciousness outer genital organs,
keratitis, deep ulcer cervicitis, uretritis,
with hypopion salpingitis,
endomethriris
papules/vesicles→erosi
ons→crust
 lever and spleen, increasing
syndrome, cramps, dark urine, enlargement of
muscular pain, jaundice,
Herpetic hepatitis: ↑tºС,
weakness, headache,

of serum АlAТ
headache, weakness

other organs (lever,

mucosal layers and
herpetic infection

Hectic fever, chill,

affection of skin,
Generalized

lungs, brain and

membrane)
meningeal
dyspeptic

→bronchi→lungs), than –
generalized form(retinitis,

encephalitis, meningitis)
HIV-positive patients

cavity→gullet→trachea
Affection of skin (deep
Herpetic infection in

ulcers) and mucosal

choreoretinitis,
layers (mouth

complications Herpetic encephalitis: Herpetic pneumonia: Generalizes herpetic infection:

disturbances of respiratory hemorrhagic syndrome, acute
psychological status and insufficiency suprarenal insufficiency,
peripheral paralysis pancreatitis,
glomerulonephritis,
monoarticular arthritis

Differential diagnosis Herpetiform Allergic Herpes zoster

Chicken pox
dermatitis dermatitis

Ulcers of genital piodermia Secondary

Gingivostomatitis
organs different syphilis
different etiology
etiology

Viral meningitis Viral heratitis keratoconjunctivitis of different

and encephalitis etiology
A, B, C, D

Laboratory Detection of virus: genome PCR and molecular hybridization

diagnostics and antigens in content of
vesicles, smears from
mucosal layers, cerebro- Reaction of immune fluorescence method,
spinal fluid, etc. electronic microscopy
 Cytological and cytochemical: detection of
intranucleal insertions in multinuclear cells

Detection antibodies to IEA: detection of ІgM (acute process) and IgG

HSV (cross-reactions are
possible)
Immune blot (Western Blot): confirmation of
IEA and estimation of correlation between
different classes of anti-HSV Ig

treatment Specific terapy Acyclovir, valacyclovir, phamcyclovir,

gancyclovir

Specific immunoglobulin

Interferon: lapheron, vipheron, ropheron, intron

-A
Inductors of interferon: amyxin, neovir, inozit,
cyclopheron

Supportive treatment dezintoxication

antibiotocs

Prophylactics Primary herpetic infection – Acyclovir, amyxin

hygienic measures

Relapsing herpetic infection Inactivated herpetic vaccine

VZV-infection

etiology Varicella (herpes) zoster (VZV)

Epidemiology Host of infection- person with chicken pox or herpes zoster. Routs
of transmission: droplet, contact, perinatal. Susceptibility is high
epithelial cells of skin

lymphatic vessels
and accumulation in

Pathogenesis
Inoculation into
primary replication
Chicken pox

inoculation

virusemia
 Concentration in

spinal cord and

beck radices of
латентна інфекція

ganglions Herpes zoster

Activation of
infection
Clinical classification CHICKEN POX

HERPES ZOSTER

Gangliodermal form
Ophthalmic form
Hant syndrome

Gangrenous (necrotic) form

Meningoencephalitic form

Clinic CHICKEN POX

Prodrome period Convalescence

Incubation period Period of rash
period

Moderate rash (on head,

weakness, loss of shoulders, breast,
appetite, subfebril abdomen, legs):
temperature hyperemia of
skin→papula→
vesicle→crust

enanthema (on
mucosal layer of
cheek, tongue):
little
vesicles→erosions
(sometimes-
aphthosis coated
with gray fur)

Severe forms
(bullas, pustulas,
hemorrhages)
t=38,5-39,5ºС,
chill, weakness,
headache, mialgias
 HERPES ZOSTER

Ganglia -skinal form→rash – by projection of nerves: hyperemia

of skin→papula→vesicle→crust

Ocular form: very sever course, affection of n. trigemini; rash by

projection of branches n. trigemini (on mucosa of eye, nose, on
skin of face); specific viral keratitis, iritis, glaucoma

Hant syndrome (ears affection): affection of ganglion; rash – on

auricle, paralysis of n. facialis is possible

Mortify (necrotic) form: deep affection of skin with formation of

ckars

Meningoencephalitic form (rare): severe course, mortality more

than 60%; ganglio-skinal affection→meningoencephalitis
(ataxia, hallucinations, hemiplegia, meningeal signs)

Complications postherpetic neuralgia Pneumonia Hepatitis

Segmental myelitis Ulcers of cornea Myocarditis

Differential Herpetic infection

erysipelas eczema piodermia
diagnosis

impetigo Allergic Contact Secondary

dermatitis dermatitis syphilis

Laboratory Detection of virus: genome PCR and molecular hybridization

diagnostics and antigens in content of
vesicles, smears from
mucosal layers, cerebro- Reaction of immune fluorescence, electronic
spinal fluid, etc. microscopy
IEA: detection of ІgM (acute process) and IgG

Antiviral drugs: acyclovir, valacyclovir,

treatment Specific therapy
famcyclovir, gancyclovir

Specific immunoglobulin

Interferon: laferon, viaferon, roferon, intron-A

Inductors of interferon: amixin, neovir, inozit,

cycloferin
 Supportive treatment desintoxicattion

antibiotics

Local treatment

Immunoglobulin for persons

prophylactics
with immunodeficiency

Indications for hospitalization

-epidemiological – living in organized collectives (hostels, caserns);

- clinical – gravity of disease (complications)

Additionally to structure and logical scheme in chapter 5 “Content of theme” can be used
tables of differential diagnostics, thesis (depending of theme difficulty, its novelty, presence of
lecture material, etc.), normative documents of MHP regulating plans of diagnostics,
prophylactics, treatment of infectious diseases, included in theme of lesson.
 6.Plan and structure of a lesson:

Main stages of lesson, its Educational Methods of Materials of Time

functions and content. aims in the control of study methodical (min.)
levels of lesson providing of
control(instructions)
1. Preparatory stage: See ch. 1 ”Actuality
1. Organization of lesson of theme”; 15 min.
2. Standing of See. ch. 2 ”Tasks of
educational tasks and studies”
motivation II Discussion.
3. Control of initial level Individual Questions for
of knowledge questioning. Test individual
control. questioning.
Content - See ch. 2.1; ch. Tests of 2nd level.
2.2 ”Educational tasks”

2. Basic stage of Forming Practical Examination of

of the system of III professional patients. 60 min.
professional abilities and training in the Case histories.
skills. decision of the Extracts from case
Content - See ch. 2.2; ch. varied (typical histories.
2.3 ”Educational aims” and atypical) Archival case
clinical tasks histories
Situation tasks of 2,
3rd level.

3. Final stage Individual 3rd level tests

1. Control and correction III control of Situation tasks of 3rd 15 min.
of level of practical skills level.
professional skills and and professional
abilities actions. Analysis
2. Working out the totals of typical
of lesson mistakes.
3. Homework with Test control.
number of thematic
literature (main and
additional)
 7. Materials of methodical supplying of a lesson

7.1 Materials for control of preparatory stage of lesson

7.1.1 Control questions for individual questioning α=2

1. To what group by transmission belong herpetic infection, chicken pox and herpes zoster?
2. Routs of transmission of herpetic infection, chicken pox and herpes zoster.
3. Stages of pathogenesis of herpetic infection, chicken pox and herpes zoster.
4. Clinical classification of herpetic infection, chicken pox and herpes zoster.
5. Main symptoms of herpetic infection, chicken pox and herpes zoster depending from form.
6. Peculiarities of herpetic infection course in patients with AIDS.
7. Complications of herpetic infection, chicken pox and herpes zoster.
8. Main reasons of mortality after herpetic infection, chicken pox and herpes zoster.
9. Plan of diagnostics of herpetic infection, chicken pox and herpes zoster.
10. Spinal liquor count in case of affection of nervous system, caused by herpetic infection.
11. Methods of specific diagnostics of herpetic infection, chicken pox and herpes zoster.
12. Specific therapy of herpetic infection, chicken pox and herpes zoster: dosage, prescription,
duration of treatment.
13. Principles of supportive treatment of herpetic infection, chicken pox and herpes zoster.
14. Rules of discharge a patients after herpetic infection from hospital.

7.1.2. The tests of the 2nd level: choose the right answer α=2

Variant 1

1. The viruses of the Herpes simplex type 1 and 2 are related to the subfamily of:
A. Alphaherpesviruses;
B. Betaherpesviruses;
C. Gammaherpesviruses;
D. 1st and 2nd types are related to the different subfamilies.

2. The chicken pox infection agent is:

A. Cytomegalovirus;
B. Epstein Barr Virus;
C. Herpes Virus type 1;
D. Herpes Virus type 2;
E. Herpes zoster.

3. Specific methods of the herpetic infections diagnosis:

A. Widal´s test in the blood serum;
B. Immunoenzyme analysis;
C. Hemoculture;
D. Fluorescing antibodies reaction;
E. Culturing of faeces and urine.

4. The source of infection diseases, caused by herpes zoster are:

A. Patient with infection mononucleosis;
B. Patient with herpes virus type 6;
C. Patient with сchicken pox;
D. Patient with Herpes zoster infection;
E. Patient with Herpes virus type 8 infection.

5. Herpes Virus type 1 affects:

A. Face;
B. Skin above the waist;
C. Mucous coat of oral cavity and lips;
D. Genitales;
E. Skin below the waist.

6. What is typical for clinical picture of chicken pox in adults:

A. Rash is symmetrical;
B. Polymorphism of rash;
C. Absence of phase character of rash;
D. Elements of rash on top of head;
E. Elements of rash mainly on plants and foots.

7. Eruption by the chicken pox includes such elements as:

A. Vesicles;
B. Roseolas;
C. Papule;
D. Pustule;
E. Crust.

8. What drug is used for the treatment of the genital herpes:

A. Amoxyclan;
B. Famciclovir;
C. Phenosal;
D. Aciclovir;
E. Valciclovir.

9. Unfavourable prognosis observed in case of chicken pox:

A. Conjunctivitis;
B. Malignant form of the chicken pox;
C. Keratitis;
D. Severe form of encephalitis;
E. Vestigial (rudimentary) process of the disease.

10. The rules of the discharge of patient after the chicken pox from the hospital:
A. After 3 times negative result of the culturing of faeces;
B. After the negative result of the Widal´s reaction;
C. After clinical recovery;
D. Not earlier than 21 days after the temperature normal;
E. After the negative result of the hemoculture.

Etalons of the right answers:

1. A 6. B, C, D
2. E 7. A, C, D, E
3. B, D 8. B, D, E
4. C, D 9. B, D
5. A, B, C
10. C
 Variant 2

1. Chicken pox infection agent is:

A. Herpes Virus type 1;
B. Herpes zoster;
C. Herpes Virus type 2;
D. Cytomegalovirus;
E. Epstein Barr Virus.

2. What is related to the group of human infection:

A. Chicken pox;
B. Lime´s disease;
C. Ornithosis;
D. Campilobacteriosis;
E. Yellow fever.

3. Incubation period of chicken pox is:

A. 1-3 days;
B. 3-7 days;
C. 5-21 days;
D. 21-25 days;
E. Over 25 days.

4. From the beginning the virus of the Herpes Simplex replicates in:
A. Spinal nerve ganglions;
B. The roots of the sensitive nerves;
C. The horns of the spinal cord;
D. Epitheliocytes;
E. Red blood cells.

5. Typical clinical aspects of chicken pox:

A. Little eruption is not observed;
B. Fever continues 2-7 days;
C. Lymphatic nodes enlarged;
D. Eruption on the skin comes with intensive itch;
E. Eruption comes first on the skin trunk, limbs then on the face, hair covered part of the head.

6. For a complete blood count by the Herpes zoster disease is observed the following:
A. Leucocytosis, increasing of the ESR;
B. Leucopenia, increasing of the eosinophiles;
C. The blood rate is normal;
D. Lymphocytosis, increased amount of atypical mononuclears;
E. Leucopenia, lymphomonocytosis, ESR is normal.
7. What is typical for the eruption in case of Herpes zoster:
A. Haemorrhagic elements star-like shape;
B. Eruption is situated on the skin in the way of groups along nerve trunk;
C. Maculo-papulous rash;
D. Roseola on pale skin;
E. Plentiful little spotted rash on hyperaemic basis.

8. In case of often relapsing herpetic infection the patient needs to be examined on:
A. Enteroviral diseases;
B. Influenza;
C. AIDS;
D. Meningococcal infection;
E. Measles, rubella.

9. In case of meningeal syndrome in patient with of Herpes zoster infection a spinal fluid is
usually:
A. Normal;
B. Lymophocytal;
C. Purulent;
D. With a moderate increasing of protein content;
E. With a moderate reducing of protein content.

10. Human Immunoglobulin against the Herpes Virus type 1 is injected:

A. Single dose 4,5 ml IM;
B. 3 times in 24 hours 8 ml IM;
C. 5 times in 24 hours 8 ml IM;
D. 5 times with 48 hours intervals 4,5 ml IM;
E. 3 times with 48 hours intervals 4,5 ml IM.

Etalons of the right answers:

1. B 6. E
2. A 7. B
3. C 8. C
4. D 9. B, D
5. B, C, D, E 10. D
 Variant 3

1. The source of herpetic infections caused by the Herpes Simplex Virus is:
A. Home birds;
B. Different diseases´ forms patients;
C. Gnawers;
D. Wild mammals;
E. Virus carriers.

2. The material for laboratory diagnostics of diseases caused by Varicella zoster virus:
A. Bone of lymphatic nodes;
B. Blood;
C. Spinal fluid;
D. Eruption elements;
E. Nasopharynx discharge.

3. When does the eruption by Herpes zoster comes:

A. On the 1st – 2nd day;
B. On the 3rd-5th day;
C. On the 8th – 10th day;
D. On the 12th – 17th day;
E. On the 17th-20th day.

4. Eruption in case of Herpes zoster the is more often localized on:

A. The skin of the head and the face;
B. The skin of the upper limbs;
C. The skin of the loin and the sacrum;
D. The skin of the lower limbs.

5. The most severe clinical process is observed in:

A. Herpes Simplex;
B. Relapsing Herpes;
C. Herpes of the genitals;
D. Herpetic meningoencephalitis;
E. Congenital mucous-skin form.

6. Herpes viruses are being activated on the basis of the diseases, which in their turn are
followed by:
A. High temperature rise;
B. Jaundice;
C. Increasing of the internal organs;
D. Oropharynx changes;
E. Immune deficiency.
 7. Pneumonia caused by Herpes zoster is characterized by:
A. Productive cough with admixture of blood;
B. Cough with poor slimy phlegm;
C. Absence of cough;
D. Rough barking cough;
E. Non-productive cough with asthmatic component.

8. In case of chicken pox the smears, taken from the vesicles content is being worked with a
special serum, marked by isotiocinatus in the reaction:
A. Compliment fixation test;
B. Indirect hemagglutination reaction;
C. Fluorescing antibodies reaction;
D. Radioimmune analysis;
E. Immunoenzyme analysis.

9. The children less than 7 years old, who contacted the chicken pox infected patients and the
children who have never been infected before have been separated from each other on:
A. 3 days;
B. 5 days;
C. 7 days;
D. 15 days;
E. 21 days.

10. Which medicines of the specific therapy are used for chicken pox treatment:
A. Jatren;
B. Aciclovir;
C. Ementine hydrochlorid;
D. Alpisarinum;
E. Metronidazolum.

Etalons of the right answers:

1. B, E 6. E
2. B, C, D, E 7. E
3. B 8. C
4. C 9. E
5. D 10. B, D

7.2 The materials of the methodical basis of the main lesson level**

7.2.1 The professional algorithm of the practical skills formation and the diagnostic skills of herpetic
infection
№ Task Performance sequence Remarks, warnings as for the self-
control
1. To study the I. To find out a To select the complaints, which
methods patient’s complaints characterize the syndromes
of clinical - general intoxication
examination II. To collect an anamnesis organs affections
of the patients 1.Anamnesis morbi To pay attention to the beginning (acute or
with gradual etc.);
herpetic To draw attention to the possible
infection, polymorphism manifestations – Herpes
chicken pox Simplex in its process can be acute and
and herpes relapsing, on prevalence local and general.
zoster To pay attention on term, time of
appearing, dynamic:
- eruption
- fever
- pain syndrome
- increasing of the lymphatic nodes
- other symptoms
2. Anamnesis vitae To find out the previous diseases
(especially followed
by immune deficiency). To ask about
pregnancy (in case of a positive answer, to
find out which term.)

3.Epidanamnesis To find out the data as for the fact of

contact, genital, airborne, percutaneous,
placental mechanism of transmission, to
pay attention to the contacts to a chicken
pox and zoster patient.
To remember: presence, expression,
symptoms´ dynamic are conditioned by a
term and an intensivity of the process of
the disease, its form and depend on the age
of the patient and concomitant pathology.
2. To perform III. To perform an objective To pay attention to:
examination of examination - temperature
a patient 1. General examination - pain syndrome
- common condition of - eruption (taking into account the
the patient; hair covered part of the head,
- skin and mucous coats conjunctivitis, mucous coats of the
- lymphatic nodes oral cavity) their localization (along
the nerve trunks etc.), eruption
2. Digestive system character and the terms of its
- tongue examination; appearance
- abdomen percussion; - itch
- abdomen palpation; - their possible increasing
 - stool characterization. To pay attention to:
- eruption ( by the lesion of upper
3. Cardiovascular system: branch of n. trigeminus herpes
- Pulse; zoster)
- arterial tension; - hepatolienal syndrome (by the
- heart auscultation; general forms)
To pay attention to:
4. Respiratory system - pulse matches the temperature
- lungs auscultation - there is a tendention to hypotension
- does not exclude the development
5. Nervous system miocarditis and endocarditis
6. Vision
To pay attention to:
7. Genitourinary - the symptoms of the pneumonia
apparatus among the part of the patients,
especially by adults (dry and moist
rales etc.)

To pay attention to:

- encephalitis, meningitis, myelitis,
ganglialitis, neuritis. neuralgia,
arachnoiditis development
possibilities
To pay attention to:

- eruption on the genitals

- frequent, painful emiction.
3. To prescribe 1. Complete blood count To pay attention to: leucopoenia,
laboratory lymphocytosis, normal ESR
additional 2. Complete urine count Absence of the considerable changes by
researches, the typical process
interpret the 3. Cerebrospinal fluid (in The picture looks like miliar tuberculosis
results. case of meningitis or Detecting antigen of Varicella zoster virus
local neurological
symptomes) Taken twice: in the acute period of the
disease and in the recovery period (in 7-10
4. Microscopy of the days), the reaction is considered to be a
smear from the positive one by the increasing of the titre of
eruption elements the antibodies not less than in 4 times
more (by chicken pox)
5. PCR for the detection of the Herpes Siplex
6. Fluorescing antibodies Virus´s DNA
reaction
7. Serum tests: Is usually lymphocytal, with a normal or
complement fixation increased protein content and the
test, indirect lymphocytes quantity, reducing Na and
hemoagglutination glucose quantity
reaction, radioimmune Found the polynuclear cells with
analysis. eosinophils inclusions in the nucleus,
 Immunoenzyme assay characted for the infection Varicella zoster
virus
Detection of the antibodies of Ig M class to
8. X-ray of the chest the antigens of Herpes Simplex type 1 and
2 for acute infection, Ig G - for chronic
relapsing process
for the detection of the antigens of the
Herpes Simplex Virus in vesicles content
9. Ultrasound scan of Enlargement of lever in case of hepatitis
abdominal cavity

** Additionally in the part 7.2 may be used according to the cathedral choice the diagnostic
algorithms, the instructions and the orders of the Ministry of Health towards to prophylactic
measures, the examinations and help to the patients with the infected diseases, which were included
into the lesson topic.
7.2.2. Situational tasks of second standard of learning: =2

Task 1
50-years-old patient, who had paroxysmal pain in the left half of the chest, general asthenia, fever,
headache two days ago, observed appearance of skin rush on his chest. Objectively: multiple integrated
vesicles with edematous top, filled up with transparent liquid of 3-5 mm in diameter – on the left sight of
the body on erythemo-edematous background along IV and V intercostal spaces.
1.Formulate previous diagnosis.
2.Plan of examination.
3.Plan of treatment.

Task 2

23-years-old patient was hospitalized on the 5th day of his disease, which has begun with
forerunners in the form of quick tiredness, headache, skin itching. Blood heat - 38°С. There were
papules on the chest skin which are quickly reformed into vesicles. Objectively: medium-weight state.
There are vesicles with serous contents on the chest skin and lateral surface of body on the left sight.
Here and there are observed some pustules. Appearance of skin rush attend with strong pain along
intercostals nerves which is keeping during examination.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 3

To 28-years-old woman disease began acutely from blood heat increased until 39°С, headache,
asthenia, pain of head skin that it was impossible to touch head. She took Coldrex and different
polyvitamines independently. On the fibrous part of the head, on the face and body she observed
eruption in the form of blotches on infiltration skin which are quickly reformed into vesicles. To the
second day of disease number of vesicles has increased.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 4

18-years-old patient hospitalized in severe condition. From the mother`s words he is ill during 1st
day. Disease began from chill, headache, blood heat increased until 39,9°С, emesis. OE: coma 1 stage,
excitement, muscular rigidity of neck muscles, Kernig`s symptom +++, pale hot skin, arterial pressure –
70/0, pulse – 140 beating. There is abundant herpetic eruption on the mucosal layer of lips.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 5

70-years-old patient that taken Prednizolon in daily dose 60 mg on the occasion of system disease
of connective tissue, hospitalized with complaints of strong pain, burning pain in projection of optic
branch n.trigiminalis. On the skin of right-hand temporal region and on the scalp visualized reddening,
small serous vesicles, erosions and incrustations.
1. Formulate previous diagnosis.
 2. Plan of examination
3. Plan of treatment.

Task 6
Patient turned to the doctor with complaints of painful sensation and eruption on his penis, which
appeared after he had flu. OE: on the balanus observed integrated vesicles and erosions with scalloped
edges, with distinct limit, soft by palpation, which are accompanied with painfulness.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 7
Patient turned to dermatologist with complaints of onset of eruption in the corner of his mouth
which is accompanied with itching and pricking. OE: there are integrated small vesicles filled up
with transparent serous liquid and small erosions in the right mouth corner on the erythematic
background.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 8

23-years-old patient turned to doctor on the occasion of vesicle`s onset in the mouth corner. He
has been ailing over a period of 3 years. The disease recurs 2-3 times a year, as a rule, after supercooling.
OE: in the right mouth corner there are integrated vesicles in a size of 2-3 mm, skin near the vesicles is
ruddy and inflamed.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 9

Acutely to the patient appeared rigor, headache, vomiting, blood heat increased until 38,5°С.
Muscular rigidity of neck, Kernig`s symptom joined in the evening. There are abundant herpetic vesicles
on the mucous tunic of lips and nose.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.

Task 10

23-years-old patient which took hormones for a long time hospitalized with temperature 39°С,
abundant eruption on the skin, mucous tunics (vesicles with hemorrhagic contents) and with
lymphadenopathy of submaxillary and cervical lymph nodes. In the hospital observed nausea, single-
phase vomiting, epistaxis.
1. Formulate previous diagnosis.
2. Plan of examination
3. Plan of treatment.
 7.3. Materials of methodic supplying of final stage of lesson
7.3.1. Tests of 3 rd
=3

Drugs, which are used in treatment of infections, caused by -herpesviruses

1st - 3rd types (acute period)

Drugs - herpesviruses 1st - 3rd types

Cyphran -
Acyklovir +
Streptomycin -
Lapheron +
Prednisolone -
Amyxine +
Nonsteroid antiphlogistic -
Cyclopherone`s liniment (locally) +
Specific immunoglobulin therapy (IM, IV) +
Ampycillin -

Laboratory control of efficiency of treatment of infection, caused by virus of simple herpes of 1st
type (VSH-1)

Methods VSH-1
DNA-diagnostics +
Biopsy -
Immunefluorescence diagnostics of antigens +
Duodenal intubation -
Detection of IgM`s antybody +
Control of lipidgram -
Control of immunogram +

Dynamics of clinic symptoms by varicella`s presence *

Term
№ з/п Signs
А B C
Average duration of latent
1. 1-2 days 1-2 weeks 2-3 weeks
period
The day of fever onset from
2. 1-2 3-4 5-6
the beginning of disease
3. Duration of fever (days) 2-7 7-14 14-28
Duration of adding eruption
4. 1-2 3-4 4-6
elements (days)
Polymorphous eruption
5. 1-2 3-4 5-6
(since what day)

1B 2А 3А 4C 5B
 Literature by theme:
1. Mandell, Douglas, Bennet Principles and Practise of Infectious Disiases (Fifth edition). – USA:
Churchill Livingstone, 2000 – V.1. – 1534 p.
2. Educational-methodical literature, recommended during learning
3. the subjects “Infectious Diseases” and “Actual problems of HIV infection”
4.
5. Nikitin E. Infectious diseases / E. Nikitin, M. Andreychyn, E. Servetskyy at all //Ternopil.-
Ukrmedkniga.-2004. -368p.
6. Manson's Tropical Diseases /Jeremy Farrar,Peter J Hotez,Thomas Junghanss,Gagandeep
Kang,David Lalloo,Nicholas J. White. - E-Book. - 2014
7. Bennett John E. Principles and practice of infectious diseases. JE Bennett, R Dolin, MJ Blaser -
2014
8. Harrison's Principles of Internal Medicine, 19th Edition Textbook
9. Panel on Antiretroviral Guidelines for Adults and Adolescents
10. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents ,
201.Department of Health and Human Services Available at:
http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
11. Editorial Commentary: HIV Infection: Still a Disease for Experts/JE Gallant - 2015
12. Park. Textbook of Preventive and Social Medicine 23rd edition (Hardcover – 2015)
13. http://scholar.google.com
14. http://www.medscape.com
15. https://www.ncbi.nlm.nih.gov/pubmed/
16. http://www.intmed.mcw.edu/drug/InfectionRx.html
17. http://journals.elsevierhealth.com/periodicals/ymic
18. http://www.aids.org
19. http://www.who.int
20. http://www.pslgroup.com