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Herpes

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

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Herpes

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  1. Herpes Dr. Meg-angela Christi Amores

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

  3. 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

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

  5. 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 oral-facial infections

  6. 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

  7. 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).

  8. 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 • HSV2 recurs more

  9. 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

  10. 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 axillarylymphadenopathy

  11. 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

  12. 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

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

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

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

  16. 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

  17. 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

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