Etiology * double-stranded DNA * 2 type: HSV type 1 (HSV-1) and HSV type 2 (HSV-2) Epidemiology * Transmission: direct contact between mucocutaneous surfaces * only natural host is humans * HSV-1 cause recurrent oral infections * HSV-2 cause recurrent genital infections * highest in developing countries and among lower socioeconomic groups * higher among females than males* Neonatal herpes is an uncommon but potentially fatal infection of the fetus or more likely the newborn. * leading cause of sporadic, fatal encephalitis in children and adults Clinical Manifestations * skin vesicles and shallow ulcers (hallmark)* Acute Oropharyngeal Infections o Herpes gingivostomatitis V affects 6 mo to 5 yr ¥ pain in the mouth, drooling, refusal to eat or drink, and fever of up to 40.0- 40.6°C v gums become markedly swollen, and vesicles may develop throughout the oral cavity, including the gums, lips, tongue, palate, tonsils, pharynx, and perioral skin Tender submandibular, submaxillary, and cervical lymphadenopathy is common. vIn older children, adolescents, and college students, the initial HSV oral infection may manifest as pharyngitis and tonsillitis rather than gingivostomatitis.* Herpes Labialis ¥ Fever blisters (cold sores) are the most common manifestation of recurrent HSV-1 infections ¥ Vermilion border of the lip- most common site ¥ Lesion begins as a small grouping of erythematous papules that over a few hours progress to create a small, thin-walled vesicle become pustular then dries and develops a crusted scab* Cutaneous Infections v herpes gladiatorum- occurs in play or contact sports ¥ scrum pox- rugby ¥ Herpes whitlow- infection of fingers or toes Y Pain, burning, itching, or tingling often precedes the herpetic eruption V lesions begin as grouped, erythematous papules that progress to vesicles, pustules, ulcers, and crusts and then heal without scarring in 6-10 days. Y results in multiple discrete lesions and involves a larger surface area. Y lesions are frequently ulcerative and nonspecific in appearance279.2 Herpes simplex infection of finger (whitlow).* Genital Herpes ¥ common in sexually experienced adolescents and young adults ¥ 90% of infected individuals are unaware ¥ genital-genital transmission (HSV-2) or oral-genital transmission (HSV-1) ¥ preceded by a short period of local burning and tenderness before vesicles develop on genital mucosal surfaces or keratinized skin and sometimes around the anus or on the buttocks and thighs ¥ Women may experience a watery vaginal discharge, and men may have a clear mucoid urethral discharge. ¥ from onset to complete healing is 2-3 wk.¥ Most sexual transmissions and maternal-neonatal transmissions of virus result from asymptomatic shedding episodes. ¥ increases the risk for acquiring HIV infection * Ocular Infections ¥ involve the conjunctiva, cornea, or retina and may be primary or recurrent. ¥ Conjunctivitis or keratoconjunctivitis is usually unilateral Y conjunctiva appears edematous but there is rarely purulent discharge. Y Vesicular lesions may be seen on the lid margins and periorbital skin. v Untreated infection generally resolves in 2-3 wk* Central Nervous System Infections Y leading cause of sporadic, nonepidemic encephalitis in children and adults in the United States Y manifest as nonspecific findings, including fever, headache, nuchal rigidity, nausea, vomiting, generalized seizures, and alteration of consciousness v untreated infection progresses to coma and death in 75% of cases. v¥ most common cause of recurrent aseptic meningitis (Mollaret meningitis ).* Perinatal Infections Y acquired in utero, during the birth process, or during the neonatal period. Y Most cases result from maternal infection and transmission during passage through an infected birth canal Y intrauterine infection: skin vesicles or scarring, chorioretinitis and keratoconjunctivitis, and microcephaly or hydranencephaly ¥ during delivery or the postpartum period: (1) disease localized to the skin, eyes, or mouth, 5-11 days of life; (2) encephalitis with or without skin, eye, and mouth disease, 8-17 days of life ; and (3) disseminated infection involving multiple organs, including the brain, lungs, liver, heart, adrenals, and skin, 5- 11 days of life ¥ If untreated, 50% of infants with HSV encephalitis die, 90% for disseminated infection“*Diagnosis * polymerase chain reaction (PCR)- is the test of choice in examining CSF in cases of suspected HSV encephalitis. * cultures “Treatment * Acyclovir- poorest bioavailability * Valacyclovir-very good oral bioavailability * Famciclovir-very good oral bioavailability“Prevention * Good handwashing * avoiding contact with lesions and secretions, during active herpes outbreaks. * avoiding genital-genital and oral-genital contact * Male circumcision * delivering the baby via a cesarean section * Infants delivered vaginally to women with first-episode genital herpes: acyclovir therapy for at least 2 wkMumps * acute self-limited infection * characterized by fever, bilateral or unilateral parotid swelling and tenderness, and the frequent occurrence of meningoencephalitis and orchitis. * remains endemic in the rest of the world, “Etiology * Mumps virus, single-stranded pleomorphic RNA virus * exists as a single serotype with up to 12 known genotypes * humans are the only natural host.“Epidemiology * occurred between ages of 5 and 9 yr * Transmission: person to person by respiratory droplets * IP: 12 to 25 days * Virus appears in the saliva from up to 7 days before to as long as 7 days after onset of parotid swelling. * The period of maximum infectiousness is 1-2 days before to 5 days after onset of parotid swelling * isolation period of 5 days after onset of parotitis for patients with mumps in both community and healthcare settings.“Clinical Manifestations * fever, headache, vomiting, and achiness resolve in 3-5 days * Parotitis accompanied by ear pain (unilateral initially but becomes bilateral in approx 70% of cases) * parotid gland is tender * parotid swelling peaks in approximately 3 days and then gradually subsides over 7 days * the angle of the jaw is obscured and the ear lobe may be lifted upward and outward * Edema over the sternum * Amorbilliform rash is rarely seenDiagnosis * history of exposure to mumps infection * isolation of the virus in cell culture * detection of viral antigen by direct immunofluorescence * RT PCR * Serologic testing “Complications * Common: Meningitis, orchitis, oophoritis * Uncommon: conjunctivitis, optic neuritis, pneumonia, nephritis, pancreatitis, mastitis, myocarditis, arthritis, thyroiditis and thrombocytopenia“Treatment * No specific antiviral therapy * Aimed at reducing the pain associated with meningitis or orchitis * Maintaining adequate hydration. * Antipyretics may be given for fever. “Prevention + ImmunizationMeasles * highly contagious, but endemic transmission has been interrupted in the United States as a result of widespread vaccination * Warthin-Finkeldey giant cells that are pathognomonic * 4 phases: incubation period, prodromal illness, exanthematous phase, and recovery “Etiology + Measles virus, a single-stranded, lipid-enveloped RNA virus * humans are the only host “Epidemiology * incidence declined dramatically following the introduction of the vaccine in 1963 * Transmission: large droplets or small-droplet aerosols * incubation period: 8-12 days * infectious from 3 days before to up to 4-6 days after the onset of rash“Clinical Manifestations * high fever, an enanthem, cough, coryza, conjunctivitis with photophobia, and a prominent exanthem * Koplik spots represent the enanthem and are the pathognomonic sign, appearing 1-4 days prior to the onset of the rash * The rash begins on the forehead (around the hairline), behind the ears, and on the upper neck as a red maculopapular eruption, It then spreads downward to the torso and extremities, reaching the palms and soles * With the onset of the rash, symptoms begin to subside, fades over about 7 days, leaving a fine desquamation of skin. + In more severe cases, generalized lymphadenopathy may be present,Diagnosis * Clinical * Serology * Culture * PCR “Complications * Pneumonia is the most common cause of death * Croup, tracheitis, and bronchiolitis are common complications in infants and toddlers * Acute otitis media is the most common * Sinusitis and mastoiditisViral and/or bacterial tracheitis Retropharyngeal abscess Diarrhea and vomiting Activation of pulmonary tuberculosis Febrile seizures Encephalitis hemorrhagic measles or black measles- hemorrhagic skin eruption and was often fatal Myocarditis (rare)* Subacute sclerosing panencephalitis (SSPE) is a chronic complication with a delayed onset and an outcome that is nearly always fatal, result from a persistent infection that is harbored intracellularly in the central nervous system for several yr leading to an inexorable neurodegenerative process. “Treatment * Supportive * Maintenance of hydration, oxygenation, and comfort are goals of therapy * Antipyretics for comfort and fever control are useful. * airway humidification and supplemental oxygen * Vitamin A should be administered once daily for 2 days at doses of 200,000 IU for children 12 mo of age or older; 100,000 IU for infants 6 mo through 11 mo of age; and 50,000 IU for infants younger than 6 mo of age“Prevention * Exposure of susceptible individuals to patients with measles should be avoided * standard and airborne precautions * Vaccine