HERPES SIMPLEX VIRUS

(HSV)

 HERPES SIMPLEX VIRUS

contain a double-stranded DNA genome of approximately 152 kb that encodes at least 84 proteins The incubation period is 212 days (average, 6 days).
Most HSV infections are self-limiting, last from a few days (for recurrent infections) to 23 wk (for primary infections), and heal without scarring.

TWO STRAINS

HSV-1 commonly infects skin and mucous membranes above the waist
HSV-2 commonly infects the genitals and the neonate.

The spread of infection appears to be determined by two factors: close body contact trauma such as teething or a break in the skin.

THREE TYPES OF INFECTION

Primary infection

- represents infection in HSVseronegative persons.

is infection in a person with immunity to one type of HSV , but infection by a second type.

First infection, nonprimary -

Recurrent infection represents reactivation of a

latent infection in an immune host with circulating antibodies.

PATHOGENESIS
a specific lesion is characterized by the presence of intranuclear inclusion bodies, which are

homogeneous masses lying in the

middle of a severely disorganized nucleus in which the basic chromatin has marginated to the nuclear

membrane.

CLINICAL MANIFESTATION

SKIN AND MUCOUS MEMBRANES

The hallmarks of common HSV

infections are skin thin walled vesicles and shallow ulcers. Classical infections present

with small, 24 mm vesicles that may be

surrounded by an erythematous base.

HERPETIC WHITLOW
is most commonly seen in infants and toddlers who suck their thumb or fingers and who are experiencing either a symptomatic or a subclinical oral HSV-1 infection.

HERPES GLADIATORUM
lesions that begin as erythematous grouped, papules

that progress to vesicles,

pustules, ulcers, and

crusts and then healing

without scarring in 610

days

ECZEMA HERPETICUM (KAPOSI VARICELLIFORM ERUPTION).

the most serious manifestation of traumatic

herpes, results from a widespread infection of the eczematous skin with HSV.

vesicles develop abruptly in large numbers over the area of eczematous skin.

HERPES LABIALIS

most common manifestation of recurrent HSV-1 infections

lesion

generally

begins

as

small

grouping of erythematous papules that

over a few hours progress to create a small, thin-walled vesicle.

ACUTE HERPETIC GINGIVOSTOMATITIS

most often affects children 6 mo to 5 yr of

age

extremely painful condition with sudden onset, pain in the mouth, drooling, refusal to eat or drink, and fever of up to 40.0

40.6C.

GENITAL HERPES

Infection may result from genitalgenital transmission (usually HSV-2) or oral-genital transmission (usually HSV-1).

OCULAR INFECTION

Conjunctivitis

or

keratoconjunctivitis

is

usually unilateral and often associated with blepharitis and tender preauricular

lymphadenopathy.

Vesicular lesions may be seen on the lid margins and periorbital skin.

PERINATAL INFECTION

Infants infected during delivery or postpartum present with 1 of 3 patterns of disease:

disease localized to the skin, eyes, or mouth (at 511 days of life)

1.

2.

encephalitis with or without skin, eye, or mouth (SEM)

disease (at 817 days of life)

3.

disseminated infection involving multiple organs, including the brain, lungs, liver, heart, adrenals, and skin. (at 511 days of life)

The hallmark of neonatal HSV infectionthe vesicular, ulcerative skin lesions

DIAGNOSIS

The diagnosis is based on any two of the following:

1. a compatible clinical pattern 2. isolation of the virus

development of specific antibodies 4. demonstration of characteristic cells, histologic changes, viral antigen, or HSV DNA in scrapings, CSF, or biopsy material.
3.

TREATMENT
o o o

Three antiviral drugs: Acyclovir valacyclovir famciclovir

PREVENTION

Patients

and

parents

should

be

advised about good hygienic practices, including handwashing and avoiding contact with lesions and secretions during active herpes outbreaks.

PREVENTION
For pregnant women with active genital herpes at the time of delivery, the risk for mother-to-baby transmission can be reduced

but not eliminated by delivering the baby via

a cesarean section (within 46 hr of rupture of membranes).

EPIDEMIOLOGY
O The only natural host is humans,
O the mode of transmission is direct

contact between mucocutaneous surfaces. O There are no documented incidental transmissions from inanimate objects such as toilet seats.