Herpes Simplex - type I (HSV-1 or HSV1)
Epidemiology
·
Person-to-person
via contact inoculation or droplet infection
·
Risk factors:
increased age, low socioeconomic status
·
80% of people of
30 are seropositive!
Clinical
presentation
·
The vast majority
of people are asymptomatic, 9% have minor disease and 1% have serious disease
on primary infection, including:
o
Gingavostomatitis (tons of blisters around and in the mouth, on lips), keratoconjunctivitis,
genital herpes, eczema herpiticum, necrotizing focal encephalitis,
disseminated herpes, Whitlow (infection of the distal phalanges
of hand – very painful) and inoculation herpes, neonatal herpes, Kaposi’s
Varicelliform Eruption (eczema herpeticum: blisters all over scalp, face
and neck), dendritic keratitis (deep stromal ulcers of the eye)
·
That 1% may have reactivation disease that includes fever blisters,
inoculation (Whitlow), keratoconjunctivitis, necrotizing focal encephalitis
Diagnosis:
·
Clinical
presentation: vesicular eruption, etc
·
Antigen detection
via DFA
·
Exfoliative
cytology or histopathology
o
Intranuclear
inclusions
o
Multinucleate
giant cells
o
Tzanck Smear of
vesicle
·
Virus isolation
in tissue culture
§
Antibody testing
§
PCR
Treatment:
§ Acyclovir (Valacylovir, Penciclovir)
§ Ganciclovir and cidofovir effective but not given first-line
§ Foscarnet for resistant virus due to Thymidine Kinase deficient mutants