HSV-1, Herpes Simplex Virus

Entities

• Herpetic rash, vesicular
• Eczema, skin cracks, crusted rashes, itching, small pimples
• Cellulite, urticaria: Redness + Swelling + Pain + Tenderness esp female genital skin and fingers.
• Myelitis esp transverse myelitis (Weakness + Paralysis + Decreased deep reflexes of the limbs):
  • Face
  • Anus, male genitalia, Bulbocavernous
  • Extremities especially lower limbs
  • Muscles, back muscles

• Neuropathy, Neuritis (Limbs, Fingers, buttocks, around the anus, lower back and sacrum and mouth) Radiculopathy, esp in the sacrum area
• Neurogenic Bladder : Large bladder + Dysuria + Urinary frequency / Incontinence + Urinary retention + Nocturnal enuresis

• Wounds: (Female, Mouth, Tongue, White sores of esophagus, anus)

• Conjunctivitis, Keratitis, Chemosis: (Photophobia, Eye pain, Corneal dendritic lesions)
• Retinitis, chorioretinitis, retinal necrosis (Blurred vision+ Blindness)
• Gingivitis, stomatitis (Necrosis + Mouth pain + the patient is unable to drink or eat)
• Pharyngitis (Exudate / Catarrh + Odynophagia + Pseudomembrane)

• Proctitis (Tenesmus + Pain = Necrosis + Constipation = Anal discharge

• Urethritis (Mucoid urethral secretions + Dysuria +Urinary frequency)
• Salpingitis, Endometritis (Leukourrhea + Painful menses)
• IUGR (Miscarriage + Itching + Blisters + Pain + Discharge
• Male Infertility, prostatitis (Itching + Pain)
• Pneumonia, interstitial tissue pneumonia, tracheobronchitis, pneumonitis: local necrosis, ARDS
• Meningitis, encephalitis: terrible dreams, sad, crying
• Myositis (Myoglobinuria, Myalgia agg with physical activity)

• Thrombocytopenia
• Hepatitis
• Adrenal lesion, Adrenal insufficiency

Lymphadenitis and lymphadenopathy: neck, axillary, limbs, especially elbow, painful inguinal lymphadenopathy

Arthritis, especially of the single-joint type

Chelitis

Gingivitis

Herpetic eruption

Keratitis

Proctitis

HSV encephalitis (HSE)

• ٍEncephalitis due to HSV-1 in 500,000 individuals per year. Annual incidence of HSE is 2 -4 cases per 1 million population.
• 90% of cases of HSE are caused by HSV-1, the rest of cases are due to HSV-2.
• Most individuals show a decrease in their level of consciousness and an altered mental state presenting as confusion.
• Patients typically have a fever and may have seizures. EEG first showing abnormalities in one temporal lobe, which spread to the other temporal lobe 7–10 days later.

• HSE can serve as a trigger of NMDR encephalitis.
• The virus lies dormant in the ganglion of the trigeminal cranial nerve, but the reason for reactivation, and its pathway to gain access to the brain, remains unclear, though changes in the immune system caused by stress clearly play a role in animal models of the disease.
• The olfactory nerve may also be involved in HSE, which may explain its predilection for the temporal lobes of the brain, as the olfactory nerve sends branches there

• Recently included 420 adult patients with schizophrenia or bipolar spectrum and 481 healthy controls. Circulating HSV1 IgG concentrations were measured with immunoassays. We measured the total grey matter volume, cortical, subcortical, cerebellar and regional cortical volumes. The results of this cross-sectional study indicate that HSV1 may be an environmental factor associated with brain structural abnormalities and cognitive impairment in severe mental illnesses such as Schizophrenia and bipolar disorder.

• HSV-1 is the most common cause of sporadic necrotizing encephalitis in the United States, with a mortality rate of 30 -70 %, and leaves various neurologic sequelae in the survivors. HSV-2 has been recognized as an etiologic agent in fatal infections in neonates and a mild meningitis in adults, but its role in encephalitis in adults is less well known. We suggest that some cases of acute psychosis may, like in our case, represent HSV-2 encephalitis.
• HSE as a cause of psychosis is rare, affecting about 1 per 200,000 cases per year. It is suggested that herpes infection like other environmental stressors causes psychosis through inhibition of NMDA receptor and subsequent microglia activation in the hippocampus.
• Common symptoms of HSE include headaches, fevers, drowsiness, hyperactivity, and/or general weakness. The disorder may have some symptoms similar to those associated with meningitis, such as a stiff neck, altered reflexes, confusion, and/or speech abnormalities. Skin lesions usually are not found in association with herpes simplex encephalitis.
• HSV-1 encephalitis is the most common cause of sporadic fatal encephalitis worldwide. The clinical syndrome is often characterized by the rapid onset of fever, headache, seizures, focal neurologic signs, and impaired consciousness.
• Seizures during the acute phase of HSE are the main risk for the development of postencephalitic epilepsy
• Persistent infection with HSV and other brain infections is consistently associated with cognitive impairment. These infections can also affect sleep. Thus, sleep abnormalities could explain the cognitive dysfunction.

Parkinsonism

Recently a relation between Parkinsonism and HSV infection is found through a population-based case-control study of incident Parkinson’s disease.

HSV-1 colitis

• Symptoms of HSV colitis are not specific and do not differ considerably from colitis caused by other agents. Watery diarrhoea with addition of blood, crampy abdominal pain, fever, arthralgia, nausea, loss of appetite and loss of weight can be found.

Remedies

1. NAT-M, ARS
2. Hep
3. Borx, Con, Arum-t, Rhus-t, Nit-ac, Mez, Kreos, Sul, Phos, Sep
4. Am-c, Aeth, Anac, Sul-ac, Canth, Graph, Hydr, Iris, Lach, Sars, Nat-c, Merc