Page 185 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 6-10 Infectious Diseases

LESIONS OF HERPES SIMPLEX

HERPES SIMPLEX VIRUS

Regional tender
Herpes simplex virus type 1 (HSV1) and type 2 lymphadenopathy
(HSV2) are the two viruses that are responsible for is commonly seen
the pro duction of both mucocutaneous and systemic in genital herpes.
disease. Mucocutaneous disease is overwhelmingly
more common than systemic disease such as HSV
encephalitis. HSV infections are ubiquitous in humans,
and almost all adults develop antibodies against one
of these viruses. Most infections are subclinical or so
mild that they are never recognized by the patient.
HSV infections are predominantly oral or genital. The
virus becomes latent in local nerves and can be reacti-
vated to produce future outbreaks. Currently, there
are eight known herpesviruses that infect humans,
including HSV1 and HSV2. HSV infections can
cause severe, life-threatening central nervous system
(CNS) disease in immunocompromised patients
and in neonates. Many unique cutaneous forms of
HSV have been described with their own clinical
characteristics.
Clinical Findings: HSV can be spread from infected
to uninfected individuals by close contact (e.g., kissing,
sexual contact). The virus is shed from the infected host
both when active lesions are present and when no clinical
evidence of disease can be seen. It is believed that sub-
clinical shedding of the virus is responsible for a great
deal of transmission. HSV can cause oral labial disease
(gingivostomatitis or herpes labialis) or genital disease,
the main mucocutaneous forms of the disease. Most
cases of oral labial disease are caused by HSV1, and
genital disease is caused predominantly by HSV2. This
is not always the case, and one can no longer assume the
viral type from the clinical location of disease. HSV
infections in other areas are becoming more common,
and recurrent bouts of disease on the buttocks is one of Marked edema and vesicle Autoinoculation lesions
the most frequently seen presentations. formation in primary herpes
The initial HSV infection can be subclinical, mild,
or severe. Subsequent reactivation of the virus typically Grouped vesiculopustules
never approaches the severity seen in the initial primary on a tender red base
infection. The exception occurs with immunosup- Primary HSV disease is almost
pressed patients, in whom a widespread or chronic always more severe than
localized version of the infection may occur. Primary reactivation of HSV.
infection manifests with severe, painful mucocutaneous
blistering and erosions. Primary oral labial herpes can
lead to weight loss, fever, gingivitis, and pain. This is
most commonly seen in children and is associated with
tender cervical adenopathy. The infection spontane-
ously resolves within 2 to 3 weeks. If treated, the disease
may be slightly decreased in length and severity, but this
is highly dependent on the timing of diagnosis and
initiation of therapy.
Herpes labialis is the term given to recurrent episodes
of oral labial herpes. The episodes are milder than the
primary infection and often start with a prodrome.
Most patients complain of a tingling or painful sensa-
tion hours to a day before the appearance of herpes
labialis. Patients can use this knowledge to their advan-
tage and begin antiviral therapy at the first indication Herpes infection of the genital region is spread by grouped vesciulopustules on an erythematous base.
of recurrence to decrease the severity of the episode or sexual contact and is one of the most common of all They are extremely tender and easily rupture to form
abort it all together. Herpes labialis, also known as a sexually transmitted diseases. Initial episodes of genital shallow ulcerations that appear “punched out” with an
cold sore, appears as a vesicle or bulla that quickly herpes infection manifest with fever, adenopathy, and overlying serous crust. The cervix is often involved, and
breaks down and forms an erosion and crusted papule painful ulcerations and blistering of the affected region. scarring can occur. Genital herpes infection almost
or plaque. The lesions last for a few days to 1 week and The primary episode is always more severe than subse- universally causes dysuria and inguinal adenopathy that
can cause significant psychological issues. quent reactivations of the virus. The ulcerations are is tender.

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 171