Viral Skin Infections Flashcards
What is herpes-simplex?
Herpes simplex = common viral infection that presents with localised blistering
=> commonly known as cold sores or fever blisters, as recurrences are triggered by a febrile illness i.e. cold
What causes herpes-simplex?
Herpes simplex is caused by:
Type 1 HSV is mainly associated with oral and facial infections
Type 2 HSV is mainly associated with genital and rectal infections
After primary infection, HSV is latent in spinal dorsal root nerves that supply sensation to the skin.
During a recurrence, the virus follows the nerves onto the skin or mucous membranes, where it multiplies, causing the clinical lesion.
Who is at risk of herpes-simplex?
Primary attacks of Type 1 HSV infections:
=> mainly in infants and young children
Type 2 HSV infections:
=> mainly transmitted sexually
HSV is transmitted by direct or indirect contact with active herpes simplex (infectious for 7–12 days)
Asymptomatic shedding of the virus in saliva or genital secretions can also lead to transmission of HSV - rare
Minor injury helps inoculate HSV into the skin. For example:
Primary infection can be mild or subclinical
Symptomatic primary infection more severe than recurrences.
*Type 2 HSV is more often symptomatic than Type 1 HSV
What is the clinical presentation of primary herpes-simplex?
- Primary Type 1 HSV most often presents as gingivostomatitis, in children 1-5 years
Primary type 1 Symptoms: => fever, => restlessness => excessive dribbling => painful drinking and eating => foul breath i => swollen, red gums that bleed easily => whitish vesicles evolve to yellowish ulcers on the tongue, throat, palate and inside the cheeks => Local lymph glands are enlarged and tender.
Recovery within 2 weeks
- Primary Type 2 symptoms:
=> genital herpes after sexual activity.
=> painful vesicles, ulcers, redness and swelling lasting for 2 to 3 weeks
=> if untreated accompanied by fever + tender inguinal lymphadenopathy
Males: glans, foreskin and shaft of the penis
Females: vulva and in the vagina. Painful, difficult to pass urine.
What is the clinical presentation of recurrent herpes-simplex?
May be no further clinical manifestations throughout life.
Immunodeficient => type 2 recurrent infections are common
Recurrences can be triggered by:
=> Minor trauma, surgery or procedures to the affected area
=> Upper respiratory tract infections
=> Sun exposure
=> Hormonal factors esp in women
=> Emotional stress
Smaller, group vesicles in recurrent herpes.
Itching or burning is followed an hour or two later by an irregular cluster of small umbilicated vesicles on a red base
Heal in 7–10 days without scarring - may be accompanied by fever, pain and have enlarged local lymph nodes
How is herpes diagnosed?
If there is clinical doubt, HSV can be confirmed by culture or PCR of a viral swab taken from fresh vesicles.
HSV serology +ve in most so not useful in diagnosis
What are the complications of herpes simplex?
Eye infection: conjunctivitis and superficial ulceration of the cornea
Throat infection: very painful and interfere with swallowing
Eczema herpeticum: hx of atopic dermatitis => severe and widespread infection (numerous blisters erupt on the face associated with swollen lymph glands and fever)
Erythema multiforme (herpes most common cause of Erythema multiforme) : rare in herpes
Nervous system: cranial/facial nerve palsies; neuralgic pain (rare)
Widespread infection: disseminated infection and/or persistent ulceration
How is herpes simplex treated?
Mild, uncomplicated eruptions of herpes simplex = no treatment
Blisters may be covered i.e. with a hydrocolloid patch
Antiviral drugs for severe herpes simplex
i.e. Aciclovir
How can herpes simplex be prevented?
Limit sun exposure by wearing a high factor sunscreen - triggers facial herpes
Antiviral drugs shorten and prevent attacks frequent attacks.
What is chicken pox?
Highly contagious viral infection that causes an acute fever and blistered rash.
Chickenpox affects anyone but most commonly in children <10 years of age.
Once you have had chickenpox, it is unlikely to get it again = lifelong immunity
What causes chicken pox?
Varicella-zoster virus (herpesviridae family)
*sometimes called herpesvirus type 3
Chickenpox = highly contagious and spread in airborne respiratory droplets from an infected person’s coughing or sneezing or through direct contact with the fluid from the open sores
=> enters through the mucosa of upper respiratory tract
A person who is not immune to the virus has a 70–80% chance of being infected with the virus if exposed in the early stages of the disease.
What are the signs and symptoms of chicken pox?
=> Rapid progression of macules to papules to vesicles to pustules within hours
=> on the stomach, back and face then spreads to other parts of the body
=> more severe in older children / debilitating in adults - experience prodromal symptoms i.e. fever, malaise, headache, loss of appetite, abdo pain upto 48hrs before breaking out in the rash
*pustules crust & clear up within one to three weeks, without scarring
How is chicken pox diagnosed?
Clinical diagnosis mostly
Laboratory tests can confirm the diagnosis:
=> PCR detects the varicella virus in vesicular fluid from skin lesions = most accurate method for diagnosis
=> Serology in pregnant women
What are the complications of chicken pox?
- Bacterial superinfection of scratched lesions => lead to abscess, cellulitis, necrotising fasciitis and gangrene
- Viral pneumonia - more common in adults + smokers
- Disseminated primary varicella infection = high morbidity
- CNS - commonly presents with acute truncal cerebellar ataxia
=> i.e. Reye syndrome,
=> Guillain-Barré syndrome
=> encephalitis - Thrombocytopenia and purpura
- Exposure to varicella virus in pregnancy = viral pneumonia, premature labour & delivery and rarely maternal death
- Congenital varicella syndrome (TORCH) => spontaneous abortion, fetal chorioretinitis, cataracts, limb atrophy, cerebral cortical atrophy and microcephaly, cutaneous scars, and neurological disability.
Mortality in newborns infected with varicella is up to 30%.
How do you manage / prevent chickenpox?
Healthy patients = no treatment + lifelong immunity from infection
Aciclovir in patients >16years
High dose Aciclovir + zoster-immune globulin in immunocompromised
Prophylaxis zoster-immune globulins in susceptible pregnant women
=> Aciclovir if chickenpox during pregnancy
Effective live attenuated varicella vaccine licensed in US but named patient basis in UK + susceptible healthcare workers
