HERPES SIMPLEX
INTRODUCTION:
There are 8 herpes viruses infecting humans. These are double-stranded DNA.
PATHOGENESIS:
l. Caused by two types of herpes simplex virus, HSV-l and HSV-2.
2. HSV-l causes cutaneous, oropharyngeal and ocular lesion, whereas HSV-2 causes genital herpes.
3. Primary infection is commonly asymptomatic, occurring in childhood via mucosal surfaces or abraded skin.
4. The virus remains dormant in sensory and autonomic ganglia.
5. Reactivation may be triggered by stress, trauma, menstruation and fever.
DIAGNOSIS:
l. Characteristic feature is multiple vesicles over an erythematous base.
2. Lab confirmation by Tzanck test, tissue culture, serology, or PCR for HSV DNA in CSF.
CLINICAL FEATURES:
l. Orofacial and eye infections: Ulcerative gingivostomatitis, pharyngitis, herpes labialis, keratoconjunctivitis.
2. Genital infections: Vulvovaginitis, urethritis, proctitis
3. Nervous system: Encephalitis, Guillian-Barre, transverse myelitis.
4. Visceral infection: Oesophagitis, pneumonitis, hepatitis.
TREATMENT:
l. Mucocutaneous infections: Acyclovir, famcyclovir and valacyclovir.
2. Eye infection: Idoxuridine, vidarabine, cidofovir.
3. HSV encephalitis: Intravenous acyclovir (10 mg/kg 8th hrly for 10 days).
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