25 - 164 - HERPES SIMPLEX Flashcards
Differentiate primary and secondary HSV based on severity, systemic signs and symptoms and rate of complications
Primary infections with HSV are usually more severe, frequently involve** systemic signs **and symptoms and have higher rate of complications compared to those associated with reactivation of HSV
What do you call orofacial HSV infections
Herpetic gingivostomatitis and pharyngitis
Common symptoms of orofacial HSV
fever, malaise, myalgia , dysphagia, irritability and cervical adenopathy
What is the most commonly affected area in reactivation of HSV in the perioral area?
Outer 1/3 of the lower lip
Other facial locations include the nose, chin, and cheek, and account for fewer than 10% of cases
Two-thirds of labial lesions involve the vermilion border, and the rest occur at the junction of the border with the skin.
What are the possible prodromal symptoms of herpes labialis?
Pain, burning, itching at the site of the subsequent eruption
What are the stages of herpes infection
- Developmental stage - prodromal, erythema and papule
- Disease stage - vesicle, ulcer and hard crust
- Resolution stage - dry flaking and and residual swelling
The lesions of herpes infection usually resolve in how many days
Within 5 to 15 days
Triggers for oral herpes recurrences
- emotional stress
- illness
- exposure to sum
- trauma
- fatigue
- menses
- chapped lips
- season of the year
Other well-documented triggers include exposure to ultraviolet irradiation, trigeminal nerve surgery, oral trauma, epidural administration of morphine, and abrasive, laser, and chemical facial cosmetic procedures
Which type of HSV causing orofacial infection is LESS LIKELY to reactivate?
HSV-2 orolabial infections are 120 times less likely to reactivate than orolabial HSV-1 disease.
True or false: Acquisition of HSV-1 in a person with prior HSV-2 infection is unusual, but HSV-2 acquisition in the presence of previous HSV-1 infection is common.
TRUE
Most common location of genital herpes in males?
Glans penis or penile shaft
Accompanying symptoms of genital herpes
Pain, itching, dysuria, vaginal and urethral discharge and tender inguinal lymphadenopathies
Systemic signs and symptoms are common and include fever, headache, malaise, and myalgias.
Without treatment genital herpes infections usually heal in how many days?
6 - 10 days
infection of the fingers by HSV acquired by direct inoculation or by direct spread from mucosal sites at the time of primary infection
Herpetic whitlow
Whitlow occurs in children who suck their fingers during a primary gingivostomatitis outbreak. It is also a well documented occupational hazard for medical personnel. It is usually caused by HSV-1, but HSV-2 whitlow may develop as a manifestation of primary inoculation following manual–genital contact with an infected partner.
most common precipitating event in cases of recurrent erythema multiforme
Recurrent HSV infection
HSV-associated erythema multiforme is usually an acute, self-limited, recurrent disease, that lasts approximately 3 weeks.
The lesions are usually symmetric, occurring on acral extremities and the face, and there is grouping of lesions over the elbow and knees as well as nailfold involvement. Mucosal involvement is usually mild and restricted to the mouth. Constitutional symptoms are rare, and the skin lesions heal without scarring.
T/F: All HSV infections involve the nervous system, as neurons are the sole proven site of virus latency.
True
For patients with active lesions, HSV can be isolated in
Cell culture
In culture, HSV causes typical cytopathic effects, and most specimens will prove positive within 48 to 96 hours after inoculation. The sensitivity of culture depends on the quantity of virus in the specimen.
Isolation of virus is most successful when lesions are cultured during the ________ stage
Vesicular stage
and when specimens are taken from immunocompromised patients or from patients suffering from a primary infection.
more sensitive than viral isolation and has become the preferred method for diagnosis of HSV
PCR
Both viral culture and PCR assays enable typing of the isolate as HSV-1 or HSV-2.
This information helps to predict the frequency of reactivation after a first episode of HSV infection.
How can you differentiate a primary from a recurrent HSV infection
Serologic detection of IgG antibodies to HSV
- The main function of serologic testing is to differentiate a primary episode from a recurrent infection.
How you do Tzanck Smear/test
It is performed by scraping the base of a freshly-ruptured vesicle and staining the slides with Giemsa or Wright stain (the Papanicolaou staining method also can be used), followed by examination for multinucleated giant cells that are diagnostic of herpetic infection
Differential diagnoses for orolabial herpes
Differential diagnoses for Genital Herpes
Clinical course and prognosis of HSV
Although most patients with HSV infections are asymptomatic, primary infections can be severe. Most recurrences are asymptomatic, but symptomatic recurrences are milder than symptomatic primary infections. The frequency and severity of recurrent HSV-1 and HSV-2 disease decrease over time; therefore, the need for continued suppressive therapy should be reevaluated.
