CLINICAL SIGNIFICANCE OF VIRAL LATENCY.* PHILIP M. SPRINKLE, M.D., ROBERT W. VELTRI, Ph.D.,
and JOHN WADE, M.D.,
Morgantown, W. Va. ABSTRACT.
Evidence is accumulating to show that a number of viruses have the ability to adapt to man's defense mechanisms and survive in a latent state for what appears to be the life of the human host. Unfortunately, latent viral presence, which may appear clinically benign initially, may manifest itself later as severe and often fatal disease. Some members of the herpes virus family have latent potential and are discussed in detail. Clinical competence would suggest a thorough understanding of these late manifestations of occult viral presence.
o INTRODUCTION.
Today and certainly tomorrow, competent diagnosis and therapy of infectious disease will depend upon: a. a thorough knowledge of normal human host defense mechanisms; b. those factors, both congenital and acquired, that compromise host defense systems; c. the infectious processes likely to result as a consequence of compromise of each specific host defense mechanism; d. a thorough clinical assessment of the immunologic competence of each host at the time of diagnosis and at the time of therapeutic intervention; and finally, e. an ongoing laboratory assessment of the host immune competence to monitor and evaluate therapeutic results. Evidence is accumulating to show that a number of viruses have the ability to adapt to man's defense mechanisms and survive in a latent state for what appears to be the life of the human host. These latent viruses may show no evidence of their occult co-habitation. Unfortunately latent viral presence, which may appear clinically benign initially, may manifest itself later as severe and often fatal disease. The purpose of this paper is to review for the practicing physician the different viruses that may exist in the human host in a latent state, and to acquaint the practicing clinician with the manifestations that can occur as a result of occult viral presence. DEFINITION.
Latent period in medicine is described in Webster's Dictionary as the time in which a disease is supposed to be existent without manifesting itself. 'Presented at the Meeting of the Southern Section of the American Laryngolog!cal, Rhinological and Otological Society, Inc., Pinehurst, N. C., January 17, 1976. Editor's Note: This Manuscript received In THE LARYNGOSCOPE Office and accepted for publication February 5, 1976. Request for Reprints should be sent to Philip M. Sprinkle, M.D., Department of Otolaryngology, West Vil'ldnia University Medical Center. Morgantown. W. Va. 2650~.
1815
1816
SPRINKLE, ET AL.: MANIFESTATION OF VIRAL LATENCY.
Chronic infection (lymphocytic
Acute infection (smallpox)
choriomeningitis in mic.) sheddino
Time (years)
~
Time (years)
Fig. 1. (Modified from Fenner, F., et al.: The Biology of Animal Viruses. Chapter 12: 453, Academic Press, New York, N. Y., and London, England, 1974.)
~
l
Fig. 5. (ll f ocl ifi ec1 f;'om F enn el', F ., ct 01 .: Th e 13 '010:;)' o f An im a l V iru ses . C h ap t er 1 2: '-153, Academ ic .P l'ess . N e w YOl'k, 1'1. Y. , :111 1..1 L oncl on, En g lAnd, 197 '1. )
Fig. 13 . (Mo ,l if ic d f r o m Fen n er , F., e t 0 1.: Th e B i o l ogy of An i ma l V i ru ses. Chaptel' 12: 4:;3. A ca c1 emi P r ess , Ne\\' Yol'l
and JOHN WADE, M.D.,
Morgantown, W. Va. ABSTRACT.
Evidence is accumulating to show that a number of viruses have the ability to adapt to man's defense mechanisms and survive in a latent state for what appears to be the life of the human host. Unfortunately, latent viral presence, which may appear clinically benign initially, may manifest itself later as severe and often fatal disease. Some members of the herpes virus family have latent potential and are discussed in detail. Clinical competence would suggest a thorough understanding of these late manifestations of occult viral presence.
o INTRODUCTION.
Today and certainly tomorrow, competent diagnosis and therapy of infectious disease will depend upon: a. a thorough knowledge of normal human host defense mechanisms; b. those factors, both congenital and acquired, that compromise host defense systems; c. the infectious processes likely to result as a consequence of compromise of each specific host defense mechanism; d. a thorough clinical assessment of the immunologic competence of each host at the time of diagnosis and at the time of therapeutic intervention; and finally, e. an ongoing laboratory assessment of the host immune competence to monitor and evaluate therapeutic results. Evidence is accumulating to show that a number of viruses have the ability to adapt to man's defense mechanisms and survive in a latent state for what appears to be the life of the human host. These latent viruses may show no evidence of their occult co-habitation. Unfortunately latent viral presence, which may appear clinically benign initially, may manifest itself later as severe and often fatal disease. The purpose of this paper is to review for the practicing physician the different viruses that may exist in the human host in a latent state, and to acquaint the practicing clinician with the manifestations that can occur as a result of occult viral presence. DEFINITION.
Latent period in medicine is described in Webster's Dictionary as the time in which a disease is supposed to be existent without manifesting itself. 'Presented at the Meeting of the Southern Section of the American Laryngolog!cal, Rhinological and Otological Society, Inc., Pinehurst, N. C., January 17, 1976. Editor's Note: This Manuscript received In THE LARYNGOSCOPE Office and accepted for publication February 5, 1976. Request for Reprints should be sent to Philip M. Sprinkle, M.D., Department of Otolaryngology, West Vil'ldnia University Medical Center. Morgantown. W. Va. 2650~.
1815
1816
SPRINKLE, ET AL.: MANIFESTATION OF VIRAL LATENCY.
Chronic infection (lymphocytic
Acute infection (smallpox)
choriomeningitis in mic.) sheddino
Time (years)
~
Time (years)
Fig. 1. (Modified from Fenner, F., et al.: The Biology of Animal Viruses. Chapter 12: 453, Academic Press, New York, N. Y., and London, England, 1974.)
~
l
Fig. 5. (ll f ocl ifi ec1 f;'om F enn el', F ., ct 01 .: Th e 13 '010:;)' o f An im a l V iru ses . C h ap t er 1 2: '-153, Academ ic .P l'ess . N e w YOl'k, 1'1. Y. , :111 1..1 L oncl on, En g lAnd, 197 '1. )
Fig. 13 . (Mo ,l if ic d f r o m Fen n er , F., e t 0 1.: Th e B i o l ogy of An i ma l V i ru ses. Chaptel' 12: 4:;3. A ca c1 emi P r ess , Ne\\' Yol'l
