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….