Presentation on theme: "Herpes simplex Causative agent of herpes simplex is Herpesvirus hominis (HSV) that involves both skin and nerves. Ninety-nine percent of the patients do."— Presentation transcript:
1Herpes simplexCausative agent of herpes simplex is Herpesvirus hominis (HSV) that involves both skin and nerves. Ninety-nine percent of the patients do not have any clinical symptoms and signs after contamination. Those patients are described as in "carrier stage".
2Herpes simplex virus (HSV) Two antigenic types of this virus are type 1 and type 2. They cause localized infections:Above the waist (Type 1)Below the waist (Type 2)
3First contact with HSV Infection usually occurs in childhood Infection No clinical symptoms (99%)CARRIERPrimary herpes simplex infections (1%)CARRIER (Recurrent herpes simplex infections; 100%)
5Primary herpetic gingivostomatitis Patients are mainly infants. Multiple vesicles appear in the mouth. After the bursting of vesicles, erosions occur secondarily. The whole oral mucosa is covered by multiple aphthae. Additionally meningitis and encephalitis may be seen besides high fever, malaise and general complaints.
6Primary herpes genitalis Patients are mainly adolescents. In this type primary herpes simplex entrance site of the HSV is genital area in the firstly contacting person with this virus. Painful grouped vesicles appear on the entrance area. Additionally meningitis and encephalitis may be seen besides high fever, malaise and general complaints.
7Primary herpetic whitlow It is seen most frequently in health personnel contacting oral mucosae. There are grouped vesicles on the entrance area as in other herpes simplex types.
8Primary herpetic keratoconjunctivitis One can initially see vesicles, then painful erosions after the bursting. Eyelids are also involved.
9Disseminated herpes simplex infection of newborn If maternal genital area has HSV type II, viruses may contaminate the neonate during the delivery. Visseral organs are also involved beside skin and mucosa. This is the most severe primary herpes simplex type and may be fatal.
10HSVAccording the accepted theory, virus shuttles periodically between entrance area and medulla spinalis in the 100% of the HSV infected persons. So, the virus periodically comes to entrance area and viral shedding occurs without clinical manifestation. Thus, the patient can contaminate other persons easily in this stage. Recurrent herpes simplex infections occur in the people exposed to predisposing factors during the viral shedding.
12Recurrent herpes simplex infections Usually same localization as primary infectionPruritus replaces the pain of the primary infection
13Recurrent herpes simplex infections Predisposing factors are mainlyAcute infectionsStressExcessive exposure to ultraviolet radiationMenstruation
14Recurrent herpes labialis The first subjective symptom is pruritus. Grouped vesicles appearing on erythematous and edematous base follow it.
15Recurrent herpes labialis Painful lymphadenopathy may follow the onset of vesicles. Erosions occur after opening the vesicles and pustules, and crusts occur after drying these lesions. Crusts cover the erosions, and finally crust falls and recurrence ends.
16Recurrent herpes genitalis Similar to herpes labialis, grouped vesicles over an erythematous base appear.
17Recurrent herpes genitalis Vesicles burst and leave an erosion with intended borders.
18Recurrent herpes genitalis This erosion may also be covered with crust. It heals spontaneously in 5-7 days.
19Recurrent herpes genitalis Formerly this virus is considered as a carcinogen in women. But real carcinogen virus is Human papilloma virus (HPV) that infects frequently the women together with type 2 HSV.
20Recurrent herpes genitalis Neonates are under risk because they may be contaminated by HSV even if the pregnant mother does not have any genital lesion.
21Recurrent herpes genitalis Differential diagnosis must be made by syphilis if the patient has erosion in the genital area.
22Recurrent lumbosacral herpes simplex It is seen more frequently in females. Classical lesions of herpes are localized to the lumbosacral area.
23Recurrent Herpetic Keratoconjunctivitis It is rare and similar to primary herpetic keratoconjunctivitis.
24Herpes encephalitis and menengitis It is rare and due to recurrence of latent infection in the brain. Mortality is high.
25Treatment Local acyclovir preparations are applied 5 times a day. Acyclovir is administered by the oral route 5 x 200 mg for 7 days.2 x 200 mg may be used for upto 1 year for recurrent infections.
26Herpes zoster (Shingles) This presentation occurs usually in adults previously infected with Varicella zoster virus due to reactivation.
27Varicella-zoster virus (VZV) VZV is an alpha herpes virus containing double strand DNA surrounded by enveloped icosahedral nucleocapsid.VZV. Electron microscopic appearance.
28Varicella-herpes zoster association VZV causes two different diseases:Varicella (Chickenpox) : In childrenHerpes zoster (Shingles) : In adults
29Varicella (Chickenpox) It is a primary infection due to VZV encountered usually in children. In most countries, over 90% of the population is infected with VZV until age 15.Clinical appearance of chickenpox
31Some factors playing role in viral reactivation Spinal traumaX rays to the spineChronic infectious diseasesMalignant diseases, especially Hodgkin disease and the treatments administeredHeavy metal intoxications and their treatmentPUVAIDIOPATHIC
32Dermatomes and the localization of shingles Thoracic %55Cranial %25Lumber %14Cervical %12Sacral % 3Generalized % 1Cranial (only trigeminal dermatome is seen)CervicalThoracicLumbarSacral
33Subjective symptom: PAIN Since there is nerve involvement, most cases are in pain (60-90%). Younger patients have less pain. Older patients have more severe and longer pain.
34Progression of lesions First maculopapular erythematous areas appear. On this base, grouped vesicles appear in hours. After 48 hours, the vesicles become pustules. After day 4, the lesions start to dry and are covered with crusts. In severe cases the vesicles may become necrotic.
35Rash: Grouped vesicles Most important feature of shingles is unilateral dermatomal involvement. Rarely one or two neighboring dermatomes may be affected.
36Lesion characteristics Since the vesicles are unilateral, the lesions end on the midline and do not cross over.The appearance of a group of vesicles is not different than herpes simplex (except for the dermatomal distribution)
37Postherpetic neuralgia It is the continuation of dermatomal pain after the lesions have disappeared. The reason is unknown. It is thought to be due to changes in the nerves progressing from the peripheric pain pathways to the central nervous system.
38TreatmentAcyclovir and its metabolites are used in treatment. Treatment should be initiated within 72 hours of onset of lesions:Acyclovir: 7 days 5 x 800 mgValacyclovir: 7 days 3 x 1000 mgFamcyclovir: 7 days 3 x 250 mgBrivudin: days 1 x 125 mg
39Other treatments Symptomatic: Wet dressings etc. Analgesics: Opioids may be necessaryCorticosteroids: In special casesTricyclic antidepressants, anticonvulsives etc for PHN
40Verrucae (Warts)They are skin and mucosal papillomas caused by Human Papilloma Virus (HPV), are benign and may regress spontaneously.
41Human papilloma virus (HPV) It is a DNA virus of the group Papovavirus. Almost 100 serologic types exist and some are oncogenic.
42Verrucae There are five morphologic types of verrucae: Verruca vulgarisVerruca plantarisVerruca planusVerruca filiformisVerruca anogenitalis (Condylomata accuminata)
43Verruca vulgarisThey are seen on the hands. Sharply bordered papules with hyperkeratosis are seen. They may spread by trauma (Koebner phenomenon).
44Verruca plantarisThey are localized to the plantar area. They are painful and must be differentiated from calluses.
45Verruca planusThey are seen on the face and hands. They are flat topped papules of several mm diameter. There may be hundereds of papules in one patient.
46Verruca filiformisThey are seen usually in males. They are pedunculated and have string like prominences on top. The face, scalp, perinasal area and eyelids are especially affected.
47Verruca anogenitalisIt is a venereal disease. It is seen as flat topped papules and pedunculated papillomas. When found in intertriginous areas they look like a rooster comb.
48TreatmentThe existence of many different shows that there is no ideal treatment.Possibility of spontaneous remission should not be forgotten.ElectrocoagulationAcid containing preparationsCO2 laser, cryotherapy, surgery vs.
49Molluscum contagiosum Causative agent is a Poxvirus. Pearl-like, hard nodules with a dimple at the top are seen.Papules are mostly seen on the face and body in children, and genitals in young adults (sexually transmitted disease).
50Molluscum contagiosum It spreads easily with autoinoculation. ayca yayılır. Central dimple is an important diagnostic clue. If it is squeezed with a pair of forceps a white greasy mass is extruded.
51TreatmentCurettage is an efficient method in treatment. Each lesion is curetted and iodine solution is applied. Electrocoagulation, cryotherapy with liquid nitrogen are also treatment methods.
52Hand-Foot-Mouth Disease Causative agent is Coxsackievirus and Enterovirus 71. Elementary lesion is an oval vesicle, based on an erythema. Palmo-plantar areas and mouth mucosa are involved.
53Hand-Foot-Mouth Disease It may cause epidemics especially in summer months. Vesicles in the mouth burst and look like aphtous ulcerations.
54Hand-Foot-Mouth Disease Lesions disappear in 8-10 days without complications. Treatment is usually unnecessary. If necessary, symptomatic treatment is used.