Herpes Simplex

Fast Shingles Cure

Fast Shingles Cure Ebook

Get Instant Access

INTRODUCTION Herpes simplex is caused by a DNA virus that is estimated to infect 60% to 90% of individuals at sometime during their life. Clinically evident infections however are much less common. Involvement of the facial region is predominantly due to type I herpes virus, with the exception of newborns, in whom overwhelming exposure to the type II variety during birth can result in development of typical skin lesions during the first few days of life, often associated with devastating CNS and systemic involvement. Primary herpes occurs in previously uninfected individuals. The chief mode of transmission is by kissing or other forms of intimate contact with an individual who has an active, usually recurrent, herpetic lesion.

CLINICAL PRESENTATION Following a 2 to 14 day incubation period there develops a mild fever with moderately painful, usually unilateral, edema and erythema of the eyelid region. This is soon followed by the development of multiple discrete 2 to 3 mm vesicles that generally have a central umblilication. These break, crust over, and most often resolve without bacterial infection or scarring over the ensuing few weeks. There is a mildly tender preauricular lymphadenopa-thy, and often vesicular lesions are found elsewhere on the face or mucous membranes. Atypical dermal manifestations include the development of a black eschar early on, or edema without obvious vesicles. A careful search often reveals a few minute vesicles sometimes hidden at the base of the lashes. Following resolution the herpes virus retreats to the trigeminal ganglion where it can later reactivate and incite recurrent infections. Recurrent herpetic infections frequently follow a fever, head cold, sun exposure, or some other trivial physical or emotional insult. Onset is often preceded by a 24-hour prodrome with focal dysethesia, numbness, and tingling. The recurrent eruption is usually less severe than the primary and is more limited. Associated ocular involvement may include a follicular conjunctivitis, dendritic keratitis, disciform keratitis, acute anterior uveitis, and rarely a necrotizing retinitis or optic neuritis.

Hsv Blepharoconjunctivitis
(Courtesy of Kenneth Cohen, M.D.) (Courtesy of Robert A. Goldberg, M.D.)

HISTOPATHOLOGY The histological features of herpes simplex virus (HSV), varicella, and herpes zoster virus skin infections are similar. In HSV, the earliest changes are seen in the epidermal cell nuclei, which enlarge, develop a homogenous "ground glass" appearance, and have peripherally clumped chromatin. Changes begin along the basal epidermal layer and progress to involve all layers. Intraepidermal vesicles soon form secondary to ballooning and acantholysis of keratinocytes. Subepidermal vesicles may result from destruction of the basal layer of epidermis. Multinucleated keratinocytes are more conspicuous in lesions that have been present for several days. The histopathological clue to diagnosis is eosinophilic nuclear inclusions, which are more common in the multinucleated cells. Diagnosis is confirmed using immunohistochemistry.

Herpes Zoster Lamina Histologica

DIFFERENTIAL DIAGNOSIS The differential diagnosis includes acute stye, insect bite, chickenpox, herpes zoster, contact dermatitis, and ulcerative blepharitis.

TREATMENT The diagnosis can usually be made clinically; however, confirmation can be accomplished by finding multinucleated giant cells on a Giemsa-stained smear. Viral cultures can be obtained and would be needed to exclude herpes zoster, which will look the same on smear. An enzyme-linked immunosorbent assay (ELISA) is also available. Because of the high risk of secondary corneal involvement in cases involving the eyelids, prophylactic treatment with idoxuridine or vidara-bine ointment to the eye four times a day until the skin lesions have dried and crusted, and then twice a day for an additional two weeks, reduces the incidence and severity of ocular infection. Use of antiviral medications on the skin lesions is also recommended in the hope of suppressing the shed of viral particles. For recurrent attacks prophylactic use of topical antiviral agents in the prodromal phase will often abort the attack. Bacterial infection occurs only occasionally, so antibiotics are not generally employed until or unless secondary infection becomes manifest. Steroids should not be used because they exacerbate ocular infections. In younger children without corneal involvement the disease can be self-limited with spontaneous resolution.

REFERENCES

Besada E. Clinical diagnosis of recurrent herpes simplex blepharitis in an adult: a case report. J Am Optom Assoc 1994; 65:235-238.

Campanella PC, Rosenwasser GO, Sassani JW, Goldberg SH. Herpes simplex blepharoconjunctivitis presenting as complete acquired ankyloblepharon. Cornea 1997; 16:360-361. Honig P, Holzwanger J, Leyden J. Congenital herpes simplex virus infections. Report of three cases and review of the literature. Arch Dermatol 1979; 115:1329-1333. Long J, Wheeler C, Briggaman R. Varicella-like infection due to herpes simplex. Arch Dermatol 1978; 114:406-409. Nauheim J, Sussman W. Herpes simplex of the lids and adjacent areas. Trans Am Acad Ophthalmol Otolaryngol 1971; 75:1236-1241.

Overall JC Jr. Persistent problems with resistant herpes viruses. N Engl J Med 1981; 305:95-97.

Pavan-Langston D. Diagnosis and management of herpes simplex ocular infection. Int Ophthalmol Clin 1975; 15:19-35. Parisi ML. A case of recurrent, isolated, simultaneous, bilateral herpes simplex lid infection. J Am Optom Assoc 1998; 69:49-56.

Pazin G, Ho M, Jannetta P. Reactivation of herpes simplex virus after decompression of the trigeminal nerve root. J Infect Dis 1978; 138:405-409.

Schneidman DW, Barr, RJ, Graham JH. Chronic cutaneous herpes simplex. JAMA 1980; 241:592-594.

Simon JW, Longo F, Smith RS. Spontaneous resolution of herpes simplex blepharoconjunctivitis in children. Am J Ophthalmol 1986; 102:598-600.

Stumpf TH, Case R, Shimeld C, Easty DL, Hill TJ. Primary herpes simplex virus type I infection of the eye triggers similar immune responses in the cornea and the skin of the eyelids. J Gen Virol 2002; 83:1579-1590. Whallett EJ, Pahor AL. Herpes and the head and neck: the difficulties in diagnosis. J Laryngol Otol 1999; 113:573-577.

Was this article helpful?

0 0
Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Responses

Post a comment