> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/microbes/herpes.md). # Herpes [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/Herpes%20Simplex%20Virus%20morphology,%20family/README.md)**Icosahedral, enveloped** capsid virus with **linear double-stranded DNA** (dsDNA). Is part of the Herpesviridae family.. clothed, double lines, blue color ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV%20types%20and%20infected%20locations/README.md)Includes two types, HSV-1 and HSV-2. **HSV-1 typically infects above the waist** and **HSV-2 typically infects below the waist**. Infections from HSV-1 and HSV-2 can each be seen both above and below the waist, possibly due to **oral sex practices**.. [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV%20skin%20association/README.md)Associated with **erythema multiforme**, which appears as a "target lesion" with a pink-red ring around a pale center.\ target stamps from hands to trunk.. appear 1-2 weeks after infection ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) ## HSV-1 [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV-1%20Transmission/README.md) is transmitted through **respiratory secretions and saliva** and is typically involved with **infections above the waist**.. ![](https://f001.backblazeb2.com/file/wikiFiles/KU2p21f.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV-1%20symptoms/README.md)When the virus invades the mucous membranes, the infection is typically asymptomatic but can cause vesicular lesions that can ulcerate and cause.. * **Gingivostomatitis** in the mouth is the most common. * **Keratoconjunctivities** on the cornea, typically presenting as a branching “dendritic ulcer.” * **Esophagitis with ulcers** that appear well-circumscribed and have a “volcano-like” appearance. Often seen in immunocompromised individuals (ie. organ and bone marrow transplant recipients). CMV: linear * red lips, red eyes, ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/OW0av2c.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/2ln6nw6.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/x5ohcLN.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/Keratoconjunctivities,%20herpes/README.md) ![](https://f001.backblazeb2.com/file/wikiFiles/OW0av2c.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/2ln6nw6.jpg) ., Primary infection with HSV-1 results in herpetic **gingivostomatitis**. Peak age for primary infection is age 6 months to 5 years. Prodromal symptoms (eg, fever, malaise, chills) begin approximately 1 week after contact with an infected person (who is generally asymptomatic). Painful **vesicles** appear, extensively covering the lips and gingiva, and may include the palate, tongue, or oropharynx. The vesicles organize into extensive ulcers and resolve within 1-2 weeks. The pain of gingivostomatitis often results in**dehydration**, the most common reason for hospitalization. [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV1%20latent%20and%20result/README.md)Primary infection resolves after 2-3 weeks and can enter local sensory nerve endings and through axonal transport the virus can become latent in **trigeminal ganglion** or other sensory ganglia. Stress can cause **viral reactivation** and can results in **herpetic labialis (cold sores around the mouth)**, gingivostomatitis, or keratoconjunctivitis.. 3 gems on his helmet ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV-1%20CNS%20symptoms/README.md)Can spread via cranial nerves to the brain and cause **focal necrotic lesion in the temporal lobe, causing inflammation and encephalitis**. Most common cause of sporadic encephalitis, and can present with * **Altered mental status** * **Seizures** * **Aphasia** (loss of ability to understand/express speech).. Number 1 cause of sporadic encephalitis in U.S.\ hemet: necrosis\ wings: hemorrhage\ wings: temporal lobe encephalitis ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV%20hand%20lesions%20name%20and%20demographics/README.md)**Herpetic whitlow** is a painful hand vesicle that can occur in healthcare workers who come in contact with herpetic lesions (ie. dental procedure).. ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) ## HSV-2 [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV2%20transmission/README.md)Through **sexual contact** and is typically involved with **infections below the waist**.. [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV2%20symptoms/README.md)When the virus invades the mucous membranes, the infection is typically asymptomatic but can cause vesicular lesions that can cause **genital herpes** and painful inguinal lymphadenopathy.. Incubation: 3-7 days\ Dew drop on rose appearance:\ vesicles on red base\ inguinal knots around skirt ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/Herpes/README.md)Thin roof lesions. Histology shows ground glass, multinucleated viral inclusions.. ![](https://f001.backblazeb2.com/file/wikiFiles/uCV0WxX.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/j2QAFr5.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV2%20latent%20in/README.md)Primary infection resolves after 2-3 weeks and can enter local sensory nerve endings and through axonal transport the virus can become latent in the **lumbosacral ganglia** or other sensory ganglia.. sacral plate ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) ## Congenital Herpes [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/Herpes%20congenital%20transmission%20and%20symptoms/README.md)Vertical transmission can occur through the placenta (intrauterine HSV) or during delivery (neonatal HSV). Neonatal HSV can be classified into three main categories: * **Skin, eye, and mouth** * **CNS disease** * **Disseminated disease**.. ​ ![](https://f001.backblazeb2.com/file/wikiFiles/gqTj93Q.jpg) ## Torch infections [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/Torch%20infections/README.md)Congenital infections.. * **To**xoplasma * **R**ubella * **C**MV * **He**rpes simplex, **H**IV * **S**yphilis [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV%20diagnosis/README.md)Diagnosis includes: * PCR, especially in early detection of encephalitis * Multinucleate giant cells on **Tzanck** smear of skin lesions * Eosinophilic **Cowdry** intranuclear inclusion bodies.. ​ ![](https://f001.backblazeb2.com/file/wikiFiles/ajel72W.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/GOUaUx1.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/QgFqQpo.jpg) ![](https://f001.backblazeb2.com/file/wikiFiles/rzSEHaB.jpg) cowdry: cow shirt ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) [\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Microbes/HSV%20treatment/README.md)Treatment includes **acyclovir for only active infections**, since HSV thymidine kinase and DNA polymerase are not made during latency.. ![](https://f001.backblazeb2.com/file/wikiFiles/4AhLlmF.jpg) Acyclovir-resistant HSV can be treated with **foscarnet** because it bypasses activation by deficient or mutated thymidine kinase.