Herpes simplex

Introduction

Introduction to herpes simplex

Herpes simplex virus infection, referred to as herpes simplex, is an acute herpetic skin disease caused by herpes simplex virus infection and is contagious. The clinical features are clustered blisters in the skin mucosa, which are self-limiting, but easy to recur. The main symptoms occur in the face, mouth or genitals. Systemic symptoms are generally mild, but if you have herpes simplex encephalitis or a systemic disseminated herpes rupture, it can be life-threatening. Clinically, it can be divided into primary herpes simplex infection and recurrent herpes simplex infection. At present, there is no ideal method for preventing recurrence, and the main incentives for recurrence should be eliminated.

basic knowledge

Sickness ratio: 0.0001%

Susceptible population: adults who have been exposed to herpes simplex virus or have been exposed to the disease, newborns, children aged 1-5

Infection mode: direct contact with infection, can also be indirectly transmitted through the tableware contaminated by saliva. The virus enters the human body through mucous membranes or skin lesions such as the nose, pharynx, conjunctiva and genitals.

Complications: herpes simplex virus infection, neonatal fever, jaundice, neonatal hepatosplenomegaly, disturbance of consciousness

Pathogen

Herpes simplex cause

Herpes simplex virus infection of DNA virus (40%):

The disease is caused by herpes simplex virus of DNA virus. Human herpes simplex virus is divided into two types, namely herpes simplex virus type I (HSV-I) and herpes simplex virus type II (HSV-II). Type I mainly causes genital mutilation. Infections other than skin, mucous membranes (oral mucosa) and organs (brain), type II mainly causes skin and mucous membrane infections in the genital area.

Route of transmission (20%):

The virus enters the body through the respiratory tract, oral cavity, genital mucosa and damaged skin. It occupies the normal mucous membrane of the human body, blood, saliva and sensory ganglion cells. When the body's resistance declines, such as fever, gastrointestinal dysfunction, menstruation, pregnancy, lesions When infection and mood change, the latent HSV in the body is activated and becomes ill. Human is the only natural host of herpes simplex virus. This virus is present in the vesicular blister fluid, saliva and feces of patients, restorers or healthy carriers. The mode of transmission is mainly direct contact infection, and can also be through the tableware contaminated by saliva. Indirect infection.

Source of infection (20%):

Clinically divided into primary herpes simplex infection and recurrent herpes simplex virus infection, primary herpes simplex infection is caused by exposure to herpes simplex, herpes simplex virus can be transmitted through the mouth-breathing, but also through the skin, mucous membranes, Infected by herpes lesions such as the cornea, active infection of herpes simplex virus and asymptomatic detoxification, there are viruses in their saliva and feces, so patients with this disease should avoid contact with other children and infants, recurrent herpes simplex. The infection is caused by the activation of the latent herpes simplex virus in the body. There is no ideal method for preventing recurrence.

Prevention

Herpes simplex prevention

Neonates, immunocompromised persons, patients with chronic skin diseases such as eczema, as far as possible to avoid contact with patients with this disease, pregnant women with genital herpes should be cesarean section, can avoid birth canal infection, genital herpes patients should avoid sex, Avoiding magnetic therapy can reduce its spread. For repeated female genital herpes, regular cervical smears should be performed to detect cervical cancer early.

After the emergence of herpes simplex in the child care institution, it should be isolated at home, and can be returned after the treatment is cured. Pregnant women with genital herpes should be delivered by cesarean section. Pregnant women with a history of genital herpes should take amniotic fluid to test IgM type HSV. If the antibody is positive, it indicates that the fetus is suffering from intrauterine infection. Discuss with the patient whether to consider selecting 0.1% eye drops and isolate it from the affected mother to avoid feeding from the mother until the mother is cured; waiting for delivery and postpartum During the observation period, the mother and her newborn should be isolated from other maternal and newborns.

Adhere to the pre-marital medical examination system, avoid sexual intercourse and promote safe sex; if necessary, use condoms during sexual intercourse to help control or reduce the prevalence of genital herpes infection, organ transplantation (including bone marrow transplantation) immediately after surgery The use of acyclovir, patients with frequent recurrence of herpes should try to remove or avoid the predisposing factors, the above measures can help prevent the occurrence of herpes simplex infection or the original hidden sexy. The episode of infection, at present, the vaccine against herpes simplex has entered the clinical trial stage.

Complication

Herpes simplex complications Complications herpes simplex virus infection neonatal fever jaundice neonatal hepatosplenomegaly consciousness disorder

Herpes simplex may cause a series of complications such as disseminated herpes, herpetic meningitis, spinal radiculopathy, and pelvic inflammatory disease. After bacterial infection, it can aggravate clinical symptoms. Herpetic keratitis is one of the common causes of blindness; genital herpes may cause psychogenic and organic sexual dysfunction in patients, and intrauterine infection can be caused by intrauterine infection. To premature birth, or congenital malformation.

Symptom

Herpes simplex symptoms Common symptoms Oropharynx blister-like damage Herpes labialis pharyngeal ulcer Oral ulcer mouth, eye, genital damage

1. The original hair style refers to the first infection of HSV, the general incubation period is 2 to 12 days, an average of 6 days, the clinical can have the following types:

(1) recessive or subclinical infection

(2) herpetic gingivitis: this type is the most common, more common in children 1 to 5 years old, occurs in the mouth, gums, tongue, hard palate, soft palate, pharynx and other parts, the lesions appear as clusters of small blister It will soon form a superficial ulcer, which can also be expressed as erythema, shallow ulcer, and obvious oral pain. It may be accompanied by fever, sore throat and local lymph node swelling. The course of disease is about 2 weeks.

(3) Neonatal herpes infection is generally caused by mothers with genital herpes, so neonatal herpes infection is mainly caused by HSV-2 subtype infection. Neonatal herpes infection mainly occurs in perinatal period, mostly in the mother's vagina. In the process of infection; or after the mother's pregnancy infection of herpes, the virus enters the uterine cavity through the cervix, resulting in intrauterine infection, intrauterine infection of the fetus can be premature birth, or various forms of congenital malformation at birth, or the body after birth Mental retardation, the so-called "TORCH" syndrome, which is named after toxoplasmosis ("T"). The other letters of the virus are abbreviated together with the English name, which is "TORCH", "TORCH" Syndrome is one of the important issues facing reproductive health medicine. See Cytomegalovirus infection for details.

Neonatal infection with herpes virus may be asymptomatic and concealed, and may also cause clinical manifestations of different forms or degrees. Light is only oral, skin, and eye herpes. In severe cases, it is a central nervous system infection or even a whole body. A sporadic infection.

The clinical manifestations of neonatal herpes simplex infection may be fever, jaundice, difficulty breathing, hepatosplenomegaly, bleeding tendency, convulsions, coma, and one third of these children have no skin herpes damage, so it may Misdiagnosed as neonatal sepsis or other diseases, the mortality rate can be as high as 95%, and survivors often have different degrees of sequelae.

(4) herpes eczema is the original chronic eczema, dermatitis and other chronic skin diseases, combined with herpes simplex virus infection and caused by the disease, easily misdiagnosed as the original eczema aggravation, eczema-like herpes is a varicella-like rash, The initial manifestation is small blisters on the skin, but it can be fused later, bleeding or pustules, and some of the blister can be umbilical-concave; with local lymphadenopathy and fever, may be due to secondary bacterial infection, or due to viral blood Scattered, involving brain tissue or other important organs, the disease is further deteriorated, and the mortality rate can reach 10% to 50%.

(5) vaccinated herpes simplex is more common in recurrent herpes or adult-onset herpes, which can occur in any part of the body, especially at the junction of the skin and mucous membranes. It is more common around the lips, mouth, and nostrils, so it is also called "Herpes rash", when the skin herpes starts, itchy local, followed by burning or stinging, congestion and redness, vesicles with large rice grains, several or dozens of clusters; blisters do not fuse with each other, but can appear at the same time Multi-cluster blister group, blister wall is thin, blister fluid is clear, short-term self-rupture, erosion, patients with primary herpes, especially traumatic skin herpes caused by invasion of obvious skin wounds, often accompanied by local lymph nodes Inflammation and fever, some can reach 39 ~ 40 ° C, but most of the disease is not heavy; 2 ~ 10 days after the disease, the skin is dry and crusted, the whole course of disease is 2 to 3 weeks, the lesions generally do not leave scars, there may be local Pigmentation, but it will gradually fade in a short period of time.

(6) HSV can also cause genital herpes and spread the disease.

2. Recurrence refers to the recurrence of the same part of the patient after the primary infection has subsided and is stimulated by the triggering factor.

Examine

Herpes simplex examination

The use of PCR technology for HSV gene detection can provide direct evidence of herpes simplex virus in patients; its sensitivity is high, and it can be detected within a few hours, which has become an important means for clinical diagnosis of HSV infection or poisoning; However, it must be carried out in an experimental medical laboratory that has passed the technical certification, and care should be taken to avoid contamination during the operation. In view of the fact that HSV-2 recessive infection may be a cause of male infertility, for the infertility clinic, PCR technology should be used to detect HSV as a routine for semen and cervical spleen screening.

Suspected and neonatal patients with intrauterine HSV infection, serum (can be collected cord blood or heel blood specimens) IgM-type HSV antibody test positive can be diagnosed, due to the high rate of HSV antibody detection in the adult population, most of the Self-hidden infection, and the presence of antibodies can not completely protect the body from repeated infections of herpesviruses; therefore, for adult cases, positive HSV antibody test is not helpful for clinical diagnosis; however, negative HSV antibody test can help to eliminate simple Herpes (if the subject has a defective immune response function, this is not the case).

Herpes simplex virus is easy to carry out in vitro cell culture and can produce visible cytopathic changes; therefore, cotton swabs can be used to sample cells in the lesion or to collect cerebrospinal fluid and other body fluid specimens for inoculation of cells, culture and isolation of viruses for diagnosis; and cell immunohistochemistry can be used. Immunofluorescence technique was used to detect herpes simplex virus antigen protein, or in situ hybridization technique to detect its genetic components, and further to classify HSV-1 and HSV-2. Viral cell culture identification is the gold standard for HSV diagnosis. However, its technical requirements are relatively high. High, so it is difficult to promote it in the clinic.

The early epidermis of histopathology is a multi-atrial blister with reticular degeneration, which is polymerized into a single atrial blister, with fibrin, inflammatory cells and balloon degeneration cells in the bleb, and basophilic inclusion bodies (late eosinophilic) in the nucleus. Patients with inflammatory cell infiltration of the dermis may have vasculitis changes.

Diagnosis

Diagnosis and diagnosis of herpes simplex

It is not difficult to diagnose the typical herpes lesions on the surface of the body. For patients with lesions only in the deep cavity, such as the genital tract, respiratory tract, and rectum, if it is neglected by a thorough and detailed physical examination, it may be misdiagnosed; Herpes is damaged, and the skin is not exposed to exposed areas such as herpes, such as herpetic encephalitis, clinically correct diagnosis is not easy, therefore, pay attention to collect epidemiological data: such as herpes patients contact history, high-risk groups (such as more Sexual intercourse), as well as a history of previous herpes, is important to suggest a diagnosis.

Differential diagnosis

1. Herpes zoster The peripheral nerves along one side of the body are distributed in a band shape. The skin lesions are a large number of clustered blisters, and herpes is arranged in a banded patch. The basal inflammation is obvious, often accompanied by significant neuralgia.

2. Impetigo occurs mostly in children, more common in summer and autumn, contact with strong contagious, large blister, there is a purplish secretion of honey yellow suede, scattered distribution.

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