Herpes nerve endings symptoms. Herpes - types and treatment of herpes. Herpes and damage to the nervous system, nerve endings, ternary, sciatic nerve

Herpes is one of the most common human viral infections and represents a serious medical and social problem. Over 90% of the world is infected with the herpes simplex virus (HSV) and up to 20% of them have some clinical manifestations of the infection. The AI ​​virus affects the skin, mucous membranes, and central nervous system.
Transmission of infection occurs in the following ways:
1) by airborne droplets;
2) sexually;
3) contact (through kisses, toys, household items);
4) transplacental (during pregnancy)

Reproduction of all herpes viruses
occurs in the nucleus of the affected cell. Invading a cell, the virus uses it structural components as a building material, and also subjugates the cell’s synthesizing systems, “forcing” the production of substances necessary for the construction of new viruses. The fastest rates of cloning of virions occur in the cells of the epithelium and mucous membranes, blood and lymphatic tissues.
HSV, like some other human herpesviruses, is capable of latent existence, followed by reaction, which can cause repeated relapses of the disease or asymptomatic shedding of the virus. Herpes has a destructive effect on the immune system and causes secondary immunodeficiency.

In humans, there are 8 in the Herpes virus family various types human herpes virus (HHV):
The most common of them are the herpes simplex virus type 1 (HSV-1 or HHV-1) and in many respects the herpes simplex virus type 2 (HSV-2 or HHV-2), which is very close to it. Herpes simplex virus I - most often causes damage in the mouth; Herpes simplex virus II - most often causes damage to the genital organs or damage to the anus.
Human herpes virus type 3 (HHV-3) provokes the development of two independent diseases - chickenpox and herpes zoster.
Human herpes virus type 4 (HHV-4) or Epstein-Barr virus can cause infectious mononucleosis and villous leukoplakia of the tongue.
Human herpes virus type 5 (HHV-5) - cause cytomegalovirus infection.
Human herpes virus type 6 (HHV-6), according to the latest data, causes sudden exanthema in young children and syndrome chronic fatigue in adults, and is also likely involved in the development of some other diseases. Relatively recently, in 1990, HHV-7 and HHV-8 were discovered, which are now being actively studied. HHV-7 is associated with lymphoproliferative diseases and chronic fatigue syndrome, HHV-8 - with Kaposi's sarcoma. However, these types of human herpes virus are not as common as HSV-1 and HSV-2.
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It is impossible to remove the virus from the body; it will remain with the person for life. The immune system responds to the penetration of herpes by producing specific antibodies that block viral particles circulating in the blood. The awakening of infection is typical in the cold season, with colds, and with a lack of vitamins.
Local form: after a short (several hours) prodromal period, accompanied by local itching or hyperesthesia, single or grouped tense vesicles with a diameter of up to 1.2 cm, containing clear liquid, appear on the skin and mucous membranes on an edematous, hyperemic base. The rashes are localized on the red border of the lips, in the nasolabial triangle, less often on the mucous membrane of the mouth, larynx, conjunctiva, and in the genital form - on the mucous membranes of the genital organs and the skin of the anogenital area. There is mild pain and enlargement of regional lymph nodes. Healing of the rash occurs from 7 to 14 days. Genital herpes is characterized by spontaneous opening of blisters and the formation of painful superficial ulcers, fever, myalgia, weakness, and dysuria.
In newborns, disseminated herpes infection manifests itself as multiple multiple organ lesions, in which signs of encephalitis, respiratory distress syndrome, and adrenal insufficiency predominate, with high mortality (up to 50%).

Organs and systems of the body that can be affected by the herpes simplex virus and the diseases it causes
1. Optic tract (keratitis, iridocyclitis, chorioretinitis, neuritis optic nerve, phlebothrombosis)
2. ENT organs (pharyngitis, “herpetic sore throat”, laryngitis, external ear, sudden deafness, vestibular disorders)
3. Oral organs (stomatitis, gingivitis)
4. Skin and mucous membranes (herpes of the face, lips, genital herpes, etc.)
5. Lungs (broncho-pneumonia)
6. The cardiovascular system(myocarditis, myocardiopathy, participation of HSV in the processes underlying atherosclerosis)
7. Gastrointestinal tract (hepatitis, ileo-colitis, proctitis)
8. Female genital organs (colpitis, intrauterine HSV infection: endometritis, amnionitis, chorionitis, metroendometritis, reproductive dysfunction)
9. Male genital organs (prostatitis, urethritis, sperm damage)
10. Central nervous system (encephalitis, sympathoglioneuritis, nerve plexus damage)
11. Psycho-emotional sphere (depression, aggravating influence of HSV on the course of hydrocyanic dementia and nuclear schizophrenia)
12. Lymphatic system(HSV lymphadenopathy)

Treatment of herpes
1. Prescription of antiviral drugs - acyclovir, Zovirax - 200 milligrams each. 5 times a day - orally. Children under 2 years old: 100 milligrams for 5-10 days.
2. Local 5% cream with acyclovir for 5-10 days. For eye herpes, 5% ointment for 3 to 20 days. You can also use ointments such as bonafton, tebrofen, oxolin, florenal.
At the 2nd stage of treatment - diet: nothing peppery, salty, fried, no alcohol. Everything is boiled and stewed. Gentle mode. Subcutaneously Timalin, interferon 1 ml. 1 time per day for 5 days.
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Currently, no guaranteed cure for herpes has been found. There are, however, drugs that, when taken regularly, can effectively suppress the symptoms of virus infection, its reproduction and development (that is, improve the patient’s quality of life): Acyclovir (Zovirax, Zovirax and numerous generics). An antiviral drug that prevents the virus from multiplying in cells. Dosage form- tablets and cream. Relatively cheap, effective for most patients. Valacyclovir (Valtrex, Valtrex). It differs from acyclovir only in the delivery method, but is more effective. In most cases, it completely suppresses the symptoms of the virus and its biological activity, blocks its reproduction and is highly likely to prevent transmission of the virus to other partners during contact. Currently, in the West, this drug is the main treatment for herpes. Famciclovir (Famvir, Famvir). Oral form penciclovir. Effective against strains of the Herpes zoster and Herpes simplex virus (including those resistant to acyclovir and those with altered DNA polymerase). The principle of action is similar to acyclovir and Valtrex. It is highly effective. The effectiveness of Famvir and Valtrex is considered higher than that of acyclovir.

LYSINE
Research by scientists of the Department of Biochemistry Russian University friendship of peoples explain why the amino acid lysine is effective against herpes. The herpes virus uses another substance for active reproduction - arginine. But he can be deceived. When there is enough lysine in the body, the herpes virus (which causes genital herpes) is tricked into using it. Then an irreversible reaction occurs with the participation of the enzyme L-lysine-alpha oxidase and the virus stops reproducing. In experiments on cell cultures, it was even possible to completely get rid of the herpes virus. We recommend taking Lysine together with Meishi for 2 months. You need to repeat courses of treatment 2 times a year or as needed during high physical or emotional stress, since genital herpes worsens more often under stress. The key enzyme in the destruction of the virus is L-lysine alpha oxidase. Probably the enhancement of the effect of lysine by medicinal mushrooms (Meishi) occurs due to the same enzymes. It is known that under severe stress, lysine reserves in the cell are quickly depleted, and the virus is activated. Therefore, people who are nervous a lot are more likely than others to experience relapses of herpes. You can prevent relapses by supporting your immune system and using the amino acid Lysine. How to take lysine: Adults, 1 capsule per day with meals in parallel with Meishi. May increase to 2 capsules per day. For herpes - 3-6 capsules per day. It is recommended to consult a doctor before use.

DIET AND NUTRITION FOR HERPES.
Dietary recommendations for people with herpes:
1. eat as many fruits and vegetables as possible;
2. drink 1 - 1.5 liters of fluid per day (if you suffer from heart disease vascular system or renal failure- consult your doctor);
3. Do not eat fatty foods;
4. Forget about sugar and chocolate;
5. Absorb less salt, vodka, peanuts, seeds;

Row food products can provoke relapses of herpes, leading to a weakening of the immune system: fatty foods rich in cholesterol, sugar, and everyone’s favorite alcohol are the cause of frequent herpetic rashes. Sugar slows down the absorption of vitamins B and C in the intestines, which leads to a decrease in immunity, because white blood cells (leukocytes) cannot suppress the virus. Alcohol has a direct toxic effect on immune cells; cholesterol reduces the formation of white blood cells.
In order to increase the intervals between relapses, people suffering from viral diseases are advised to adhere to a diet with a high content of the essential amino acid LYSINE in food products, which prevents the activation of viral infections and reduces the frequency of relapses.

Natural springs lysine:
- Potato broth
- Casein
- Meat protein
- Egg white
- Soy
- Potato
- Wheat germ
- Lentils
Let me give you an example list of "harmful", in which the content of arginine is 2 times more than lysine and products useful for herpes patients.
“Harmful” foods include: peanuts, chocolate, raisins, some grains, especially wheat-based products.
Healthy - fruits and vegetables, white chicken, fish, legumes, incl. beans; eggs. It should also be remembered that a balance between dishes with a high content of amino acids and natural alkalis is important. The first includes meat dishes, the second includes dishes made from fruits, vegetables, and legumes. An imbalance will immediately lead to a relapse, so every sour dish must be eaten with an alkaline one.

Vitamins:
Vitamin C - consumption of 600 mg of vitamin C + 600 mg of B vitamins 3 times a day for 3 days, started in the prodromal period, leads to the disappearance of symptoms.
During the first outbreaks of herpes (itching), taking vitamin C along with vitamin P prevents the appearance of rashes in two out of three cases.
Vitamin E - the use of vitamin E for fever on the lips can reduce painful sensations and thanks to its restorative properties, accelerate the healing of ulcers. Applied as oil solution on the affected areas for 15 minutes. After about half an hour, the pain subsides. If itching and tingling returns, the vitamin must be reapplied.
Zinc Zn - found in pumpkin seeds, seafood, red meat. When taken twice a day for 6 weeks, 25 mg together with 250 mg of vitamin C leads to a decrease in the frequency and duration of relapses.

Plant extracts:
Eleutherococcus tincture, Zhen-Shen root, Golden root, mumiyo, thuja extract, echinacea, pantocrine from its own horns - the listed natural remedies have a stimulating effect on the immune system: the production of white blood cells increases, the ratio between subtypes of leukocytes is normalized, the process of restoration of damaged and reproduction is accelerated cells. Increase the duration of the relapse-free period.

Approximate plan - treatment regimen for herpes WITH NATURAL REMEDIES:
During a relapse:
1. At the onset of a relapse, apply ice cubes to the causative site for 10 minutes. Several times a day. Avoid cold burns to the “causal” areas.
2. Applying 2% Acyclovir (Zovirax) ointment to the lesion
3. Lysine 1000 mg x 3 times a day
4. Vitamin C and B vitamins 600 - 800 mg daily
Outside of relapse:
1. Eat a diet with plenty of lysine (vegetables, fish, beans, chicken legs)
2. Lysine 1500 mg once a day
3. Sex with a condom treated with an antiseptic such as nonoxynol - 9.

Below is a table that doctors use when developing a diet for herpes sufferers. It reflects the content of the amino acids lysine and arginine in a number of foods included in the diet of the average US resident, and the ratio between these amino acids. The higher the number reflecting the lysine/arginine ratio, the higher the “dietary” value of the product, or the higher the product is at the top of the table, the healthier it is. Lysine/arginine ratio table in foods

Once in the body, lysine replaces another amino acid - arginine. In terms of their chemical structure, they are like twin brothers. The herpes virus “makes a mistake” and builds new viruses not from arginine, but from lysine, which can be figuratively compared to building houses from sand rather than concrete. Naturally, “newborn” viruses built from lysine die immediately - reproduction stops.

Fish, chicken, pork, many fruits and vegetables, and eggs are also useful. It is important to eat foods containing protein and fruits and vegetables throughout the day. In this case, the body maintains an optimal acid-base balance.
There is a lot of lysine in green vegetables and fruits, zucchini, pumpkin, melon.

Therefore, instead of traditional coffee and tea in winter, it is advisable to drink herbal teas. To increase immunity, the following collection is used:
l Rose hips - 3 parts, Rhodiola rosea roots - 3 parts, hawthorn fruits - 2 parts, St. John's wort herb - 1 part, black currant leaves - 1 part. Grind everything and mix. Pour 1 tablespoon of the mixture into 350 ml of boiling water, heat in a water bath for 15 minutes, leave for 1 hour, strain. Add honey to the warm infusion at the rate of 1 tablespoon per 1 glass of boiling water. Drink 1/2 glass 3 times a day 30 minutes before meals. The course of taking the collection is 1 month, then you need to take a break for a month.
During pregnancy, you should avoid taking lysine and adaptogens, because lysine can inhibit fetal growth, and adaptogens can increase blood pressure.

Herpetic encephalitis. Almost a fifth of sporadic viral encephalitis is caused by herpes simplex viruses, in the vast majority of cases (95%) by HSV-1. The disease most often occurs between the ages of 5 and 30 years and over 50 years. In children and young people, herpetic encephalitis can develop during primary infection, and also be one of the lesions of the body during a generalized infectious process.

Herpetic encephalitis in most adults develops following herpetic lesions of the skin or mucous membrane. The disease is characterized by increased body temperature, symptoms general intoxication and focal, associated primarily with the temporal lobe of the brain, lesions of the central nervous system.

Herpetic meningitis. Its share in the overall incidence of serous meningitis in people is 0.5-3%. As a rule, the disease develops in individuals with primary genital herpes. It is manifested by increased body temperature, headache, moderate photophobia, stiff neck, Kernig's sign, as well as a moderate increase in the number of lymphocytes in the cerebrospinal fluid. The disease in most cases is mild. Symptoms of the disease persist for 3-7 days. After meningitis, relapses sometimes occur.

Herpetic lesion internal organs. As a rule, it is a consequence of viremia and is accompanied by the involvement of several organs simultaneously. However, there are cases where only the esophagus, lungs or liver are affected.

Herpetic esophagitis develops as a result of the spread of herpes simplex viruses from the mucous membrane of the oropharynx or due to their penetration along the vagus nerve during reactivation of the infection. Patients develop dysphagia, chest pain, as well as multiple oval-shaped ulcers of the esophageal mucosa detected during endoscopy, located on an infiltrated base, covered in some cases with a white film. Along with this, inflammation of the entire esophageal mucosa is often observed.

Herpetic pneumonia develops in immunodeficiency states. It occurs as a result of the introduction of the herpes simplex virus from the trachea and bronchi during herpetic tracheobronchitis and is focal in nature. With hematogenous dissemination of the virus from the oral mucosa or genital tract, bilateral (less often unilateral) interstitial pneumonia often develops. In both cases, a layering of secondary (bacterial, fungal and other) microflora occurs. As a result, the disease becomes severe with high (up to 80%) mortality.

Herpetic hepatitis. The initial period of the disease occurs with elevated body temperature, symptoms of intoxication, moderately severe disorders of pigment metabolism (darkening of urine) and increased activity of alanine transaminasemia. During the height of the disease, icteric discoloration of the skin, sclera, and soft palate develops, the liver enlarges, and in some cases, the spleen, and alanine transaminasemia reaches high levels. Sometimes hemorrhagic syndrome is observed. In peripheral blood there is a tendency to leukopenia and lymphocytosis.

Rare forms herpetic infection are pancreatitis, glomerulonephritis, idiopathic thrombocytopenia, enterocolitis.

Herpetic lesions of newborns(children up to 6-7 weeks of age) develops during intrauterine (at the time of birth) infection with herpes simplex viruses, mainly HSV-2. As a rule, the disease occurs with damage to internal organs and/or the central nervous system and high mortality (65%). Unlike adults, herpetic rashes appear only in the late stages of the disease.

Infection of newborns with HSV-1 occurs in the postnatal period through contact with family members suffering from latent or manifest forms of the disease, as well as as a result of intrahospital transmission of viruses during hospitalization.

Generalized herpetic infection develops not only in newborns, but also in adults with immunodeficiency conditions (those suffering from lymphogranulomatosis, oncological processes, long-term users of glucocorticoids and cytostatics, HIV-infected people, etc.) The disease is characterized by fever with large daily fluctuations in body temperature, chills, myalgia , headache, severe general weakness, damage to the skin, mucous membranes of internal organs (liver, lungs, brain or meninges).

Herpes infection in HIV-infected people associated with activation of latent herpetic infection against the background of an immunodeficiency state. Initially, the disease manifests itself only as damage to the skin and mucous membranes. As immunodeficiency progresses, a generalized form of herpetic infection develops. Initially it manifests itself as a spread pathological process from the oral mucosa to the esophagus, trachea, bronchi, and then to the lungs.

When a herpetic infection is generalized, the retina of the eye (retinitis or chorioretinitis), the brain (encephalitis) or the meninges (meningitis) can also be affected. Herpetic skin rashes in these patients turn into deep ulcerations.

Diagnosis and differential diagnosis. Diagnosis of diseases with skin lesions and mucous herpetic infection (vesicular rashes on an infiltrated base) usually does not cause difficulties. In other cases, mandatory laboratory confirmation of the diagnosis is required. For these purposes, methods are most often used to detect the causative agent of the disease in material from the patient (the contents of vesicles, scrapings from lesions - the cornea, genitals, etc., blood, cerebrospinal fluid, tissue biopsies). This is achieved through virological studies or more simple method- detection of herpes virus DNA in polymerase chain reaction (PCR). The use of light microscopy of Romanovsky-Giemsa-stained preparations for these purposes is much less informative than PCR. Serological methods for confirming the diagnosis of herpes infection (RSC, RN) make it possible to detect a fourfold increase in antibody titer only in the case of a primary disease. When it recurs, it occurs in no more than 5% of cases.

Complications. Herpetic encephalitis can leave behind persistent mental status disorders and peripheral paralysis. Herpetic pneumonia can be complicated by respiratory failure. Generalized herpetic infection in some cases is accompanied by the development of hemorrhagic syndrome, acute adrenal insufficiency and acute pancreatitis, glomerulonephritis, and monoarticular arthritis.

Treatment. The basis of therapy for patients with herpetic infections are etiotropic measures carried out with the help of the chemotherapy drug acyclovir (synonyms - virolex, zovirax), interferon and interferonogens - amixin, etc. Their effectiveness is much higher when treatment is started early (in the first days of the disease). For herpetic lesions of the skin and mucous membranes, including genital herpes, acyclovir is prescribed 200 mg 5 times a day for 7-10 days or amixin 0.125 g 1 time a day on 1, 2, 4, 6, 8, 10 , 12, 14, 16 and 18 days (10 tablets per course of treatment). In case of a disease accompanied by single small elements of rashes on the skin or lips, you can limit yourself to taking Amixin and topical application of 5% Zovirax ointment (cream).

For herpetic proctitis, acyclovir should be prescribed 400 mg 5 times a day for 8-12 days and amixin 0.125 g - 1 time per day on days 1, 2, 4, 6, 8, 10, 12, 14, 16 and 18 treatment (10 tablets per course of therapy).

For generalized and visceral forms of herpetic infection, intravenous administration of acyclovir solution at a dose of 15-30 mg/kg per day is recommended ( daily dose administered in 3 doses - after 8 hours) for at least 10 days and interferon preparations (reaferon 1-3 million units/day or others).

For herpetic lesions of the cornea, solutions of interferon, vidorabine and acyclovir should be used locally.

Along with etiotropic treatment, pathogenetic (corresponding to the clinical form of the disease) measures are carried out.

Forecast. Generalized herpetic infection, as well as occurring with encephalitis, hepatitis, pneumonia, in the absence of etiotropic therapy ends in death in 60-90% of cases. Herpetic infection of the eye can cause loss of vision. Herpetic infection of the skin and mucous membranes in HIV-infected people can be complicated by a deep ulcerative process with a tendency to become chronic.

Discharge rules. Discharge is determined by the timing of clinical recovery of convalescents.

Clinical examination. Those who have recovered from herpetic meningitis and encephalitis are subject to observation by a neurologist, hepatitis - by an infectious disease specialist, pneumonia - by a therapist, and herpetic eye damage - by an ophthalmologist - for the generally accepted periods for such types of diseases.

Prevention and measures in the outbreak. In case of herpetic infection with damage to the oral mucosa and respiratory tract preventive measures are carried out for influenza and acute respiratory diseases (see Influenza). Prevention of genital herpes is based on the use of condoms. Prevention of infection with herpes simplex viruses in newborns is based on timely treatment of women suffering from genital herpes who are preparing to become mothers, as well as protecting infants from contact with patients with herpes infection.

Convalescents, after a frequently recurrent herpetic infection (genital herpes, etc.), need measures that can prevent the manifestation of the infectious process. For these purposes, it is recommended to take acyclovir (200 mg 2-3 times a day for 2-6 months) or amixin 0.125 g once a week for 6-10 weeks a year.

However, a more significant effect is provided by anti-recurrent treatment of herpetic infection with amixin (0.125 g per dose every other day, N10), supplemented 2 months after the last relapse of the disease with vaccine therapy using an inactivated herpetic vaccine.

The course of vaccine therapy involves intradermal (into the palmar surface of the forearm) administration of 0.2 ml of a standard vaccine solution five times with an interval of 3-4 days. It is repeated twice (after 2 weeks and 6 months).

Medical examination. Convalescents after a generalized herpetic infection, as well as diseases affecting the central nervous system, eyes, and internal organs, are relieved of duty for the period of rehabilitation treatment. They can receive rehabilitation measures in rehabilitation departments, centers or sanatoriums. Military personnel who, after a course of rehabilitation treatment, continue to have changes that reduce their performance, are examined to determine the degree of suitability for military service. Aviation flight personnel are allowed to fly after passing a medical flight examination.

Modern science knows eight herpes simplex viruses (HSV – human herpes virus). Primary infection with any of the eight viruses usually occurs in childhood, and is either asymptomatic or produces fever and rash on the skin or mucous membranes; in rare cases, other organs may be involved.

After the initial infection, the herpes virus remains in latent form in the ganglia or lymphoid tissue. With the exception of HHV-8, which causes Kaposi's sarcoma in patients with AIDS, reactivation of HHV can produce one or more of the following complications: meningitis, encephalitis, myelitis, vasculopathy, ganglioneurotia, retinal necrosis, and optic neuritis. The disease can be monophasic, recurrent or chronic. Each type of herpes infection produces distinctive clinical features and visualization of deviations. This highlights an overview of neurological symptoms and signs, as well as typical clinical picture, obtained using each of the VHVs. The optimal virologic testing of blood, cerebrospinal fluid, and affected tissue to confirm the diagnosis is discussed; this is especially important because some HHV infections of the nervous system can be successfully treated with antiviral drugs.

INTRODUCTION

Herpes viruses are large, double-stranded DNA viruses. About 130 different herpes viruses have been identified not only in mammals, but also in frogs, lizards, birds, fish and mosquitoes. There are eight human herpes simplex viruses (HSV): herpes simplex virus (herpes simplex HHV-1, HHV-2), varicella-zoster virus (HHV-3), Epstein-Barr virus (HHV-4), cytomegalovirus (CMV or HSV- 5), HHV-6, HHV-7, and HHV-8. Characteristic feature All herpes viruses are characterized by their ability to be in a latent form, primarily in the ganglia of the nervous system and lymphoid tissue. For example, HHV-1 and HHV-3 are found in ganglion neurons, while HHV-4 is hidden in B lymphocytes. Most HHVs are neurotropic and rarely cause serious acute and chronic neurological diseases of the PNS and CNS, which can be monophasic, recurrent or chronic. Each type of herpes infection has different clinical features, and many HHV infections can now be treated. This review focuses on neurological complications in HCH and discusses the latest treatments for these disorders.

HERPES SIMPLE VIRUS 1 (Herpes simplex)

Clinical features

Encephalitis is the most serious neurological complication caused by HHV-1. Symptoms and signs of encephalitis may include fever, headache, lethargy, irritability, confusion, aphasia and seizures, and they reflect viral replication in the medial temporal lobe and orbital surface frontal lobes. Survivors may experience disturbances in consciousness, changes in mental status, aphasia, or stiffness. Before the development of the drug acyclovir, most patients with viral encephalitis died.

Figure 1 shows typical CT and MRI abnormalities in patients with HHV-1 encephalitis compared with abnormalities in VZV vasculopathy (see below) and other viral encephalitises.

(A) Herpes simplex virus 1 (HHV-1) encephalitis: MRI of the brain demonstrates bilateral temporal lobe involvement. ( B) varicella zoster virus (VZV) vasculopathy: proton density MRI scan of the brain shows multiple regions of the myocardium in both hemispheres, particularly involving the white matter (thin arrow) and extending to the gray-white matter (thick arrow). ( C, D) CT and MRI changes in a patient with probable enteroviral encephalitis. Other viruses can make the same changes. In contrast to A and B, panel C shows relative effacement of the sulci posteriorly in both hemispheres (thin arrows), compared with normal distances anteriorly (thick arrow). Panel D indicates the recovery of the inversion. An MRI of the brain scans the same patient, showing areas of increased signal in both hemispheres, more on the right and even more noticeably in the back (arrow), reflecting increased water content in this swollen brain.

Pathogenesis and latency

Primary HHV-1 infection often results in skin or mucosal lesions, but can also be asymptomatic. The virus multiplies at the site of infection, usually around the mouth or genitals, leading to infection of sensory nerve endings. The virus is then transported to nearby ganglia, where it establishes itself in a latent form. The frequency of relapses is directly related to the severity of the primary infection, as evidenced by the size, number and area of ​​distribution of the lesions. The mechanism by which HHV-1 infects the central nervous system to cause encephalitis is not yet fully understood. The predilection of HHV-1 for the orbital surface of the frontal lobe and the medial surface of the temporal lobe suggests that the virus can be transmitted through the olfactory mucosa through the ethmoid bone plates in the anterior cranial fossa. Latent virus in the trigeminal ganglia may also activate and spread through the tentorial nerves that innervate the meninges of the anterior and middle cranial fossa. Most people have latent HHV-1 (1).

HHV-1 is activated by increased ultraviolet (UV) radiation, adrenaline, hyperthermia, or even social stress. Accumulating evidence from rodent studies suggests that HHV-1 infection suppresses the hypothalamic-pituitary-adrenal axis during primary infection and that this stress-induced suppression plays an important role in viral reactivation. The relevance of animal studies to humans, however, must always be questioned. For example, guinea pigs vaccinated with HHV-2 glycoprotein D were protected from reactivation, whereas subunit vaccines were only marginally effective in human trials (2).

Treatment

Intravenous acyclovir (10 mg/kg body weight three times daily for 14–21 days) is the standard treatment for HHV-1 encephalitis in adults (Table 1). Steroids are sometimes given, although evidence regarding the effectiveness of this approach is sparse. Cognitive impairment and seizures are significant neurological complications in treated patients.

Table 1 Antiviral treatment herpes infections of the human nervous system

n. “colds” - to psychiatric and oncological diseases.

Symptoms of herpes type 1 - the virus that causes the “cold”

Herpes type 1 is the simplest and most quickly suppressed virus. The infection is mainly stored in the nerve endings cervical spine spine in a dormant state, but with a decrease in immunity or under the influence of stress, it is activated and manifests itself with the following symptoms:

1. First, the skin turns red and there is a burning sensation and itching.
2. After 6-48 hours, one or more vesicles - bubbles containing a clear liquid inside - form on the inflamed area.
3. If left untreated or scratched, the vesicles burst, spreading infected fluid around and causing the affected area of ​​skin to enlarge.
4. In place of the burst bubbles, a wound appears, which over time becomes covered with a crust.
5. With the support of the immune system, the disease gradually “falls asleep” again - goes into a latent state. Without support, large areas are damaged and wounds do not heal normally.

If a person has symptoms, they can infect others through contact. Most often, herpes 1 is localized on the face and mucous membranes of the mouth. It can affect the lips, cheeks, chin, mucous membranes of the nose, eyes, mouth or larynx. Sometimes the infection gets to the skin of the torso, causing the disease to spread to the body.

Symptoms of herpes type 2 - the genital form of the virus

The symptoms of herpes type 2 are similar to type 1, but the localization of the blisters is different. In a dormant state, this virus is located in the nerve endings of the sacral clutch. Vesicles are formed mainly in the groin area, on the thighs, buttocks, anus and genitals.

In addition to the usual symptoms, deterioration in mood and mental state, loss of appetite, and signs of intoxication are observed. Possible enlargement of the lymph nodes in the groin area. In women, vesicles can appear inside the vagina and on the cervix, in men - in the urethra.

Symptoms of herpes type 3 - the Zoster virus, which causes chickenpox and shingles

The herpes zoster virus is usually infected in childhood, and it manifests itself in the form of ordinary chickenpox. When the child recovers, at the end of his trigeminal nerve The infection remains forever, although it does not manifest itself under normal living conditions.

When immunity falls, a person gets sick with an acute respiratory infection or simply lives unhealthy, the symptoms of the disease appear again. Most often, the lesion occurs in people over 50 years of age, while recurrence of this type of herpes is the rarest (observed in only 5% of patients).

Repeated disease is called herpes zoster and has the following symptoms:

• the affected nerves hurt, burn, or tingle;
• when moving, heating or touching this area, the discomfort increases;
• duration of pain – 3-12 days;
• the temperature may rise to subfebrile;
• a few days after the onset of pain, redness and swelling occur on the skin and mucous membranes;
• contagious (infectious) vesicles appear on the surface of the inflamed area;
• the liquid in the bubbles gradually becomes cloudy, after which they explode;
• wounds from burst vesicles become covered with crusts.

As a rule, the disease goes away after 1-3 weeks. After the rash appears, the pain is replaced by itching. In rare cases, the pain does not go away, it subsides, but appears throughout life.

Symptoms of herpes type 4 - mononucleosis from the Epstein-Barr virus

Epstein-Barr virus causes a disease called infectious mononucleosis. The disease is quite dangerous and requires treatment to prevent undesirable consequences - deep genital ulcers in women, destruction of blood cells, oncological pathologies (types of lymphomas), autoimmune diseases and chronic fatigue syndrome.

Typically, when infected with herpes virus type 4, the following symptoms are observed after 7-14 days:

• weakness;
• headache;
• drowsiness;
• nausea;
• heat;
• sore throat with cough;
• enlarged lymph nodes;
• itchy rash;
• white or yellowish coating on the palate;
• enlarged liver and spleen (possible jaundice);
• formation of atypical cells in the blood - mononuclear cells.

The patient is often thirsty and has a fever for about a week. Lymph nodes shrink within a month, blood changes can last up to 6 months. Correct treatment leads to recovery and lifelong immunity; its absence leads to a chronic form of the disease:

1. Erased - muscle pain, aching joints, frequent low-grade fever, fatigue.
2. Atypical – frequent relapses of infectious diseases (acute respiratory infections, diseases of the gastrointestinal tract or genitourinary system).
3. Active - ordinary mononucleosis symptoms are complicated by herpetic eruptions, fungal or bacterial infection. Possible damage to the mucous membranes of the gastrointestinal tract, dyspepsia.
4. Generalized – severe damage to the central nervous system, including meningitis, encephalitis, radiculoneuritis. Increased risk of myocarditis, hepatitis or pneumonitis.

Symptoms chronic infection Epstein-Barr disease manifests itself in waves - the number and intensity of symptoms gradually increase and also gradually decrease depending on the state of the immune system.

Symptoms of herpes type 5 - cytomegalovirus infection (CMV)

Cytomegalovirus does not appear immediately after infection; the carrier of the infection often does not even know about his own situation. With a strong immune system, the disease may never enter the active phase, but simply “sleep” in the body asymptomatically until the end of life (in 90% of cases this happens). However, the person will continue to transmit the virus to other people.

Patients with symptoms of CMV most often complain of signs of acute respiratory infections and mononucleosis (fever, fatigue, headaches, chills) that occur just after infection. The duration of the disease is generally 4-6 weeks. If the activity of the virus is caused by immunodeficiency, pleurisy, pneumonia, arthritis, encephalitis or myocarditis may occur. Autonomic disorders are observed.

In its generalized form, CMV causes damage to the entire body - inflammation of the tissues of internal organs, eyes, brain, as well as paralysis. In men, there may be damage to the tissues of the testicles and urethra; in women, there may be inflammation or erosion on the cervix, uterus, vagina or ovaries, and blue-white discharge.

Symptoms of poorly studied forms of herpes virus types 6, 7 and 8

Herpes type 6 lives in microphages and lymphocytes. Among all adults, about 50% are carriers of this infection, infecting the rest through blood and saliva, as well as by airborne droplets.

Symptoms of the disease are an itchy rash on the skin and mucous membranes, fever, ulcers or spots on the skin of the back, chest or abdomen (exanthema), mononucleosis syndrome, asthenia. With immunodeficiency, encephalitis is possible.

The infection often occurs in young children (3 months - 4 years). It is manifested by sudden exanthema and fever (up to 40° C), signs of intoxication. Symptoms last up to 4 days, then they are replaced by a rash that goes away within 3 days. Sometimes after a fever there are no rashes, but there may be cramps due to too much high temperature. Upon reaching 5 years of age, most children develop immunity against herpes type 6; relapse can only be caused by particularly severe immunodeficiency.

Herpes type 7 promotes the activation of type 6 virus and increases the risk of developing chronic fatigue syndrome. This syndrome is the main manifestation of a viral infection.

It manifests itself with the following symptoms:

• general loss of strength;
• constant fatigue and lack of tone;
• bad mood, anxiety and psycho-emotional overload;
• loss of ability to work and concentrate;
• lack of positive changes even after a long rest;
• memory disorders;
• headaches and tearfulness;
• sleep disturbances and lack of sleep even during prolonged sleep;
• signs of depression;
• slight increase in temperature long time(up to six months);
• enlarged lymph nodes.

Herpes type 8 is the least studied. Its symptoms include the development of other diseases - Kaposi's sarcoma, primary lymphomas, Castleman's disease and multiple myeloma. In this case, the patient appears malignant neoplasms on the skin, mucous membranes, internal organs and lymph nodes, looking like symmetrical plaques or spots of dark red or purple. There may also be a bloody cough, severe dyspepsia, and pain when eating.

Symptoms of any type of ocular herpes

Ophthalmoherpes develops on the retina, eyelids or mucous membranes of the eyes. Relapses can occur 3-5 times a year - this is one of the most common forms of herpes infection, mainly caused by types 1 and 3 of the virus.

Symptoms of ocular herpes are similar to allergies or from bacterial infection, herpetic vesicles appear before our eyes, and the following signs are also observed:

• the eyeballs and eyelids turn red;
• there is pain and a feeling as if there is a foreign body in the eye;
• in good lighting there is discomfort;
• visual acuity decreases and becomes “foggy”;
• sparks or flashes are visible before the eyes;
• the shape and size of objects seem incorrect or double;
• twilight vision is significantly reduced;
• blepharospasms - the eyelids contract convulsively.

Patients often complain of severe pain in the orbit and above the eyebrow. The field of view becomes narrower, and there may be a blind spot in the center. Moving your eyes is difficult and painful. All this may be accompanied by nausea, low-grade fever and headaches.

Symptoms of herpetic sore throat

Adults and children who have the herpes virus in their bodies often experience a sore throat caused by this infection. Its onset is usually abrupt and extremely acute:

1. The temperature rises to 40-41° C, as with pneumonia.
2. Severe pain occurs in the throat, it is very difficult to swallow, the discomfort lasts for at least 3 days.
3. The mucous membrane of the pharynx becomes swollen, visible on the tonsils and palate herpetic rash with white bubbles.
4. Over time, the vesicles merge with each other, forming a dense white “patina” covered with a film and surrounded by redness.
5. Suppuration of the rash lasts up to 3 weeks, during which herpes can spread to the skin of the face.

Incubation period herpetic sore throat lasts 1-2 weeks. Sometimes the patient recovers easily - intoxication goes away before the vesicles appear by 6 days, treatment is greatly simplified. Sometimes complications arise - herpetic rhinitis, chronic tonsillitis, otitis media, myocarditis, encephalitis, etc.

Symptoms of herpes on internal organs

Internal herpes manifests itself usual symptoms other diseases, since it causes them. None visible signs it is the herpes virus that is usually not observed; the type of infection can only be determined by clinical studies and laboratory tests.

As a rule, with ulcers in the esophagus due to herpes rashes, a person suffers from pain behind the sternum and when swallowing. A doctor can detect ulcers through an endoscopic examination. Pneumonia, bronchitis and tracheitis with characteristic symptoms(fever, cough, shortness of breath) detected through special tests for herpes type 1, often these diseases are accompanied by a fungal or bacterial infection.

If the patient has herpetic hepatitis, the symptoms will be similar to those usual for hepatitis B or C - jaundice, change in the color of urine and stool, fever. To identify the cause of the disease, the patient is prescribed a test for herpes viruses. And so with any other damage to internal organs, this virus does not have any specific symptoms.

Symptoms of postherpetic neuralgia

Postherpetic neuralgia is an echo of the disease after recovery from type 3 herpes. After a relapse of the Zoster virus, the patient remains with a feeling of discomfort and symptoms of infection, although the disease has already “subsided.” Acute symptoms they pass completely. So, with such neuralgia there are:

• residual drying and flaking crusts in places where there was shingles;
• throbbing pain or tingling in this area, sometimes extremely strong;
• itching between painful attacks, causing irritation, which only intensifies subsequent pain;
• numbness of the skin areas at the site of the former lichen or an extremely strong reaction to external irritants;
• muscle weakness and paralytic conditions (more often in old age).

Typically, postherpetic neuralgia lasts 2-3 weeks, but sometimes it remains for 2 months or even a year. Some symptoms last even longer, such as muscle weakness or extreme skin reactions. All this interferes with the normal lifestyle of people who have experienced reactivation of the chickenpox virus.

All information is provided for informational purposes. And is not an instruction for self-treatment. If you feel unwell, consult a doctor.

Neuralgia after herpes zoster, developmental phases

Herpetic neuralgia is a disease with characteristic features. It is determined by skin pigmentation and pain. But special skin manifestations disappear quickly with proper treatment, and painful feelings can haunt a person for months, sometimes even years. Herpetic neuralgia appears after herpes zoster. Another name is herpes zoster.

Herpes zoster or shingles

This is a viral illness, special in that characteristic unilateral herpetiform spots with pain appear on the skin.

In children who have chickenpox, the virus goes dormant, hiding in the spinal ganglia. The disease lichen occurs when an infection re-enters the human body. The virus travels along the axons and when it reaches the nerve ending, it causes an infection. It accumulates in this place greatest number viral antibodies. Complete regeneration begins in 2-4 weeks, but painful feelings can remain for years, as nerve cells are damaged, which cause discomfort. This condition is called postherpetic neuralgia.

Herpetic neuralgia

Symptoms

The disease has special symptoms that cannot be confused with others. These are some “bubbles” increased sensitivity to external stimuli, pain. It can feel different and has different phases.

• Constant pain is a mild pain with a clear location.
• Intermittent pain - stabbing or shooting sensations that appear at chaotic times.
• Allodynic - extreme pain, but disappears almost instantly after manifestation.

There are three phases and as the phase changes, the symptoms also change.

• The acute phase is pain along with the appearance of skin spots. Pain may occur even before pigmentation appears. The phase continues until the skin manifestations disappear. In some patients, it is accompanied by combined systemic inflammation: fever, malaise. On early stage, without pigments, it is difficult to determine the origin of the pain. The source of the syndrome becomes obvious only after the appearance of specific rashes. The explicitness of the acute pain phase increases with age.
• Subacute phase - appears after the disappearance of characteristic vesicles and lasts until the postherpetic phase. It lasts for approximately three months. Over time, the pain becomes constant.
• Postherpetic neuralgia - it is characterized by the persistence of pain for more than four months from the moment of herpes. The pain may remain for several years.

Not only pain is characteristic of this disease. For example, a feeling of weakness in the limbs, headaches, itching, numbness of the skin. Herpetic neuralgia also affects mental condition person, to their standard of living. People become more irritable, restless, and the activity of their brain centers decreases. This phase is usually accompanied by sleep disturbances, loss of appetite, weight loss, and depression. All this certainly plays a role in everyday life.

Herpetic neuralgia - groups and risk factors

Only people who have once had chickenpox can get lichen. But 80% of patients, after the crusts dry, do not feel any discomfort. What can play a role in getting into this ill-fated 20%?

• The age of the person. In older people, the immune and regenerative systems weaken. This is also associated with the aging of nerve cells. Thus, the risk of getting PHN in older people is 30%, and in young people - 10%.
• Concurrent presence of other diseases. It doesn't always matter what kind of disease it is, the immune system fights several diseases at the same time, which is not good. The risk of developing postherpetic neuralgia increases significantly.
• Location of occurrence of lichen. This is due to the thinness and sensitivity of the skin and nerve endings. So, if herpes appears on the face and neck, the risk of PHN is greater than if it appears on the ribs and abdomen.

How to reduce the risk of the post-herpetic phase?

Antiviral treatment at the stage of herpes zoster. Herpetic neuralgia improves with early prescription of antiviral drugs. They reduce the period of viral shedding and the formation of new foci.

Help from specialists

Doctors are satisfied with the fact that the patient suffered from herpes zoster and neuralgia can already be identified by characteristic signs.

The main treatment is the dosage of antiviral drugs. Often, Ganciclovir, Valacyclovir, Famciclovir are prescribed. They are used in a dosage of 500 mg two to three times a day. The sooner treatment for lichen begins, the faster the rashes and pain associated with postherpetic neuralgia go away.

To reduce pain, the following drugs are used:

• Antidepressants. These medications are an important part of the treatment of herpetic neuralgia. Amitriptyline, its action is associated with pain reduction, but this drug has many side effects, so it is prescribed with caution, especially to older people. But they found a good analogue for it - nortriptyline. It has less impact on the body with unpleasant symptoms, therefore it is more preferable for older people.

• If the ternary nerve is damaged, antiepileptic drugs are prescribed. Karamazepine and Gabapentin reduce the number of intermediaries in the dendrites, which subsequently reduces the conduction of nerve impulses. These medications are light in dosage and are therefore well suited for older people.
• Patches and creams with lidocine produce an analgesic effect for five to six hours. They are not used on inflamed or damaged skin. Which means they cannot be used while herpes is active. The analgesic effect is achieved by preventing the conduction of neuronal activity potentials.
• Sometimes these medications are not enough, so opioid analgesics have to be used. For example, Morphine or Methadone. Studies show that opioid medications work better against pain than placebo, but there may be a variety of unpleasant side effects. adverse reactions. For example, vomiting, intestinal disturbances gastric tract, lethargy, loss of appetite, dependence on medications.

IN Lately treatment is being developed by internally introducing Lidocoine or Dexamethasone into the affected area. Also, stimulation is used experimentally spinal cord electrical impulse.

Help yourself

Herpetic neuralgia involves arousal from external provocateurs, so you should separate yourself. To do this you need to comply correct image life.

• • Keep your immunity normal.
  • Follow a proper diet.
  • Try to eliminate stressful situations.
  • Protect the body from hypothermia.

Herpes simplex. Causes, symptoms and treatment of herpes infection

Herpetic infection (herpes simplex, herpes simplex) is a widespread anthroponotic viral disease with a predominantly contact mechanism of transmission of the pathogen, characterized by damage to the outer integument (skin and mucous membranes), the nervous system and a chronic relapsing course.

B00.0. Herpetic eczema.

B00.1. Herpetic vesicular dermatitis.

B00.2. Herpetic viral gingivostomatitis and pharyngostomatitis.

B00.3. Herpetic viral meningitis (G02.0*).

B00.4. Herpetic viral encephalitis (G05.1*).

B00.5. Herpetic viral eye disease.

B00.7. Disseminated herpetic viral disease.

B00.8. Other forms of herpes viral infection.

B00.9. Herpetic viral infection unspecified.

Causes (etiology) of herpes simplex

The causative agent is herpes simplex virus (HSV) types 1 and 2 (human herpes virus types 1 and 2), family Herpesviridae, subfamily Alphaherpesviruses, genus Simplexvirus.

Herpes simplex virus

The genome of the human herpes virus is represented by double-stranded linear DNA, molecular mass about 100 mDa. Capsid correct form, consists of 162 capsomeres. Virus replication and nucleocapsid assembly occur in the nucleus of the infected cell. The virus has a pronounced cytopathic effect, causing the death of affected cells, however, the penetration of the herpes virus into some cells (in particular, neurons) is not accompanied by virus replication and cell death. The cell has an inhibitory effect on the viral genome, bringing it into a latent state, when the existence of the virus is compatible with its normal activity. After some time, activation of the viral genome may occur, followed by replication of the virus; in some cases, herpetic eruptions may reappear, which indicates reactivation and transition of the latent form of infection to the manifest one. The genomes of HSV-1 and HSV-2 are 50% homologous. Both viruses can cause damage to the skin, internal organs, nervous system, and genitals.

However, HSV-2 causes genital lesions much more often. There is evidence indicating the possibility of mutation of the herpes simplex virus with the acquisition of new antigenic properties.

The herpes simplex virus is resistant to drying and freezing, and is inactivated within 30 minutes at a temperature of 50–52 °C. The lipoprotein shell of the virus dissolves under the influence of alcohols and acids.

Regular disinfectants do not have a significant effect on the herpes virus. Ultraviolet irradiation quickly inactivates the virus.

Epidemiology of herpes simplex

Herpetic infection is widespread everywhere. Antibodies to HSV are found in more than 90% of the population over the age of 40 years. The epidemiology of herpes infection caused by the HSV-1 and HSV-2 viruses is different. Primary infection with HSV-1 occurs in the first years of life (from 6 months to 3 years), most often manifested by vesicular stomatitis.

Antibodies to HSV-2 are usually found in individuals who have reached puberty. The presence of antibodies and their titer correlate with sexual activity. 30% of people who have antibodies to HSV-2 have a history of previous or current infection of the genital organs, accompanied by rashes.

The source of HSV-1 is a person during the period of reactivation of a herpes infection with the release of the virus into environment. Asymptomatic excretion of HSV-1 in saliva was observed in 2–9% of adults and 5–8% of children.

The source of HSV-2 is patients with genital herpes and healthy individuals, the secretion of the mucous membrane of the genital organs contains HSV-2.

The mechanisms of transmission of HSV-1 and HSV-2 are also different. A number of authors classify HSV-1 as an infection with an aerosol transmission mechanism. However, although HSV-1 infection occurs in childhood, unlike other childhood droplet infections, HSV-1 infection is not focal (for example, in children's institutions) and seasonal. The main substrates of the virus are saliva, the secretion of the mucous membrane of the oropharynx, the contents of herpetic vesicles, that is, transmission of the virus occurs through direct or indirect (toys, dishes, other salivated objects) contact. Damage to the respiratory tract and the presence of catarrhal phenomena, which provide airborne transmission of the pathogen, are of little significance.

The main mechanism of transmission of HSV-2 is also contact, but it is carried out mainly through sexual contact. Since transmission of HSV-1 is also possible through sexual contact (oral-genital contact), herpes infection is classified as a sexually transmitted disease. Herpes simplex virus can be detected in saliva and the genital tract of clinically healthy individuals. However, in the presence of active manifestations of infection, the frequency of virus isolation increases several times, and the titer of the virus in the affected tissues increases by 10–1000 times or more. Transplacental transmission of the virus is possible if a pregnant woman has a relapse of herpes infection, accompanied by viremia. However, more often the fetus becomes infected when passing through birth canal.

Transmission of the virus is possible through blood transfusion and organ transplantation. Susceptibility is high. As a result of a herpes infection, non-sterile immunity is formed, which, due to various endo- and exogenous reasons, can be disrupted.

Pathogenesis of herpes infection

The virus enters the human body through mucous membranes and damaged skin (there are no receptors for the virus in the cells of the keratinizing epithelium of the skin). Reproduction of the virus in epithelial cells leads to their death with the formation of foci of necrosis and vesicles. From the primary focus, the herpes virus migrates through retrograde axonal transport to the sensory ganglia: HSV-1 mainly to the trigeminal ganglion, HSV-2 to the lumbar ganglia. In the cells of the sensory ganglia, the replication of the virus is suppressed, and it persists in them for life. Primary infection is accompanied by the formation of humoral immunity, the intensity of which is maintained by periodic activation of the virus and its penetration into the mucous membranes of the oropharynx (HSV-1) and genital organs (HSV-2). In some cases, reactivation of the virus is accompanied by clinical manifestations in the form of blistering rashes (relapse of herpes infection). Hematogenous spread of the virus is also possible, as evidenced by the appearance of generalized rashes, damage to the central nervous system and internal organs, as well as detection of the virus in the blood by PCR. Relapses of herpes infection are associated with a decrease in the level of specific immunity under the influence of nonspecific factors (excessive insolation, hypothermia, infectious diseases, stress).

As a rule, one strain of human herpes virus is isolated from one patient, but in patients with immunodeficiency several strains of the same subtype of the virus can be isolated.

The immune status of the body largely determines the likelihood of developing the disease, the severity of the course, the risk of developing latent infection and persistence of the virus, and the frequency of subsequent relapses. The state of both humoral and cellular immunity is important. The disease in persons with impaired cellular immunity is much more severe.

Herpes infection can cause immunodeficiency. Proof of this is the ability of the virus to multiply in T- and B-lymphocytes, which leads to a decrease in their functional activity.

Symptoms (clinical picture) of herpes simplex

Classification of herpes infection

Generally accepted clinical classification absent. There are congenital and acquired herpes infections, the latter is divided into primary and recurrent. Depending on the location of the pathological process, herpetic lesions of the mucous membranes, skin, eyes, nervous system, internal organs, genitals, and generalized herpes are distinguished.

The main symptoms of herpes and the dynamics of their development

Clinical signs and course of the disease depend on the localization of the process, the age of the patient, immune status and the antigenic variant of the virus.

Primary infection is often accompanied by systemic signs. In this case, both mucous membranes and other tissues are affected. With primary infection, the duration of clinical manifestations and the period of virus shedding are longer than with relapses. Viruses of both subtypes can cause damage to the genital tract, oral mucosa, skin, and nervous system. Clinically, infection caused by HSV-1 or HSV-2 is indistinguishable.

Reactivation of genital tract infections caused by HSV-2 occurs twice as often, and relapses occur 8–10 times more often than with HSV-1 genital tract infections. Conversely, recurrences of oral and skin lesions with HSV-1 infection occur more often than with HSV-2 infection.

Symptoms of herpes simplex on the lips

Congenital herpes infection is observed when pregnant women have active clinical manifestations of the disease, accompanied by viremia. Depending on the timing of infection, the formation of various fetal malformations (microcephaly, microphthalmia, chorioretinitis, intrauterine death) or the death of a newborn is possible. clinical manifestations generalized herpetic infection.

Acquired herpes infection is possible in newborns when infected during passage through the birth canal, and then at various periods of life, most often in childhood. The earlier infection occurs, the more severe the disease, but asymptomatic infection is also possible (antibodies to HSV-1 are detected in the blood serum of 60% of children under 6 years of age).

The incubation period for primary herpetic infection is 5–10 days (variations from 1 to 30 days are possible).

Damage to mucous membranes and skin

Viral pharyngitis and stomatitis are observed more often in children and young people. The disease is accompanied by fever, chills, malaise, irritability, myalgia, difficulty eating, and hypersalivation. The submandibular and cervical areas become enlarged and painful The lymph nodes. Grouped vesicles appear on the mucous membrane of the cheeks, gums, inner surface of the lips, less often the tongue, soft and hard palate, palatine arches and tonsils, and after opening, painful erosions form. The duration of the disease ranges from several days to two weeks.

Herpetic lesions of the pharynx usually lead to exudative or ulcerative changes in it back wall and/or tonsils. In 30% of cases, the tongue, mucous membrane of the cheeks and gums can be simultaneously affected. The duration of fever and cervical lymphadenopathy ranges from 2 to 7 days. In persons with insufficient immunity, the virus can spread deep into the mucous membrane and into the underlying tissues, leading to loosening, necrosis, bleeding, and the formation of ulcers, which is accompanied by severe pain, especially when chewing.

When a herpetic lesion of the skin occurs, a local burning sensation and itching of the skin occurs, then swelling and hyperemia appear, against which round grouped blisters with transparent contents form, which then becomes cloudy.

The blisters can open with the formation of erosions that become covered with a crust, or they can shrink, also becoming covered with a crust, after which the epithelialized surface is revealed. The duration of the disease is 7–14 days. Favorite localization - lips, nose, cheeks. Disseminated forms with localization of rashes in distant areas of the skin are possible.

Acute respiratory diseases

HSV can cause diseases reminiscent of acute respiratory viral infections - the so-called herpetic fever, which is characterized by an acute onset, severe temperature reaction, chills and other symptoms of intoxication. Catarrhal phenomena in the nasopharynx are weakly expressed. Possible coughing due to dry mucous membranes, moderate hyperemia of the arches and soft palate. These symptoms persist for several days. Rashes typical for a herpetic infection are not always observed in the first days of the disease, but may appear on the 3-5th day from the onset of the febrile period or be absent.

Herpetic eye lesions

Herpetic eye lesions can be primary or recurrent. It most often develops in men under 40 years of age. This is one of the most common reasons corneal blindness. Clinically, superficial and deep lesions are distinguished. Superficial include herpetic keratoconjunctivitis, dendritic keratitis, herpetic marginal corneal ulcer; to deep - discoid keratitis, deep keratitis, parenchymal uveitis, parenchymal keratitis.

Herpes damage to the nervous system

In the etiological structure of viral encephalitis (meningoencephalitis), about 20% is due to herpetic infection. Mostly people aged 5–30 years and over 50 years old are affected. The incidence is 2–3 per year (US data), the incidence is uniform throughout the year. Herpetic meningoencephalitis is caused by HSV-1 in 95% of cases.

The pathogenesis of herpetic encephalitis is different. In children and young people, primary infection can manifest as encephalomyelitis.

It is assumed that an exogenously acquired virus penetrates the central nervous system, spreading from the periphery through the olfactory bulb. Most adults first develop Clinical signs generalized infection, in some cases damage to the mucous membranes and skin, and then damage to the central nervous system, that is, the virus can penetrate the central nervous system hematogenously.

The onset of the disease is always acute, with an increase in body temperature to high numbers. Patients complain of malaise and persistent headache. In a third of patients, moderate respiratory catarrhal syndrome is possible in the first days of illness. Herpetic exanthema and stomatitis occur rarely. After 2–3 days, the patients’ condition sharply and progressively worsens due to the development of neurological symptoms. Consciousness is depressed, meningeal syndrome develops, generalized or focal tonic-clonic convulsions appear, repeated many times during the day. General cerebral symptoms are combined with focal manifestations (impaired cortical functions, damage to cranial nerves, hemiparesis, paralysis). The further course of the disease is unfavorable; after a few days, coma develops. Throughout the disease, the body temperature remains high and the fever is irregular. In the absence of antiviral therapy, mortality reaches 50–80%.

A characteristic feature of herpetic encephalitis is damage to the temporal lobe on one or both sides, which is manifested by personality changes with a decrease in intellectual functions and mental disorders.

CSF examination reveals lymphocytic or mixed pleocytosis, increased protein levels, xanthochromia, and the appearance of red blood cell admixture. Changes in the EEG are possible. MRI of the brain reveals lesions with predominant changes in the anterior temporal lobes with predominant involvement of the cortex. MRI for herpetic encephalitis has a significant advantage over CT, as it allows visualization of brain damage already in the first week of the disease.

Possible atypical manifestations herpetic encephalitis with damage to the brain stem and subcortical structures, abortive course of the disease, chronic and recurrent course of herpetic encephalitis as a slow infection of the central nervous system.

Another form of damage to the central nervous system of a herpetic nature is serous meningitis. Serous meningitis is most often caused by HSV-2; the disease usually develops in people suffering from genital herpes. The proportion of HSV infection among viral meningitis does not exceed 3%.

Clinically, meningitis is characterized by an acute onset, headache, fever, photophobia, and the presence of meningeal symptoms. When examining the CSF, pleocytosis of 10 to 1000 cells per μl (average 300–400) of a lymphocytic or mixed nature is observed. Clinical symptoms persist for about a week, then disappear on their own without neurological complications. Relapses are possible.

Other common form damage to the nervous system by HSV-2 - radiculomyelopathy syndrome. Clinically, it manifests itself as numbness, parasthesia, pain in the buttocks, perineum, or lower limbs, pelvic disorders.

Pleocytosis, increased protein concentrations, and decreased glucose levels in the CSF may occur. There is evidence of the isolation of HSV-1 from the CSF of patients with cervical and lumbar radiculitis. The assumption about the connection of HSV-1 with the lesion was confirmed facial nerves(Bell's palsy).

Herpetic lesion of internal organs

Herpetic lesions of internal organs are the result of viremia. Several organs are involved in the process; isolated damage to the liver, lungs, and esophagus occurs less frequently. Herpetic esophagitis can result from direct spread of infection from the oropharynx to the esophagus or occur due to reactivation of the virus. In this case, the virus reaches the mucous membrane via the vagus nerve. The dominant symptoms of esophagitis: dysphagia, chest pain and weight loss. Esophagoscopy reveals multiple oval ulcers on an erythematous base. The distal section is most often affected, but as the process spreads, diffuse loosening of the mucous membrane of the entire esophagus occurs.

In persons who have undergone a bone marrow transplant, interstitial pneumonia may develop in 6–8% of cases, as proven by the results of biopsy and autopsy. The mortality rate from herpetic pneumonia in patients with an immunosuppressed state is high (80%).

Herpetic hepatitis develops more often in people with immunodeficiency, with body temperature rising, jaundice appearing, bilirubin concentration and aminotransferase activity in the blood serum increasing. Sometimes signs of hepatitis are combined with manifestations of thrombohemorrhagic syndrome.

Herpetic lesions of the genitals

Genital herpes is most often caused by HSV-2. May be primary or recurrent. Typical rashes are localized in men on the skin and mucous membrane of the penis, in women - in the urethra, on the clitoris, in the vagina.

Possible rashes on the skin of the perineum and inner thighs. Vesicles, erosions, and ulcers form. Hyperemia, swelling of soft tissues, local pain, and dysuria are noted. May cause pain in the lower back, sacrum, lower abdomen, or perineum. In some patients, especially with primary herpetic infection, inguinal or femoral lymphadenitis is observed. There is a connection between the frequency of genital herpes and cervical cancer in women and prostate cancer in men. In women, relapses occur before the onset of menstruation.

Generalized herpetic infection

Generalized herpetic infection develops in newborns and in persons with severe immune deficiency (with hematological diseases, long-term use of glucocorticoids, cytostatics, immunosuppressants, with HIV infection). The disease begins acutely and progresses severely, affecting many organs and systems. Characterized by high fever, widespread lesions of the skin and mucous membranes, dyspeptic syndrome, central nervous system damage, hepatitis, and pneumonia. Without the use of modern antiviral drugs, the disease is fatal in most cases.

Generalized forms of the disease include Kaposi's sarcoma herpetiformis, which is observed in children suffering from exudative diathesis, neurodermatitis or eczema. It is characterized by severe intoxication, profuse rashes on the skin, especially in areas of previous damage. The rash spreads to the mucous membranes. The contents of the vesicles quickly become cloudy, and they often merge with each other. Possible death.

Herpes infection in HIV-infected people

Herpetic infection in HIV-infected people usually develops as a result of activation of a latent infection, and the disease quickly becomes generalized. Signs of generalization are the spread of the virus from the oral mucosa to the esophageal mucosa, the appearance of chorioretinitis. Skin lesions in HIV-infected people are more extensive and deep with the formation of not only erosions, but also ulcers. Reparative processes occur extremely sluggishly, characterized by prolonged non-healing of ulcers and erosions. The number of relapses increases significantly.

Complications of herpes simplex

Complications are usually caused by the addition of secondary microflora.

Diagnosis of herpes simplex

The diagnosis of lesions of the skin and mucous membranes is established on the basis of clinical data (characteristic herpetic rash). In case of damage to the central nervous system, visceral and generalized forms, it is necessary laboratory diagnostics. The diagnosis of herpes infection is confirmed by virus isolation or serology. The material for isolating the herpes simplex virus from a patient is the contents of herpetic vesicles, saliva, blood, and CSF. Pieces of the brain and internal organs are taken from the deceased for research. For serological diagnosis, RPGA, ELISA and other methods are used that detect specific antibodies (class M immunoglobulins, the level of which increases by the 3-5th day of the disease).

CNS damage is diagnosed using PCR. CSF is used for research. In addition, the level of antibodies in the CSF and blood serum is determined (not earlier than the 10th day of illness). On high level antibodies persist for 1.5–2 months or more. RIF is used to detect a specific antigen in the CSF. The detection of characteristic lesions in the temporal lobes of the brain by MRI is important.

Differential diagnosis of herpetic infection

Differential diagnosis is carried out, depending on the localization of the process and the form of the disease, with viral stomatitis, herpangina, herpes zoster, chickenpox, pyoderma, meningoencephalitis and meningitis of other etiologies, keratoconjunctivitis of adenoviral etiology, eye damage due to tularemia, benign lymphoreticulosis.

Indications for consultation with other specialists

Consultation with a neurologist is indicated for damage to the central nervous system, a dentist for stomatitis, a gynecologist for genital herpes, and an ophthalmologist for ophthalmic herpes.

An example of a diagnosis formulation

B00.4. Herpetic viral encephalitis, severe, stage II coma (HSV-1 was detected in the CSF by PCR).

Indications for hospitalization

Hospitalization is indicated for generalized forms of the disease, damage to the central nervous system, and ophthalmoherpes.

Treatment of herpes infection

Treatment is prescribed taking into account clinical form diseases.

Etiotropic treatment of herpes simplex

Etiotropic treatment of herpetic infection involves the prescription of antiviral drugs (Table 18-25). The most effective of them is acyclovir (Zovirax, Viralex).

Table 18-25. Antiviral drugs used to treat herpes infection

Herpes nerve endings symptoms

Inflammation of nerve endings: treatment and symptoms

Pain is one of the main alarm signals in the body, which haunts a person. People with a healthy psyche certainly react to pain. Nerve endings are responsible for this sensation; pain can occur when they are irritated or inflamed. It is for this reason that we feel pain in the area of ​​the abscess or bruise. Nerve endings should not be confused with nerve roots and trunks. Their compression, on the contrary, leads to numbness and paralysis. Inflammation of the nerve endings can occur with various specific and nonspecific infections when neuritis develops, for example, with herpes zoster or, as it is also called, herpes zoster. But most often you have to deal with the fact that the initiator of the process is muscle spasm, and, as a result, compression of the blood vessels in this area occurs. Impaired blood supply leads to damage to nerve endings.

What are the symptoms of nerve irritation?

How to recognize inflammation of nerve endings and the symptoms of this disease? The main symptom is pain, while neither the focus nor visible changes indicating the disease can be identified. The pain may worsen in the cold, during movement or at night, even with slight touch. To others characteristic feature are so-called paresthesia: tingling and burning sensations in the affected area. Often in this area one can find, upon examination, spasmodic, tense muscles that are painful on palpation.

Treatment of inflammation of nerve endings

What treatment can be given for inflammation of nerve endings? To eliminate the symptoms of the disease, use medications: non-steroidal anti-inflammatory drugs (diclofenac, nise, movalis, etc.), glucocorticoid hormones (dexamethasone, prednisolone, etc.), B vitamins and other drugs. In addition, patients are prescribed physiotherapeutic procedures (electrophoresis, phonophoresis, amplipulse, etc.). However, medications have many side effects and are not safe for our body.

Is it possible to cure inflammation of nerve endings without drugs? Our nervous system produces its own painkillers - endorphins and enkephalins; a person can initiate or enhance their synthesis. In addition, special gymnastics can relieve muscle spasms, improve blood supply to the source of inflammation and eliminate pain. There are also other methods and techniques to combat pain and inflammation. You can learn more about them at a special course at the M.S. Center. Norbekova First health course. Wellness courses will teach you how to restore physical health, increase immunity, launch regeneration processes, and normalize your emotional background.

Shingles or herpes zoster occurs because the chickenpox virus is once activated. After recovery, it remains in the human body forever, and with a decrease in immunity, the skin will begin to suffer again, and the nerve endings will be affected.

Trigeminal herpes is a complication of trigeminal ganglionitis. It is difficult for people with this disease to live. Doing household chores is difficult, numerous problems arise, fatigue and stress are constantly present.

The main symptom of the disease is the presence severe pain in the place where herpes was previously localized. Its character can be different: pulsating, sharp, aching, burning, shooting, etc.

The sensitivity of the area where shingles used to be may be increased or decreased. Moreover, if it is reduced, slight numbness may bother you. In addition, allodynia can develop - this is a feeling of pain from something that normally should not cause it.

For example:

• combing;
• putting things on;
• being in a draft;
• touching your body and so on.

The first few days, when the disease just begins to develop, the following symptoms may be present:

• feeling of malaise and weakness throughout the body;
• pain in the facial area;
• feeling of a strong headache, its pulsating nature;
• feeling of aching throughout the body;
• a slight increase in body temperature is possible.

Many patients, after the appearance of such symptoms, believe that they are developing some kind of viral disease. For the purpose of treatment, they begin to take antiviral drugs, as well as antipyretics.

After a few days, a burning sensation begins to be present in the area of ​​the ternary nerve, and other symptoms appear, namely:

• rashes on the mucous membranes;
• rash in the area of ​​the ternary nerve;
• severe headaches;
• one half of the face swells slightly;
• There is a burning sensation behind the ears and in the temple area.

The rashes appear within a few weeks, after which they dry out and begin to crust over. Subsequently, they will disappear, and nothing will remain in their place.

Important! You should not be near a person who has herpes zoster; the rash is dangerous. A virus that enters the eyes can cause encephalitis.

The video in this article explains in more detail how the disease develops.

Reasons for the development of the disease

It is generally accepted that herpes of the ternary nerve develops due to inflammatory process V peripheral nerve and nerve endings. It is inflammation that causes the virus to become activated and begin to spread.

Interesting! Due to the inflammatory process, an imbalance occurs between the analgesic and pain mechanisms, and they also stop interacting. Subsequently, control over neuronal excitability is impaired.

Postherpetic neuralgia does not always develop after herpes. This can only happen due to provoking factors, namely:

1. Old age. People aged 30 to 50 years old experience the disease in 10% of cases. Patients over 60 years of age are several times more likely to suffer from the disease. Persons over 75% of age suffer from the disease in 70% of cases. Experts believe that in young people, the body can more quickly cope with inflammation and eliminate its consequences. In older people, immunity decreases, which is why they get sick more often.
2. Foci of prevalence of rashes. Neuralgia of this type is most often localized on the torso.
3. What is the affected area? The risk of further development of the disease largely depends on the area of ​​the rash. This may be due to the fact that the body's defenses are weakened.
4. How severe is the pain?. The more painful it is at the stage of appearance of the rash, the higher the likelihood that neuralgia will begin to develop.
5. At what time did the disease begin?. If the patient starts taking antiherpetic drugs late, the virus can lead to the development of complications.

It is worth noting that symptoms of postherpetic neuralgia will appear only on the third or fourth day after the virus begins to activate and spread.

Treatment methods

If trigeminal herpes develops, treatment is carried out with the use of medications.

1. Amitriptyline. This is a tricyclic antidepressant that can quickly relieve neuropathic pain. It has a direct effect on those substances that are located in the brain and spinal cord, they are the ones that respond to pain and reduce sensitivity. It is recommended to take the medicine in small dosages; depending on the results and the presence of side effects, you can gradually increase it. Symptoms will disappear and relief will come only after the required dosage is selected.
2. Pregabalin. It is an anticonvulsant and is used for epilepsy. Due to the fact that the product muffles nerve impulses, it is possible to quickly relieve neuropathic pain.

Both drugs are available in the form of tablets and syrups.

Interesting! This treatment does not always completely relieve pain.

Instructions for use must be strictly followed.

If treatment does not bring the desired result, doctors may prescribe other drugs:

1. Tramadol. Medicine belongs to the group of opioids, with its help you can quickly relieve neuropathic pain. The drug is fraught with the fact that over time it can become addictive. Manages to get rid of pain, with side effects patients do not encounter. In addition, you can combine the medicine with other drugs.
2. Lidocaine patch. Allows you to relieve pain in the area where it is glued. Before use, you should read the instructions.

To relieve pain caused by neuralgia, opioid medications, such as Morphine, can be used. You must first undergo an examination by a neurologist; taking into account the prevalence of the virus and the level of pain, the doctor will select the necessary dosage.

Traditional methods of treatment

Pain may remain even after the rash on the body has passed, but small traces remain. In this case, you can try to get rid of the unpleasant sensations with your own hands. Consult your doctor first and take into account contraindications.

The most popular treatment methods:

1. Geranium leaves. Apply the leaf to the source of pain and secure it with something on top. After two hours, remove the leaf.
2. Garlic oil. The recipe is simple: dilute half a liter of vodka with a tablespoon of oil. Directions for use: Rub the resulting product into the area of ​​pain three times a day.
3. Club moss. Pour boiled water over a spoonful of crushed and dry raw materials and let it brew for half an hour. Drink a tablespoon three times a day.
4. Willow bark. Recipe: pour ten grams of crushed bark with water and put on fire. Once everything comes to a boil, remove from heat and let cool. Just like in the previous case, drink a tablespoon three times a day.
5. A decoction of pine branches and cones. Place young pine branches in a saucepan, add water, and boil over low heat for half an hour. Cover with a lid and let sit for six hours. Every time you are going to take a bath, add the product.

Important! It is not recommended to use during the acute stage of the disease. traditional methods. This may cause the infection to penetrate into the nerve, and the area affected by herpes will be enlarged.

The photo below is an example of what folk methods can be used for treatment.

Other treatment methods

You can get rid of pain, stress, anxiety, traditional methods in combination with alternatives.

Auxiliary therapies:

• massage – it can be used to relieve pain, it should be performed by a professional;
• meditation or other methods of relaxation - help relieve stress and tension;
• acupuncture – the procedure relieves pain;
• analgesics;
• immunoglobulins - given intramuscularly;
• antiviral agents;
• taking vitamins – necessary to strengthen the immune system and increase the body’s defenses;
• ointment containing acyclovir.

In a protracted form of the disease, when there is a risk of chronic form, hormone therapy may be added. Potassium supplementation is prescribed along with corticosteroids. X-ray therapy is extremely rarely used.

The effectiveness of all the methods listed above has not been proven. You can relax and relieve tension by simply listening to relaxing music and taking a warm bath.

Herpes of the ternary nerve, what should not be done?

After the examination has been completed and the course of treatment has begun, many patients continue to make mistakes, thereby aggravating their condition.

That is why you need to know what to do under no circumstances:

• herpes papules should not be cauterized or squeezed out, as this will lead to further spread of the infection;
• do not touch your face with dirty hands;
• do not heat the reddened areas; you should also not apply anything cold;
• Any nerve stimulants are prohibited during the treatment period: alcohol, caffeine, nicotine, etc.

Taking into account all these rules, you can cope with the infection faster; there will be no marks left on the skin or in the nerve plexuses.

Prevention

People who have once had herpes can experience herpes again. chicken pox. To prevent the disease from progressing, special attention should be paid to prevention.

You can prevent the virus from entering the nervous system as follows:

• harden your body, teach your children to do the same from childhood;
• nutrition should be balanced and rational, in this way the metabolic process can be regulated;
• spend a lot of time outdoors;
• do not spend a lot of time in the cold;
• control the level of physical activity.

If herpes or so-called colds constantly appear in the mouth area, it is recommended to take antiviral drugs in the fall and spring. People over 60 years of age are vaccinated to strengthen the immune system, thus avoiding the activation of the virus.

Trigeminal nerve and herpes are something that should never come together. Remember that infection can cause dire consequences. Immediately after you see suspicious symptoms, contact a medical facility.

Frequently asked questions to the doctor

Herpes and its reproduction

Tell me, how does the herpes virus multiply?

The virus multiplies in the nucleus of the cell into which it has penetrated. All its structural components are used as building materials. In addition, the production of substances that promote the construction of new viruses begins. Once infected, the virus will remain forever human body, but many may not even know about it.

Herpes prognosis

What is the prognosis for recovery if I have herpes simplex?

Symptoms of the disease on the genitals disappear within ten days. In people with weakened immune systems, symptoms may be more pronounced. The infection may manifest itself repeatedly from time to time, each time contributing to the appearance of symptoms.

Even frequent and prolonged exposure to the sun, stress, ARVI, flu and other diseases can cause a relapse. When conducting healthy image Throughout your life, you can protect yourself from the disease and never experience its symptoms.