Herpes Simplex & Molluscum Contagiosum

HERPES SIMPLEX & MOLLUSCUM CONTAGIOSUM SHAVEEN E V 24TH BATCH Medical College,Thrissur India

HERPES SIMPLEX VIRUS HSV-1& HSV-2  INFECIONS-----MUCOCUTANEOUS

CNS  &  VISCERAL  AGENT– ds DNA;LIUEAR STRAND 

PATHOGENESIS  ENTRY

& MULTI IN DERMIS & EPIDERMIS

SENSORY/A,NOMIC NERVE ENDINGS,, INTRA AXONALLY THRU CELL BODIES TO GANGLIA

CENTRIFUGAL MIGRATION

MODE OF SPREAD EXPLAINS…. 1. 2. 3.

LARGE SURF AREA HIGH FREQUENCY OF LESIONS DISTANCE 4M INITIAL

IMMUNITY  ANTIBODY

& CELL MEDIATED  CMI MOR IMP THAN ANTIBODY  CD8+ T CELL REQ 4 CLEARANCE OF LESION

EPIDEMIOLOGY  HBV1

COMMON IN 90% OF ADULTS IN 5TH DECADE OF LIFE  MOD OF TRANSMISSION  HBV1—DIRECT CONTACT  DROPLET SPREAD  HBV2---VENERAL

CLINICAL SPECTRUM  GENERALLY

HSV1—ABOVE WAIST  HSV2---BELOW WAIST  BUT CLINICALLY INDISTINGUISHABLE WHETHER HSV 1 OR 2  RECURRENCE—IS MORE TYPIFIED 

OROFACIAL  GINGIVOSTOMATIS

& PHARYNGITIS  RE ACTIVATION—REC HERPES LABIALIS  CONST SYMPTOMS+CERVICAL LYMPHADENOPATHY+INABILITY TO EAT  REACTIVATION OF HSV IN TRIGEMINAL GANGLIA---SHEDDING IN SALIVA…

Continue…  HSV+ATOPIC

ECZEMA=== KAPOSI’S VARICELLIFORM ERUPTION  CANDIDA—  BELLS PALSY

GENITAL INFECTIONS  SPECIFIC—PAIN,ITCHING,DYSURIA

DISCHARGE,LYMPHADENOPATHY  LESIONS---VESICLE,PUSTULE & PAINFUL ERYTHMATOUS ULCERS  VULVOVAGINITIS—CAN GO UP N UP  BALANITIS– PROSTATITIS  CLEAR MUCOID DISCHARGE N’ DYSURIA

HERPETIC WHITLOW  FINGER

INFECTION  EDEMA,ERYTHEMA N’ TENDERENESS

EYE,CNS N VISCERAL  CORNEAL

BLINDNESS IN US  RECURRENT– MOLLARET MENINGITIS N’ ENCEPHALITIS  ESOPHAGITIS

DIAGNOSIS  TZANC

SMEAR– MULTINUCLEATE GIANT CELL  INTRANUCLEAR INCLUSION -LIPSHUTZ BODIES  BEST– DEMO HSV ANTIGEN BY PCR

TREATMENT  ACYCLOVIR—200

mg 5 times/day

 FAMCYCLOVIR  VALACYCLOVIR—BETTER

BIOAVAIL N’ USED B/W SEXUAL PARTNERS  ADV– RENAL INSUFFICIENCY  RES—FOSCARNET  CIDOFOVIR

MOLLUSCUM CONTAGIOSUM

AGENT N’ LESION  POX

VIRUS ,ds DNA  MULTIPLE DOME SHAPED FIRM ROUNDED PEARLY WHITE UMBILICATED DISCRETE PAPULES  2-5MM,DIMPLE IN CENTRE NO INFL N’ NECROSIS  COMMON ON FACE N’HANDS  GENITAL—SEXUAL TRANS  AUTOINOCULATION

Continue…  INVOLUTE

IN 3-4 MONTHS  INRACYTOPLASMIC IB—MOLLUSCUM BODY[HENDERSON PATERSON]  DIAGNOSIS-->DEMO OF VIRUS 4M D LESION

TREATMENT  SCRAPIN

AWAY,CURRETAGE  FREEZIN BY ETHYL CHLORIDE  CHEMICAL CAUTRISATION– CARBOLIC ACID,TCAA,IOD TINCTURE  NO SYS COMPLI/SKIN LESION 4 3-5 YEARS  CIDOFOVIR—INVITRO IN IMMUNOCOMPRISED…

THANKS…. IN THE END….