12- Diseases caused by herpes virus. Clinical presentation and treatment of progenital herpes.

What is herpes simplex

• Viral infection caused by herpes simplex virus -> both HSV1, 2 can cause HS

How do you diagnose herpes simplex

• Direct microscopy

  • Tzanck smear-> giant multinucleated acantholytic keratinocytes

  • Antigen detection, culture, serolgy, PCR

What is HSV1

• Transmitted by direct contact or droplets

• Primary infection can be asymptomatic or self limiting lesions of painful vesicles with erythematous base

What are the presentations of HSV1

• primary herpetic gingivostomatitis

• herpes labialis

• herpetic whitlow

• erythema multiforme

• eczema herpetiform

Describe primary herpetic gingivostomatitis

• Erythematous oral mucosa with multiple painful blisters that usually turn into erosions/ ulcers

• Gingiva is erythematous and edematous, often with fibrin deposits

Describe herpes labialis

• Cold sores

• Small, painful blisters on the lips and around the mouth

• Vesicles can develop into pustules

Describe herpetic whitloq

• Painful vesicles usually on the distal phalanx of the finger

• Can be due to HSV1 or 2

• reaction pattern

Describe erythema multiforme

• Reaction pattern of blood vessels that have secondary epidermal changes

• Symmetric lesions that look like a bullseye with a dark red centre

• Can have blister/ crust, surrounded by pale pink ring and darker outermost ring

• Can develop into papules and vesiculobullous lesions

• Usually in palms, soles, face, mucous membranes

• May be pruritic and painful

• Treated by oral GC, and anti viral therapy

Descrieb eczema herpetiform

• Widespread, disseminated cutaneous vesicles and "punched out" erosions

• Often there is an underlying skin condition

  • Atopic dermatitis, bullous pemphigus, pemphigus vulgaris, burn injuries

• Treated by antiviral therapy + treating underlying skin condition

Wha tis HSV2

• Usually sexually transmitted

What is genital herpes

• Primary + recurrent

• Common chronically sexually transmitted disease

What is the characteristics of genital herpes

• Primary symptomatic eruptions seen as grouped painful vesicles at site of inoculation + lymphadenopathy

  • Can have fever, pruritus, dysuria, urethral discharge

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What are the symptoms in recurrent genital herpes

• itching,

• burning,

• redness,

• irritation,

• fissure formation prior to vesicle formation

What is the treatment for HSV

• Topical acyclovir or peniclovir cream

• Systemic acyclovir or valacyclovir or famciclovir

What is herpes zoster, VZV

• VZV

  • Primery infection: varicella

  • Zoster is infectious for varicella negative individuals

What is the acute dermatomal infection in herpes zoster

• Herpetiform papules, vesicles, erosions

• unilateral pain

What are the symptoms of herpes zoster

• painful and burning spots and vesicles on one side of the trunk,

• fever

What are the risk factors for Herpes zoster

• Stress,

• immunocompromised- malignancy, immunosuppression, lymphoproliferative disorders, chemotherapy, radiotherapy, HIV/AIDS

What are thee complications of Herpes zoster

• pneumonia

• encephalitis

• bacterial superinfection

• malignant varicella

What is the prophylaxis treatment for herpes zoster

• vaccine

What is the treatment of herpes zoster

• systemic acyclovir + painkillers + local disinfectants

 

Describe chicken pox

• Disseminated, strongly pruritic vesicles that can develo into pustules, crusts and scars

• After primary lesion -> virus retains lifetime latency in sensory ganglia

• Incubation period of 14 days

Describe shingles

• Recurrent infection

• If immunosuppression

• VZV reactives within the nerve cells -> travels to skin -> painful vesicles in dermatomal pattern