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Herpes Simplex and Varicella-Zoster Virus Infections

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Asymptomatic, mucocutaneous, neonatal, CNS,

Type 1: gingivostomatitis, whitlow, keratoconjunctivitis, encephalitis, eczema herpeticum

Type 2: genital herpes simplex, meningitis

Classification: primary; non primary, first episode; recurrent, reinfection

Latency: sensory or autonomic neurons; LATS Reactivations: trauma, sunlight, stress (despite antibodies)

Host: normal vs. immunocompromised

Neonatal HSV Infections

Congenital 5%; most HSV 2 (poorer prognosis)

Most mothers asymptomatic; antibodies may modify

Attack rate after primary maternal infection over 50% (> 10 times

than after recurrent infection) herpe

Cesarean section controversial in women with recurrent HSV at delivery

Culture baby (eye, skin, throat) after 24 hours old

Categories, prognosis: skin/eye/mouth, CNS, disseminated

Symptoms: skin vesicles, fever, intractable seizures, pneumonia, DIC, conjuncti vitis, recurrent skin vesicles after therapy

Herpes Simplex Virus Encephalitis

Most common sporadic, focal encephalitis in US.

Estimate 1,000 cases yearly in U.S.

May be due to 1 or reactivation HSV infection; skin lesions a "red herring"

Symptoms: headache, fever, personality change, focal seizures

Differential diagnosis: TB meningitis, arbovirus, enterovirus,

 Varicella-Zoster Virus Infections

HSV Infections

Asymptomatic, mucocutaneous, neonatal, CNS, latent

Type 1: gingivostomatitis, whitlow, keratoconjunctivitis, encephalitis, eczema herpeticum

Type 2: genital HSV, meningitis

Classification: primary; non primary, first episode; recurrent, reinfection

Latency: sensory or autonomic neurons; LATS Reactivations: trauma, sunlight, stress (despite antibodies)

Host: normal vs. immunocompromised

Neonatal HSV Infections

Congenital 5%; most HSV 2 (poorer prognosis)

Most mothers asymptomatic; antibodies may modify

Attack rate after primary maternal infection over 50% (> 10 times

than after recurrent infection)

Cesarean section controversial in women with recurrent HSV at delivery

Culture baby (eye, skin, throat) after 24 hours old

Categories, prognosis: skin/eye/mouth, CNS, disseminated

Symptoms: skin vesicles, fever, intractable seizures, pneumonia, DIC, conjunctivitis, recurrent skin vesicles after therapy

HSV Encephalitis

Most common sporadic, focal encephalitis in US.

Estimate 1,000 cases yearly in U.S.

May be due to 1E or reactivation HSV infection; skin lesions a "red herring"

Symptoms: headache, fever, personality change, focal seizures

Differential diagnosis: TB meningitis, arbovirus, enterovirus,

Mycoplasma, mumps, tumor, toxoplasmosis, aneurysm

HSV Infections, Diagnosis

Isolate HSV, identify HSV antigen (immunofluorescence) in skin

CSF: abnormal; virus isolation + rare (except HSV 2 meningitis)

Antibody titers don't differentiate 1 vs. 2 (except g G)

Encephalitis: EEG, CT/MR, DNA/PCR, brain biopsy, antigen, antibody 

HSV Infections, Therapy: Acyclovir (ACV) PO or IV

Resistance: Especially with Repeated Treatment immunocompromised; TK negative (less virulent) foscarnet

Indications: neonatal, encephalitis, primary/recurrent in immunosuppressed, primary genital, eczema

Questionable efficacy: gingivostomatitis, recurrent infections

Keratitis: topical trifluorothymidine + ACV; ophthalmologist

Encephalitis: poor outcome if late, in coma, adult