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Herpes simplex virus type 1 (HSV-1) is a neurotropic herpes virus that normally infects its host subclinical to then establish a lifelong persistent infection in sensory ganglion neurons related to the cranial nerves such as trigeminal nerve. In most people established an asymptomatic infection.
HSV-1 can sometimes cause clinical symptoms of primary infection, usually as stomatitis. It is more common manifestations of reactivation, and then usually in the form of cold sores (oral herpes).
A number of relatively rare complications from the nervous system as well as skin / mucous membranes have been linked to the virus, and are described below. HSV-1 has also been found to cause pneumonitis, especially when severe trauma.
HSV-1 has been shown as an ordinary agent even when genital herpes, especially at the first episode of this disease in women (see the link below, herpes simplex type 2).
In immunocompromised patients can sometimes HSV-1 give more manifestations of the skin and mucous membranes.
Gingivostomatitis (also known as primary herpetic gingivostomatitis or orolabial herpes) is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection., with boys affected more often than girls), with intense mucosal changes such as the gums. Fever and constitutional symptoms are common, and mucous membrane can be as difficult to insertion of the patient to the fluid supply may sometimes be necessary. Antiviral therapy may then likely shorten the process.
At 1/3 of the infected recurrence of HSV-1 more or less regularly as a localized, unilateral blistering in the oral region, usually on the lip. Skin symptoms often preceded by a moderate but sharp burning pain in the same region, called prodromal symptoms. Relapse with cold sores can be initiated by UV radiation, hormonal fluctuations during menstruation, and other infections such as pneumococcal pneumonia.
Blister formation of the cuticle that recur on the same finger can be caused by HSV-1 or HSV-2.
HSV-1 can also cause recurring eye infections, corneal dendritic ulcers which can be seen after staining. On suspicion of herpetic patient should be referred to an ophthalmologist, when the specialist is necessary. Herpetic keratitis is a major cause of corneal transplantation.
Although most manifestations of reactivated HSV-1 infection is localized, the virus has been found in both the skin and the circulatory erythema multiform, a condition with scattered rash sometimes relapsed.
Approximately every 4 cases are caused by HSV-1, which is present in relatively large amounts in the sensory ganglia (g. Stellate) which is located at the upper part of the facial nerve. Optimal treatment is not determined.
In extremely rare cases occurs a destructive virus multiplication in the brain, highlighting the limbic system including the hippocampus, temporal lobe and the frontal lobe and the motor cortex. Fever occurs almost always accompanied by neurological symptoms like aphasia, decreased consciousness and / or convulsions. On suspicion of herpes encephalitis should be taken contact with the attending infectious diseases.
Newborns can during the first month after falling ill with a severe herpes simplex infection in which one or more of the following pictures seen: blistering of the skin or the mouth and throat, generalized sepsis-like picture or encephalitis. The condition can occur without evidence of current herpes infection in the mother. On suspicion of neonatal herpes infection should contact taken by the attending pediatrician.
Many skin manifestations are clinically typical, and herpes viral genes may be confirmed by DNA detection (PCR). Diagnostics with the typing of HSV-1 or -2 is recommended in considerable discomfort and before treatment is inserted as treatment recommendations differ for the two subtypes. Neurological complications as above shall be investigated etiologic with lumbar puncture for PCR and / or serology.
Available antiviral agent inhibits viral DNA replication and should be started early for the best effect. At skin manifestations, should treatment initiated within 24-48 hours (orally) or a few hours (local treatment) after onset.
Antiviral resistance occur but is rare in immunocompetent patients.
Treatment may be administered topically, orally or systemically depending on the severity. Severe CNS infection such as encephalitis should always be treated with iv added acyclovir.