Herpes simplex

Herpes simple (a synonym: herpes simple bubble) - a chronic relapsing disease, manifested by bubble rashes on the skin and mucous membranes. Along with skin changes in the pathological process, various organs and systems of the body can be involved.

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Causes of cold sores

The causative agent of the disease is the herpes simplex virus (HSV). It is predominantly a dermatotropic DNA-containing virus that also has tropism for some other tissues.

There are viruses of simple herpes of types I and II. Herpes simplex virus can be the causative agent of both genital and non-genital forms of the disease. Herpetic infection is transmitted mainly by contact (sexual contact, kiss, through household items). An airborne transmission path is also possible. The virus penetrates the body through the skin or mucous membranes, enters the regional lymph nodes, blood and internal organs. In the body it spreads hematogenously and along nerve fibers. Soon after infection, antibodies to the herpes simplex virus form in the body.

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Histopathology

There are ballooning and reticular dystrophy of the epidermis, acanthosis, acantholysis, intra-epidermal vesicles. Giant multinuclear keratinocytes have viral inclusions.

Symptoms of cold sores

Herpetic infection is characterized by a variety of clinical manifestations, localization, severity of the course. Depending on the course of the simple herpes are divided into primary and recurrent.

Primary herpes occurs after first contact with the herpes simplex virus. The disease occurs after the incubation period lasting from several days to 2 weeks.

Depending on the location of the skin-pathological process of HSV-infection are classified as follows:

• herpetic lesions of the skin and mucous membranes (herpes of the lips, wings of the nose, face, hands, stomatitis, gingivitis, pharyngitis, mucous membranes and skin of the penis, vulva, vagina, cervical canal, etc.);
• herpetic lesions of the eyes (conjunctivitis, keratitis, iridocyclitis, etc.);
• herpetic lesions of the nervous system (meningitis, encephalitis, neuritis, meningoencephalitis, etc.);
• generalized and visceral herpes (pneumonia, hepatitis, esophagitis, etc.).

Acute herpetic stomatitis is one of the most common clinical manifestations of primary infection. The disease occurs often in young children. The incubation period is from up to 8 days, then the grouped painful blister rashes appear on the edematous-hyperemic base. General clinical symptoms of the disease are observed: chills, high body temperature, headache, general malaise. Bubbles in the oral cavity are more often localized on the mucous membrane of the cheeks, gums, the inner surface of the lips, tongue, less often - on the soft and hard palate, palatine arches and tonsils. They quickly burst, forming erosion with the remains of exfoliated epithelium. At the lesion sites, hardly noticeable point erosions are formed, and when they merge - foci with scalloped contours on a swollen background. There is a sharp increase and soreness of regional lymph nodes (submandibular and submandibular).

In clinical practice, a recurrent form of primary herpes is common. In comparison with primary herpes, the intensity and duration of clinical manifestations of relapses are less pronounced and the antibody titer is practically unchanged with recurrent herpes.

The process is most often located on the face, conjunctiva, cornea, genitalia and buttocks.

Usually after the prodromal phenomena (burning, tingling, pruritus or others), grouped vesicles of 1.5-2 mm appear appearing on the background of erythema. The rash is often located in single foci, consisting of 3-5 merging vesicles. As a result of traumatization and maceration the bubble cover is destroyed, forming slightly painful erosions with scalloped contours. Their bottom is soft, smooth, reddish, the surface is moist. In the case of secondary infection, purulent discharge, consolidation of the erosion base (or ulcers) and the appearance of the inflammatory rim are noted, which is accompanied by an increase and soreness of the regional lymph nodes. Over time, the contents of the bubbles are poured into brownish-yellowish crusts, after the fall of which appear slowly disappearing secondary reddish-brownish spots. Primary herpes differs from recurrent with a sharp increase in the level of antibodies in the blood serum.

Atypical forms of herpes simplex

There are several atypical forms of herpes simplex: abortive, edematic, zosteriformnuyu, hemorrhagic, elefantiazopodnuyu, ulcerative-necrotic.

The abortive form is characterized by the development of erythema and edema without the formation of vesicles. This form of infection includes cases of the appearance of subjective sensations characteristic for herpes in places of usual localization in the form of pain and burning, but without the appearance of a rash.

The oedemas form differs from the typical sharp edema of the subcutaneous tissue and skin flushing (more often on the scrotum, lips, eyelids), vesicles may be absent altogether.

Zosteriform simple herpes in connection with the localization of rashes along the nerve trunks (on the face, trunk, extremities) resembles herpes zoster, the pain syndrome is less pronounced.

Hemorrhagic form is characterized by hemorrhagic contents of vesicles instead of serous, often with the subsequent development of ulceration.

The ulcerative-necrotic form develops with a pronounced immune deficit. On the skin ulcers are formed, extensive ulcerous surfaces with a necrotic bottom and serous-hemorrhagic or purulent discharge are sometimes covered with crusts. The reverse development of the pathological process with rejection of crusts, epithelization and scarring of ulcers occurs very slowly.

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Serology

The most modern diagnostic method is a polymerase chain reaction (PCR) for the detection / detection of HSV antibodies.

Herpes simplex treatment

The main objectives of antiherpetic therapy are:

• a decrease in the severity or a decrease in the duration of such symptoms as itching, pain, fever, lymphadenopathy;
• decrease in the duration and severity of virus isolation in the lesions;
• reduction of the period of complete healing of lesions;
• decrease in the frequency and severity of relapses;
• Elimination of infection to prevent relapse.

The effect can be achieved only if treatment with chemotherapy drugs is started within the first 24 hours after the primary infection, which will prevent the virus from becoming latent.

The main basic treatment is the use of antiviral drugs (acyclovir, valtrex, famciclovir). The mechanism of action of acyclovir is based on the interaction of synthetic nucleosides with replicative enzymes of herpesviruses, their inhibition and suppression of individual parts of virus reproduction.

Thymidine kinase of herpesvirus is a thousand times faster than the cellular one, it binds to acyclovir, so the drug accumulates practically only in infected cells.

Acyclovir (ukaril, herpevir, vorraks) is administered orally 200 mg 5 times a day for 7-10 days or 400 mg 3 times a day for 7-10 days. When relapsing form, it is recommended to 400 mg 5 times a day or 800 mg twice a day for 5 days or to appoint valtrex 500 mg 2 times a day for 5 days. Acyclovir and its analogues are also recommended for pregnant women as a therapeutic and preventive agent for neonatal infection. Treatment of recurrent herpes simplex is more rationally performed in combination with leukocyte human interferon (for a course of 3-5 injections) or inductors of endogenous interferon. In the inter-recurrent period, repeated cycles of antiherpetic vaccine are shown, which are intradermally injected into 0.2 ml 2-3 days per cycle - 5 injections. Cycles are repeated at least twice a year.

With the expressed suppression of the T-cell link of immunity, it is necessary to appoint immunotropic drugs (immunomodulin, thymalin, tactivin, etc.). Proteflasitis simultaneously possesses antiviral (suppresses DNA polymerase and thymidine kinase of the virus) and immunocorrecting property. The drug is used on 20 drops 2 times a day for 25 days.

External with herpetic infection use 0.25-0.5% banaflopovuyu,% tebrafenovuyu, 0.25-3% oxalic, 0.25% rhyodoxal ointment, which are applied to the lesion 4-6 times per day for 7-10 days. A good effect is noted from topical application of acyclovir (2.5 and 5% ointment) for 7 days.