Herpesviruses are a leading cause of human viral diseases and can cause active disease or remain dormant. There are three subfamilies of herpesviruses: alphaherpesviruses like herpes simplex virus 1 and 2 and varicella zoster virus, betaherpesviruses like cytomegalovirus and human herpes virus 6 and 7, and gammaherpesviruses like Epstein-Barr virus and human herpes virus 8. Herpes simplex viruses can cause oral-facial infections like gingivostomatitis or cold sores, genital infections, ocular infections, and in rare cases encephalitis. The viruses spread through contact with infected secretions and can

1. Herpesviruses

4. • Are a leading cause of human viral diseases;
second only to influenza and cold viruses
• The name herpes comes from the Greek
word herpein which means to creep:
creeping or spreading nature of the skin
lesions
• Can cause active disease or remain silent
lifelong to be reactivated during periods of
immunosuppression
Herpesviruses

5. 1. Alphaherpesviruses
 Herpes simplex virus (HSV-1 & 2)
 Varicella zoster virus (VZV)
2. Betaherpesviruses
 Cytomegalovirus (CMV)
 Human herpes virus-6 (HHV-6 & 7)
3. Gammaherpesviruses
 Epstein bar virus (EBV)
 Human herpes virus-8 (HHV-8)
Herpesviruses: subfamilies

6. Herpesvirus Particle
• Enveloped double stranded DNA viruses
(Linda Stannard, University
of Cape Town, S.A.)
Fried-egg appearance

7. Herpes Simplex
Viruses (HSV)

8. Properties
• Are very large viruses
• Types: HSV-1 & HSV-2
• Man is the only natural host

9. Epidemiology
• The virus is shed in saliva, tears, genital and
other secretions:
Spreads by:
Kissing
Sexual contact
Use of utensils contaminated with saliva
Mother to child during birth and postnatal
Mother to fetus in utero

10. Replication of HSV

11. Replication of HSV

12. Primary infection
• Is usually subclinical in most individuals
• Generally HSV-1 causes infection above
the waist and HSV-2 below the waist
 40% of genital sores are due to HSV-1
 5% of facial herpes are due to HSV-2
• HSV spreads locally and a short-lived
viraemia occurs
Pathogenesis

13. Pathogenesis

14. Latency in ganglia

15. Pathogenesis
Reactivation occurs due to:
Physical or psychological stress
Infection
Fever
Irradiation including sunlight
Menstruation
• 45% of oral lesions
• 60% of genital herpes

16. Clinical Manifestations
1. Acute gingivostomatitis
2. Herpes Labialis (cold sore)
3. Ocular Herpes
4. Herpes Genitalis
5. Other forms of cutaneous herpes
6. Meningitis
7. Encephalitis
8. Neonatal herpes

17. Sites of HSV 1 & 2 Infection
Almost any human cell type can be infected by HSV

18. Oral-facial Herpes
Acute Gingivostomatitis
• The commonest manifestation
of primary herpetic infection
• Pain and bleeding of the gums
• Ulcers with necrotic bases
• Usually a self limiting disease
which lasts around 13 days.

19. Herpes labialis (cold sore)
• Is a recurrence of oral HS in about
45% of individuals
• A prodrome of tingling, warmth or
itching at the site
• About 12 hours later, redness appears
followed by papules and then vesicles
Oral-facial Herpes

21. Ocular Herpes
Mild superficial lesions of the external
eye, to severe sight-threatening diseases
of the inner eye.
• Keratitis – dendritic ulcers
• Conjunctivitis
• Iridocyclitis, chorioretinitis

22. Genital Herpes
• May be primary or recurrent
• Infection sites can be the external genitalia,
vagina, cervix, bladder, the sacral nerve routes
• Redness on the external genitalia followed by
itching papules and then vesicles
• The lesions are prone to secondary infection
e.g. S. aureus, Streptococcus and Candida
albicans

23. Genital Herpes

24. Herpes Simplex Encephalitis (HSE)
A serious complications
• Global involvement of the brain
• The brain is almost liquefied
• The mortality rate approaches 100%
• IV acyclovir is given in all cases of
suspected HSE

26. Other Cutaneous
Manifestations
Eczema Herpeticum
• A potentially serious disease that
occurs in patients with eczema
Herpetic Whitlow
• Arise from implantation of the virus
into the skin and typically affect the
fingers
Herpes Gladiatorum
• This is contracted by wrestlers.
• Spreads by direct contact from skin
lesions on one wrestler to the other
Herpetic Whitlow
Herpetic Whitlow

27. Lab Diagnosis
• Culture: requires a 3-7 days for result; has
limitations
• ELISA & IF to detect virus specific glycoproteins:
same day result; can differentiate between HSV 1 &
HSV 2
• ELISA & IF to detect antibodies: not useful in
recurrent infections
• PCR for HSV-DNA particularly in CSF in herpes
encephalitis
• Tzanck Smear: cells from base of ulcer are
stained with Giemsa stain: Presence of
multinucleated giant cells suggests HSV

28. Cytopathic Effect of HSV in cell
culture: Note the ballooning of cells.
Positive immunofluorescence test
for HSV antigen in epithelial cell.

29. Management
Only a few indications of antiviral
chemo­therapy:
 Severe primary infection
 Sight­threatening ocular herpes
 Herpes simplex encephalitis
Acyclovir
• I.V, Oral, Cream, Ophthalmic ointment