بسم الله الرحمن الرحيم

VIRAL INFECTIONS

Herpes simplex. Herpes zoster. Warts. Molluscum contagiosum. Small pox / Chicken pox. Measles / German measles. AIDS / Infectious mononucleosis. Roseola infantum / Kaposi sarcoma. Hand, foot & mouth disease. Herpangina / Erythema Infectiosum (5th disease). Orf / Burkitt’s lymphoma.

Herpes Simplex (HS) Cause: HSV. Types: I & II. Incidence: Commonest. Sites: Skin & mucous membranes. Transmission: Skin-to-skin or skin-to-MM. IP: 3-5 days.

Predisposing factors: Pathogenesis: Invades mucosal surface or traumatized skin Replication Primary infection Neural tissue (Dorsal root ganglia) Reactivation Recurrence Predisposing factors: Fever / Fatigue / Food. Trauma / UV /Stress . Menstruation / Altered immune state.

Oral mucosa: 1ry Herpetic gingivostomatitis Age: 1-5 years. Subclinical: 90 %. Clinically apparent: Tongue, pharynx, palate, buccal mucosa & surrounding skin. Accompanied by: Fever, sore throat, malaise, loss of appetite and lymphadenopathy Fever subsides after 3-5 days Recovery after 2 weeks. Recurrence: Lips or face / Oral mucosa.

The lips: Recurrence of primary Age: Over 5 years. C/P: Unilateral or bilateral and symmetrical One week No scarring if secondary infection does not occur. Regional LNs: Enlarged if secondary infection. The face: Recurrence of primary C/P: Around orifices & on cheeks.

The genitals: Sex: Both sexes. Common cause of: Genital ulceration. Males: Glans & shaft of penis + Urethritis. Females: Labia, vulva, vagina, perineum & cervix. C/P: Local or radiating pain may precede the lesions by 24 hours Intact vesicles Recurrent, irregular, superficial, grouped, soft ulcers Lymphadenopathy. Recurrent infection: Less severe.

Complications: Serious neonatal infection. *Neonatal herpes simplex: Passage of fetus through birth canal Infection Fatal CS.

Diagnosis: Complications: C/P. Tzanck smear. Viral culture. Serological test. PCR. Complications: Impetigo. Eczema herpeticum. EM. Keratitis and corneal ulcers. Encephalitis & meningitis.

Treatment: Avoid precipitating factors if possible I) Local ttt: Mild cases a) Drying, soothing antiseptic lotions: Boric acid lotion / KMNO4 / Aluminum acetate lotion 10 %. b) Topical antivirals: Acyclovir cream / Pencyclovir cream. c) Topical antibiotics. d) Idoxuridine (IDU). II) Systemic ttt: Severe cases a) Acyclovir. b) Valacyclovir. c) Famcyclovir.

Herpes Zoster (HZ) Cause: VZV. Sex: Both sexes. Age: Any age, more in adults.

Pathogenesis: Recurrence 1ry is chickenpox Virus in dorsal nerve roots & dorsal root ganglia Reactivation Nerves Recurrence. Predisposing factors: Trauma. Drugs. Diseases of the spine. Malignant diseases.

C/P: Pain Chest: 50 %. Face: Eye involvement. Unilateral grouped vesicles on erythematous base along distribution of a sensory nerve Local lymph nodes Vesicles dry up Recovery after 2-4 weeks May leave scars Permanent immunity

Clinical types: Complications: Ordinary vesicular type. Bullous type. Haemorrhagic type. Gangrenous type. Abortive type. Generalized type. Complications: Secondary infections. Post-herpetic neuralgia. Nervous system Eye: HZ ophthalmicus.

Treatment: General ttt: Bed rest. Ophthalmology consultation. Local ttt: Antiseptic drying lotions: In vesicular stage. Topical antibiotic ointments: In healing stage. Systemic ttt: Analgesics. Antibiotics. Systemic acyclovir.

Warts (Verrucae) Cause: HPV. Types: 50. Age: Children & young adults. Sex: Both sexes. Transmission: Direct / Indirect / Autoinoculation. IP: 1-6 months. Involution: 2/3 of lesions within 2 years.

Types: Common warts (Verruca Vulgaris): Plane warts (Verruca Plana): Hands & fingers. Asymptomatic / Skin-colored or darker / Firm / Rough hyperkeratotic mamillated surface. Spread. Plane warts (Verruca Plana): Face, neck, forearms & hands. Asymptomatic / Skin-colored or darker / Flat-topped / Smooth & slightly elevated. Koebner’s phenomenon. Filliform warts (Verruca Filiformis): Sides of the neck and eyelids. Long, thin thread-like skin growths. Finger-like processes (Digitate warts).

Plantar warts (Verruca Plantaris): Soles of the feet. Painful & tender / Black / Thick / Flattened & deeply embedded. Against pressure points. Venereal warts (Condyloma Accuminata): Skin and mucous membranes of genital organs of males & females. Painless / Pinkish / Soft / Moist, foul-smelling & bleed easily. Differentiated from Condyloma lata.

Complications: Spread: To same patient or to others. Malignancy: HPV 6, 16 and 18.

Treatment: Electric cautery. Cryocautery. Chemical cautery: Carbolic acid / Glacial acetic acid / TCA / Salicylic acid / Cantharidin Podophyllin resin: 25 % in alcohol or paraffin. Autosuggestion & hypnosis. Surgical excision.

Molluscum Contagiosum Cause: Pox virus. Transmission: Direct & indirect. IP: 2-6 weeks. C/P: Shiny, pearly white, dome-shaped, sessile papules with a smooth surface and central umbilication. *Squeezing the lesion White cheesy material. Sites: Face & neck: In children and young adults. Genitals, lower abdomen & thighs: STD.

Treatment: Electric cautery. Cryocautery. Chemical cautery. Laser treatment.

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