Herpes simplex

definition

Herpes simplex is a virus (herpes simplex virus) that causes numerous diseases, especially skin diseases, and can be divided into two subgroups. A distinction is made between HSV 1 and HSV 2.
Cold sores (in the mouth area) are usually triggered by HSV 1, genital herpes, however, by HSV 2.

For more information, see the main Herpes article.

transmission

Similar to that Varicella zoster virus will that Herpes Simplex Virus 1 mostly absorbed by the human body in childhood. The virus is transmitted through the Air via droplet infection (e.g. sneezing) or through direct skin or mucous membrane contact (e.g. kissing). In 99% of the cases there are no symptoms at first contact, rarely the so-called occur Mouth rot (Aphthous stomatitis). The virus remains unnoticed in nerve endings, but can break out under certain conditions and it comes to Cold sore.

One goes from one today almost 90% contamination of the virus in the population. Are particularly at risk immunocompromised and elderly patientswho, due to their weakened general condition, can become life-threatening due to a herpes infection.

Herpes simplex virus 2 however, it is usually transmitted through sexual contact. The first infection usually only takes place in late adolescence to adulthood. When there is an outbreak, it happens Genital herpes.

HSV 1 - localization and symptoms

Basically any skin area in the body can be affected by a herpes simplex infection. The most common locations are Outside of the lips. It mostly arise painful blisters with purulent, crusty coverings. Many patients notice an itching or burning sensation before the actual outbreak occurs.
Of course, you should be aware that you are infected during an active period as well contagious are. So contagious that over 90% of all adults latent, so without complaints are infected with the herpes simplex virus type 1. Anyone who is once infected with the virus has a "chance" of about 20-30% that the annoying blisters will come back. Fortunately, for an unknown reason, these reactivations are becoming increasingly rare over time.

Depending on where the viruses have been carried, corresponding infections of herpes simplex can develop in different parts of the skin. Also to be mentioned are:

• Nasal herpes (Herpes nose) on the outside of the nose
• Herpes buccalis on the cheek mucosa
• Herpes facialis along the mimic muscles.

Unlike the Shingles however is not a whole Dermatome affected, the borders are therefore not sharply delineated but rather flowing. The appearance of the flaking skin, the redness and the elevation can, however, resemble shingles.

HSV 2 - localization and symptoms

This virus is when Sexual intercourse or at the birth transfer. With this infection, itchy blisters form on the Genital mucosa. The risk of infection is present with an active infection, but it can be through Condoms effectively prevented.
If a pregnant woman suffers from genital herpes, a Caesarean section can be done to prevent infection of the child during birth. Infection is particularly dangerous in newborns, as they tend to be life-threatening due to a still weak immune system Meningitis to get.

Severe courses and complications of herpes simplex

Herpes simplex infections can be particularly difficult if inner areas of the body are not affected.
Severe courses and complications are:

• Herpes simplex retinitis:
  In some cases, the Retina of the eye is afflicted with herpes simplex infection. The disease is also known as herpes simplex retinitis serious and dangerous. If not treatment started immediately threatens a strong one Loss of vision or even one Blindness.
• Eczema herpeticatum:
  Has existed before the herpes simplex infection another skin condition it can happen that the herpes infection settles "on" the already damaged and affected skin areas. This happening is called Superinfection designated and complicates the healing process the already damaged skin. The resulting clinical picture is also called Eczema herpeticatum designated. It can too severe general symptoms, how fever and General condition reduction come and not infrequently life threatening condition result, which must be treated in the intensive care unit.
• Herpes sepsis:
  Basically any herpes infection can cause one systemic infestation come, i.e. the body's viral load is so great that that immune system no longer complies with the cleanup. It comes to Blood poisoning (sepsis). In some cases, patients die, especially if they are already immunocompromised, are elderly or have severe comorbidities.
• Herpes esophagitis:
  Occurs rather less often Involvement of the esophagus on. So-called herpes esophagitis is relatively difficult to diagnose at first and requires a gastro-esophagoscopy (EGD).
• In special cases it can happen that a particularly large accumulations of herpes viruses leads to nerve involvement. This is then in a Insufficient function of the nerves clearly and in extreme cases in one complete nerve paralysis. Sometimes they are Facial nerves affected, which can lead to drooping corners of the mouth and eyelids. An exact proof of herpes involvement is still missing. However, the nerve limitation may decrease over time. Treatment with acyclovir for virus control should definitely be carried out.

Encephalitis

The herpes simplex virus can rarely have one Inflammation of the brain (called encephalitis) cause. In this case, what is actually a harmless herpes infection becomes a serious medical emergency that, if left untreated, results in more than 75% of cases fatal runs.
Since using Antivirals, i.e. agents that inhibit the multiplication of viruses, the risk of dying from herpes encephalitis has become relatively low. Therefore, only if herpes encephalitis is suspected, courageous treatment is required.
Although herpes simplex encephalitis accounts for only 10% of all encephalitis, it is responsible for most of the deaths from encephalitis. Get sick every year 1-2/100.000 People with herpes encephalitis.
Encephalitis almost always develops from an acute infection with the herpes simplex virus. The viruses migrate from the blood via the so-called Cranial nerves retrograde, so practically backwards into the brain, mostly this happens along the Olfactory nerves. Unfortunately, there are no known factors that affect the likelihood that a "normal" herpes infection will turn into encephalitis, so there is little protection against such an infection.
It is known, however, that most of the brain inflammation occurs reactivated infections arise and not from initial infections.
If you have encephalitis, the symptoms usually begin flu-like, so with fever and Headache and body aches. After a few days, complaints from the impairment of the brain come to the fore. It often happens Impaired consciousness and epileptic seizures. Not infrequently also occur Speech disorders and Signs of paralysis on.
Which mostly Not occurs are Cold sore. If the meninges are also affected by the infection, severe headaches and neck stiffness usually occur. If herpes encephalitis is suspected, this is always a emergency and must be treated in a neurological ward. Usually the brain will then use one MRI of the brain examined for suspicious changes and also from the spinal canal nerve fluid (so-called "Liquor") Taken.
This CSF is then examined to confirm the suspicion. Regardless of this, before there is any certainty about the pathogen, "Acyclovir“Administered. This is an active ingredient that can also be found in creams for cold sores. In encephalitis, however, the drug is injected in high doses through a vascular access or as a infusion administered. In addition, because of the risk of epileptic seizures, an epilepsy drug is administered until the encephalitis is over.

forecast

This is decisive for the chances of survival early treatment of encephalitis. Here, “danger recognized, danger averted” actually applies. Because if no therapy is administered, the mortality is 70%, with therapy only at 20%.
In the case of survivors, the lasting damage after the illness is great differently often, depending on how quickly therapy was started. Around half of the patients retain permanent damage on average, mostly epileptic seizures or mental impairments. If therapy is started very early, this number drops to below 30%. So overall, herpes simplex encephalitis is one serious illnesswhich is unfortunately difficult to identify due to its mostly unspecific complaints. If it is recognized, however, herpes simplex encephalitis can be treated very well.

diagnosis

For the diagnosis of a herpes simplex infection, the clinical look. If the course is severe, or if the internal organs are also affected, it can go through appropriate immunological procedures evidence of a herpes infection can be provided.

treatment

The treatment is carried out with so-called antivirals, which inhibit the further multiplication of the virus. Acyclovir is used for herpes simplex infections. In the case of mild infections, it can be local, e.g.as an ointment, in severe cases or when complications occur, it must be given systemically (e.g. as an infusion).

However, what no drug can do today is to fight the viruses in their permanent form in the nerve cells.

Read more on the subject at: Duration of cold sores