viral disease

1. PRESENTED BY Dr IQRA
DAUD AWAN
(DENTAL SURGEON HIMS
MPH 2ND SEMESTER)

2. INTRODUCTION
Herpes simplex is a word from Greek
language meaning creeping or latent (after
primary infection it enter the nerve of the site
of primary infection, migrates to the cell body
of neuron & becomes latent in the ganglion)

3. It is one of the 8 following human herpes
viruses belonging from family herpes viridae
1. Herpes simplex virus (type I)
2. Herpes simplex virus (type 2)
3. Varicella zoster virus (type 3)
4. Epstein Barr virus (type 4)
5. Cytomegalovirus (type 5)
6. Human herpes virus 6,7,8 (associated to
kaposi’s sarcoma)

4. EPIDEMIOLOGY
 Worldwide rates of both are 60-95%
 HSV1 is more common then HSV2 with rate increasing with
age
 HSV1 is 70-80% in low socioeconomic and 40-60% in
improved socioeconomic status population
 HSV2 prevalance is 16% of population in 2003
 In USA 57.7% of population is infected with HSV1 and
16.2% infected with HSV2

5. MODE OF ACTION
ACTIVE PERIOD
(INFECTIOUS BLISTERS
CONTAINING VIRUS)
LASTS FOR 2-21 DAYS
REMISSION PERIOD

6. MODE OF TRANSMISSION
 Direct contact with the lesion or infected body
fluid
 Skin to skin contact
 Transmission between discordant partners;
person with history of infection (HSV
seropositive) can pass the virus to HSV
seronegative person.
 Via infected saliva, semen and vaginal fluids

7. CLASSIFICATION
 Herpes simplex virus (type I):
affect mouth, throat, face, eyes and CNS.
 Herpes simplex virus (type 2):affect
anogenital area.

8. CONDITIONS RELATED TO HSV

9. HERPETIC GINGIVOSTOMATITIS
 Initial presentation during
first herpes infection
 Incubation period is of 5
day
 Malaise, fever, tenderness
 Body aches, sore throat
 Red & sore oral mucosa
 Oral & circum oral
ulceration

10. HERPES LABIALIS
 Infection occurs when virus comes
in contact with oral mucosa or
abraded skin
 Triggering factors include
menstruation, common cold,
exposure to strong sunshine,
emotional upsets, dental treatment
 Burning sensation>>> erythema at
site of attack>>>vesicle formation at
the mucocutaneous junction of lip
and extending skin>>> vesicle
weep>>>crust formation after 2-3
days

11. HERPETIC WHITLOW &
GLADIATORUM
 Painful infection affecting
fingers & thumbs &
occasionally nails and
cuticles.
 Individuals playing rugby,
soccer, wrestling etc
acquires herpes
gladiatorum, scrumpox, mat
herpes etc caused by HSV
1.
 It involves sore throat, fever,
headache & swollen glands.
Can occasionally effect eyes
or eyelids

12. HERPES GENITALIS
 Clusters of inflammed papules occur
on the glans penis or other parts of
the genital region, on the inner thigh,
buttocks, or anus, on or near the
pubis, clitoris or other parts of the
vulva.
 pain, itching, and burning. Less
frequent, yet still common, discharge
from the penis or vagina , fever,
headache, muscle pain (myalgia),
enlarged lymph nodes and malaise.
 Women often experience additional
symptoms that include painful
urination (dysuria) andcervicitis.

13. HERPES KERATITIS
 Herpetic simplex keratitis is a form of
keratitis caused by recurrent
herpes simplex virus in cornea
 It is the most common cause of
cornea derived blindness in developed
nations
 Infection most commonly manifests
as blepharoconjunctivitis
i.e. infection of lids and conjunctiva
that heals without scarring. Lid
vesicles and conjunctivitis are seen in
primary infection. Corneal involvement
is rarely seen in primary infection.

14. HERPES VIRAL ENCEPHALITIS
 Herpes simplex encephalitis (HSE) is an
acute or subacute illness that causes both
general and focal signs of cerebral
dysfunction.
 Brain infection is thought to occur by
means of direct neuronal transmission of
the virus from a peripheral site to the brain
via the trigeminal or olfactory nerve.
 The exact pathogenesis and precipitating
factors are unknown.
 Common symptoms are Fever, Headache,
Psychiatric symptoms, Seizures,
Vomiting ,Focal weakness & Memory loss.

15. HERPES VIRAL MENINGITUS
 Herpes viral
meningitis is meningitis associated
with herpes simplex virus (HSV).
 HSV-2 is the most common cause of
Mollaret's meningitis, a type of
recurrent viral meningitis.This condition
was first described in 1944 by
French neurologist Pierre Mollaret.
 Recurrences usually last a few days or
a few weeks, and resolve without
treatment. They may recur weekly or
monthly for approximately 5 years
following primary infection.

16. HERPES ESOPHAGITIS
 The herpes simplex type 1 virus that
causes esophagitis is spread through
infected saliva or Engaging in oral sex
with someone who has an active
herpes outbreak.
 Most people with strong immune
systems will not develop, even after
being infected by the virus. risk
increases in HIV, leukemia or other
cancers, organ transplants, diabetes
etc
 Symptoms like difficulty
swallowing, painful swallowing, joint
pain, Chills, Fever & general malaise.

17. Neonatal herpes simplex
 Neonatal herpes simplex is a
rare but serious condition,
usually caused by vertical
transmission of herpes simplex
virus from mother to newborn.
 It manifests itself in three forms:
skin, eyes, and mouth herpes
(SEM) sometimes referred to as
"localized", disseminated
herpes (DIS), and central
nervous system herpes(CNS)

18. HERPETIC SYCOSIS
Recurrent or primary
infection affecting hair
follicles, after repeated
shaving. It is caused by
HSV 1.

19. ECZEMA HERPETICUM
Infection caused by herpes
virus associated with
dermatitis extending to
different parts of the
body

20. BELL’S PALSY
 It is acute isolated facial nerve
paralysis often caused by herpes
simplex virus.
 Infection results in swelling of
nerve within facial canal
resulting in loss of nerve impulse
conduction leading to facial
paralysis

21. ALZEIMER’S DISEASE
HSV-1 causes this
disease due to
damage to the
nervous system

22. PATHOPHYSIOLOGY
 Cure for herpes is not yet been developed, once infected it
remains in the body throughout life.
 Treatment can reduce viral shedding and alleviate the the
severity of symptoms
 HSV asymptomatic shedding occurs at some time in most of
the infected individuals.
 Virus enters into susceptible cells via entry receptors
 Infected person showing no visible symptom may still shed &
transmit the virus through skin.
 Antibodies formed as a result of primary infection with type of
HSV prevents reinfection with the same virus type.

23. DIAGNOSIS
APPEARANCE AND DISTRIBUTION
 Multiple round superficial oral ulcers accompanied by
acute gingivitis.
 Aphthous ulcers also resemble intra oral herpes but donot
have vesicular stage
 Genital herpes caused by HSV-2 are more difficult to diagnose
as they donot have classical symptoms.
 Genital herpes resemble several other conditions e.g. lichen
planus, fungal infections etc . Therefore it is difficult to diagnose

24. LABORTARY TESTS
 Virus culture
 Direct flourescent antibody (DFA)
 Skin biopsy
 Polymerase chain reaction (PCR)
 Immunodot glycoprotein G-specific HSV test
(98% specific in discriminating HSV-1 from
HSV-2)

25. PREVENTION
WOMEN ARE MORE SUSCEPTIBLE THEN MEN
METHODS
 BARRIER METHOD: use of condoms or dental
dams
 ANTIVIRALS: reduce asymptomatic shedding
 PREGNANCY: Since the risk of transmission from
mother to baby is more therefore suppressive
therapy of antiviral are given during last months of
pregnancy

26. MANAGEMENT
HERPES CANNOT BE ERADICATED FROM BODY
 ANTIVIRALS: reduce the frequency, severity and
duration of disease .e.g. Acyclovir, Famciclovir,
Penciclovir etc
 ANALGESICS: To relieve pain and fever (Ibuprofen,
paracetamol etc)
 TOPICAL ANESTHETICS: to relieve pain and
itching( lidocaine, benzocaine etc)

27. PROGNOSIS
MANY HSV INFECTED PEOPLE
EXPERIENCE THE RECURRENCE
DURING FIRST YEAR OF INFECTION