Herpes Simplex Virus
Evaluation
General—family of viruses responsible for varied infections including
Herpes simplex virus 1 (HSV1)—typically associated with nongenital infections (orofacial, encephalitis)
HSV2—typically associated with genital infections
Structure—HSV is a double-stranded DNA virus.
Mechanism—to spread, the virus relies on contact between one who is shedding virus and a host.
Contact must be with a mucosal surface or open skin to begin the infectious process.
The virus can then establish itself in sensory neurons and can be reactivated at a later date.
Epidemiology—most humans have been infected with HSV and maintain latent virus.
Diagnosis—for a definitive diagnosis, isolate the virus from an affected site or bodily fluids.
Can perform a cell culture (PCR) to detect HSV DNA
Clinical manifestations
Gingivostomatitis (usually HSV1)
Clinical—fever, sore throat, erythema—vesicular lesions on oral/pharyngeal mucosa
Risk factors for recurrence—triggers include fever, stress, and so on
Typically found on border of the lip as herpes simplex labialis (cold sores)
Herpetic simplex keratitis (usually HSV1)
Clinical—conjunctivitis (most common infectious cause of blindness in the United States)
Additional cutaneous manifestations of herpes
Herpetic whitlow—herpetic lesions on open skin or fingers of health care workers
Herpes gladiatorum—disseminated cutaneous herpetic infection associated with wrestlers
Herpes simplex encephalitis (usually HSV1)
Clinical—fever, headache, altered mental status, temporal lobe involvement
Mechanism—unilateral disease that causes hemorrhagic necrosis of the temporal lobe
Epidemiology—mortality and morbidity are high even with treatment.
Genital herpes (usually HSV2)
Clinical—fever, malaise, inguinal lymphadenopathy → vesicles at primary infection
Recurrence varies greatly from individual to individual.
Complications (aseptic meningitis, urinary retention) are common in women.
Epidemiology—Twenty percent of Americans have genital herpes; risk factor for human immunodeficiency virus (HIV).
Clinical—It includes cutaneous lesions, encephalitis, or disseminated infection.
Mechanism—fetus contacts infected genital secretions from mother at delivery.
Epidemiology—mortality and morbidity are high, especially for disseminated infection.
Herpes simplex virus in the immunocompromised host
General—typically occurs from reactivation of a latent herpes infection
Clinical—includes disseminated cutaneous infection, pneumonitis, gastrointestinal (GI) manifestations, and so onRelated posts:
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