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Hsv Tvrao
 

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

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 Hsv Tvrao Presentation Transcript

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