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Full text and additional images for Herpes Simplex Virus Blepharitis are available in VisualDx. VisualDx is a web-based clinical decision support system used in over 1,500 hospitals and large clinics. 60% of the millions of people infected with herpes don’t know that they’re carrying the virus. Die genitale Manifestation des Herpes simplex wurde bereits von Hippokrates als Symptom einer sich ausbreitenden Bläschenkrankheit beschrieben. Full text and additional images for Neonatal Herpes Simplex Virus are available in VisualDx. Primary orofacial herpes is readily identified by clinical examination in persons without a previous history of lesions, and with reported contact with an individual with known HSV-1 infection.
Neonates delivered from mothers who have had their first episode of HSV during gestation (primary HSV) are at greatest risk for neonatal HSV.
The appearance and distribution of sores, in these individuals, typically presents as multiple, round, and superficial oral ulcers, accompanied by acute gingivitis.[1] Adults with non-typical presentation are more difficult to diagnose. Laboratory tests include culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, polymerase chain reaction (PCR) to test for presence of viral DNA.


However, prodromal symptoms that occur before the appearance of herpetic lesions helps to differentiate HSV symptoms from the similar symptoms of, for example, allergic stomatitis. A Tzanck test (or smear), can also be performed although this cannot differentiate between herpes simplex or varicella (chicken pox) (the primary infection of varicella zoster virus (VZV or shingles). There is increased lacrimation in severe cases.The spectrum of ocular herpetic disease also includes conjunctivitis, iritis, and keratitis. Although these procedures produce highly sensitive and specific diagnoses, their high costs and time constraints discourage their regular use in clinical practice.[1] Serological tests for antibodies to HSV are rarely useful to diagnosis but are important in epidemiological studies. Epithelial keratitis involves only the superficial layer of the cornea and although less severe still can lead to scarring and vision loss. These neonates are frequently premature and can have associated microcephaly, chorioretinitis, and cerebral abnormalities.
Serologic assays cannot differentiate between antibodies generated in response to a genital versus an oral HSV infection and as such cannot confirm the site of infection. Stromal keratitis, however, involves deeper layers of the cornea and also may lead to vision loss.Primary ocular HSV infections occur most often in children between the ages of 6 months and 5 years, and such infections almost always present as blepharitis or blepharoconjunctivitis. Absence of antibody to HSV-2 does not exclude gential infection because of the increasing incidence of genital infections caused by HSV-1.


Disseminated disease can involve the liver, lungs, or present as disseminated intravascular coagulation.Maternal history of HSV infection could help aid the diagnosis, but most women are asymptomatic and it is, therefore, not a reliable clue. Corneal involvement with HSV necessitates treatment with antiviral agents to prevent complications.Differentiate this condition from preseptal or orbital cellulitis on the basis of vesicles and ulcerations. Intrauterine infection presents typically with scarring skin lesions, ophthalmologic findings, and neurologic involvement. Disseminated HSV infection in the neonate can cause encephalitis and is potentially a life-threatening condition. Rapid antiviral therapy is imperative in neonates with suspected HSV infection.For a discussion of HSV acquired by older infants, see herpes simplex virus.



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