Pathology and Clinical Manifestations

Rosacea Free Forever

Rosacea Free Forever Cure By Laura Taylor

Get Instant Access

The virus multiplies in the epithelium at the portal of entry. The epithelial cells increase in size and contain an enlarged nucleus with intranuclear inclusions. The developing blisterlike vesicle is intradermal and is surrounded by inflammatory cells, edema, and congestion. Viremia may develop in malnourished infants as an accompaniment to measles, and in patients with extensive burns or in those on immunodepressant drugs. Systematic disease accompanies viremia.

The initial lesion at the site of inoculation or at the site of recurrence, whether in the skin or mucous membrane, is a small reddened area that develops into a small, thin-walled, blisterlike vesicle filled with clear fluid. Equally as common is the appearance of a group of small vesicles on the erythematous base.

Gingivostomatitis is the usual type of primary or initial HSV-1 lesion in infants and young children and is seen occasionally in adults. There may be several days of prodromal symptoms such as malaise, fever, and usually cervical lymphadenopathy. Commonly, by the time a physician is consulted, the gums are inflamed and ulcerated. Pain is distressing and may interfere with eating; the course is normally a week to 10 days.

Labial herpes only occasionally represents the initial HSV-1 lesion, but the "cold sore" or "fever blister" of the lip is the most common lesion of recurrent disease. Here a cluster of vesicles appears after a couple of days of hyperesthesia and erythema, to last from several to 10 days. Most commonly these appear at the vermilion line of the skin of the lower lip or on the skin of the upper lip, at times extending to or into the nostril. The term "fever blister" stems from the frequency with which herpetic recurrence accompanies febrile illnesses. Before the age of antibiotics, it was more likely to accompany pneumococ cal pneumonia than other types of pneumonia or febrile disease.

Conjunctivitis with or without keratitis may be the primary lesion of herpes virus infection. Then the preauricular lymph node commonly is enlarged. Keratitis is characterized by dendritic ulceration.

Cutaneous herpes (HSV-1) may involve the skin of the body, anywhere above the waist and including the feet. (HSV-2 has been isolated from fingers from autoinoculation or genital-to-finger contact in sexual play.) It may be accompanied by edema, fever, lymphangitis, and lymphadenopathy.

Herpes genitalis also has the incubation period of several days following exposure to infection. It may be subclinical, especially in women having lesions only in the vagina or the cervix rather than on the vulva. Herpetic infection is more obvious in men with localized pain, erythema, and the development of one or a group of vesicles on the glans, prepuce, or elsewhere on the penis. The inguinal lymph nodes may be swollen and tender. Urethral involvement in both sexes is manifested by dysuria (painful or difficult urination), and a discharge may be noted in male patients. Pelvic pain accompanying the dysuria is common in women. (The virus can be isolated from the urethra of both sexes. Primary infection with HSV-2 virus often is accompanied by systemic symptoms during the first several days (see Figure VIII.64.3). Complications of primary infection reveal a generalized infection, especially as aseptic meningitis and other indications of viral invasion of the central nervous system.

In a study of 148 newborns with herpes, A. J. Nahmias and colleagues (1970) reported an incubation period of up to 21 days; almost all were infected with HSV-2 and had evidence of dissemination. The overall fatality rate was 71 percent, and 95 percent among those with disseminated infection. Of those recovering, 15 percent had sequelae, especially defects in the central nervous system.

Some studies show recurrences within the first year in 80 percent of infections with HSV-2. Recurrent lesions commonly present with milder symptoms initially, are generally of shorter duration, and are rarely accompanied by overt systemic symptoms. These lesions commonly appear on the genitalia, but may appear on the buttocks and elsewhere adjacent to the genital area. Latent infection presumably is established in the sacral-nerve-root ganglia. From a study of 375 patients, Stanley Bierman (1983) found that recurrences ceased in half of them after some 7 years following the onset of disease. In others, however, the recurrences may span many years.

Figure VIII.64.3. Schematic graph of the clinical course of primary genital herpes. (From L. Corey. 1984. Genital herpes. In Sexually Transmitted Diseases, ed. King K. Holmes et al., 453, by permission of the McGraw Hill Book Company.)

DURATION VIRAL SHEDDING

DURATION VIRAL SHEDDING

Figure VIII.64.3. Schematic graph of the clinical course of primary genital herpes. (From L. Corey. 1984. Genital herpes. In Sexually Transmitted Diseases, ed. King K. Holmes et al., 453, by permission of the McGraw Hill Book Company.)

contact noted contacted lesion start gone unless healed formation to lesions common heal irritated contact noted contacted lesion start gone unless healed formation to lesions common heal irritated

It is unclear what triggers recurrent genital herpes. Emotional stress, fever, heat, trauma, coitus, and the menses have all been suggested. But they lack the certainty that a febrile illness seems to play as a provoking factor in HSV-1 recurrences.

Was this article helpful?

0 0
How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

Get My Free Ebook


Post a comment