Hsv Tvrao


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Human Herpes simplex infection are a grwoing concern to Medical Profession Need effective prevention Diagnosis and treatment. HSV are more Important in the era of AIDS

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Hsv Tvrao

  2. 2. Human Herpes viruses <ul><li>A big family of viruses </li></ul><ul><li>Most Important viral infections </li></ul><ul><li>Outstanding character – Produce life long infections. </li></ul><ul><li>Assosicated with maligencies </li></ul><ul><li>1 Epstein Barr virus ( EBV ) causes </li></ul><ul><li>Burkett's lymphoma </li></ul><ul><li>Nasopharyngeal carcinoma </li></ul><ul><li>2 HHV 8 with primary effusion, Lymphoma and Kaposi’s sarcoma </li></ul>
  3. 3. Human Herpes viruses Identified types <ul><li>1 Herpes simplex 1 ( type 1 ) </li></ul><ul><li>2 Herpes simplex 2 ( type 2 ) </li></ul><ul><li>3 Varicella zoster ( type 3 ) </li></ul><ul><li>4 Epstein- Barr - Infectious mononucleosis </li></ul><ul><li>type 4 </li></ul><ul><li>5 Cytomegalovirus ( type 5 ) </li></ul><ul><li>HHV – 6 causes Roseola subitum </li></ul><ul><li>HHV - 7 Human infections ? </li></ul><ul><li>HHV - 8 - Linked to Kaposi's Sarcoma </li></ul>
  4. 4. Herpes simplex-1,2
  5. 5. Herpes simplex virus <ul><li>Virion - Spherical in shape. </li></ul><ul><li>Size is 150 – 200 nm </li></ul><ul><li>( Icosahedral ) </li></ul><ul><li>More than 35 proteins are present. </li></ul><ul><li>Contains Viral glycoprotein's </li></ul>
  6. 6. Herpes simplex-1,2 <ul><li>Herpes virus 1 affect mainly oral cavity </li></ul><ul><li>Herpes virus 2 affect Genital tract. </li></ul><ul><li>Herpes 2 infections have increased with sexual activity </li></ul><ul><li>Recent findings - Even HSV 1 has increased association with urogenital infections in USA and Israel > 65 – 70% </li></ul>
  7. 7. Long persistence <ul><li>Herpes viruses produce both Primary and Reactivations of disease </li></ul><ul><li>In advanced HIV infection HSV infections reactivate more rapidly </li></ul>
  8. 8. Clinical features HSV 1 <ul><li>HSV1 associated with Mucocutaneous lesions involving mouth and oral cavity </li></ul>
  9. 9. Herpes simplex 1 <ul><li>HSV1 mainly produce moist ulcers and lesions get epithelized in 1 – 2 weeks Recurent eruptions but heal faster </li></ul><ul><li>Stress, fever,infections, </li></ul><ul><li>sunlight.chemotherpay </li></ul><ul><li>Many non specific condtions predispose to eruptions </li></ul>
  10. 10. Sites of HSV 2 predisposition
  11. 11. Herpes simplex-2 Genital lesions.
  12. 12. Herpes simplex 2 <ul><li>HSV 2 infections are mainly associated with Genital regions </li></ul><ul><li>More in the Developing world </li></ul><ul><li>Virus have presacral latency </li></ul><ul><li>Present with multiple painful small vesicles May manifest with pelvic pain </li></ul><ul><li>Aseptic meningitis. </li></ul>
  13. 13. Herpes simplex 2 <ul><li>Risk factors include </li></ul><ul><li>Female sex, </li></ul><ul><li>Black race </li></ul><ul><li>Sexaulually traanmitted infections in the partners </li></ul><ul><li>Contact with sex workers </li></ul><ul><li>Lower economic status </li></ul><ul><li>Sexaully acitivity at yonger age </li></ul>
  14. 14. Risk of HSV infection <ul><li>Shedding of the virus can spread the transmission in the vicinity of the infected. </li></ul><ul><li>HSV 2 increases the risk of HIV acquisition. </li></ul><ul><li>Control of HSV 2 carries top priority in reducing the Incidence of HIV infection </li></ul>
  15. 15. HSV – Ocular infections <ul><li>Keratitis </li></ul><ul><li>Blepharitis </li></ul><ul><li>Kerato conjunctivitis </li></ul><ul><li>Predisposes to recurrences </li></ul><ul><li>Difficult to diffentiate from Adenovirus infections. </li></ul>
  16. 16. HSV – Neonatal and congenital infections <ul><li>Can lead to congenital malformations </li></ul><ul><li>Organomegaly </li></ul><ul><li>Bleeding tendencies </li></ul><ul><li>CNS abnormalities </li></ul><ul><li>Neonatal transmision common during delivery than intrauterine infection </li></ul><ul><li>Vacum / Forceps use during delivery increases the neonatal infections. </li></ul>
  17. 17. HSV – Encepalitis and Meningitis <ul><li>May present as Flu like illness </li></ul><ul><li>Temporal seizures </li></ul><ul><li>CSF present with pleocytosis with presence of Red blood cells. </li></ul><ul><li>Prompt Diagnosis reduces Morbidity and Mortality. </li></ul><ul><li>Diagnosis </li></ul><ul><li>MRI scans are more useful in diagnosis </li></ul><ul><li>HSV – PCR – DNA are emerging technologies carreis good Sensitivity and specificity </li></ul><ul><li>Antibodies can be detected in the CSF - affordable investigation in Devloping world. </li></ul><ul><li>Patients may present with recurrent lymphocytic meingitis </li></ul>
  18. 18. HSV – Disseminated Infections <ul><li>Can produce life threatening conditions In </li></ul><ul><li>Immunosupressed On higher / prolonged use of cortosteriods </li></ul>
  19. 19. HSV – Other manifestations <ul><li>Bells palsy </li></ul><ul><li>Esophagitis </li></ul><ul><li>Erythema Multiformis </li></ul>
  20. 20. Health care workers and HSV <ul><li>Health care workers, Doctors, Nurses and Dentists can present with Whitlows. </li></ul><ul><li>Precautions in handling infected patients and material is a priority. </li></ul>
  21. 21. Diagnosis of HSV infections <ul><li>PCR technology a growing tool for specific diagnosis. </li></ul><ul><li>Specimens can be obtained from </li></ul><ul><li>Throat washings, CSF, and Stool </li></ul><ul><li>Viral cultures and use of Neutralization protocols </li></ul><ul><li>Direct fluorescent Microscopy helpful </li></ul><ul><li>Tzanck preparation with scrapings from material – is simple and practicable methods in resource poor settings. </li></ul>
  22. 22. Serological diagnosis - HSV <ul><li>Serology is simple affordable in resource poor countries </li></ul><ul><li>Antibodies develop as early as 4 -7 days </li></ul><ul><li>peak titers appears in 2 – 4 weeks </li></ul><ul><li>Use of HSV type specific antibodies clinches the Diagnosis </li></ul>
  23. 23. Treatment and Prevention <ul><li>Antiviral agents </li></ul><ul><li>1 Acyclovir </li></ul><ul><li>2 Famciclovir </li></ul><ul><li>3 Foscarnet </li></ul><ul><li>( Used In Immunosupressed ) </li></ul><ul><li>4 Val acyclovir </li></ul><ul><li>5 Idoxuridine for Topical applications </li></ul><ul><li>6 Interferon alfa – 2b </li></ul>
  24. 24. HSV and AIDS <ul><li>It is important to HIV infected should be assayed for HSV 2 antibodies </li></ul><ul><li>Use of HAART ( In AIDS ) reduces the associated lesions of HSV 2 infections and reduces the complication and lesions. </li></ul>
  25. 25. Why HSV 2 Important in AIDS <ul><li>Control, prevention and treatment of HSV2 reduces the incidence of HIV infections </li></ul>
  26. 26. Prevention of HSV 2 infections. <ul><li>Barrier precautions during sexaul intercourse </li></ul><ul><li>Hand washing in the working environment by Health care workers when dealing with HSV patients. </li></ul><ul><li>Gloves and Gowning to be practiced </li></ul>
  27. 27. Counseling in HSV infections. <ul><li>Needs counseling at Prenatal clinics,HIV,and Sexaully transmitted Infection centers, with </li></ul><ul><li>1 Uncertain clinical History </li></ul><ul><li>2 High risk behaviour </li></ul><ul><li>3 Increaed number of sex partners. </li></ul>
  28. 28. Vaccine for HSV ? <ul><li>Yet there is no successful vaccine to the universal use </li></ul><ul><li>A glycoprotein vaccine for HSV 2 for women with negative serology, on record with success </li></ul>
  29. 29. Created for Medical and Health care workers in Developing World Dr.T.V.Rao MD Email [email_address]
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