Herpes simplex in children

Simple herpes is clinically manifested by the defeat of many organs and tissues, accompanied by the emergence of grouped bubble rashes on the skin and mucous membranes. Has a tendency to long latent flow with periodic relapses.

ICD-10 code

• 800.0 Herpetic eczema (sighting of Kaposi).
• 800.1 Herpetic vesicular dermatitis.
• 800.2 Herpetic gingivostomatitis and pharyngotongzillitis.
• 800.3 Herpetic meningitis.
• 800.4 Herpetic encephalitis (herpetic meningoencephalitis, monkey disease B).
• 800.5 Herpetic eye disease.
• 800.7 Disseminated herpetic disease (septicemia due to herpes simplex virus).
• 800.8 Other forms of herpetic infections (herpetic hepatitis, purulent inflammation of the flesh of the distal phalanx of the finger).
• 800.9 Herpetic infections, unspecified.

Epidemiology

Epidemiology

The infection is widespread. Infection occurs during the first three years of life. Children of the first half of life are not affected by herpes simplex due to the presence of specific IgG antibodies obtained transplacentally from the mother. In the absence of immunity in the mother, the children of the first months of life in the case of infection are particularly ill - there are generalized forms. Practically 70-90% of children of 3 years of age have a sufficiently high titer of virus neutralizing antibodies against the herpes simplex virus (HSV). From the age of 5-7, the number of children with a high level of antibodies and HSV2 increases.

The source of infection is sick and virus carriers. Transmission is carried out by contact, sexual and airborne droplets. Infection occurs when kissing through saliva, as well as through toys, household items, infected with saliva of the patient or virus carrier.

A transplacental route of transmission is possible, but especially often the infection of the child occurs during the passage of the birth canal.

Usually there are sporadic cases of diseases, but in organized collectives and especially among weakened children, small epidemics can occur in hospitals, more often in winter.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

Causes of the herpes simplex

The causes of herpes simplex in children

Herpes simplex virus - a DNA-containing virus with a diameter of 120 to 150 nm, multiplies well in the tissues of a chicken embryo. In infected cells it forms intranuclear inclusions and giant cells, exerts a pronounced cytopathic effect, manifested in rounding and formation of multinucleated giant cells. There are HSV1 and HSV2. The first group is associated with the most common forms of the disease - damage to the skin of the face and mucous membranes of the mouth. Viruses of the second group often cause damage to the genital organs, as well as meningoencephalitis. Infection with one type of herpes simplex virus does not prevent the onset of infection caused by the herpes simplex virus of another type.

What causes herpes simplex?

Symptoms of the herpes simplex

Symptoms of herpes simplex in children

The most common clinical manifestation of herpes simplex is acute stomatitis or gingivostomatitis. It is observed in children of any age, but more often at the age of 2-3 years. After the incubation period (from 1 to 8 days), the disease begins acutely, with the rise in body temperature to 39-40 ° C, the appearance of chills, anxiety, general malaise, refusal to eat due to sharp soreness in the mouth. They note increased salivation, smell from the mouth. In young children, weight loss is reduced, intestinal disorders and slight dehydration are possible. The mucous membrane of the oral cavity is brightly hyperemic, edematous. On the mucous membrane of the cheeks, gums, tongue, inner surface of the lips, on the soft and hard palate, palatine arches and tonsils - herpetic eruptions in the form of vesicles, elements 2-10 mm in diameter, first with clear, and then yellowish contents. They quickly open, forming erosion with the remains of exfoliated epithelium. Regional lymph nodes are always enlarged, becoming painful on palpation. The disease lasts 1-2 weeks. The body temperature is normalized by 3-5 days. In some cases, the disease recurs.

Symptoms of simple herpes

Forms

Classification of herpes simplex in children

Depending on the localization of the pathological process, distinguish:

• defeat of the mucous membranes (gingivitis, stomatitis, tonsillitis, etc.);
• eye damage (conjunctivitis, blepharoconjunctivitis, keratitis, keratoiridocyclitis, chorioretinitis, uveitis, retinal perivascular, optic neuritis);
• damage to the skin (herpes of the lips, nose, eyelids, face, hands and other skin areas);
• herpetic eczema;
• genital herpes (lesion of the penis, vulva, vagina, cervical canal, perineum, urethra, endometrium);
• defeat of the central nervous system (encephalitis, meningoencephalitis, neuritis, etc.);
• visceral forms (hepatitis, pneumonia, etc.).

In the formulation of the diagnosis should also indicate the prevalence of lesions (localized, common or generalized simple herpes). The course of the disease can be acute, abortive and relapsing. In any case, after the elimination of clinical manifestations, in spite of the formation of specific antibodies, the herpes virus remains in the body in a latent state for life and under adverse conditions can again manifest itself in the same place as initially, or affect other organs and systems.

Examples of the formulation of the diagnosis: "Simple herpes localized, facial skin lesions, acute course"; "Simple herpes common, defeat of the mucous membranes of the mouth, nose, genital organs, recurrent course"; "Herpes simplex generalized. The defeat of the liver, lungs, acute current. "

[14], [15], [16], [17], [18], [19]

Diagnostics of the herpes simplex

Diagnosis of herpes simplex in children

Simple herpes is diagnosed by typical grouping of bubble rashes on the skin or mucous membranes, often recurrent. For laboratory confirmation of the diagnosis, it is crucial to detect the virus in the contents of vesicles, skin ulcers, blood, cerebrospinal fluid by PCR. Serological methods are less informative, except for the definition of specific IgM. For the diagnosis of recurrent herpes, the detection of high IgG titres or the increase in titer in the course of the disease is of particular importance. Simple herpes is differentiated with herpes zoster, enterovirus infection, accompanied by herpetic rashes on the mucous membranes of the mouth, adenovirus keratoconjunctivitis, vaccinal eczema.

[20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]

Treatment of the herpes simplex

Treatment of herpes simplex in children

With localized lesions of the skin and mucous membranes, it is shown topically to apply acyclovir ointment, liniment 5% cycloferon and other antiviral drugs. Effective interferon in the form of ointments, lotions, rinses, installations. Affected areas of the skin and mucous membranes are treated with 1-2% alcohol solution of brilliant green, 1-3% alcohol solution of methylene blue. A good sanitizing effect with herpetic stomatitis has a 3% hydrogen peroxide solution (treated with the mouth cavity, gums). Locally used painkillers (anesthesin, lidocaine), allowing you to eliminate pain and make it possible to feed the baby.

Treatment of herpes simplex

Prevention

Prevention of herpes simplex in children

Of great importance are the tempering of children and the formation of general hygiene skills. Eliminate the factors contributing to exacerbation of the disease (exercise, ultraviolet rays, other stressful effects). Since children are most often infected through saliva with a kiss of parents with clinically pronounced herpes, great importance is paid to sanitary and educational work. It is especially important to protect children suffering from eczema and damp forms of atopic dermatitis. Newborns in contact with patients with herpes should be isolated. A mother with manifestations of herpes on the skin and mucous membranes should wear a surgical mask while communicating with the child, she can not be pressed or kissed a newborn until the crusts completely fall off and the erosions heal. You can allow breastfeeding if there are no lesions on the chest.

How to prevent herpes simplex?