Herpes simplex
Herpes simplex: Excerpt from Handbook of Diseases
A recurrent viral infection, herpes simplex is subclinical in about 85% of cases. The others produce localized lesions and systemic reactions. After the first infection, a patient is a carrier susceptible to recurrent infections, which may be provoked by fever, menses, stress, heat, and cold. In recurrent infections, the patient usually has no constitutional signs and symptoms.
Causes
Herpes simplex is caused by Herpes-virus hominis (HVH), a widespread infectious agent. Type 1 herpes, which is transmitted by oral and respiratory secretions, affects the skin and mucous membranes and commonly produces cold sores and fever blisters.
Type 2 herpes primarily affects the genital area and is transmitted by sexual contact. Cross-infection may result from orogenital sex.
Incidence
Primary HVH is the leading cause of gingivostomatitis in children ages 1 to 3. It causes the most common nonepidemic encephalitis and is the second most common viral infection in pregnant women. It can pass to the fetus transplacentally and, in early pregnancy, may cause spontaneous abortion or premature birth.
Herpes is equally common in males and females. It occurs worldwide and is most prevalent among children in lower socioeconomic groups who live in crowded environments. Saliva, stool, urine, skin lesions, and purulent eye exudate are potential sources of infection.
Signs and symptoms
Primary infection in childhood may be generalized or localized.
In neonates, HVH symptoms usually appear 1 to 2 weeks after birth. They range from localized skin lesions to a disseminated infection of such organs as the liver, lungs, and brain. Common complications include seizures, mental retardation, blindness, chorioretinitis, deafness, microcephaly, diabetes insipidus, and spasticity. Neonates with disseminated disease have a high mortality.
Generalized infection
After an incubation period of 2 to 12 days, onset of generalized infection begins with fever, pharyngitis, erythema, and edema. After brief prodromal tingling and itching, typical primary lesions erupt as vesicles on an erythematous base, eventually rupturing and leaving a painful ulcer, followed by a yellowish crust. Healing begins 7 to 10 days after onset and is complete in 3 weeks.
Vesicles may form on any part of the oral mucosa, especially the tongue, gingiva, and cheeks. In generalized infection, vesicles occur with submaxillary lymphadenopathy, increased salivation, halitosis, anorexia, and a temperature as high as 105° F (40.6° C). Herpetic stomatitis may lead to severe dehydration in children.
A generalized infection usually runs its course in 4 to 10 days. In this form, virus reactivation causes cold sores — single or grouped vesicles in and around the mouth.
Localized infection
Genital herpes usually affects adolescents and young adults. Typically painful, the initial attack produces fluid-filled vesicles that ulcerate and heal in 1 to 3 weeks. Fever, regional lymphadenopathy, and dysuria may also occur.
Usually, herpetic keratoconjunctivitis is unilateral and causes only local symptoms, including conjunctivitis, regional adenopathy, blepharitis, and vesicles on the lid. Other ocular symptoms may be excessive lacrimation, edema, chemosis, photophobia, and purulent exudate.
Other signs and symptoms
Both types of HVH can cause acute sporadic encephalitis with an altered level of consciousness, personality changes, and seizures. Other effects include smell and taste hallucinations and neurologic abnormalities such as aphasia.
Herpetic whitlow, an HVH finger infection, commonly affects health care workers. First, the finger tingles and then it becomes red, swollen, and painful. Vesicles with a red halo erupt and may ulcerate or coalesce. Other effects may include satellite vesicles, fever, chills, malaise, and a red streak up the arm.
Diagnosis
Typical lesions may suggest HVH infection. Confirmation requires isolation of the virus from local lesions and a histologic biopsy. A rise in antibodies and moderate leukocytosis may support the diagnosis.
Treatment
Symptomatic and supportive therapy is essential. Generalized primary infection usually requires an analgesic-antipyretic to reduce fever and relieve pain. Anesthetic mouthwashes, such as viscous lidocaine, may reduce the pain of gingivostomatitis, enabling the patient to eat and preventing dehydration. Drying agents, such as calamine lotion, make labial lesions less painful.
Refer patients with eye infections to an ophthalmologist. Topical cortico-steroids are contraindicated in active infection, but idoxuridine, trifluridine, and vidarabine are effective.
A 5% acyclovir ointment may bring relief to patients with genital herpes or to immunosuppressed patients with HVH skin infections. I.V. acyclovir helps treat more severe infections. (See Treating and preventing herpes simplex.)
Special considerations
❑ Abstain from direct patient care if you have herpetic whitlow.
❑ Patients with central nervous system infection alone need no isolation.
❑ Teach patients how to care for themselves during an outbreak of HVH and how to avoid infecting others.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Cold sores
More Medical Textbooks Online about Cold sores
Review other book chapters online related to Cold sores:
Medical Books Excerpts
- Common cold
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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