Page 186 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 6-11 Integumentary System

LESIONS OF HERPES SIMPLEX (CONTINUED)

HERPES SIMPLEX VIRUS
(Continued)

Recurrent episodes of genital herpes produce a
milder version of the primary infection. The systemic Ulcerative lesions of genitalia
constitutional symptoms are often absent, but the seen in chronic HSV and during
grouped vesicles and ulcers can cause excruciating pain healing of vesicular stage
and social stigma. The frequency and severity of recur-
rent episodes in an individual patient are variable and
impossible to predict. A generalization can be made that
those who have more severe primary infections tend to
have more relentless recurrences.
Herpetic whitlow is the name given to a specific form
of infection that is most commonly seen in medical
laboratory workers and health care providers. It occurs
from accidental inoculation of the herpesvirus into the
skin. The finger is the area most commonly involved,
because of accidental needle sticks. A painful primary
viral infection may occur at the site of inoculation.
Eczema herpeticum, Kaposi’s varicelliform eruption,
is often encountered in a young child with severe atopic
dermatitis who is exposed to the herpesvirus. Because
of the widespread skin disease, the virus is able to infect
a large surface area of the body. This results in extensive
skin involvement with multiple vesicles and punched-
out ulcerations.
The transmission of HSV from mother to child Herpes progenitalis
during the birthing process is of significant concern,
and mothers with active HSV disease at the time of
delivery most likely should undergo cesarean section to Tender grouped vesicles on a red base
help decrease the risk of transmission. Neonatal HSV
infection is a life-threatening disease. The neonate may
have widespread multiorgan disease, with CNS involve-
ment being the major cause of morbidity and mortality. Vesicles
Temporal lobe involvement can lead to seizures,
encephalitis, and death. The skin is always infected, and
this is a clue for the clinician to search for other organ
system involvement, especially involvement of the CNS
and the eye. Ocular infection can lead to severe corneal
scarring and blindness. Ruptured vesicle
HSV encephalitis is a life-threatening disease that causing a thin
causes a necrotizing encephalitis. Patients complain of erosion
an acute onset of fever and headache, with rapidly
evolving seizures and focal neurological deficits.
Without treatment, coma and death occur in three
quarters of affected patients. The temporal lobes and
insula are almost always affected. Prompt recognition
and therapy have decreased the mortality rate to 1 in 4.
A Tzanck preparation is a long-used bedside proce-
dure that takes only a few minutes to perform and is
positive in cases of HSV1, HSV2, or varicella-zoster
virus (VZV) infection. The procedure does not differ- Herpes genitalis. Regional adenoopathy is often appreciated.
entiate among the three viruses. However, HSV infec-
tion can be distinguished from varicella clinically. The
procedure is done by unroofing a vesicle and scraping
its base with a no. 15 blade scalpel. The scrapings are Rapid immunostaining is available and can be used sample fluoresces with one of the specific viral stains.
placed on a glass slide and allowed to air dry for 1 to 2 with high sensitivity and specificity to diagnose and This test takes 1 to 2 hours to perform.
minutes. A blue stain such as Giemsa or toluidine blue differentiate the various herpesvirus types. This form Viral tissue cultures can also be performed to dif-
is applied for 60 seconds and then gently rinsed off. The of direct fluorescent antibody (DFA) testing is similar ferentiate the HSV types, but the results can take days
slide is dried, mineral oil is applied, and the preparation to the Tzanck preparation. As in the Tzanck prepara- to 1 week to obtain. This is the most sensitive and
is covered with a microscope cover slip. It is then ready tion, scrapings of the blister base are placed on a glass specific test for the infection.
to be viewed. Multinucleated giant cells are readily seen microscope slide. The slide is stained with antibodies Histology: Examination of a biopsy specimen of a
throughout the sample, confirming the viral etiology of corresponding to the various herpesviruses. The sample blister shows ballooning degeneration of the epidermal
the blister. is viewed under fluorescent microscopy, and a positive keratinocytes. This degeneration forms the blister

172 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS