A 23-year-old woman diagnosed with a viral infection participates in a longitudinal research study. The patient experiences symptoms of similar spectrum over a specific time, as shown in the image. Which of the following mechanisms is most likely responsible for the pattern of illness seen in this patient?

Question

A 23-year-old woman diagnosed with a viral infection participates in a longitudinal research study.  The patient experiences symptoms of similar spectrum over a specific time, as shown in the image.  Which of the following mechanisms is most likely responsible for the pattern of illness seen in this patient?

Quizplus · Accepted Answer

11ec160b_3837_6b20_9249_e78494f0241a_MD0001_00 Patients with herpes simplex virus (HSV) usually have symptoms that flare and remit in a cyclical fashion. Initial HSV infections are marked by viral replication at the site of exposure (eg, perioral or genital skin), which leads to vesicular mucocutaneous lesions and flulike symptoms. Manifestations last a week or two and then resolve spontaneously when viral replication ceases. However, the virus also spreads to dermal nerve terminals and is transported in a retrograde fashion to the sensory ganglia, where it establishes a lifelong latent infection within the neuronal cell bodies. During latent infection, no viral replication occurs, so the disease is asymptomatic. However, infected cells continue to produce some HSV genes (eg, latency-associated transcript gene), and stress and other triggers can reactivate viral replication and lead to the re-emergence of symptoms (eg, vesicular lesions on the oral/genital mucous membranes, low-grade fever, malaise). Recurrent symptoms last a week or two and then resolve; they are often less severe than the initial episode. (Choice A) Infection with hepatitis B or C virus usually results in chronic hepatocyte infection and persistent viral replication. Patients are usually asymptomatic for years or decades and then eventually develop cirrhosis and related complications (eg, jaundice, ascites, encephalopathy). Latent infections do not occur. (Choice C) Epstein-Barr virus has a tropism for B-lymphocytes. Initial infection is associated with infectious mononucleosis (eg, sore throat, lymphadenopathy, malaise, atypical lymphocytosis); latent infection is usually asymptomatic, but there is a small risk of B-cell or Hodgkin lymphoma due to malignant transformation. Both Epstein-Barr virus and herpes simplex virus are members of the Herpesviridae family. (Choice D) Hepatitis D virus is a small RNA molecule that requires coinfection with hepatitis B virus to have complete viral assembly. Superinfection by hepatitis D virus in patients with hepatitis B virus can lead to acute hepatic failure. (Choice E) Influenza has a segmented genome, which leads to high rates of gene reassortment when 2 strains infect the same cell. Gene reassortment of surface glycoproteins (eg, hemagglutinin, neuraminidase) causes new strains to emerge and can result in new infections in those with a history of previous influenza infection; because surface proteins have changed, previous immunity is insufficient. Educational objective: Patients infected with herpes simplex virus develop a lifelong latent infection of the sensory ganglion. Periodic viral replication can lead to symptoms that flare and resolve over time.

A 23-Year-Old Woman Diagnosed with a Viral Infection Participates in a Longitudinal