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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
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
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