Herpes simplex natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Usama Talib, BSc, MD [3]

Overview

Herpes simplex infection can be symptomatic or asymptomatic. If left untreated herpes simplex can become recurrent. Neonatal herpes infection is a rapidly progressive disease resulting in CNS disease and disseminated disease. Clinical presentation of herpes initially include vesicular skin rash. Early diagnosis and treatment with acyclovir prevents the progression of disease. If left untreated the infection can rarely progress to involve the CNS and other organ systems. Involvement of CNS presents with irritability, confusion and respiratory difficulty. Disseminated disease may result in rare cases. CNS disease can have residual neurological deficits. Other complications include pneumonia, esophagitis, encephalitis, premature birth, spontaneous abortion and death of the infant. Babies can have developmental delay and death.[1]The prognosis is good for herpes skin infections in immunocompetent individuals. The use of acyclovir has reduced mortality in CNS and disseminated disease but the overall prognosis is poor in immunocompromized and infants.[2][3]

Natural History

If left untreated herpes simplex can become recurrent. Neonatal herpes infection is a rapidly progressive disease resulting in CNS disease and disseminated disease. Clinical presentation of herpes initially include vesicular skin rash. Early diagnosis and treatment with acyclovir prevents the progression of disease. If left untreated the infection can rarely progress to involve the CNS and other organ systems. Involvement of CNS presents with irritability, confusion and respiratory difficulty. Disseminated disease may result in rare cases. CNS disease can have residual neurological deficits. Babies can have developmental delay and death.[1][4]

Complications

Individuals with HIV or other immunocompromized patients are at a higher risk of complications of HIV. The complications of herpes simplex infection include: [5][6][7][8]

  • Recurrent painful genital sores
  • Psychological distress
  • Developmental delay
  • Damaged adrenals

Prognosis

  • The prognosis is good for herpes skin infections in immunocompetent individuals.
  • The use of acyclovir has reduced mortality in CNS and disseminated disease but the overall prognosis is poor in immunocompromized and infants.[2][9]

References

  1. 1.0 1.1 Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Frenkel LM, Gruber WC, Rathore M, Bradley JS, Diaz PS, Kumar M, Arvin AM, Gutierrez K, Shelton M, Weiner LB, Sleasman JW, de Sierra TM, Soong SJ, Kiell J, Lakeman FD, Whitley RJ (2001). "Natural history of neonatal herpes simplex virus infections in the acyclovir era". Pediatrics. 108 (2): 223–9. PMID 11483781.
  2. 2.0 2.1 Whitley RJ, Corey L, Arvin A, Lakeman FD, Sumaya CV, Wright PF, Dunkle LM, Steele RW, Soong SJ, Nahmias AJ (1988). "Changing presentation of herpes simplex virus infection in neonates". J. Infect. Dis. 158 (1): 109–16. PMID 3392410.
  3. Ahmad Tavakoli, Seyed Hamidreza Monavari, Farah Bokharaei-Salim, Hamidreza Mollaei, Bahman Abedi-Kiasari, Fatemeh Hoda Fallah & Helya Sadat Mortazavi (2017). "Asymptomatic Herpes Simplex Virus Infection in Iranian Mothers and Their Newborns". Fetal and pediatric pathology. 36 (1): 27–32. doi:10.1080/15513815.2016.1229368. PMID 27762667. Unknown parameter |month= ignored (help)
  4. Lucas Harless, Nancy Jiang, Frank Schneider & Megan Durr (2017). "Herpes Simplex Virus Laryngitis Presenting as Airway Obstruction: A Case Report and Literature Review". The Annals of otology, rhinology, and laryngology. 126 (5): 424–428. doi:10.1177/0003489417699421. PMID 28397560. Unknown parameter |month= ignored (help)
  5. Template:Corey, Lawrence, et al. "Genital herpes simplex virus infections: clinical manifestations, course, and complications." Annals of internal medicine 98.6 (1983): 958-972.
  6. Ahmad Tavakoli, Seyed Hamidreza Monavari, Farah Bokharaei-Salim, Hamidreza Mollaei, Bahman Abedi-Kiasari, Fatemeh Hoda Fallah & Helya Sadat Mortazavi (2017). "Asymptomatic Herpes Simplex Virus Infection in Iranian Mothers and Their Newborns". Fetal and pediatric pathology. 36 (1): 27–32. doi:10.1080/15513815.2016.1229368. PMID 27762667. Unknown parameter |month= ignored (help)
  7. Lucas Harless, Nancy Jiang, Frank Schneider & Megan Durr (2017). "Herpes Simplex Virus Laryngitis Presenting as Airway Obstruction: A Case Report and Literature Review". The Annals of otology, rhinology, and laryngology. 126 (5): 424–428. doi:10.1177/0003489417699421. PMID 28397560. Unknown parameter |month= ignored (help)
  8. Helena Reich Camasmie, Caroline Barbosa, Omar Lupi, Ricardo Barbosa Lima, Marcio Serra, Antonio Macedo D'Acri & Carlos Jose Martins (2017). "Extensive and refractory genital herpes in human immunodeficiency virus-infected patient successfully treated with imiquimod: Case report and literature review". Indian journal of dermatology, venereology and leprology. 83 (2): 256–259. doi:10.4103/0378-6323.199423. PMID 28164895. Unknown parameter |month= ignored (help)
  9. Ahmad Tavakoli, Seyed Hamidreza Monavari, Farah Bokharaei-Salim, Hamidreza Mollaei, Bahman Abedi-Kiasari, Fatemeh Hoda Fallah & Helya Sadat Mortazavi (2017). "Asymptomatic Herpes Simplex Virus Infection in Iranian Mothers and Their Newborns". Fetal and pediatric pathology. 36 (1): 27–32. doi:10.1080/15513815.2016.1229368. PMID 27762667. Unknown parameter |month= ignored (help)

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