Clinical manifestation

Neonatal infection: onset of illness within 24 hours of birth; most often, symptoms of illness within the first week of life; rash noted after symptoms begin; manifestations of illness representative of the organ systems involved (i.e., CNS, lungs, gastrointestinal tract, heart, kidneys); skin vesicles develops on an erythematous base, which may coalesce into playues; localized eye infection with conjunctival injection and a watery discharge; dendritic lesions on fluo-rescein staining of the cornea; acute gingi-vostomatitis: most frequent clinical presentation of first-episode, primary HSV infection, although most patients have asymptomatic first infection; fever (102-i04°F); listlessness or irritability; inability to eat and/or drink; gingivitis with markedly swollen, erythematous, bleeding gums; occasional increased drooling noted in infants; vesicular lesions develop on the tongue, buccal mucosa, and palate, with extension to lips and face; tender submandibular or cervical adenopathy; disease lasting from 3-7 days; recurrent orolabial herpetic infection (herpes labialis): heralded by a prodrome of pain, tingling, burning, or itching, usually lasts up to 6 hours; vesicular rash in crops of 3-5 vesicles, frequently arising near the vermillion border; recurrences often associated with febrile illnesses, local trauma, sun exposure, or menstruation; primary genital infections: most infections asymptomatic; severe constitutional symptoms: fever, malaise, myalgias, and occasional headache; vesicular rash; lesions sometimes persist for up to 3 weeks; painful inguinal lym-phadenopathy; dysuria; vaginal discharge; recurrent genital infections: vulvar irritation and/or ulcerating or vesicular lesions; symptoms more severe in females; recurrent infections in males sometimes present with vesicular lesions on the shaft of the penis; local symptoms of recurrence: pain, itching, and dysuria; CNS infection: encephalitis possible manifestation of primary or recurrent infection; other sequelae: aseptic meningitis, transverse myelitis; herpetic whitlow (infection of a digit): presents with acute onset of edema, erythema, and localized pain and tenderness in the finger; associated fever and enlarged regional adenopathy; herpes gladiatorum: begins with painful vesicular lesions, frequently over the shoulders and neck in wrestlers (sites of skin-to-skin contact); Kaposi's varicelliform eruption (eczema herpeticum): clusters of umbilicated vesicu-lopustules in areas of a pre-existent derma

284 Herpes zoster titis; transmission occurs through contact with an infected person or by dissemination of primary or recurrent herpes; recurrent episodes sometimes occur, but milder and not usually associated with systemic symptoms; severe cases sometimes cause scarring

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