Herpes Dr Megangela Christi Amores Herpes Simplex Etiologic

Herpes Simplex • Etiologic agent: – Herpes Simplex Virus (HSV) • DNA virus •

Herpes Simplex • Pathogenesis – Exposure to HSV at mucosal surfaces or abraded skin

Herpes Simplex • Immunity – antibody-mediated and cell-mediated – Immunocompromised patients with defects in

Clinical Spectrum • clinical manifestations and course of HSV infection depend on the anatomic

Oral-facial Infection • Gingivostomatitis and pharyngitis – most common clinical manifestations of first-episode HSV-1

Oral-Facial Infection • recurrent herpes labialis – most common clinical manifestation of reactivation HSV-1

Genital Infection • First episode: – fever, headache, malaise, and myalgias – Pain, itching,

Genital Infection • Both HSV-1 and HSV-2 can cause symptomatic or asymptomatic rectal and

Other areas • Herpetic whitlow—HSV infection of the finger – may occur as a

Other areas • Herpes gladiatorum – Common among wrestlers – HSV infections of the

Other areas • Eye Infection – most common cause of corneal blindness in the

• Central and Peripheral Nervous System infections – accounts for 10– 20% of

Management • Diagnosis – clinical and laboratory – characteristic multiple vesicular lesions on an

Management • Treatment – mucocutaneous infections: Acyclovir – topical use in HSV eye infections:

Management • Acyclovir is the agent most frequently used for the treatment of HSV

Management • Prevention – Barrier forms of contraception (especially condoms) decrease the likelihood of

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Herpes Dr. Meg-angela Christi Amores

Herpes Simplex • Etiologic agent: – Herpes Simplex Virus (HSV) • DNA virus • HSV 1 and HSV 2

Herpes Simplex • Pathogenesis – Exposure to HSV at mucosal surfaces or abraded skin – Entry of virus and replication in epid and dermis – sensory or autonomic nerve endings – On entry into the neuronal cell, the virus— or, more likely, the nucleocapsid—is transported intra-axonally to the nerve cell bodies in ganglia – Contiguous spread of locally inoculated virus

Herpes Simplex • Immunity – antibody-mediated and cell-mediated – Immunocompromised patients with defects in cell -mediated immunity experience more severe and more extensive HSV infections

Clinical Spectrum • clinical manifestations and course of HSV infection depend on the anatomic site involved, the age and immune status of the host, and the antigenic type of the virus • incubation period ranges from 1 to 26 days (median, 6– 8 days) • Both viral subtypes can cause genital and oralfacial infections

Oral-facial Infection • Gingivostomatitis and pharyngitis – most common clinical manifestations of first-episode HSV-1 infection – among children and young adults – fever, malaise, myalgias, inability to eat, irritability, and cervical adenopathy, may last 3– 14 days – Lesions may involve the hard and soft palate, gingiva, tongue, lip, and facial area

Oral-Facial Infection • recurrent herpes labialis – most common clinical manifestation of reactivation HSV-1 infection • HSV-1 and varicella-zoster virus (VZV) have been implicated in the etiology of Bell's palsy (flaccid paralysis of the mandibular portion of the facial nerve).

Genital Infection • First episode: – fever, headache, malaise, and myalgias – Pain, itching, dysuria, vaginal and urethral discharge, and tender inguinal lymphadenopathy – Widely spaced bilateral lesions of the external genitalia – Lesions varied: vesicles, pustules, or painful erythematous ulcers – HSV 2 recurs more

Genital Infection • Both HSV-1 and HSV-2 can cause symptomatic or asymptomatic rectal and perianal infections. • subclinical perianal shedding of HSV is detected in women and men who report no rectal intercourse • anorectal pain, anorectal discharge, tenesmus, and constipation

Other areas • Herpetic whitlow—HSV infection of the finger – may occur as a complication of primary oral or genital herpes by inoculation of virus or – direct introduction of virus into the hand through occupational or some other type of exposure – abrupt-onset edema, erythema, and localized tenderness of the infected finger – Vesicular or pustular lesions of the fingertip – Fever, lymphadenitis, and epitrochlear and axillary lymphadenopathy

Other areas • Herpes gladiatorum – Common among wrestlers – HSV infections of the thorax, ears, face, and hands – facilitated by trauma to the skin sustained during wrestling

Other areas • Eye Infection – most common cause of corneal blindness in the United States – acute onset of pain, blurred vision, chemosis, conjunctivitis, and characteristic dendritic lesions of the cornea

• Central and Peripheral Nervous System infections – accounts for 10– 20% of all cases of sporadic viral encephalitis

Management • Diagnosis – clinical and laboratory – characteristic multiple vesicular lesions on an erythematous base – detection of virus, viral antigen, or viral DNA – PCR

Management • Treatment – mucocutaneous infections: Acyclovir – topical use in HSV eye infections: idoxuridine, trifluorothymidine, topical vidarabine, and cidofovir – encephalitis and neonatal herpes, IV acyclovir

Management • Acyclovir is the agent most frequently used for the treatment of HSV infections and is available in IV, oral, and topical formulations. • acyclovir, valacyclovir, and famciclovir – effective in shortening the duration of symptoms and lesions of mucocutaneous HSV infections

Management • Prevention – Barrier forms of contraception (especially condoms) decrease the likelihood of transmission of HSV infection – When lesions are present, HSV infection may be transmitted by skin-to-skin contact despite the use of a condom