Herpes simplex virus

[Anonymous]

The patient usually presents to the clinician with full-blown oral and systemic disease, but a history of the mode of onset is helpful in differentiating lesions of primary HSV infection from other acute multiple lesions of the oral mucosa. The incubation period is most commonly 5 to 7 days but may range from 2 to 12 days. Patients with primary oral herpes have a history of generalized prodromal symptoms that precede the local lesions by 1 or 2 days. This information is helpful in differentiating this viral infection from allergic stomatitis or erythema multiforme, in which local lesions and systemic symptoms appear together.These generalized symptoms include fever, headache, malaise, nausea, and vomiting. A negative past history of recurrent herpes labialis and a positive history of direct intimate contact with a patient with primary or recurrent herpes are also helpful in making the diagnosis. Approximately 1 or 2 days after the prodromal symptoms occur, small vesicles appear on the oral mucosa; these are thin-walled vesicles surrounded by an inflammatory base. The vesicles quickly rupture, leaving shallow round discrete ulcers. The lesions occur on all portions of the mucosa. As the disease progresses, several lesions may coalesce, forming larger irregular lesions. An important diagnostic criterion in this disease is the appearance of generalized acute marginal gingivitis. The entire gingiva is edematous and inflamed. Several small gingival ulcers are often present. Examination of the posterior pharynx reveals inflammation, and the submandibular and cervical lymph nodes are characteristically enlarged and tender. On occasion, primary HSV may cause lesions of the labial and facial skin without intraoral lesions.

TREATMENT
Primary HSV in otherwise healthy children is a self-limiting disease. The fever ordinarily disappears within 3 or 4 days, and the lesions begin healing in a week to 10 days, although HSV may continue to be present A significant advance in the management of herpes simplex infections was the discovery of acyclovir, which has no effect on normal cells but inhibits DNA replication in HSV-infected cells.24 Acyclovir has been shown to be effective in the treatment of primary oral HSV in children when therapy was started in the first 72 hours. Acyclovir significantly decreased days of fever, pain, lesions, and viral shedding. Newer antiherpes drugs are now available, including valacyclovir and famciclovir. The advantage of the newer drugs is increased bioavailability, allowing for effective treatment with fewer doses. Milder cases can be managed with supportive care only. The use of antiviral drugs in the management of recurrent disease or in immunocompromised patients is discussed later in this chapter in sections on recurrent and chronic HSV.
Routine supportive measures include aspirin or acetaminophen for fever and fluids to maintain proper hydration and electrolyte balance. If the patient has difficulty eating and drinking, a topical anesthetic may be administered prior to meals. Dyclonine hydrochloride 0.5% has been shown to be an excellent topical anesthetic for the oral mucosa. If this medication is not available, a solution of diphenhydramine hydrochloride 5 mg/mL mixed with an equal amount of milk of magnesia also has satisfactory topical anesthetic properties. Infants who are not drinking because of severe oral pain should be referred to a pediatrician for maintenance of proper fluid and electrolyte balance. Antibiotics are of no help in the treatment of primary herpes infection, and use of corticosteroids is contraindicated. Future therapy may include prevention of the infection with use of a genetically disabled HSV vaccine.

        

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[Anonymous]

Oral Herpes (HSV-1) Symptoms and Signs

* Incubation period: For HSV-1, the amount of time between contact with the virus and the appearance of symptoms, the incubation period, is two to 12 days. Most people average about four days.

* Duration of illness: Signs and symptoms will last two to three weeks. Fever, tiredness, muscle aches, and irritability may occur.

o Pain, burning, tingling, or itching occurs at the infection site before the sores appear. Many patients have reported these symptoms prior to the appearance of sores or blisters. Then clusters of blisters erupt. These blisters break down rapidly and, when seen, appear as tiny, shallow, gray ulcers on a red base. A few days later, they become crusted or scabbed and appear drier and more yellow.

o Oral sores: The most intense pain caused by these sores occurs at the onset and may make eating and drinking difficult.

+ The sores may occur on the lips, gums, throat, the front of the tongue, the inside of the cheeks, and the roof of the mouth.

+ They may also extend down the chin and neck.

+ The gums may become mildly swollen, red-colored, and may bleed.

+ Neck lymph nodes often swell and become painful.

+ People in their teens and 20s may develop a painful throat with shallow ulcers and a grayish coating on the tonsils

        

[Anonymous]

Oral Herpes (HSV-1) Diagnosis

A doctor will base a presumptive diagnosis on information provided by the patient and on the physical examination. The characteristic appearance of the herpes sores leaves little doubt about the diagnosis. Further testing is usually not necessary.

If a definitive diagnosis is needed, because, for example, the infection involves other organ systems, the doctor may conduct laboratory tests listed below:

* A sample (tissue or fluid) from the sores to identify the virus as HSV

* A viral culture analysis

* A staining test called the Tzanck smear (shows nonspecific cell nucleus changes due to HSV)

* Antigen and antibody studies (serologic and PCR tests to determine if infection is caused by HSV-1 or HSV- 2)

        

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