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Herpes simplex type I (HSV1)

Micro > Virology > DNA viruses > Herpes viruses
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
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