In the name of god

Herpes simplex Herpes simplex virus HSV1 HSV2 HSV1: cause a majority of cases of oral and pharyngeal infection, meningoencephalitis and dermatitis above the waist HSV2: is implicated in most genital infections

Primary herpes simplex virus infections Primary HSV infection occurs in patient who do not have immunity resulting from previous contact with the virus The majority of oral HSV infections is caused by HSV1, but primary oral HSV infections may also occur chiefly result of oral-genital contact Infection of the finger (herpetic whitlows) of health professionals may occur during treatment of infected patients.

During the first 6 months: are protected Newborn After 6 month of age : incidence of primary HSV1 infection increases Between 2 and 3 years of age: incidence of primary HSV1 infection reaches a peak

Incidence of primary HSV2 infection dose not increase until the age when sexual activity begins The incidence of primary herpes infection has been shown to vary according to socioeconomic group

Clinical manifestations History of generalized prodromal symptoms that precede the local lesions bye 1 or 2 days. These generalized symptoms include fever, headache, malaise, nausea, and vomiting. A negative past history of recurrent herpes labialis. A positive history of direct intimate contact whit a patient whit primary or recurrent herpes

1 or 2 days after generalized symptoms small vesicles (thin walled-inflammatory base) rupture shallow round discrete ulcers An important diagnostic criterion in this disease is the appearance of generalized acute marginal gingivitis Primary HSV in healthy children is self-limiting disease.

Laboratory diagnosis Cytology :giant cell. Syncytium. Ballooning degeneration HSV isolation: is the most positive method of identification and sensitivity 100% Antibody titers: antibody to HSV will begin to appear in a week and reach a peak in 3 weeks

treatment Acyclovir : inhibits DNA replication in HSV infected cell Valacyclovir & famciclovir : effective treatment with fewer doses. Supportive treatment:1)aspirin or acetaminophen for fever 2) fluids to maintain proper hydration and electrolyte balance.

Recurrent herpes simplex virus Recurrent herpes is a reactivation of virus that remains latent in nerve tissue. Several mechanisms for reactivation of latent HSV: low serum IgA, cell mediated immunity salivary antiherpes activity, ADCC and interleukin2

Clinical manifestations Tingling or burning with edema a cluster of small vesicle(1-2 cm – 1 to 3 mm in diameter)

Diagnosis Giant cell Ballooning degeneration

Treatment Acyclovir: suppress the formation and shorten the healing time of new recurrent lesions. Famciclovir: decrease the rate of HSV latency

Good luck