Infections Causes By Herpes Simplex Virus

Herpes Simplex virus infection may be caused by type I or type II virus and the infection may be primary or recurrent.

Primary Infection
The manifestations of primary Infection includes:

1. Systemic infection: e.g fever, sore throat and lymphadenopathy that may pass unnoticed. If the patient is immunocompromised, then the disease may become life threatening with fever, lymphadenopathy, pneumonitis and hepatitis.

2. Gingivostomatitis: Ulcers filled with yellow slough appear in the mouth.

3. Herpetic Whitlow: A breach in the skin that may be due to any minor trauma allows the virus to enter the finger, causing a vesicle to form. Often this condition is seen in children nurses.

4. Traumatic Herpes: Also known as Herpes gladiatorum. In this condition vesicles develop at any site where herpes simplex virus have been inoculated on the skin by brute force.

5. Eczema Herpeticum: HSV infection superimposed on eczematous skin. Usually seen in children.

6. Herpes Simplex Meningitis: This is uncommon and if occurs it is usually self limiting.

7. Genital Herpes: It is usually caused by HSV type II. In males it presents as grouped vesicles and papules that develop around anus and penis associated with fever, pain and dysuria. In females the symptoms are more severe and there are blisters and vesicles appearing on the on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus. In moist areas, the vesicles rupture, leaving exquisitely tender ulcers. The vaginal mucosa is inflamed and edematous. There is severe burning and pain on micturition and there is associated flu like symptoms including fever, headache and lymphadenopathy.

8. HSV Keratitis: It presents as corneal dendritic ulcers.

9. Herpes Simplex Encephalitis: Usually caused by HSV type I. Spreads cenripetally, e.g from cranial nerve ganglia to frontal and temporal lobes. Suspect if patient presents with fever, fits, headache, odd behaviour, hemiparesis or coma. Diagnosis is made by urgent PCR on CSF sample and CT scan or MRI and EEG may show temporal lobe changes but these are non-specific and unreliable.

Recurrent HSV Infections
They commonly occur at the lips and adjoining skin the condition is known as Herpes Labialis. HSV lying dormant in ganglion cells may be reactivated by illness, immunosuppression, mensturation or even sunlight. Genitial herpes lesions also commonly recur.

InvestigationsHerpes simplex virus infection is usually diagnosed clinically and by rising antibody titres in primary infection. Culture may be done as well as PCR is available for fast diagnosis.

Treatment

• For mild infection no specific treatment is needed other then symptomatic management.
• For severe infections Acyclovir is available in oral, topical cream and IV preparations. Also eye drops are available.
• In genital herpes give proper analgesia for pain relief along with famciclovir 250 mg/8 hrly (500 mg if patient is immunocompromised) per oral for 5 days. Advise condoms and if disease is frequent or recurrent then give continous Acyclovir 400 mg per oral 12 hrly.
• If Herpetic keratitis is suspected avoid steroids and give acyclovir eye drops.
• In Herpes encephalitis patients needs ICU care and immediately start Acyclovir 10 mg/kg/8hrly IV for 10 days