Herpes simplex infections

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Section 1: Blisters (vesicles and bullae)

1

Herpes simplex infections

Neonatal herpes. Grouped vesicles on a red base on the scalp of a 9-day-old.

Neonatal herpes. Widespread vesicles and erosions in 2-day-old.

Primary herpes gingivostomatitis. Oral erosions seen in this 3-month-old.

Primary herpes gingivostomatitis. Perioral and lip vesicles in a 10-month-old infant.

Recurrent herpes labialis with grouped vesicles on upper lip.

Recurrent herpes labialis with grouped vesicles on lower lip.

Herpes keratitis. Grouped vesicles on lower eyelid and red eye in child.

Herpes facialis. Recurrent grouped vesicles on child’s cheek. No eye involvement.

Herpetic whitlow. Grouped vesicles on red base at base of thumb in thumbsucker.

Herpetic whitlow. Grouped vesicles on middle finger of child.

Photomicrograph of smear of blister contents showing transformed epidermal cells (giant cells) in herpes simplex infection.

Eczema herpeticum. Numerous vesicles and erosions in child with atopic dermatitis and HSV 1 infection.

CLINICAL FEATURES

Grouped vesicles on a red base are the characteristic lesions of herpes simplex regardless of location on the skin. On mucous membrane, the blister roof is easily shed and erosions are seen. A variety of clinical patterns are seen.

Neonatal herpes simplex Grouped vesicles on a red base may be found anywhere on skin of neonate and lesions may be widely scattered. Mucous membrane involvement is common. Vesicles may be present at birth but can appear 1 to 7 days after birth. Two-thirds are caused by HHV 2, one third HHV 1. Of mothers with active HHV 2 infections, 10% of their newborns will be affected. The disease may at first be mild skin involvement but systemic disease will eventuate with hypothermia, jaundice, progressive hepatosplenomegaly and CNS symptoms. With encephalitis, death within 96 hours has been reported.

Primary gingivostomatitis In infants less than 6 months, severe oral erosions and grouped vesicles on lips and gums appear. The child has a foul breath and is unable to eat. The disease lasts 7 to 14 days. Many infants encountered with HHV 1 result in a mild pharyngitis without characteristic vesicles.

Recurrent herpes simplex infection Herpes simplex viruses may persist in nerve ganglia and reactivate after UV light exposure, fever, trauma or menses. Vesicles recurring in the same site should be considered to be due to herpes simplex.

Herpes labialis The majority of recurrent HSV infections are on the lips. It occurs in 20% of children who have had primary HSV infection. A prodrome of lower lip pain precedes development of vesicles on a red base on the lip, lasting 8 days.

Herpes keratitis Involvement of the skin around the eye should bring concern about corneal herpes. Dendritic ulceration occurs and may lead to scarring and permanent loss of vision. Periorbital vesicles and a red eye should prompt ophthalmologic consultation.

Herpes facialis Recurrent episodes of grouped vesicles on the forehead or cheek are less common and misdiagnosed.

Herpetic whitlow Herpes finger and hand infections occur in 10% of infants and children. Because the stratum corneum is thicker in these areas the vesicles appear deceptively deep.

Herpes progenitalis Teens and young adults may have prodromal pain followed by grouped vesicles on a red base on the genitalia. Severe infections may produce fever, lassitude, lymphadenopathy and severe pain. HHV 2 is responsible for this recurrent sexually transmitted disease.

Herpes simplex in the immunosuppressed Atypical appearances of HSV occur in the immunosuppressed, genetic immune deficiencies, children with cancer or the malnourished child. Grouped vesicles progress to giant bullae and erosions often with purpura or hemorrhage. After 24–48 hours, widespread lesions may appear. The red base may not be evident.

Eczema herpeticum (Kaposi’s varicelliform eruption) Children with atopic dermatitis may develop superinfection with HHV 1 with multiple groups of vesicles and high fever. Herpes encephalitis or pneumonia may ensue if untreated.

TREATMENT

Neonatal HSV should be treated with high-dose intravenous acyclovir at 20–40 mg/kg/day. In addition, maintenance of fluid and electrolyte balance, and temperature regulation are necessary. The baby should be isolated.