What is Herpes in children?
Simple herpes in children is a disease that affects many tissues and organs of the child, which is accompanied by rashes on the skin and mucous membranes in the form of vesicles. In most cases, treatment is prolonged latent, there are periodic relapses.
Simple herpes in children, according to the international classification, is divided into:
- herpetic eye disease (divided into anterior uveitis, keratoconjunctivitis, keratitis, iritis, iridocyclitis, eyelid dermatitis, conjunctivitis);
- herpetic encephalitis;
- herpetic gingivostomatitis and pharyngotongzillitis;
- herpetic meningitis;
- herpetic vesicular dermatitis;
- herpetic eczema;
- disseminated herpetic disease;
- herpetic infections, unspecified;
- other forms of herpetic infections.
Infection affects children who become infected with infection in the first 3 years of life. Newborns can not contract this disease for up to six months, since they have specific IgG antibodies in their blood. But there are very rare cases when the mother has no antibodies in her blood, and so does the baby. Then, in case of infection, the child has a generalized form of the disease, the course is heavy. At the majority of children of 3-year-old age in a blood there are enough antibodies protecting an organism. The number of children with a high level of antibodies to HSV2 increases by 5-7 years of age.
Infection is tolerated and spread by both patients and virus carriers. Ways of transmission of infection: contact, sexual and, presumably, airborne. You can get infected, as for adolescents, when kissing – through saliva. Also, the infection occurs through household items, toys and other items on which the saliva of the infected person may be. A child can become infected in the womb or at birth in the birth canal.
Diseases occur periodically, in individual cases throughout the country. But in the winter period (less – in other seasons) there are small epidemics in kindergartens, schools and other children’s groups.
The speed and extent of the spread of herpes are affected by hypothermia, poor sanitation, increased insolation, crowding, etc.
Causes of Herpes in Children
Herpes simplex virus (abbreviated as HSV) contains RNA. The diameter of the virion is 120-150 nm. Reproduction of the virus occurs best in the tissues of a chicken embryo. In infected cells, due to the influence of the virus, intranuclear inclusions and giant cells are formed.
It is best to keep the herpes virus at a low temperature (-70 ° C). It can be inactivated by raising the temperature of the medium to 50-52 ° C for half an hour. Also, the virus is destroyed by ultraviolet and X-rays. In the dried state can maintain life about 10 years.
Herpes simplex virus is divided into HSV1 and HSV2. The first group results in damage to the facial skin and mucous in the mouth. HSV2 affect the genitals, cause meningoencephalitis. If a child has contracted one type of virus, an infection can also occur, caused by the second type.
Pathogenesis during herpes in children
Infection enters the body of the child through damaged mucous membranes and injured skin. HSV causes rashes in the lesions. In rare cases, the virus from the primary localization site enters the regional lymph nodes, even more rarely it enters the bloodstream.
The development of infection further depends on the state of the systems responsible for immunity. If the forms of herpes are localized, then the process ends only with local manifestations. The virus with blood enters the lungs, liver, spleen or other organs and affects them – this occurs when generalized forms of herpes. In this process, virus-neutralizing antibodies soon accumulate in the blood. Viral DNA inside the cell is not inactivated. The virus can not be killed until the end, it stays in the body all life, because of which from time to time there are repetitions of the disease. Relapses occur, despite the fact that there are virus neutralizing antibodies in the blood.
The virus is in the blood, is activated from the “trigger factor”, for example, from the effects of ultraviolet rays, physical stress, hypothermia. These factors stimulate the formation of prostaglandins and corticosteroid hormones, which affects the release of free viral DNA from the cells.
Relapses occur because of the weakening of local immunity or because of the genetically determined deficit of cellular immunity. If the immune control is weakened, the virus freely passes through the cells and between them.
Pathomorphology. Pathological changes depend on the location of the infection. There is a balloting degeneration of the epithelium, which manifests as inflammation in the epidermis in the form of vesicles. The vesicle lies on the infiltrated and edematous papillate layer of the dermis.
In generalized forms of the disease, small foci of coagulative necrosis appear in many organs and systems of the body. There are changes in the central nervous system. There is a possibility of hemorrhages in the subarachnoid space (the cavity between the arachnoid and the soft medulla).
Discover a picture of leptomeningitis with and the filtration of the membranes and walls of the vessels with cellular lymphohistiocyte elements. Changes of the same nature can occur in the lungs, liver, bone marrow, spleen and adrenal cortex.
Symptoms of Herpes in Children
The incubation period of the disease is 6 days (on average), but in different cases it can last 2-14 days. Localization of the pathological process makes it possible to distinguish such types of lesions:
- damage to the eyes (manifested as blepharoconjunctivitis, conjunctivitis, keratitis, chorioretinitis, etc.);
- damage to the mucous membranes (manifested as stomatitis, tonsillitis, gingivitis, etc.);
- defeat of the skin (manifested as herpes nose, herpes of the lips, eyelids of the hands, face, etc.);
- genital herpes (lesions of the vulva, penis, urethra, etc.);
- herpetic eczema;
- visceral forms (pneumonia, hepatitis);
- defeat of the central nervous system (neuritis, meningoencephalitis, etc.).
The diagnosis usually indicates how widespread the lesions (herpes: localized, common or generalized simple). Course of the disease: acute, abortive, relapsing. The abortive form indicates a rapid, premature cessation of the painful process. The recurrent course indicates a recurrence of the disease in the form of recovery and a new return of the symptoms. After the disappearance of clinical manifestations in the blood there are antibodies, but the virus is present in the body, not showing itself. In the case of the activation factor, it manifests itself and affects the same or other human organs.
One of the most common symptoms of herpes in children is the defeat of the mucous membranes. It manifests as acute stomatitis or gingivostomatitis. This symptom can be in children of any age, but in most cases – in children from 2 to 3 years. The incubation period lasts from one day to eight. The disease has an acute onset with a rise in temperature to 39-40 ° C. The child is shivering, he begins to show concern (newborns and babies). There is a general malaise. The kid refuses to eat, because it causes pain in the mouth. Parents can note active salivation and characteristic odor from the mouth. In young children, the body weight decreases, there are rare cases of indigestion, it is possible dehydration.
When the mucous membranes are affected, the mouth inside is edematous and reddish. The mucous membrane is covered with rashes ranging in size from 2 to 10 mm, which look like vesicles. First they are transparent, and then yellowish content appears. They soon burst, after the bubbles remain erosion. Regional lymph nodes are enlarged and painful (pain in palpation). The disease lasts from 1 to 2 weeks. On 3-5 days the temperature of the body comes back to normal. In some cases, relapse of the disease is possible.
The defeat of the skin in most cases occurs around the mouth, nose and ears. A few days before the appearance of rashes, burning, as well as itching, tingling, or slight pain can occur. It is worth noting that the liquid in the later bubbles may be with a trace of blood. When the erosion bubbles appearing on the spot are tightened, a brownish-yellowish crust appears. Crusts fall off soon, in their place the skin can be red or slightly pigmented.
Vesicles are often “grouped”, such groups of rashes are surrounded by a zone of hyperemia. The process of formation and drying of vesicles can last from 10 to 14 days. In some children who have become ill, the vesicles can merge into a large bubble form. After it is opened (bursting), in its place a large erosion is formed.
HSV causes localized and common skin lesions. Localized are characterized by the fact that the general condition of the ill does not deteriorate, the temperature is normal. The common (disseminated) form has a sharp onset, the body temperature reaches 39-40 ° C, which sometimes leads to chills. The general condition of the child worsens, there are headaches, as well as pain in the muscles and joints. At the height of the manifestation of symptoms, vomiting (or nausea), convulsions occurs. At the end of the first day (in rare cases – on the second or third day) simultaneously herpetic vesicles with a tendency to “grouping” appear on the face, arms and trunk. The disease lasts up to 14-21 days. In some cases – longer. This form of the disease prevails in younger children.
The next form of herpes is herpetic eczema. Occurs in children with eczema, neurodermatitis and other dermatoses, in which there are erosive lesions (through which the infection enters the body). The disease is also called differently: Kaposi’s rash-like rashes, vaccine-shaped pustules, herpetiform eczema, and so on.
The incubation period with herpetic eczema lasts from 3 to 5 days. An acute onset, sometimes a short prodromal period (before the appearance of the “clinic”), the temperature rises to 39-40 ° C. Symptoms (such as anxiety, lethargy, drowsiness, prostration) progress rapidly.
There is a possibility of seizures, loss of consciousness is short-lived. From the first day of the disease there is a profuse rash, sometimes it can appear only on 2-3 days. The rash lasts up to 2-3 weeks. There is a painful regional lymphadenitis. At first the bubbles are transparent, then they become more turbid and denser. Elements of the rash on the second day resemble vaccinal pustules. Vesicles merge with each other, bursting, crusting. In severe cases, the rash leaves scars on the skin. The disease can last for a long time, there is a possibility of repeated rashes for 2 or 3 weeks. On the 7-10th day the body temperature returns to normal, the general condition of the patient improves. After that, the skin begins to clean. If the child’s body is weakened, herpetic eczema has a severe course. The pathological process affects not only the mucous membranes and skin, but also the nervous system, visceral organs, eyes, resulting in untimely treatment and weakening of the body to death.
Because of the vastness of the skin lesions, a secondary bacterial infection is a threat.
The defeat of the eyes (ophthalmoherpes) often develops due to infection with the herpes virus. It can manifest itself as an isolated eye injury, but cases of combining the damage to the eye, the mucous membranes of the mouth and skin are also common. Regional lymph nodes increase, follicular, catarrhal or vesicular ulcerous conjunctivitis develops.
Ophthalmoherpes begins acutely, conjunctivitis, ulcers or hermetic vesicles on the skin of the eyelid near the eyelashes. The course of superficial herpetic keratitis in most cases is benign. Deep discoid herpetic keratitis has a severe course, which often leads to inflammation of the anterior part of the vascular tract.
These are tortuous and often recurrent processes. As a result of keratoiridocyclitis, corneal opacity and a “drop in” vision may occur. Infants up to 6 months of age may develop chorioretinitis, cataract and uveitis.
Genital herpes occurs in older children – adolescent and older. Sexually transmitted. At children of younger age groups at first the simple herpes, and sexual bodies are amazed again. In such cases, the virus “picks up” through the hands, on which there is an infection, linen, towels. It is also possible that initially the external genitalia will be affected. Infection occurs by contact from parents with herpes simplex. The disease most often causes HSV 2.
Clinical manifestations of genital herpes are different. The course in most cases persistent and relapsing. Genital herpes in adolescents and children of other ages causes vesicular and erosive-ulcerative rashes on the skin and mucous membrane of the genital organs.
In women who have fallen ill, rashes can be localized on the labia (small and large), in the perineum, less often on the inner surface of the thighs. In even more rare cases, rashes may appear on the mucous membrane of the vagina, clitoris or anus. In male cases, rashes are localized on the inner leaf of the foreskin and skin of the scrotum. Also, there are cases of rashes on the mucous membrane of the urethra, which turn into a rash on the bladder. The disease is manifested by fever, pain, itching, burning, etc. on the areas affected by the disease. Heavier than in children, genital herpes occurs in adults. After the disappearance of symptoms, a long latent virus carrier can occur, which increases the risk of infection of surrounding children and adults.
The defeat of the nervous system with herpes. The spread of the virus through the bloodstream can lead to infection of the brain. CNS lesion may have a course similar to meningocephalitis, encephalitis, meningitis, meningoencephaloradulitis. The most common forms of herpes are encephalitis and meningitis, which usually affect newborns and infants.
According to clinical manifestations, herpetic encephalitis does not differ from other viral encephalitis. In children of early age, there is often a primary generalized infection, although CNS damage is possible simultaneously with the appearance of rashes on the lips, eyes, etc. Herpetic encephalitis begins acutely, with a very high temperature. The headache is severe, chills are felt, repeated vomiting is possible. You need to observe the child, then you can notice the inhibition and drowsiness, but in some cases – on the contrary – the excitement. In the midst of the disease, convulsions, fainting, paralysis and even reflex reflexes can occur. The course of the disease is severe, the consequences are serious. Particularly severe cases result in a fatal outcome. In such cases, an autopsy shows acute hemorrhagic necrosis in the cerebral cortex.
Analysis of cerebrospinal fluid shows lymphocyte cytosis and elevated protein.
Visceral forms are manifested in the form of acute parenchymal hepatitis, pneumonia, kidney damage and other organs.
Herpetic hepatitis is common mainly among newborns, but also occurs in older adults. Usually hepatitis appears as a consequence of the generalization of herpes simplex, which results in the defeat of many organs of the child. But it is also possible, albeit rarely, an isolated lesion of the patient’s liver.
Herpetic hepatitis is manifested by high fever, expressed symptoms of intoxication, drowsiness, respiratory distress, dyspnea, cyanosis, liver enlargement, vomiting, enlarged spleen, etc. There is also jaundice, as with other forms of hepatitis.
Herpetic pneumonia and herpetic focal nephritis do not clinically differ from lung and renal lesions of other etiology. The disease has a current like a virus-bacterial infection. The course is acute or recurrent. Basically – it is recurrent. The disease is repeated due to overcooling or overheating, the addition / activation of viral and bacterial infections. In girls, the period of a new exacerbation of the disease may be the time of menstruation. Relapses usually have a light course.
Complications of herpes occur in the case of attachment of a bacterial infection.
Diagnosis of Herpes in children
Herpes simplex is determined by physicians according to the characteristic bubble rashes, grouped on the skin and mucous membranes. Laboratory confirmation is performed by analyzing the presence of the virus in vesicle-blisters, skin ulcers, in the blood, in cerebrospinal fluid (PCR method). For the diagnosis of recurrent herpes, detection of high IgG antibodies or a build-up of titer in the course of the disease is of particular importance.
The prognosis is favorable for localized forms of the disease. In generalized forms, treatment is more severe and prolonged, lethal outcomes are not excluded. Especially severe prognosis with herpetic encephalitis, meningoencephalitis, I also with congenital herpes and with diseases of newborns.
Treatment of Herpes in Children
Localized lesions of mucous membranes and skin are treated with a local method – ointment of acyclovir, 5% liniment with cycloferon and other antiviral drugs. Interferon is prescribed in the form of lotions, ointments, rinses of mucous or inhalation. Affected areas of skin and mucous membranes are treated with 1-2% alcohol solution of brilliant green, 1-3% alcohol sword maple blue. The oral cavity is treated with a 3% solution of hydrogen peroxide, which gives a sanitizing effect in herpetic stomatitis. To infants can eat without pain, apply pain medication topically – for example, anesthesin or lidocaine.
If the temperature is greatly increased, the patient is given ibuprofen. Severe forms of herpes are treated with acyclovir. Combination therapy includes acyclovir + cycloferon.
With the recurring course of the disease, a course of viferon, vitamins B, B2, B12, pyrogenal is prescribed. It is also prescribed an extract of Eleutherococcus liquid, tincture of ginseng, etc. Also specific for anti-herpetic immunoglobulin and antiherpetic vaccine are effective, especially in combination with cycloferon.
In some cases, interferon inducers are prescribed, for example, cycloferon or anaferon for children. Accession of bacterial infection means that antibiotic therapy should be added to treatment. Contraindicated for the treatment of herpes corticosteroid hormones, but they are connected with severe forms of herpetic encephalitis and meningoencephalitis.
In the recurrent course of herpes, acyclovir is ineffective, nunjo to apply it in a complex, together with cyclophorone.
Prophylaxis of Herpes in children
Preventive measures include the tempering of children and the development of hygiene skills. Infected children are not recommended for ultraviolet irradiation, physical activity, severe stress.
It is especially important to protect children suffering from eczema and wet forms of atopic dermatitis. Newborns who had contact with a person with herpes, are subject to isolation. If the mother is infected with herpes, and there are rashes on her skin and mucous membranes, she must wear a surgical mask when she is in contact with the baby. While the erosion after the falling off of the crusts does not heal, the infected mother can not cuddle up to the baby’s skin and kiss him. If there are no herpes on the breast, feeding is allowed.
To prevent intrauterine infection of the baby, pregnant women are recommended to be examined for HSV. If there are clinical signs of infection, administer immunoglobulin (0.2 ml / kg). If signs of genital herpes are found before childbirth, labor should be performed with caesarean section. But this measure does not completely exclude the possibility of infecting a newborn.
If the mother had signs of herpes or suspected of it, the newborn should be sent for examination. If they have a herpes virus, children are treated with acyclovir. If the clinical manifestations of herpes in a child is not born, he is followed for 1-2 months.