HERPES SIMPLEX &
MOLLUSCUM CONTAGIOSUM
SHAVEEN E V24TH BATCHMedical College,ThrissurIndia
HERPES SIMPLEX VIRUS HSV-1& HSV-2HERPES SIMPLEX VIRUS HSV-1& HSV-2
INFECIONS-----MUCOCUTANEOUSINFECIONS-----MUCOCUTANEOUS CNSCNS && VISCERALVISCERALAGENT– ds DNA;LIUEAR STRANDAGENT– ds DNA;LIUEAR STRAND
PATHOGENESISPATHOGENESIS
SENSORY/A,NOMIC NERVE ENDINGS,,
INTRA AXONALLY THRU CELL BODIES TO
GANGLIA
CENTRIFUGALMIGRATION
ENTRY & MULTI IN ENTRY & MULTI IN DERMIS & DERMIS & EPIDERMISEPIDERMIS
MODE OF SPREAD MODE OF SPREAD EXPLAINS….EXPLAINS….
1.1. LARGE SURF AREALARGE SURF AREA
2.2. HIGH FREQUENCY OF LESIONSHIGH FREQUENCY OF LESIONS
3.3. DISTANCE 4M INITIALDISTANCE 4M INITIAL
IMMUNITYIMMUNITY
ANTIBODY & CELL MEDIATEDANTIBODY & CELL MEDIATEDCMI MOR IMP THAN ANTIBODYCMI MOR IMP THAN ANTIBODYCD8+ T CELL REQ 4 CLEARANCE OF CD8+ T CELL REQ 4 CLEARANCE OF
LESIONLESION
EPIDEMIOLOGYEPIDEMIOLOGY
HBV1 COMMON IN 90% OF ADULTS IN HBV1 COMMON IN 90% OF ADULTS IN 55THTH DECADE OF LIFE DECADE OF LIFE
MOD OF TRANSMISSIONMOD OF TRANSMISSION HBV1—DIRECT CONTACTHBV1—DIRECT CONTACT DROPLET SPREADDROPLET SPREAD HBV2---VENERALHBV2---VENERAL
CLINICAL SPECTRUMCLINICAL SPECTRUM
GENERALLY GENERALLY HSV1—ABOVE WAISTHSV1—ABOVE WAIST HSV2---BELOW WAISTHSV2---BELOW WAISTBUT CLINICALLY INDISTINGUISHABLE BUT CLINICALLY INDISTINGUISHABLE
WHETHER HSV 1 OR 2WHETHER HSV 1 OR 2RECURRENCE—IS MORE TYPIFIEDRECURRENCE—IS MORE TYPIFIED
OROFACIALOROFACIAL
GINGIVOSTOMATIS & PHARYNGITISGINGIVOSTOMATIS & PHARYNGITISRE ACTIVATION—REC HERPES RE ACTIVATION—REC HERPES
LABIALISLABIALISCONST SYMPTOMS+CERVICAL CONST SYMPTOMS+CERVICAL
LYMPHADENOPATHY+INABILITY TO LYMPHADENOPATHY+INABILITY TO EATEAT
REACTIVATION OF HSV IN REACTIVATION OF HSV IN TRIGEMINAL GANGLIA---SHEDDING IN TRIGEMINAL GANGLIA---SHEDDING IN SALIVA…SALIVA…
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HSV+ATOPIC ECZEMA=== KAPOSI’S HSV+ATOPIC ECZEMA=== KAPOSI’S VARICELLIFORM ERUPTIONVARICELLIFORM ERUPTION
CANDIDA—CANDIDA—BELLS PALSYBELLS PALSY
GENITAL INFECTIONSGENITAL INFECTIONS
SPECIFIC—PAIN,ITCHING,DYSURIA SPECIFIC—PAIN,ITCHING,DYSURIA DISCHARGE,LYMPHADENOPATHYDISCHARGE,LYMPHADENOPATHY
LESIONS---VESICLE,PUSTULE & LESIONS---VESICLE,PUSTULE & PAINFUL ERYTHMATOUS ULCERSPAINFUL ERYTHMATOUS ULCERS
VULVOVAGINITIS—CAN GO UP N UPVULVOVAGINITIS—CAN GO UP N UPBALANITIS– PROSTATITISBALANITIS– PROSTATITISCLEAR MUCOID DISCHARGE N’ CLEAR MUCOID DISCHARGE N’
DYSURIADYSURIA
HERPETIC WHITLOWHERPETIC WHITLOW
FINGER INFECTIONFINGER INFECTIONEDEMA,ERYTHEMA N’ TENDERENESSEDEMA,ERYTHEMA N’ TENDERENESS
EYE,CNS N VISCERALEYE,CNS N VISCERAL
CORNEAL BLINDNESS IN USCORNEAL BLINDNESS IN USRECURRENT– MOLLARET MENINGITIS RECURRENT– MOLLARET MENINGITIS
N’ ENCEPHALITISN’ ENCEPHALITISESOPHAGITISESOPHAGITIS
DIAGNOSISDIAGNOSIS
TZANC SMEAR– MULTINUCLEATE TZANC SMEAR– MULTINUCLEATE GIANT CELLGIANT CELL
INTRANUCLEAR INCLUSION --INTRANUCLEAR INCLUSION --LIPSHUTZ BODIESLIPSHUTZ BODIES
BEST– DEMO HSV ANTIGEN BY PCRBEST– DEMO HSV ANTIGEN BY PCR
TREATMENTTREATMENT
ACYCLOVIR—200 mg 5 times/dayACYCLOVIR—200 mg 5 times/dayFAMCYCLOVIRFAMCYCLOVIRVALACYCLOVIR—BETTER BIOAVAIL N’ VALACYCLOVIR—BETTER BIOAVAIL N’
USED B/W SEXUAL PARTNERSUSED B/W SEXUAL PARTNERSADV– RENAL INSUFFICIENCYADV– RENAL INSUFFICIENCYRES—FOSCARNETRES—FOSCARNET CIDOFOVIRCIDOFOVIR
MOLLUSCUM CONTAGIOSUM
AGENT N’ LESIONAGENT N’ LESION
POX VIRUS ,ds DNAPOX VIRUS ,ds DNAMULTIPLE DOME SHAPED FIRM MULTIPLE DOME SHAPED FIRM
ROUNDED PEARLY WHITE ROUNDED PEARLY WHITE UMBILICATED DISCRETE PAPULES UMBILICATED DISCRETE PAPULES
2-5MM,DIMPLE IN CENTRE NO INFL N’ 2-5MM,DIMPLE IN CENTRE NO INFL N’ NECROSISNECROSIS
COMMON ON FACE N’HANDSCOMMON ON FACE N’HANDSGENITAL—SEXUAL TRANSGENITAL—SEXUAL TRANSAUTOINOCULATIONAUTOINOCULATION
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INVOLUTE IN 3-4 MONTHSINVOLUTE IN 3-4 MONTHS INRACYTOPLASMIC IB—MOLLUSCUM INRACYTOPLASMIC IB—MOLLUSCUM
BODY[HENDERSON PATERSON]BODY[HENDERSON PATERSON]DIAGNOSIS-->DEMO OF VIRUS 4M D DIAGNOSIS-->DEMO OF VIRUS 4M D
LESIONLESION
TREATMENTTREATMENT
SCRAPIN AWAY,CURRETAGESCRAPIN AWAY,CURRETAGEFREEZIN BY ETHYL CHLORIDEFREEZIN BY ETHYL CHLORIDECHEMICAL CAUTRISATION– CARBOLIC CHEMICAL CAUTRISATION– CARBOLIC
ACID,TCAA,IOD TINCTUREACID,TCAA,IOD TINCTURENO SYS COMPLI/SKIN LESION 4 3-5 NO SYS COMPLI/SKIN LESION 4 3-5
YEARSYEARSCIDOFOVIR—INVITRO IN CIDOFOVIR—INVITRO IN
IMMUNOCOMPRISED… IMMUNOCOMPRISED…
IN THE END….THANKS….