To the Editor: A 33-year-old woman presented with tenderness of the left breast and nipple of 2 weeks’ duration and fever of 2 days’ duration. The pain was so severe it precluded nursing. [mdedge.com]

A 13-year-old girl presented with postural hypotension, severe abdominal pain and diarrhoea, parotid pain and a transient encephalopathy. [ncbi.nlm.nih.gov]

Special treatment situations Special considerations Consider seeking specialist advice before treating any complicated presentation. Situation Recommended Pregnant women Aciclovir is the preferred agent in pregnancy. [sti.guidelines.org.au]

[…] as cold sores Triggers are many, including UV-radiation, minor trauma and stress The clinical presentation of a cold sore is that of grouped vesicles, especially of the lips and perioral skin. [pcds.org.uk]

• Fever

  Fever Blister, Fever Blisters, Sore, Cold, Sores, Cold, herpes labialis, Fever sore, Cold sores lip, Cold sore (herpetic), Herpes on lip, fever blister, herpes febrilis, Herpes Labialis [Disease/Finding], fever sores, lip herpes, herpes lips, herpes [fpnotebook.com]

  In addition, hand-foot-mouth disease (viral etiology) needs to be considered because multiple pinpoint oral vesicles and ulcers, as well as fever, are common signs. [softdental.com]

  To the Editor: A 33-year-old woman presented with tenderness of the left breast and nipple of 2 weeks’ duration and fever of 2 days’ duration. The pain was so severe it precluded nursing. [mdedge.com]

  halitosis Yes 7 Skin lesion, conjunctivitis Maternal: WB Neonate: Cx, WB SEM 10 Alive Yes M 24 C/S 3rd Fever, oral ulcerations, adenopathy No 4 Fever, tachypnea, jaundice, bradycardia Maternal: WB Neonate: FA, Cx, WB Disseminated 11 Died N/A M 25 Vaginal [academic.oup.com]

  The affected person may feel well or suffer from fever, pain and have enlarged local lymph nodes. [dermnetnz.org]

• Malaise

  Fever, malaise, headache, and sore throat are presenting features. The vesicles rupture to form ulcerative lesions with grayish exudates on the tonsils and the posterior pharynx. [emedicine.medscape.com]

  The primary episode of herpetic gingivostomatitis is characterized by constitutional symptoms such as malaise, fever and regional lymphadenopathy. Acute ulcerative gingivostomatitis occurs as a result of virus replication in the affected tissues. [softdental.com]

  The symptoms can be quite severe and may include: blisters and ulceration on external genitalia, in the vagina, or on the cervix vaginal discharge pain and itching tender, enlarged lymph nodes pain when urinating high temperature ( fever ) malaise (feeling [medicalnewstoday.com]

  Primary maternal infection may present as a flu-like syndrome with fever, headache, malaise, and myalgias. Many individuals with HSV-2 may never have sores or have only very mild symptoms. [perinatology.com]

• Dysphagia

  A 63-year-old man was urgently admitted to hospital with laryngeal dyspnoea associated with dysphagia but without dysphonia. Physical examination demonstrated the vocal cords in a paramedian position with paralysis of abduction. [ncbi.nlm.nih.gov]

  Weight loss is not uncommon, either related to illness or dysphagia (in primary gingivostomatitis). [www1.cgmh.org.tw]

  Other symptoms include sore throat, dysphagia. The mouth disease can be associated with lesions elsewhere, such as primary herpetic dermatitis, ocular and nasal herpes, herpetic whitlows and even genital herpes. [virology-online.com]

  Herpes esophagitis Symptoms may include painful swallowing ( odynophagia ) and difficulty swallowing ( dysphagia ). It is often associated with impaired immune function (e.g. HIV/AIDS, immunosuppression in solid organ transplants ). [en.wikipedia.org]

• Aphthous Stomatitis

  The differential diagnosis of primary herpetic gingivostomatitis has been reviewed in the differential diagnosis of recurrent aphthous stomatitis. [softdental.com]

  RIH may appear similar to traumatic lesions (mechanical/thermal/chemical) or other types of oral mucosal disorders, such as aphthous stomatitis. [jcda.ca]

• Periodontitis

  […] diseases Acute necrotizing ulcerative gingivitis Pericoronitis Peri-implantitis Periodontal abscess Periodontal trauma Periodontitis Aggressive As a manifestation of systemic disease Chronic Perio-endo lesion Teething Periapical, mandibular and maxillary [en.wikipedia.org]

• Skin Ulcer

  Individuals who participate in contact sports such as wrestling, rugby, and football (soccer), sometimes acquire a condition caused by HSV-1 known as herpes gladiatorum, scrumpox, wrestler's herpes, or mat herpes, which presents as skin ulceration on [en.wikipedia.org]

• Vesicular Rash

  An extensive vesicular rash was noted on the posterior aspect of the right thigh, and bilaterally in the sacral and perianal areas. There were no vesicles elsewhere. [jnnp.bmj.com]

• Headache

  Symptoms include lymph node enlargement, fever, tiredness, headache, and muscle aches during the episode. Recurrences are preceded by a tingling, itching or burning sensation on the penis one to two days prior to visible blisters and sores. [biology.kenyon.edu]

  An initial infection starts after an incubation period of 3-7 days, after which fever, headaches, fatigue and muscle pains can occur. [americanskin.org]

  Fever, malaise, headache, and sore throat are presenting features. The vesicles rupture to form ulcerative lesions with grayish exudates on the tonsils and the posterior pharynx. [emedicine.medscape.com]

  Primary maternal infection may present as a flu-like syndrome with fever, headache, malaise, and myalgias. Many individuals with HSV-2 may never have sores or have only very mild symptoms. [perinatology.com]

• Oscillopsia

  Neurological examination revealed an intention tremor, marked upper limb and truncal ataxia, oscillopsia, and variable ophthalmoplegia with diplopia and multidirectional nystagmus. [jnnp.bmj.com]

• Viral Inclusion Body

  General Pathology Corneal scrapings of HSV keratitis prepared with Giemsa stain may reveal the presence of intranuclear viral inclusion bodies. Multinucleated giant cells may also be found. [eyewiki.aao.org]

• Liver Biopsy

  A laparoscopic liver biopsy [Figure 2] A showed necrotic areas in the liver containing inflammatory infiltrates with "glassy" nuclei around the necrotic areas. Immunoperoxidase staining and PCR of the biopsy tissue was positive for HSV [Figure 2] B. [sjkdt.org]

Complete resolution of respiratory symptoms was observed after 21 days of treatment with intravenous aciclovir. Gerhardt syndrome comprises inspiratory dyspnoea without dysphonia. [ncbi.nlm.nih.gov]

She was otherwise fit and well and taking no regular drug treatment. She had not travelled outside the United Kingdom in the previous 10 years. [jnnp.bmj.com]

PO, BD for 1 day Recurrence: Suppressive therapy Valaciclovir 500mg PO, daily for 6 months Famciclovir 250mg PO, BD for 6 months Treatment advice Treatment should not be delayed for those presenting with severe episodes, particularly initial episodes [sti.guidelines.org.au]

Figure 4: Response to treatment in Case 1. Rapid improvement in AST following treatment with IV aciclovir. [sjkdt.org]

See “Diagnostics” and "Treatment" below. [amboss.com]

Where dissemination occurs, infection carries a grave prognosis. Infection is particularly dangerous in premature infants. In mature infants, infection 10 days or more after birth carries a much improved prognosis. [virology-online.com]

Prognosis Prognosis is usually good, but greatly varies depending on severity and number of recurrences of the disease. [eyewiki.aao.org]

Herpes simplex virus-associated acute liver failure: A difficult diagnosis with a poor prognosis. Liver Transplant 2005;11(12):1550-5. 5. Norvell J, Blei A, Jovanovic BD, et al. [sjkdt.org]

It considers diagnosis and prognosis according to infection category, along with testing modalities and limitations. [cps.ca]

Prognosis Spontaneous recovery in a few days to a week, occasionally longer. Recurrence is common. The virus remains in the body for life, but it is usually dormant. Research continues in developing a vaccine. Other Nothing Specified. [rxmed.com]

For genital herpes during pregnancy, see congenital herpes simplex virus infection Herpetic gingivostomatitis Etiology : severe manifestation of an (often primary) HSV-1 infection Mainly in children (∼ 1–6 years), but also immunocompromised patients [amboss.com]

In addition, hand-foot-mouth disease (viral etiology) needs to be considered because multiple pinpoint oral vesicles and ulcers, as well as fever, are common signs. [softdental.com]

Acute respiratory disease of university students with special reference to etiologic role of herpes virus hominis. Am. J. Epidemiol. 101 (1975) 111–121. Google Scholar 2. Katz, J., Mamary, I., Ben-Yehuda, A., Barak, S., Danon, Y. [link.springer.com]

Etiology HSV Keratitis is caused by the herpes simplex virus, a double stranded DNA virus made up of an icosahedral shaped capsid surrounding a core of DNA and phosphoproteins of viral chromatin. [eyewiki.aao.org]

It covers: the etiology or herpes simplex labialis, describes the symptoms associated with cold sores, discusses methods to prevent the recurrence of cold sores, identifies the categories of drugs which can be used to provide symptomatic relief, and explains [dentalresource.org]

Hiroshi Kimura, Shinji Kido, Naoki Hanada, Motohiro Shibata, Tsuneo Morishima, Yoichiro Kino Abstract The clinical features and the molecular epidemiology of primary herpes simplex virus type 1 (HSV-1) infection among children younger than 3 years of [pediatrics.aappublications.org]

Epidemiology Fetal HSV infection much less common than neonatal HSV infection. The estimated incidence is at ~ 1 in 200,000 deliveries 3. Complications Overwhelming fetal sepsis might result in multi-organ failure, including fetal brain death. [radiopaedia.org]

Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis, therapy and prevention. Virol J 2009 Occurrence of cytomegalovirus and herpes simplex virus infections in pregnancy. [perinatology.com]

Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv. 2002; 57 :245–256. [ PubMed ] [ Google Scholar ] 8. Fowler KB, Stagno S, Pass RF. [ncbi.nlm.nih.gov]

Selected epidemiological features of herpes genitalis in Israel based on laboratory data. Isr. J. Med. Sci. 30 (1994) 375–379. Google Scholar 8. Leventan-Reiss, S., Rannon, R., Jaffe, R. [link.springer.com]

The pathophysiology of Gerhardt syndrome remains unexplained, but the possible role of herpes simplex infection should be considered in cases of laryngeal palsy. [ncbi.nlm.nih.gov]

General information Pathophysiology Inoculation : The virus enters the body through mucosal surfaces or small dermal lesions. Neurovirulence : The virus invades, spreads, and replicates in nerve cells. [amboss.com]

Pathophysiology Add text here Primary prevention Prevention of herpetic infection includes avoidance of direct contact with known HSV. [eyewiki.aao.org]

Pathophysiology All herpes viruses are enveloped, double-stranded DNA viruses. The DNA sequences of HSV-1 and HSV-2 are very similar, but differences in their envelope proteins allow for serologic distinction between the two. [pedclerk.bsd.uchicago.edu]

Pathophysiology: HSV, belonging to the family Herpesviridae and to the subfamily Alphaherpesvirinae, is a double-stranded DNA virus characterized by the following unique biological properties: Neurovirulence (the capacity to invade and replicate in the [www1.cgmh.org.tw]

To prevent this infection, gloves should be used routinely when examining or treating patients. [softdental.com]

It does not clear the virus but prevents the virus from multiplying. It may not have much effect once the blisters and ulcers are well developed. [patient.info]

N/A How can HSV-1 infection be prevented? Reducing transmission is an important aspect of prevention. Children with gingivostomatitis should be excluded from child care to prevent transmission to susceptible infants. [clinicaladvisor.com]

Centers for Disease Control and Prevention. [On-line information]. Available online at http://www.cdc.gov/std/tg2015/herpes.htm. Accessed October 2016. Ural, S. (2015 April 16 Updated). Genital Herpes in Pregnancy. [labtestsonline.it]

Prevention and treatment of cold sores. December 2003. Copyright ©2004 Daniel Ravel DDS, FAAPD [dentalresource.org]