Transcript Herpes Simplex virus

Herpes Simplex Virus
Karen Estrella-Ramadan
07/02/12
 Double stranded DNA virus
 Serotypes:

HSV-1: “above the waist”
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HSV-2: “ below the waist”: sexually transmitted

25%: oral lesions
 Transmission: both symptomatic and
asymptomatic (1%) and may occur with primary
(higher concentration) or recurrent infection
 Shedding: primary: 1wk (genital and gingival),
recurrent: 3 days
Neonatal
 20-40% preterm
 75% sec to HSV-2
 Primary genital infection: risk: near to 50%
 Reactivation: <5%
 However: >75% who acquire it have been
born of mothers who didn’t have symptoms
 Occurs between birth and 4wks of age
Types
1. Disseminated: CNS, liver, lungs EARLY (<1wk)
2. SEM: skin, eyes, mouth (1-2wks)
1. Trauma
3. Localized: CNS (LATE: 2-3wks)
Mucocutaneous
 HSV-1
 Incubation: 2d-2wk
 Consider child abuse if child
with HSV2
 Manifests as:
 Herpes labialis
 Gingivostomatitis
 Ezcema herpeticum
 Herpetic whitlow
 Herpes gladiatorum
 Genital herpes
Herpes labialis
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recurrrent: w/ stress, hormonal changes, immunosupression, UV light
Sec to latency in trigeminal ganglion
Prodrome: localized pain, tingling, itching, burning 6hr-48hrs
1 or group in vermillion
Gingivostomatitis
• 1st episode: 6mo-5y
• Anterior oral mucosa + fever, fussiness, droolingdecrease po,
painful submandibular or cervical adenopathy
• Last for 10-14 days, shedding up to 23 days
• Watch for dehydration, manage pain
Ezcema herpeticum
Fever + vesicles umbilicated
pustules in areas of ezcema
Herpetic whitlow
• Complication of primary oral or
genital herpes via brake in skin
in hand
• Thumb suckiing
Herpes gladiatorum
Thorax, face, ear, hands in
wrestlers
Conjuntivitis and keratitis
 Complication from autoinoculation from
oral shedding
Genital

> primary: asymptomatic, 70-80% seropositive

Lesions develop over 7-8 days, shedding: 2 days

Infections due to HSV-2 are more likely to recur than HSV-1, reactivation: less
pianful
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If HSV-1: consider autoinoculation in children but sexual abuse on
prepubertal
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Prevention; condoms
CNS manifestations
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Fever, change in mental status, seizures, focal neuro
findings
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HSV-1
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cute and fulminent if not tx
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Dx: CSF: pleocytosis, > Lymphocytes
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50% may have RBC
Meningitiss: nospecific, mild nadn self limited
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Encephalitis: Risk 0.5-5% of children
Rare, no need for antiviral tx, related fo HSV-2
3-12 days fter genital lesions
Other: Bell’s palsy, trigeminal neuralgia, atypical pain
syndrome
Diagnosis

In neonates: if suspicion tx until confirm it
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Mucocutaneous: if clinically compatible no cx
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CNS: EEG and MRI : will show abnormalities in
temporal lobe
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Edema, hemorrhage, necrosis
 Cx: first signs at 72hrs, final at 2wks
 90% skin: will be positive but almost none in
CSF
 Tzank: multinucleated giant cells and
eosinophilic inclusions: not specific for HSV
Tx
NEONATAL
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If active lesions: c/s only if ROM is less than 6hrs
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If born during active infection: controversy if tx vs.
observe
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However if rash develops or signs of sepsis get:
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Cx of lesions: nasopharynx, conjunctivae, stool, umbilicus
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Observe for dev: vesicles, jaundice, resp distress, sz
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Remember: it can happen even after 4 wks!!!
IV ACYCLOVIR + HYDRATION
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2 wks SEM, 3 wks CNS (continue until CSF PCR neg)
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For ophthalmic add: topical
Prognosis developmental delay:2% SEM, 70% on CNS
and 25% on disseminated (>than 50% die )
TX
MUCOCUTANEOUS::
 PO therapy if at onset, decrease course by 2
days
 Manage Pain + hydration
OCULAR:
 1-2% trifluridine, 1% iodoeoxyuridine, 3%
vidarabine
 No steroids
 For recurrency, may give po acyclovir
Tx
GENITAL
 PO Tx started <5days from onset: decrease
shedding by 3-5 days
 Topical: no no
 Latency: sacral ganglia
 If >6 x/yr: give po acyclovir for 1 yr
IMMUNOCOMPROMISED:
 If resistant to acyclovir, give foscarnet
References
 http://pedsinreview.aappublications.org/co
ntent/25/3/86.full.pdf
 http://emedicine.medscape.com/article/96
4866-overview