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Herpes simplex (herpes infection): symptoms
Last reviewed: 23.04.2024
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The conventional clinical classification of herpes simplex (herpetic infection) is absent. Distinguish the congenital and acquired herpetic infection, the latter is divided into primary and recurrent. Depending on the localization of the pathological process, herpetic lesions of the mucous membranes, skin, eyes, nervous system, internal organs, genitalia, generalized herpes are isolated.
The course and symptoms of herpes simplex (herpetic infection) depend on the localization of the process, the age of the patient, the immune status and the antigenic variant of the virus. Primary infection is often accompanied by systemic signs. In this case, both mucous membranes and other tissues are affected. With the primary infection, the duration of clinical manifestations and the period of virus isolation are greater than when relapses. Viruses of both subtypes can cause damage to the genital tract, oral mucosa, skin, nervous system. Symptoms of herpes simplex (herpetic infection) caused by HSV-1 or HSV-2 are indistinguishable. Reactivation of infection of the genital tract caused by HSV-2 occurs twice as often, and relapses - in S-10 times more often than with lesions of the genital tract HSV-1. Conversely, relapses of the oral cavity and skin lesions with HSV-1 infection occur more often than with HSV-2 infection,
Congenital herpetic infection is observed when pregnant women have active clinical manifestations of the disease, accompanied by viremia. Depending on the timing of infection, it is possible to form various malformations of the fetus (microcephaly, microphthalmia, chorioretinitis, intrauterine death) or the death of a newborn in clinical manifestations of generalized herpetic infection.
Acquired herpetic infection is possible in newborns with infection during passage through the birth canal, and then at different periods of life, more often in childhood. The earlier the infection occurs, the more severe the disease, but also the asymptomatic infection is possible (antibodies to HSV-1 are determined in the serum of 60% of children under the age of 6 years).
The incubation period with primary herpetic infection is 5-10 days (fluctuations from 1 to 30 days are possible).
Herpetic infection of mucous membranes and skin
Viral pharyngitis and stomatitis are observed more often in children and young people. The disease is accompanied by fever, chills, malaise, ezdrazhitelnostyu, myalgia. Difficulty in eating, hypersalivation. The submaxillary and cervical lymph nodes increase and become painful. On the mucous membrane cheeks, gums, the inner surface of the lips. Less often the tongue, soft and hard palate, palatine arches and tonsils appear grouped vesicles, after the opening of which painful erosions are formed. Duration of the disease - from a few days to two weeks.
Herpetic lesions of the pharynx usually lead to exudative or ulcerative changes in its posterior wall and / or tonsils. In 30% of cases, the tongue, the mucous membrane of the cheeks and gums can be affected simultaneously. The duration of fever and cervical lymphadenopathy is from 2 to 7 days. In persons with immunodeficiency, the virus can spread deep into the mucous membrane and into the underlying tissues, leading to loosening, necrosis, bleeding, ulceration, which is accompanied by severe pain, especially when chewing.
With a herpetic lesion of the skin, there is local burning, itching of the skin, then there is swelling and hyperemia, against which are formed rounded grouped vesicles with transparent contents, which then becomes turbid. Vesicles can be opened with the formation of erosions, crusted, or shriveled, also covering with a crust, after falling off which is found epithelialized surface. Duration of the disease is 7-14 days. Favorite location - lips, nose, cheeks. Possible disseminated forms with the localization of rashes in remote areas of the skin.
Acute respiratory diseases
Herpes simplex virus can cause diseases resembling ARVI - the so-called herpetic fever, which is characterized by an acute onset, severe temperature reaction, chills and other symptoms of intoxication. Catarrhal phenomena in the nasopharynx are poorly expressed. Coughing is possible due to dryness of mucous membranes, moderate hyperemia of the arch and soft palate. This symptomatology persists for several days. Typical symptoms of herpes simplex (herpetic infection), namely, rashes are not always observed in the early days of the disease, and may join on the 3-5th day from the onset of a febrile period or absent.
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Herpetic infection of the eyes
Herpetic lesions of the eyes can be primary and relapsing. It often develops in men under the age of 40 years. This is one of the most common causes of corneal blindness. Clinically distinguish between superficial and deep lesions. To superficial are herpetic keratoconjunctivitis, dendritic keratitis, herpetic marginal corneal ulcer; to deep - diskoid keratitis, deep keratoitis, parenchymal uveitis, parenchymal keratitis.
Herpetic infection of the nervous system
In the etiological structure of viral encephalitis (meningoencephalitis), about 20% falls on the proportion of herpetic infection. Mostly patients are aged 5-30 years and over 50 years old. The incidence is 2-3 per 1,000,000 (US data), the incidence is uniform throughout the year. Herpetic meningoencephalitis in 95% of cases is caused by HSV-1.
The pathogenesis of herpetic encephalitis is different. In children and young people, primary infection can manifest with encephalomyelitis. It is suggested that the exogenously trapped virus penetrates the central nervous system, spreading from the periphery through the olfactory bulb. Most of the adults first have clinical signs of generalized infection, in some cases, damage to the mucous membranes and skin, and then defeat the central nervous system, that is, the CNS virus can penetrate hematogenically.
The onset of the disease is always acute, with an increase in body temperature to high digits. Patients complain of malaise, persistent headache. A third of patients in the first days of the disease may have a moderate respiratory-catarrhal syndrome. Herpetic exanthema, stomatitis rarely occur. In 2-3 days the patients' condition sharply and progressively worsens due to the development of neurological symptoms. The consciousness is being depressed, the meningeal syndrome develops, generalized or focal tonic-clonic convulsions appear, repeated many times during the day. General cerebral symptoms of herpes simplex (herpetic infection) are combined with focal manifestations (disruption of cortical functions, lesion of cranial nerves, hemiparesis, paralysis). The further course of the disease is unfavorable, after several days a coma develops. During the entire disease, the body temperature remains high, the fever is incorrect. In the absence of antiviral therapy, lethality reaches 50-80%.
A characteristic feature of herpetic encephalitis is the defeat of the temporal lobe on one or both sides, which is manifested by personality changes with a decrease in intellectual functions and mental disorders.
An investigation of the cerebrospinal fluid reveals lymphocytic or mixed pleocytosis. An increase in the protein level, xanthochromia and the appearance of an impurity of erythrocytes. EEG changes are possible. With MRI of the brain, foci of lesion are detected with predominance of changes in the anterior sections of the temporal lobes with predominant involvement of the cortex. MRI in herpetic encephalitis has a significant advantage over CT, as it allows you to visualize brain damage in the first week of the disease.
Possible atypical manifestations of herpetic encephalitis with brainstem and subcortical lesions, abortive course of the disease, chronic and recurrent course of herpetic encephalitis as a slow infection of the central nervous system.
Another form of lesion of the central nervous system of a herpetic nature is serous meningitis. Serous meningitis most often causes HSV-2. Usually the disease develops in persons suffering from genital herpes. The proportion of herpes simplex virus infection among viral meningitis does not exceed 3%.
Clinically, meningitis is characterized by acute onset, headache, fever, photophobia, and meningeal symptoms. In the study of cerebrospinal fluid, pleocytosis is observed from 10 to 1000 cells per ml (on average 300-400) of a lymphocytic or mixed character. Clinical symptoms persist for about a week, then disappear on their own without neurological complications. Relapses are possible.
Another common form of the defeat of the nervous system by the herpes simplex virus-2 is the syndrome of radiculomyelopathy. Clinically, it manifests itself by numbness, parasthesia, pain in the buttocks, perineum or lower extremities, pelvic disorders. Perhaps the emergence of pleocytosis, increasing protein concentration and lowering glucose in the cerebrospinal fluid. There is evidence of the isolation of HSV-1 from spinal cord fluid in patients with cervical and lumbar radiculitis. A hypothesis was confirmed that HSV-1 was associated with facial nerve damage (Bell's paralysis).
Herpetic infection of internal organs
Herpetic lesions of the internal organs are the result of viremia. Several organs are involved in the process, less isolated lesions of the liver, lungs, esophagus develop less often. Herpetic esophagitis may result from the direct spread of the infection from the oropharynx into the esophagus or due to the reactivation of the virus. In this case, the virus reaches the mucous membrane along the vagus nerve. Dominant symptoms of esophagitis: dysphagia, retrosternal pain and weight loss. When esophagoscopy is detected, multiple oval ulcers on the erythematous base. The distal part is more often affected, but as the process spreads, diffuse loosening of the mucosa of the entire esophagus occurs.
In persons who have undergone bone marrow transplantation, in 6-8% of cases, the development of interstitial pneumonia is possible, which is proved by the results of biopsy and autopsy. Mortality from herpetic pneumonia in patients with immunosuppression is high (80%).
Herpetic hepatitis often develops in people with immunodeficiency, with increased body temperature, jaundice, increased bilirubin concentration and aminotransferase activity in the blood serum. Sometimes signs of hepatitis are combined with manifestations of thrombohemorrhagic syndrome.
Herpetic infection of the genitals
Genital herpes is more often caused by HSV-2. May be primary or recurrent. Typical rashes are localized in men on the skin and mucous membrane of the penis, in women - in the urethra, on the clitoris, in the vagina.
Possible rashes on the skin of the perineum, the inner surface of the hips.
Vesicles, erosions, ulcers are formed. There is hyperemia, swelling of soft tissues, local soreness, dysuria. May be painful in the lower back, in the sacrum, in the lower abdomen, in the perineum. Part of the patients, especially with the primary herpetic infection, have inguinal or femoral lymphadenitis. There is a relationship between the frequency of genital herpes and cervical cancer in women, prostate cancer in men. In women, relapses occur before the onset of menstruation.
Generalized herpetic infection
Generalized herpetic infection develops in newborns and in persons with severe immune deficiency (with hematological diseases, long-term use of glucocorticoids, cytostatics, immunosuppressants, and HIV infection). The disease begins acutely, it proceeds hard with the defeat of many organs and systems. Characterized by high fever, widespread skin and mucous membrane damage, dyspeptic syndrome, CNS damage, hepatitis, pneumonia. Without the use of modern antiviral drugs, the disease in most cases ends lethal.
Generalized forms of the disease include Keposi's herpetiform sarcoma, which is observed in children suffering from exudative diathesis, neurodermatitis or eczema. It is characterized by severe intoxication, abundant rashes on the skin, especially in the areas of its previous lesions. Rashes spread to the mucous membranes. The content of the vesicles rapidly becomes turbid, they often merge with each other. A lethal outcome is possible.
Herpes infection in HIV-infected
Herpetic infection in HIV-infected patients usually develops as a result of activation of a latent infection, and the disease quickly acquires a generalized character. Signs of generalization - the spread of the virus from the mucous membrane of the oral cavity to the mucosa of the esophagus, the appearance of chorioretinitis. Skin lesions in HIV-infected people are more extensive and profound with the formation not only of erosion, but also of ulcers. Reparative processes occur extremely sluggishly, characterized by prolonged non-healing of ulcers and erosions. Significantly increases the number of relapses.