How is herpes infection transmitted? Herpes virus infection in adults and children

Viruses belonging to the herpesvirus family are very widespread in nature. They can cause diseases various types wild and domestic animals. Currently, more than 100 herpesviruses are known, 8 of them have been isolated from humans. Herpes viruses are capable of persisting in the human body for life and causing diseases with a variety of clinical manifestations. Externally, the similarity of herpes viruses is so great that under an electron microscope it is almost impossible to distinguish them. The individuality of “relatives” begins to appear only when it comes to the antigenic properties of virion proteins and the degree of DNA homology. Characteristic feature, which helps electron microscopic recognition of the virus is the presence of a large envelope, although non-enveloped viruses may also be present in the preparations.

Human herpesviruses and major clinical forms infections

Herpes simplex virus (HSV) types 1 and 2

HSV enters the human body through damaged skin and mucous membranes. IN first phase Pathogenesis, the virus invades epithelial cells (oral mucosa, pharynx or genital organs), where it multiplies. Papules and vesicles characteristic of herpetic infection appear on the mucous membranes and skin.

In second phase pathogenesis, HSV penetrates into sensory nerve endings and along centripetal nerve fibers into the paravertebral ganglia. Virus replication occurs in the nuclei of neurons. Along the efferent nerve fibers, the virus again reaches the skin and mucous membranes, where it spreads with the appearance of new rashes.

IN third phase pathogenesis (2-4 weeks after infection), with a normal immune response, the primary disease resolves and HSV is eliminated from tissues and organs. However, in the paravertebral ganglia the pathogen remains in a latent state throughout a person’s life.

In the fourth phase of pathogenesis, reactivation of HSV reproduction occurs and its movement along nerve fibers to the site of primary entry (gate of infection) with a relapse of a specific infectious-inflammatory process and possible dissemination of the infection.

Genital herpes (GG)

The herpes simplex virus persists in men in the genitourinary tract, and in women - in the cervix, vagina and urethra. Asymptomatic individuals are reservoirs of infection. Infection with genital herpes occurs mainly through sexual contact. During the period of viremia in pregnant women, infection of the fetus occurs through the hematogenous route, and during childbirth - through contact. According to clinical and morphological manifestations, genital herpes is divided into 4 types.

1. First clinical episode of primary genital herpes- a true manifestation of primary herpetic infection. Swelling and hyperemia develop on the genitals, then vesicular rashes appear, usually abundant. The vesicles quickly burst, forming erosive, erosive-ulcerative surfaces. All this is accompanied by a burning sensation, itching, weeping, and pain.
2. Primary clinical episode of existing herpetic infection characterized by a primary clinical manifestation against the background of seropositivity to the herpes simplex virus. All symptoms are less pronounced than with the first type.
3. Recurrent genital herpes. Reactivation of herpes viruses usually occurs in the first few months after the initial episode of the disease. Manifestations of recurrent genital herpes can vary: from asymptomatic viral shedding or mild symptoms to very painful confluent ulcerations with clear boundaries.
4. Atypical herpes occurs in approximately 20% of all cases of genital herpes and is characterized by the fact that the specific manifestations of herpetic infection are hidden by the symptoms of concomitant local infectious diseases (most often candidiasis).

Neonatal herpes

Most often (85%) infection of a newborn occurs intrapartum (during the passage of the birth canal), regardless of whether there are currently foci of damage in the cervix and vulva or not (with asymptomatic virus shedding). Postnatal infection of a newborn is also possible in the presence of herpetic manifestations in the mother and medical staff, or when infected equipment is used to care for newborns. Transplacental infection of the fetus with HSV can lead to termination of pregnancy, birth defects are rare. Infected babies are often born premature and of low birth weight. Asymptomatic HSV infection, while common in older children, is rarely seen in newborns. Neonatal herpes manifests itself in three clinical forms:

1. Local, with damage to the skin and mucous membranes.

2. Local form with damage to the central nervous system.

3. Disseminated form of herpetic infection with damage to the central nervous system, liver, lungs, adrenal glands, DIC syndrome.

With herpes infection, as a result of viremia, several organs can be involved in the process simultaneously. The development of herpetic esophagitis, pneumonitis, hepatitis is possible. Damage to the peripheral nervous system can occur in the form of ganglionitis, ganglioneuritis, radiculoneuritis, polyneuropathy. Damage to the central nervous system during herpetic infection most often occurs in the form of encephalitis or meningoencephalitis.

Laboratory diagnostics: virological methods for detection and identification of herpes simplex viruses; methods for detecting antigens of herpes simplex viruses - immunofluorescent and linked immunosorbent assay; polymerase chain reaction (PCR); cytomorphological methods; detection of antibodies using ELISA; assessment methods immune status. Material for research is taken depending on the location of the lesions (contents of vesicles, scraping of cells, cerebrospinal fluid, bronchial aspirate, biopsy, blood.

Treatment: antiherpetic drugs.

Varicella-zoster virus

Already from the very name of the pathogen you can guess that it causes two types of lesions - chicken pox (varicella) and herpes zoster ( zoster). Basic transmission routes virus - airborne and contact (through discharge of a vesicle). Children can get chickenpox from close contact with someone who has shingles.

Chicken pox. The virus enters the respiratory tract, where it replicates; sometimes the virus invades the lymph nodes, causing primary viremia. Clinically manifests as acute infection, accompanied by fever and macular vesicular rash on the skin and mucous membranes. It initially manifests itself in the form of a small spotty rash, which then transforms into papular and vesicular; False polymorphism of the rash is characteristic. During the period of convalescence, the blisters dry out with the formation of crusts and healing without the formation of defects.

Shingles characterized by rashes along individual sensory nerves of fuzzy pinkish spots (3-5 cm in diameter), against which after 18-24 hours groups of painful vesicles form; the main feature that distinguishes them from other herpes skin lesions, - the presence of a clear demarcation zone. Most often the lesions are located on chest, but can also be located along any sensory nerve and, as a rule, unilaterally. The lesions disappear within 2-4 weeks, but the pain may persist for weeks to a month.

Diagnostics: isolation by culture method, microscopy (Tzanck cells), serological methods (determination of antibodies to viral proteins).

Treatment: for chickenpox in most cases it is symptomatic, for herpes zoster - antiherpetic drugs.

Prevention. Developed live vaccine against chickenpox, recommended for administration to children over 1 year of age.

Epstein-Barr virus (EBV)

Epidemiology. The only reservoir of infection is humans. The main route of transmission is airborne, less often transmissible or sexual.

IN early age the infection is accompanied by erased manifestations, or it is generally asymptomatic; Primary infection during adolescence or later may cause a condition known as Infectious mononucleosis. The pathogenesis of infectious mononucleosis involves viral replication in upper sections respiratory tract and associated lymphoid tissue with the development of local inflammatory reactions and feverish condition. The pathogen induces the appearance of a population of reactive T cells (atypical lymphocytes), as well as polyclonal activation of B cells and their differentiation into plasma cells that secrete heterophilic AT with low affinity for the virus, but react with various substrates, including erythrocytes of various animals. In this case, the virus genome can be stored in B lymphocytes in a latent form. Much less common is the chronic persistence of the virus, known as reactivated chronic EBV infection. The condition comes in many forms and is quite rare; among them are more often observed chronic mononucleosis syndrome(complaints of constant weakness in the presence or absence of any changes in laboratory parameters are typical). Chronic active EBV infection is common in immunocompromised patients (most commonly AIDS and transplant recipients). It most often manifests itself as a progressive lymphoproliferative disease or CNS lymphomas. The ability of the pathogen to cause malignant transformation of cells gives reason to assume the participation of the virus (as a cocarcinogen) in the development of malignant growth diseases, such as the African forms Burkett's lymphoma, nasopharyngeal carcinoma in men of some ethnic groups of Southern China, as well as Kaposi's sarcoma in patients with AIDS.

The mechanisms of development of malignant transformations induced by EBV are associated with the ability to infect B lymphocytes and disrupt their further differentiation; in this case, part of the viral genome is expressed in infected lymphoblasts.

Diagnostics: detection of atypical mononuclear cells in the blood, serological methods, PCR.

Treatment: in infectious mononucleosis, usually symptomatic; the virus is sensitive to a number of antiherpetic drugs.

Cytomegalovirus (CMV) infection

The virus enters the body through saliva during kissing and through genital secretions during sexual intercourse, through breast milk and when using a non-sterile syringe, during organ transplantation and transfusion donated blood, when using donor sperm and eggs. It is believed that the main repository of viruses are mononuclear phagocytes - monocytes and macrophages, as well as epithelial cells salivary glands and renal tubules, hepatocytes and some other cells.

Infection with cytomegalovirus can occur during fetal development. A necessary condition infection of the fetus is viremia of pregnant women. If the fetus becomes infected with this virus in the womb, then it will be congenital cytomegalovirus infection. Such children may have jaundice, enlarged liver and spleen, and may have severe congenital defects, sometimes incompatible with life. The infection may be asymptomatic, but 5-25% of such children may experience hearing loss, mental disorders, and eye abnormalities over the next few years. If a child becomes infected during or a short period of time after birth, he will not gain weight well and may develop hepatitis, anemia, a rash will appear.

IN adolescence cytomegalovirus infection can manifest itself as mononucleosis. With this disease, the temperature rises, muscle pain appears, and fatigue develops. In people with immunodeficiency, the infection is usually severe.

Cytomegalovirus infection is common companion of AIDS. In this case, many internal organs are affected, which can result in the death of the patient. Main symptoms: fever, malaise, lack of appetite, muscle pain, cough. In case of defeat small intestine Ulcers may occur, which in turn may bleed or perforate (a through hole will appear in the wall of the stomach or intestines). Retinitis (damage to the retina) caused by cytomegalovirus can lead to blindness. In a person with normal immunity, cytomegalovirus infection does not manifest itself in any way and may not make itself felt throughout his life. After organ transplantation and bone marrow active cytomegalovirus infection usually develops in the first four months after surgery and very often causes illness and even death in recipients. The source of infection can be reactivation of one's own CMV or re-infection of the recipient through donor organs, transfusion of blood and its components. There is an assumption that CMV infection plays a certain role in the pathogenesis of acute and chronic graft-versus-host reactions.

Diagnostics: isolation of the virus from urine (tropic to kidney tissue), microscopy (cells in the form of an “owl’s eye”), serological methods, PCR.

Treatment: modern antiherpetic drugs - acyclic nucleosides - have high specificity and have proven themselves well in the treatment of cytomegalovirus infections. In recent years, strains of CMV have been discovered that are double resistant to ganciclovir and foscarnet.

Herpes virus type 6 (HV-6)

Clinical manifestations VH-6 infections:

Diagnostics: isolation in cell culture, immunological methods, microscopy.

Treatment: treatment is symptomatic, data on the effectiveness of ganciclovir have been obtained.

Herpes virus type 7 (HV-7)

Properties of the virus: grows slowly, only on human CD4 lymphocytes, which have cellular receptors for this virus. The virus is detected in peripheral blood and saliva. Very often, people with herpes virus type 7 are isolated from herpes virus type 6.

Causes diseases: is a possible cause chronic fatigue syndrome (Chronic Fatigue Syndrome, CFS). It is believed that human herpes virus type 7 may be the cause of lymphoproliferative diseases.

Manifestations of the disease: chronic fatigue syndrome can be suspected based on a combination of a number of signs: causeless weakness, increased tearfulness; high fatigue; increased level of anxiety; depression; sleep disturbance (phases of falling asleep). In the morning, feeling overwhelmed; temperature 36.9-37.3 degrees. Celsius for 6 months; causeless enlargement of lymph nodes - lymphadenopathy.

Diagnostics: polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA); immunogram, which can be noted: a decrease in NK (natural killer) cells, an increase in CD8 lymphocytes, CEC, IgG; analysis of the patient's personality (simulation).

Treatment: symptomatic. Conducted by a neurologist or psychiatrist. Consists in antiviral therapy and treatment aimed at strengthening the immune system.

Prevention: not developed.

Herpes virus type 8 (VH-8, HHV8)

The DNA of this virus is consistently found in the tissue of AIDS-associated Kaposi's sarcoma, while it is not detected in normal tissue from adjacent areas. HHV8 has been found to be associated with all types of Kaposi's sarcoma, including endemic in Africans, classic in older Mediterranean people, and transplant-associated. It has been shown that the development of Kaposi's sarcoma is preceded by an infection caused by HHV8 by 3-10 years. Using PCR, some authors detected the virus in seminal fluid and sperm, although others did not confirm this. HHV8 was detected in endothelial cells, circulating CD20 + lymphocytes (B cells), nasal secretions, and bronchoalveolar left fluid in patients with pulmonary Kaposi's sarcoma.

Clinic. The classic form manifests itself in the form of localized nodes of brown-red - bluish-red color localized mainly on the skin lower limbs. The following stages of the disease are distinguished: skin manifestations, localized torpid course (classical), skin manifestations, localized aggressive course with or without increase lymph nodes(African localized aggressive variant), generalized skin manifestations and/or lymph node involvement (African lymphadenopathy and endemic variant), visceral manifestations (epidemic variant).

Treatment. Today there are quite a lot of chemotherapy drugs recommended for the treatment of Kaposi's sarcoma in patients with AIDS, although the effect of therapy is not always satisfactory; surgical and radiation treatment are also used.

Related materials

• Practical guide to anti-infective chemotherapy
  edited by L.S. Strachunsky, Yu.B. Belousova, S.N. Kozlova
• Clinical use of interferon drugs
  V.V. Rafalsky
• Laboratory diagnosis of viral infections
  N.N. Nosik, V.M. Stakhanov. KMAH, 2000; 2:70-78.
• Genital herpes: modern problems and ways to solve them
  V.A. Akovbyan, S.A. Masyukova, E.V. Vladimirova, A.B. Zudin, S.B. Pokrovskaya.
  KMAH, 2003; 5:4-18.

Articles

• Infections and the risk of developing bronchial asthma in children
  The incidence of bronchospasm in 7-year-old children is inversely proportional to the incidence of herpes viral infection in the first 3 years of life.
• Do infections lead to the development of cardiovascular diseases?
  People aged 65 years and older who are infected with HSV-1 are twice as likely to develop acute coronary artery disease and die as those who are not infected. At the same time, such a phenomenon was not observed during infection with cytomegalovirus.

Herpes virus types 1 and 2 (herpes simplex virus)

• Herpes simplex virus infections
  In the journal Lancet An article by leading American experts has been published on the problems of diseases caused by the herpes simplex virus (HSV) types 1 and 2, which are widespread in the population.
• Herpes virus against metastatic melanoma
  According to the results of a pilot study conducted in the UK, injection of an avirulent but replication-capable herpes simplex virus into the tumor tissue of metastatic melanoma causes the death of tumor cells without damaging adjacent healthy tissue.
• Two decades of use of antiviral drugs did not affect the level of resistance of the herpes simplex virus to acyclovir and penciclovir
  Although total of these nucleoside analogues used for the treatment of herpesvirus infection exceeded 2.3x10 6 kg, the frequency of resistance to acyclovir among HSV strains isolated from patients with normal function immune system remained at the same level and amounted to 0.3%.
• Risk factors and frequency of transmission of herpes virus infection from mother to newborn
  The most common route of transmission of herpesvirus infection to newborns is contact of the fetus with infected contents of the mother's genital tract during childbirth.
• Treatment of exacerbations of herpes simplex with short courses of valacyclovir
  In the journal published the results of two randomized, placebo-controlled, multicenter studies on the treatment of exacerbations of orofacial herpes using short courses of valacyclovir ( Valtrexa).
• FDA approves valacyclovir for daily therapy Herpes labialis
  The company's drug valacyclovir GlaxoSmithKline(Valtrex) has been approved by the FDA for one-day therapy of herpes labialis with the goal of reducing treatment duration and improving outcomes.
• New large-scale studies confirm the effectiveness of acyclovir for labial herpes
  According to data published in the journal Antimicrobial Agents and Chemotherapy, acyclovir cream is safe and effective in treating infection caused by herpes simplex virus type 1 ( Herpes labialis), but does not prevent the occurrence of new rashes.
• New drugs for local treatment Herpes labialis
  There are currently 3 new drugs for local treatment Herpes labialis which have been approved for use by the FDA food products And medicines USA (FDA): penciclovir cream (Denavir), n-docosanol cream (Abreval) and acyclovir cream.
• Advantages of automated PCR in identifying and determining the type of genital herpes
  In the journal Sexually Transmitted Infections British researchers from the Sandyford Initiative, Glasgow, note that automated PCR is effective method identifying and determining the type of genital herpes.
• A two-day course of acyclovir for the treatment of recurrent genital herpes
  To evaluate the effectiveness of a shorter course of therapy, scientists led by Anna Wald from the University of Washington (USA) conducted a randomized, double-blind, placebo-controlled study of the effectiveness of acyclovir (800 mg orally 3 times a day for 2 days) in recurrent genital herpes caused by HSV-2.
• Valaciclovir in the treatment of genital herpes: comparison of 3-day and 5-day courses of treatment
  A short course of treatment for episodes of recurrent genital herpes with valacyclovir is as effective as a 5-day prescription of the drug.
• FDA approves shorter course treatment for recurrent genital herpes with valacyclovir
  The US Food and Drug Administration (FDA) has approved an addition to the prescribing information for the company's antiherpetic drug Valtrex (valacyclovir). GlaxoSmithKline. According to this supplement, if genital herpes recurs, a shorter course of treatment may be used.
• The first effective vaccine to prevent genital herpes is sex specific
  At the 40th Annual Conference on antimicrobial drugs and chemotherapy (ICAAC) presented the results of the development of a vaccine for the prevention of genital herpes, which, as it turns out, is effective only in women.

Herpes virus type 3

• Decline in chickenpox incidence following introduction of vaccination in the United States
  The incidence of chickenpox during the period from 1995 to 2000 in the studied regions of the United States decreased significantly, despite moderate vaccination coverage of the child population in these areas.
• S.pyogenes often causes complications in children with chickenpox
  The aim of a prospective study conducted by German scientists from the University of Munich was to study the epidemiological aspects of severe complications of chickenpox that occurred in immunocompetent children.

Herpes virus type 4

• Epstein-Bar virus and tumor development
  Scientists from the University of Michigan Medical School have discovered a probable link between the development of breast cancer, malignant blood diseases and the Epstein-Bar virus, which causes infectious mononucleosis.

Herpes virus type 5

• Cytomegalovirus infection of the central nervous system usually occurs in patients with immunological disorders
  Cytomegalovirus infection (CMVI) most often occurs in patients with impaired immunological status, for example, in HIV-infected patients or during immunosuppressive therapy in patients who have undergone organ transplantation.
• Valacyclovir is the drug of choice for the prevention of cytomegalovirus infection in patients after bone marrow transplantation
  In a multicenter randomized trial, the results of which were published in the journal Clinical Infectious Diseases, 168 bone marrow transplant patients with antibodies to cytomegalovirus (CMV) were included.
• The use of ganciclovir in children with congenital CMV infection prevents hearing loss
  Ganciclovir may prevent hearing loss or progression of hearing loss in children with congenital cytomegalovirus (CMV) infection, according to data presented at the American Academy of Pediatrics (AAP) annual national conference.
• Congenital cytomegalovirus infection
  According to data obtained by Brazilian scientists and published in The Pediatric Infectious Disease Journal, cytomegalovirus infection is the most common congenital infection, and 34% of children who then CMV infection manifested clinically, they are born prematurely.
• Transmission of cytomegalovirus from mother to newborn through breast milk
  According to data published in the magazine Lancet, the risk of transmission of cytomegalovirus infection during breastfeeding significantly higher in premature newborns than in children born at term.

Herpes virus type 6

• Ganciclovir is effective in treating infections caused by herpes virus type 6
  According to Japanese researchers, ganciclovir is effective in treating infections caused by herpes virus type 6 (HH-6) in children who have undergone allogeneic hematopoietic stem cell transplantation.

Herpes virus type 8

• Kaposi's sarcoma-associated herpes virus can be transmitted vertically
  The results of a new study conducted by scientists from the University of Nebraska (Lincoln, USA) were published in the journal International Journal of Cancer. It turned out that herpes virus type 8 (herpesvirus family, subfamily of gammaherpes viruses), associated with Kaposi's sarcoma - Kaposhi Sarkoma Herpes Virus (KSHV) - can be transmitted vertically from mother to fetus.
• Herpes virus type 8 can be transmitted through blood
  Herpes virus type 8 can be transmitted through blood, according to a report published in the journal Medicina, drug users who share needles can become infected with herpes virus type 8 (HV-8), which is associated with the development of Kaposi's sarcoma.

antiviral drug for external use. Active against Herpes simplex viruses types I and II Herpes zoster. Inhibits the absorption and penetration of viruses into the cell. Viral resistance to the drug does not occur. Relieves pain, burning and itching characteristic of herpetic infection, shortens the duration of the disease, and lengthens periods of remission.

herpesvirus herpes infection, herpes simplex virus, genital neonatal herpes varicella-zoster, chickenpox, herpes zoster, Epstein-Barr, cytomegalovirus, ganciclovir, chronic fatigue syndrome, HHV8, Kaposi's sarcoma, AIDS

One of the most common infections is rightfully considered to be herpes virus infection. Infection of the population with herpes reaches 95%. In this case, several types of herpes can be present in the patient’s body at the same time.

Herpes viruses are pathogens that are unable to reproduce outside host cells. They contain DNA surrounded by 2 shells (nucleocapsid and supercapsid), between which there is an amorphous substance consisting of proteins that trigger the reproduction process.

Belongs to the Herpesviridae family. Of the 80 types of viruses in this group studied, only 8 are dangerous to humans. In their structure, they are practically indistinguishable. Their difference is manifested in the antigenic properties that they begin to exhibit when they enter the human body.

Diseases that are caused by herpes viruses differ in clinical symptoms, methods of spread in environment and treatment methods.

Herpes pathogens are common in any climate zone and habitat.

The source of infection and the reservoir for them is a person (a carrier or with obvious signs of the disease). You can become infected with the herpes virus through direct contact with a patient, through blood and by inhaling air containing the pathogen.

Viruses of this group are capable of persisting in the human body for life.

The concept of persistence includes the ability of the herpes virus to reproduce in affected cells in a constant or cyclical mode with the threat of an infectious disease.

Once in the human body, herpes viruses are located in tropic (specific) cells, periodically causing herpes virus infections with a variety of clinical manifestations. Infection most often occurs in childhood, and subsequent clinical manifestation is a manifestation of relapse of the disease. Thus, herpes virus infection - chronic illness with polymorphic clinical manifestations.

Herpes simplex virus

Human herpes virus (HHV) type 1 is the most common of the entire group of herpes viruses. The pathogen penetrates through microdamages on the skin and mucous membranes through close contact with an infected person.

Skin cells on the face, mucous membranes of the lips, nose, eyes, and throat are damaged. Initially, having penetrated the epithelium, the virus begins to multiply, causing the appearance of characteristic papules, which quickly become vesicles (bubbles) filled with transparent or cloudy contents. The appearance of these elements is preceded by itching and burning at the site of localization.

Bubbles appear on an edematous and hyperemic (red, due to blood flow) background. They are located in groups, sometimes merging with each other. They quickly open up, forming small erosions covered with a crust. After it disappears, an area of ​​light pigmentation remains.

Primary herpes infection in childhood can manifest itself as damage to the oral cavity with the development aphthous stomatitis on the mucous membrane. Lesions of the respiratory (breathing) tract are manifested by cough, runny nose, and sore throat. Herpes virus infection of the eyes often occurs with the development of ophthalmoherpes.

The virus penetrates the nerve endings after the initial infection has occurred. New rashes appear on the skin in the projection of the passage of the nerve. After a period of two to four weeks, healing occurs. But the herpes pathogen remains in a latent (hidden) state for life.

When the process is reactivated (resumed) under the influence of unfavorable factors, the herpes virus multiplies with a relapse of the cascade of characteristic inflammatory reactions.

Genital herpes

The causative agent is herpesvirus type 2. It is transmitted sexually through close contact.

This type of herpesvirus is constantly found in men in the urethra, in women in the urethra, on the mucous membrane of the cervix and vagina. Against an edematous and hyperemic background, vesicles appear that quickly burst. After this, weeping erosions and sometimes erosive-ulcerative elements are formed. In the future, if an exacerbation of genital herpes occurs, it will proceed more easily.

The period of rashes is accompanied by pain, itching, enlargement of the lymph nodes located in these areas and a burning sensation. During an active process, body temperature may increase. Rashes with herpes occur on the skin of the perineum, labia, on the thighs with inside, scrotum, less often, on the mucous membrane of the urethra, bladder.

Neonatal herpes

The causative agent of herpes of the neonatal period is HHV type 2. Infection occurs in utero or during passage through the birth canal. In the first case, infection of the fetus can lead to premature termination of pregnancy at any time. Often children affected by HSV type 2 are premature and have low body weight.

With intrauterine infection from birth, a triad of characteristic symptoms is observed:

• vesicular elements on the skin or scars;
• eye damage, up to complete blindness;
• microcephaly ( small size head) or hydrocephalus.

Additionally, the following forms of neonatal herpes are distinguished:

• localized infection (damage to the skin and mucous membranes);
• generalized;
• damage to the central part of the nervous system.

The localized form of infection caused by herpes is characterized by a specific rash that appears on days 5-14 of life, which can be represented by single or multiple elements. Eye damage manifests itself in the form of damage to the mucous membrane (keratoconjunctivitis), blood vessels (uveitis, choreoretinitis), and underdevelopment of the retina.

In the generalized form, the disease manifests itself on days 5-10 and proceeds as neonatal sepsis. The liver and lungs are involved in the process; hemorrhage in the adrenal glands may occur or disseminated intravascular coagulation syndrome may develop.

Damage to the central nervous system in the form of encephalitis appears 2-4 weeks after birth. First, the body temperature rises, the baby loses appetite, and there is an alternation of episodes of lethargy with overexcitation of the nervous system. Then difficult-to-treat generalized seizures develop.

With neonatal herpes, the following complications can develop:

• herpetic esophagitis (inflammation of the esophagus);
• pneumonitis (damage to lung tissue);
• hepatitis;
• infection of the nerve plexuses and roots, the nerves themselves, single or several (ganglionitis, ganglioneuritis, radiculoneuritis, polyneuropathy);
• encephalitis;
• meningoencephalitis (combined inflammation of the brain and its membranes).

Damage to the brain by herpes viruses is the main cause of further neurological deficits in the child.

Varicella Zoster virus

The third type of herpes virus causes such well-known infectious diseases, like chickenpox and shingles. The virus is transmitted through the air and by contact from a sick person.

With chickenpox there are high values temperatures up to febrile levels, at the height of which typical elements of a rash appear. The skin, including the scalp, and mucous membranes are susceptible to damage during this infection. Specific for chickenpox is the polymorphism of the elements of the rash, which is false. It lies in the fact that the rash can be detected at different stages at the same time.

Initially, the rashes are small-spotted, then transform into papules (tubercles) and vesicles (vesicles). The vesicles dry out and brown crusts form in their place. After the last traces fall off, there are no traces left if there was no addition of pyogenic flora.

Shingles is characterized by the appearance of herpetic skin rashes along the sensitive nerve fibers. At the beginning of the disease, fuzzy light pink spots are noted, against which vesicles form, and the entire pathological process is accompanied by a pronounced pain reaction.

Recovery occurs within 2-4 weeks, but the pain reaction persists long time. The rash may leave areas of mild hyperpigmentation.

Epstein–Barr virus

Belongs to type 4 human herpesviruses. The infection can occur as primary or secondary. The primary ones include infectious mononucleosis and lymphoproliferative syndrome. Secondary ones are characterized by the development of cancer in persons predisposed to it.

Infectious mononucleosis in adults occurs without symptoms or as a respiratory infection. An enlarged anterior cervical lymph node is characteristic.

Among the oncological diseases, the Epstein-Barr herpes virus provokes the following:

• Burkitt's lymphoma is a tumor process that affects nervous system, kidney tissue and liver, upper jaw tissue, ovaries;
• nasopharyngeal carcinoma - occurs in the nose and grows into the pharynx with metastases to the lymph nodes;
• malignant lymphomas;
• leukemia;
• Kaposi's sarcoma is multiple skin tumors of a malignant nature.

Infection with type 4 herpes virus in people with immunodeficiency causes damage to almost all organs.

Cytomegalovirus infection

Infection of the population with this herpes virus infection exceeds 90%. Type 5 of the human herpes virus enters the body in the following ways:

• through saliva during kissing;
• when feeding a newborn;
• use of non-sterile instruments for intravenous infusions;
• during transplantation and blood transfusion (blood transfusion);
• with discharge during sexual intercourse;
• from germ cells (sperm, eggs), which are used in artificial insemination;
• transplacentally from mother to fetus;
• upon contact with affected tissues of the birth canal.

From clinical features cytomegalovirus infection can be distinguished by the development at the onset of the disease of fever, lack of appetite and malaise, moderate catarrhal symptoms with an unproductive cough. The virus persists in the parotid and salivary glands.

Under the influence of herpes virus type 5 on the mucous membrane small intestine Bleeding ulcers may form, which lead to perforation of the intestinal wall.

Damage to the retinal vessels with the development of retinitis can cause vision loss.

Treatment

Treatment of herpes virus infection is aimed at suppressing the reproduction of the virus in damaged cells and reducing the severity of symptoms.

The developed antiherpetic drugs are highly toxic, the main burden falls on the liver and hematopoietic organs, so their independent use is strictly prohibited.

When a mild or localized herpes virus infection develops, treatment can be done at home. For this, ointments with an antiviral effect (Acyclovir, Zovirax, Oxolin 3%) are used, which are applied to the area of ​​the rash.

For prevention bacterial complications in case of herpes virus infections, elements of the rash, especially with chickenpox, need to be treated with alcohol-containing antiseptics (Fukortsin, brilliant green, Chlorophyllipt).

The use of immunomodulators is justified to restore damaged parts of the immune system and stimulate the production of endogenous interferons (Polyoxidonium, Cycloferon, Reaferon).

Vitamin therapy is included in the treatment; for this purpose, you can use multivitamins and ascorbic acid. Antipyretic drugs are indicated as symptomatic drugs.

In case of complicated course of the disease caused by herpes infection, antiviral drugs For intravenous administration, containing Acyclovir and Ganciclovir, immunoglobulins (Neocytotec, Pentaglobin). If necessary, carry out infusion therapy. Upon joining bacterial microflora Antibacterial agents are added to the course of therapy.

Although herpes viruses are widespread and well studied, effective means, capable of completely removing the pathogen from the body, has not been found.

Most people are familiar with the herpes virus and its clinical manifestations. Persistent herpesvirus infection is especially dangerous for pregnant women, newborns, the elderly and people with immunodeficiency, so it is very important to observe preventive measures, aimed at general strengthening of the body to avoid activation of an infectious agent.

An infectious disease caused by several types of herpes viruses is a herpesvirus infection. Foci of inflammation are localized in various parts of the body, bringing a person a lot of discomfort and manifesting itself in the form of eruptions, varying in accordance with the stage in which the disease is located.

All people face this infection. This usually happens in early childhood, when the baby gets chickenpox. There is confidence that having had chickenpox once, a person can no longer be afraid of reinfection. However, with a detailed study of everything related to the herpes virus, it becomes clear that it does not disappear from the body, but only goes into a latent form of existence.

Forms of manifestation

The classic manifestation of the disease in humans is the appearance of a rash on various parts of the body. The localization of foci of inflammation depends on the method of infection. Itchy rashes, blisters and sores appear:

• on lips, eyes;
• nose, behind the ears;
• on the hands, feet;
• surfaces of the thighs, buttocks;
• in the form of herpes zoster on the torso;
• on the shoulders, chest;
• around the anus, on the genitals;
• on mucous membranes.

Localization varies. It depends on the type of virus with which the patient is infected. Thus, type I herpes usually affects the mucous membranes of the mouth and lips, type II manifests itself on the mucous membranes of the genital organs, III - IV affects the limbs and body of a person, V - cytomegalovirus.

The first sign of infection is itching, but few people pay attention to a slight increase in body temperature and malaise. Patients rarely associate such deterioration in well-being with herpes. However, the process is evolving.

1. Itchy red spots appear on certain parts of the body.
2. The temperature rises and more and more noticeable weakness appears.
3. Dizziness, nausea and vomiting may occur.
4. At the sites of the rash, blisters appear filled with a cloudy liquid, the itching intensifies and a burning sensation is added.
5. Sleep is disturbed and irritability appears. Body temperature reaches 380 Celsius.
6. The blisters burst and in their place bleeding wounds form.
7. The erosions gradually heal, becoming covered with a rough crust, which when the slightest movement cracks.

The course of the disease can be divided into several stages, each of which is characterized by special manifestations and changes in the patient’s condition. Patients complain of changes in body temperature, lack of sleep due to constant unbearable itching or pain in the area of ​​the rash. One state of a sick person is replaced by another in accordance with the stage of the disease.

1. Deterioration general condition and the appearance of a rash.
2. The appearance of blisters.
3. Rupture of bubbles and formation of erosions.
4. Healing.

Causes and routes of infection

Primary infection does not necessarily cause the development of pathology. A person becomes a carrier of a virus, which, remaining in a latent form, manifests itself during an exacerbation or re-infection. The pathogenic microbe enters the baby’s body even before birth. This intrauterine infection, which is transmitted to the fetus from the mother through the blood.

Other people first become infected in childhood, through contact with children who have chickenpox. It is important that once a herpes virus infection enters the body, it does not disappear. The virus is here to stay. It is stored in the nerve ganglia, all its external manifestations correspond to the course of the affected nerve fibers.

It is especially dangerous for people with reduced immunity. Poor resistance of the human body causes the rapid development of pathology, but, in addition, the cause of its occurrence is:

• hyperglycemia;
• malignant neoplasms;
• severe hypothermia;
• presence of chronic diseases;
• frequent colds;
• stressful situation;
• age-related hormonal changes;
• alcoholism and drug addiction.

The routes of transmission from a sick person to a healthy person are different, but are characteristic of each individual type of virus. Infection occurs through direct contact, by airborne droplets, through blood, during the use of other people's things or household and personal hygiene items. Intrauterine infection is especially dangerous, since it affects a baby with an immature immune system.

Peculiarities of manifestation of individual species

Human infection is possible at any age, but the appearance of each of the established types is different from one another. Hippocrates described this disease as creeping. This is due to the fact that in the absence of timely and proper treatment, the wounds seem to crawl across the patient’s body, gradually spreading and occupying an increasingly larger area. The most striking example of such spread is chickenpox.

Type 1 virus

It is often called a cold sore. It affects the mucous membranes of the oral cavity and appears on the lips and face of both adults and children. Most often this happens during the flow colds against a background of high temperature.

Second type

Affects the mucous membranes of the genital organs. IN acute form transmitted during sexual intercourse. A person who is a carrier can infect his sexual partners, and during childbirth, a sick mother can infect her newborn child.

The danger is also that without treatment, the infection actively develops and complications are possible in the form of damage to other organs of the genitourinary system, including the urethra, ureters, and kidneys.

Third type of virus

Shingles and chicken pox are diseases well known to everyone. But still not all parents know that these childhood diseases are a manifestation of the third type of herpes virus. Children and adults are susceptible to it, but patients at an early age tolerate the painful condition much more easily.

In children, the temperature does not rise above 38 or 38.50, but the increase in body temperature in adults can reach critical values ​​and, possibly, treatment will be carried out in a hospital.

Herpes zoster in adults is accompanied by high temperature, joint pain, the contents of the blisters are opaque, bloody or purulent fluid.

home distinguishing feature This type is that having had it once, a person becomes immune to this type. This does not mean the virus is absent from the body. He still remains in it forever, taking hidden form and being in the nerve ganglia. The manifestations will be different. Therefore, shingles may recur. There can be no recurrence of chickenpox alone.

Cytomegalovirus and mononucleosis

They cause a lot of trouble for patients and doctors. They are common among the population of megacities and just multi-story buildings. The spread of infection is possible through ventilation and is similar to the spread of influenza.

The forms that these types of virus take are identical to ARVI and bronchitis, but more severe forms this infection is localized in the internal organs of a person and affects the entire genitourinary system and hematopoietic organs.

Treatment and prevention

Treatment of infection associated with the human herpes virus requires the mandatory participation of specialists. These include dermatologists, neurologists, and other specialized specialists, depending on which human organs are affected. to a greater extent. In any case, treatment will require strict adherence to the recommendations of the attending physician in order to avoid the development of complications.

To relieve unpleasant symptoms and fight infection, you will need to take antiviral drugs in tablet form, in the form of injections, or ointments. You can use the funds traditional medicine in the form of infusions and decoctions.

Important! At the first manifestations of an infection caused by the herpes virus, you should immediately seek help from an experienced specialist. You should not self-medicate, which can lead to the development severe complications

or hormonal imbalance. To prevent diseases associated with the human herpes virus, it is necessary to strengthen the immune system, avoid close contact with patients, and follow the doctor’s instructions. Regular use of immunomodulators is recommended for both children and adults; adults are advised to avoid bad habits , regular And proper nutrition healthy image

life.

Herpes virus infection.

There are 8 known types of herpes virus isolated from humans. They all have common antigens, a similar structure and are DNA-genomic intracellular pathogens. Herpes viruses consist of 3 main components: a nucleoid, which is double-stranded DNA, a capsid and a protein-lipid shell. Etiologically significant viruses are herpes simplex viruses-1 (HSV-1) and HSV-2. Pathogenesis. HSV has a pronounced cytopathic effect, causing the death of infected cells. Cells of epithelial origin are predominantly affected, since they are characterized by the highest metabolic rate (Dolgikh M.S., 2001). HSV infection most often occurs antenatally or in the first years of a child's life. The source of the infectious agent is sick and healthy virus excretors. Herpetic infection in pregnant women can be either asymptomatic or lesions of the genital tract (colpitis, cervicitis, endometritis). If adverse effects occur during an asymptomatic course of a herpetic infection, activation of the virus may occur, creating a risk of infection of the embryo both transplacentally and through the amniotic fluid. With an obvious form of herpetic infection of the mother's genital tract, the fetus can become infected through the ascending route or during the passage of the mother's birth canal (intranatally).

The pathogenesis of herpesvirus infection (HVI) is complex and diverse. Prerequisite for development pathological process is the state of the immune system. The pathogenetic mechanisms of infection development are based on changes in the main indicators of cellular and humoral immunity. During the process of antigen recognition and presentation by macrophages, there is an increase in the concentrations of pro-inflammatory cytokines (interleukins 1, 8, 6, tumor necrosis factor α), which are necessary for the activation, proliferation and differentiation of lymphocytes. Activators of macrophages are interferon α and γ, which trigger a cascade of humoral and cellular reactions, capable of suppressing viral replication.

Mucosal epithelial cells are targets of herpes viruses. However, there is some information about the effect of herpes virus types 1 and 2 on blood coagulation. Active herpes infection is histologically manifested by fibrin deposition in microvessels. Herpes viruses change the surface conformation of the endothelium; on the infected endothelium, the level of thrombin production increases 2-3 times, tissue expression of thrombomodulin and activation of protein C decreases. Starting from 4 hours from the moment of infection, herpes infection induces the production of tissue factor (T.F.) (Vercelotti G.M., 1990). Herpes viruses types 1 and 2 are capable of initiating the production of thrombin, since they have on their surface pro-phospholipid, TF, which initiates the activation of coagulation factor X and the transition of Xa and Va factors to thrombokinase, responsible for the production of thrombin. Herpes viruses increase the adhesiveness of platelets and neutrophils to the endothelium. Vascular endothelium damaged by herpes viruses loses its anticoagulant properties and becomes procoagulant. This information suggests that thrombosis, and in particular venous thrombosis, is one of the mechanisms of brain damage in children with neonatal herpetic encephalitis.

Significant disturbances are detected in patients with HVI and in tissue metabolism, for example, with herpes viremia, the intensity of lipid peroxidation and the level of catalase increases. These tests are offered as diagnostic criteria in assessing the activity of the infectious process (Kuselman A.I., Vorona L.D., 2007).

One of the main systems for regulating nonspecific antiviral defense is the interferon (IFN) system. It serves as the first barrier limiting the development of a viral infection. Depression of IFN production contributes to the progression of viral infection and the protracted and recurrent course of the disease. The main producers of endogenous IFN are monocytes, macrophages, lymphocytes, fibroblasts and epithelial cells. IFNs α, β and γ have antiviral, antiproliferative and immunomodulatory effects. A reduced level of α-interferon is found in children with perinatal herpesvirus infections (Ivanova V.V. et al., 2008). Detected immune depression in newborns with intrauterine infection persists for 6 months or more, being the basis for the formation of immune-mediated pathology. The emerging insufficiency of the immune system in the early postnatal period is a condition for further reproduction of the virus and the background for the development of recurrent diseases of various localizations.

Clinic. The criterion for herpetic lesions of the fetus is the presence of characteristic rashes on the skin and conjunctiva. With the hematogenous spread of herpes, the virus penetrates the placenta, causing necrosis of the trophoblast of the villi, which leads to their gluing and malnutrition of the fetus. Pathognomonic for herpetic infection of the placenta is the presence of foci of necrosis during its histological examination, as well as the detection of typical basophilic intranuclear inclusions (Cawdry bodies) in the cells.

In women infected with the herpes virus, the course of pregnancy is usually unfavorable (previous respiratory infections, nephropathy, threat of miscarriage, etc.), during childbirth they have early rupture amniotic fluid, bleeding, endometritis with fever. Children can be born with asphyxia, often with signs of central nervous system depression or premature, but they can also be born with good Apgar scores, with sufficient weight and body length. In the neonatal period, children infected with herpes may experience vesiculopustulosis, and in the subsequent months of their life they are susceptible to frequent respiratory diseases (bronchitis, otitis, pneumonia). Some children exhibit central nervous system pathology and developmental delays. Such forms of infection are recognized promptly. Diagnostic difficulties are presented by those patients who were born to mothers with asymptomatic herpes. The main changes in children infected with herpes are usually found in the neurological status, which is associated with intrauterine hypoxia. Modern means treatments used in patients with hypoxia are accompanied by relatively favorable neurological outcomes (this pathology is currently manageable). However, an unrecognized herpes infection in a child’s body takes a latent course. With the latent form of herpesvirus infection, a milder course is observed; hypotrophy is not detected in children at birth, neurological symptoms It is mild and usually disappears by the end of the first year of life. The latent form of GVI is characterized increased level IFN α and IFN γ and normal content IL4 and IL2. Subsequently, under adverse influences (stratification of a respiratory viral infection, vaccination, cooling), the herpes virus is reactivated, causing disease internal organs, skin and mucous membranes.

Infection with herpes viruses in the postnatal period in most cases occurs through airborne droplets. Primary infection with HSV occurs in 40% of cases in early childhood. Clinically, herpesvirus infection in these children manifests itself as stomatitis and damage to the mucous membrane of the upper respiratory tract, and among schoolchildren and adolescents it is more often asymptomatic in a persistent form. Its most severe manifestations are observed during reactivation of the pathogen, which usually develop against the background of stress and immunodeficiency. Reactivation of herpes viruses then manifests itself as conjunctivitis, keratitis, encephalitis and other generalized lesions of various organs.

Human herpes virus type 6 causes erythema infectiosum with symptoms of vasculitis (sudden erythema), otitis media, diarrhea, encephalitis, hepatitis. This virus is capable of infecting T cells with CD4+, CD3+, CD5+, CD8+ determinants, as well as monocyte-macrophage, megakaryocyte, B-lymphoblast and thymic cell lines.

Among the affected organs, changes are also detected in the lungs, liver, and esophagus. Lung damage due to herpetic infection is accompanied by the development of focal pneumonia. In the mucous membrane digestive tract, especially the esophagus, erosions or ulcers with perifocal edema occur. Pediatric gastroenterologists (N.V. Gonchar, N.B. Dumova, 2001) began to discover similar changes in the esophageal mucosa in gastroesophageal reflux disease in children and adolescents. The fact of herpes viral infection in them was confirmed by immunocytochemical examination of biopsy samples and smears of the esophageal mucosa. Herpes viruses were reliably often detected in the esophageal mucosa in patients with erosive lesions of the esophagus, which indicates the provoking role of herpes infection in the development of destructive lesions of the esophageal mucosa. These are the adverse consequences of the persistence of herpes infection in a child’s body.

Diagnostics. For the diagnosis of herpetic infection, cytological, immunofluorescent, serological and PCR methods. At cytological examination scraping smears reveal cells containing granular cytoplasm and large basophilic nuclei; fuchsinophilic or basophilic inclusions are found in them.

Immunofluorescence study areas of the placenta reveals the presence of immunoglobulins of different classes (IgG, A, M) in case of infection with the herpes virus.

Virological research for herpes infection, detects complement-fixing antibodies to HSV-1 or -2 in maternal blood, fetal cord blood and amniotic fluid.

PCR method. The material for testing for herpes is blood, throat swabs, the contents of blisters, and ulcers. In case of urogenital manifestations of infection, the material for examination may be smears from the urethra, the contents of vesicles of the affected areas of the mucosa.

Modern virological methods for diagnosing herpes virus infections use a modified complement fixation reaction with the determination of antigens of herpes simplex virus types 1 and 2, cytomegalovirus, Epstein-Barr virus and specific immune complexes with antigen. The study of specific antibodies of various subclasses: IgM, IgG 1-2, IgG 3 and IgG 4 to herpes viruses is important. The detection in the blood serum of children of specific immunoglobulins M, IgG 3, IgG 1-2 in a titer > 1:20, viral antigen and specific immune complexes with antigen indicates the severity of the infectious process (active phase), and the determination of only specific IgG 4 is regarded as latent infection phase or carriage of maternal antibodies.

Treatment. The drug of choice for the treatment of herpes infection is acyclovir (Zovirax), which is effective in both immunocompetent and immunodeficient patients. The mechanism of action of acyclovir is based on the fact that it competitively interacts with viral thymidine kinase, is included instead of deoxyguanosine in viral DNA and suppresses viral replication. Once administered, it is preferentially taken up by virus-infected cells, reducing its potential toxicity to healthy (uninfected) cells. The drug has no effect on a dormant virus. It must be applied as early as possible to influence the replication of viral particles. Acyclovir penetrates well into the cerebrospinal and ocular fluids, as well as through the placenta. Breastfeeding is not contraindicated when the mother is taking acyclovir.

Acyclovir is prescribed to sick children only with clinical symptoms, confirming infection. For generalized forms of herpetic infection, herpes encephalitis, acyclovir (Zovirax) is administered intravenously at 30 mg/kg per day in 3 doses for 2-3 weeks. For neonates less than 34 weeks' gestational age, acyclovir is administered at a dose of 10 mg/kg every 12 hours for at least 14 days. For herpetic lesions of the oral mucosa with frequent relapses and genital herpes, treatment with acyclovir is carried out orally at a dose of 40-80 mg/kg/day, for 5-10 days or intravenously at 15 mg/kg/day, a course of 5-7 days. Acyclovir ointment is prescribed for external use.

In older children and adolescents, oral famciclovir or valacyclovir may be used instead of acyclovir. For herpetic eye lesions, use topically eye drops: solution of vidarabine and trifluridine.

If there is no effect from acyclovir, patients can be prescribed ganciclovir; it is an acyclic nucleotide that most effectively suppresses the replication of the herpes virus.

Cycloferon is effective in treating herpetic infections in children. The drug is an interferon inducer, which determines wide range biological activity (antiviral, immunomodulatory, anti-inflammatory, etc.). Cycloferon activates T-lymphocytes, natural killer cells, stimulates the formation of granulocytes, and normalizes the balance between subpopulations of T-helpers and T-suppressors. Crosses the blood-brain barrier. Cycloferon is effective against herpes viruses, cytomegaly, influenza, etc. In pediatric practice, cycloferon is used intramuscularly or intravenously, once a day. For herpes infection, the drug is administered on days 1, 2, 4, 6, 8, 11, 14, 17, 20 and 23. If the replicative activity of the virus remains, the course of treatment is continued according to a maintenance regimen with administration once every five days for four weeks. For the treatment of patients with erosive lesions of the esophagus N.V. Gonchar et al. (2001) effectively used cycloferon in school-age children in an intermittent regimen for oral administration at a dose of 300 mg once a day according to the scheme for 1, 2, 4, 6, 8 days of therapy and then at an interval of 2 days for another five days.

Among the new immunomodulators for herpes infection, the drug Gepon (synthetic tetradecapeptide) is used. Gepon activates secretory immunoglobulins, reduces the level of pro-inflammatory cytokines, and suppresses viral replication. The drug is used as irrigation of the mucous membranes or orally for 5 (or 10) days.

In children in the first months of life with a generalized form of herpesvirus infection, complex treatment regimens using, along with acyclovir, normal human immunoglobulin- immunovenin for intravenous administration followed by transition to Viferon-1. Latent forms of herpesvirus infection are supervised by Viferon in age-specific doses according to an intermittent pattern (A.V. Kravchenko, 2008).

For postnatal persistent herpesvirus infections accompanied by relapses of croup or bronchial obstruction, combined immune-oriented therapy is indicated. For this purpose, Gepon is first prescribed (for 5 days), then a combination of Arbidol with Viferon is recommended. Arbidol has immunomodulatory, interferon-inducing, virus-specific and antioxidant effects. The basis of the virus-specific action of arbidol is the ability to inhibit the process of fusion of the viral envelope with endosome membranes, leading to the release of the viral nucleocapsid and the beginning of transcription. It has been established that the leading mechanism through which the stimulating effect of arbidol on immune system, is to enhance the production of interleukin 2. In addition to influencing the T-system of immunity, arbidol promotes the activation of macrophages and neutrophils, to a greater extent their absorption function, enhancing their overall phagocytic activity. When monitoring the dynamics of patients with persistent herpesvirus infection using combined antiviral and immunomodulatory therapy, a shortening of the period of relapse of the disease, the disappearance of low-grade fever and lymphoproliferative syndrome are noted (Kharlamova F.S. et al., 2007).

Let's give clinical example persistent persistence of herpesvirus infection in a patient with chronic pathology gastroduodenal region. Patient Dmitry L., 11 years old, was under observation for 2 years. Ill since the age of 6, there were recurrent abdominal pains. At the age of 9, after a fibrogastroscopic examination, it was revealed chronic gastroduodenitis(CGD), multiple chronic gastric erosions, treatment without effect, GM erosions did not epithelialize.

Anamnesis of life. The mother suffered from herpetic vulvitis during pregnancy. Childbirth 2, on time, weight 3600 g, length 52 cm. Breastfed for up to 9 months, complementary foods were introduced according to age. In the first year he suffered from chickenpox, acute respiratory infections 2-3 times a year with herpetic rashes on the lips.

Objectively: asthenic physique, low nutrition. Pale skin, periorbital shadows. The tongue is covered with a white coating. Tonsil hypertrophy, granularity back wall throats. Polyadenia. The heart and respiratory organs are unremarkable. The abdomen is painful on palpation in the epigastrium and pyloroduodenal region. The liver and spleen are not enlarged. The chair is half-formed. Diuresis is normal.

IN clinical analysis blood - leukopenia, neutropenia, eosinophilia, ESR - 5 mm/hour. Biochemical analysis blood, bacteriological, serological examination data - without pathology. Acid formation in the stomach is preserved. Fibrogastroscopy (FGS) - the esophagus and cardia are not changed. The mucous membrane of the stomach is diffusely hyperemic, in the body of the stomach and in the antrum there are multiple erosions, “raised”, from 1 to 10 mm in diameter, cannot be counted (at least 16-18), some erosions with umbilical impressions. Mucous duodenum(DPC) is moderately hyperemic. The urease test is positive.

Histological conclusion: in a biopsy of the gastric mucosa there is a picture of capillaritis with secondary vascular changes in the coolant.

She was treated with diet (table 1), a course of triple therapy, Venter, and multivitamins. Control FGS after 2 weeks, 1, 3 and 9 months did not reveal any dynamics. Endoscopic changes persisted. In a repeated biopsy of the coolant, a picture of capillaritis, swelling and hyperchromatosis of the endothelium was observed. There are cells with perinuclear clearings.

Conclusion: the detected changes in the vascular endothelium and gland epithelium are due to the presence of DNA viral damage to the mucous membrane and blood vessels of the stomach. A virological examination established a diagnosis of chronic herpetic infection.

Treatment was carried out with antiviral and immunocorrective drugs. FGS was performed 3 months after the start of antiviral therapy. Superficial changes in the coolant fluid in the antrum were detected. No erosions were found. The urease test is negative. In the subsequent period, the patient remained in stable remission.

Thus, a patient with a congenital herpesvirus infection received vertically from a mother who suffered herpetic vulvitis during pregnancy. In the first year of life, the child suffered from chickenpox (i.e., a virus from the herpes virus family). In to school age suffered from acute respiratory infections skin rashes herpes virus, which indicated the persistence of the herpes virus in the child’s body. At school age, when a gastroenterological disease (CGD) occurred, an association of causative agents of the herpes virus and Helicobacter pylori infection developed. The combination of Hp(+) infection and herpes virus aggravated the course of the erosive process in the coolant. Only sanitation of the HP infection did not make it possible to cope with the destructive damage to the coolant. Targeted antiviral and immunotropic treatment made it possible to stop the persistence of a viral infection, cure multiple chronic erosions of the gastric mucosa and reduce the foothold of damage to the gastric mucosa.

In case of persistent chronic erosions of the coolant, it is necessary to search not only for Hp infection, but also for viral associations in order to exclude persistent herpesvirus and other chronic infections in children.

Herpesvirus infection is a collective concept that includes DNA viruses belonging to the Herpesviridae family. As is known, today there are eight types of herpes viruses that have the ability to infect the human body. They differ in symptoms, methods of spread and treatment methods. The causative agents of herpes infection are ubiquitous, therefore, with symptoms of a chronic viral infection, a herpesvirus infection is often suspected.

It is believed that 90% of the population contains at least one type of virus in their bodies. Moreover, primary infection with the herpes simplex virus occurs mainly in children under two or three years of age, but its subsequent manifestations are considered relapses. U healthy people Most often, herpes is asymptomatic, and frequent exacerbations and complex symptoms are typical for people with immune system disorders.

What viruses infect humans? How do they differ, how are they transmitted, how is herpesvirus infection treated and what methods of prevention exist today?

Herpes simplex virus types 1 and 2

These types of herpes virus enter the body through contact through lesions on the skin and mucous membranes. First, it penetrates the epithelium, where it multiplies, then penetrates the nerve endings and paravertebral ganglia, where it remains for life.

This virus is also called herpes simplex virus (HSV). Herpes virus type 1 most often causes lesions on the lips (labial herpes). It is considered the most common and can affect:

• mucous membranes of the genitals, mouth, eyes;
• skin of hands, feet, face;
• nasolabial triangle;
• tissues of the nervous system.

Sometimes HSV can cause respiratory diseases and rash on the mucous membranes of the eyes and mouth. In adults, during oral sex, the virus can pass from one person to another and cause rashes on the genitals. Such rashes are more common in women. General signs HSV-1 are:

• fever;
• pain in joints and muscles;
• headache.

Diagnosis of HSV-1 and 2 is carried out in a laboratory. The type of pathogen is identified based on its affinity for immunoglobulin, HSV types 1 and 2 are differentiated, and the stages of the disease are determined. In order to obtain more information about the disease, the presence of immunoglobulins M and G in the blood is determined, and:

1. From the fifth day of illness, Ig M is determined.
2. From the second week - Ig G.
3. Ig M remains in the blood for several months, IgG for recurrent herpes - for life.
4. IgM does not have the ability to neutralize the virus; it is a factor that triggers immune processes.
5. During pregnancy, HSV type 1 can be dangerous to the fetus as it penetrates the placenta. In addition, since pregnancy itself is a factor that lowers immunity, relapses are much more common and the activity of the virus increases. Primary infection is very undesirable during pregnancy. In this case, there are no antibodies in the body, which significantly increases the risk of infection of the baby. In the first half of pregnancy, intrauterine infection can lead to deformities. However, in most cases, the virus still causes just a rash on the lips.

Herpes virus type 2 is also called genital herpes. Under certain conditions, it can affect other parts of the body. Transmitted sexually. Antibodies to HSV-1 do not prevent infection with this type of virus. 70% of herpes affecting the genitals means HSV-2.

Up to 75% of patients with this type of virus have relapses of manifestations; in 15% of cases, degeneration of cervical tissue occurs. It is transmitted from mother to child during childbirth or through the placenta in utero. Clinical manifestations two weeks before delivery are an absolute indication for cesarean section.

Clinically manifested by vesicular rashes on the genitals, swelling, redness, itching. The vesicles burst and form erosive surfaces.

Neonatal herpes.

Neonatal herpes is the infection of a newborn with HSV types 1 and 2. Occurs in 0.05% of all births. Gives a high probability of death (up to 70% of cases). Timely initiation of therapy reduces this figure to 20%. The prognosis is less favorable for those infected with HSV type 2.

When passing through birth canal up to 85% of children become infected. In 20% of cases, herpes does not appear, but the virus is nevertheless released. It is also possible to become infected in early childhood by contact, through general subjects everyday life. In case of intrauterine infection, a decision is often made to terminate the pregnancy. Neonatal herpes manifests itself in three clinical forms:

1. Local form. Rashes are found on the mucous membranes and skin.
2. Local form with damage to the central nervous system.
3. Disseminated form, in which the central nervous system and internal organs are damaged.

The development of meningoencephalitis, herpetic hepatitis, pneumonitis, radiculoneuritis and other diseases is possible.

Varicella zoster

Varicella zoster is a type 3 herpes virus. It causes mainly two diseases: chickenpox in children and herpes zoster in adults. In rare cases, shingles can occur in children. Mainly - in the presence of neonatal or intrauterine infection or against the background of reduced immunity.

Enters the body by airborne droplets or contact. Incubation period lasts 18–21 days. After children have had chickenpox, they remain carriers of the virus for the rest of their lives, rarely when immunity is not developed and chickenpox develops again.

Chickenpox symptoms look like this:

• spots on the body, which already on the second day of the disease become vesicles - flesh-colored or reddish rashes filled with liquid;
• increased body temperature;
• itchy skin.

In old age, relapse of the disease with decreased immunity causes herpes zoster. It is characterized by the following symptoms:

• pain along the nerve trunks;
• increased body temperature;
• swelling and redness of the skin;
• vesicular-type rashes that end in scarring and recovery within three weeks.

Complications may include diseases in which the nerve nodes become inflamed - ganglioneuritis or ganglionitis, which are accompanied by eczema, ulcers, conjunctivitis or allergic reactions. Treatment of the disease caused by the herpes zoster virus in children is carried out on an outpatient basis for an uncomplicated course of the disease or in a hospital.

Epstein-Barr virus

Herpes virus type 4, or Epstein-Barr virus, causes a disease in children called infectious mononucleosis. In addition to children, people with immunodeficiency suffer from this disease. The disease is characterized by damage to the mucous membranes of the nasopharynx and lymph nodes, and fever. Damage to the liver, spleen and sometimes changes in the morphology of blood cells. Infection from person to person occurs through airborne droplets or contact. The incubation period can last from five to 50 days.

The main symptoms of the disease are:

• Significant increase in body temperature (up to 38–40 degrees).
• Strong pain syndrome. Painful sensations appear in the muscles, joints, head, throat.
• Feeling of loss of strength, fatigue, drowsiness.
• Swelling of the nasopharynx.
• Plaque on the tonsils is whitish-yellow.
• Papules on the skin and mucous membranes.
• Enlarged lymph nodes.

Diagnosis of the disease is carried out laboratory methods. The presence of type 4 herpes virus in the blood is determined. HSV-4 can provoke cancer - Burkitt's lymphoma.

Cytomegalovirus infection

Herpes virus type 5, or cytomegalovirus infection, rarely manifests itself clinically. Most often, the disease passes in a latent form. Infection occurs by contact, by airborne droplets, through contact with genital secretions, mother's milk, etc. When the immune system is weakened, the clinical picture appears:

• temperature increase;
• fatigue, fatigue;
• pain in the head and throat;
• damage to the liver, spleen and other internal organs;
• damage to the eyes and central nervous system.

It is dangerous because it can affect the course of pregnancy. Causes intrauterine infection and fetal development abnormalities.

Suspect cytomegalovirus infection During pregnancy, it is possible to perform an ultrasound. In this case, a violation of blood circulation in the uterus and umbilical cord vessels is determined. Also, oligohydramnios is determined, the fetal heart rate suffers, there are signs of developmental delay and organ pathologies.

The presence of antibodies to HSV-5 and the virus in the blood is determined by PCR diagnostic methods. Based on a comprehensive examination of the patient, a decision is made to continue the pregnancy and treat the disease. Primary infection is an indicator for termination of pregnancy.

Herpes virus type 6

Herpes virus type 6 (subtype A) is responsible for the development multiple sclerosis. Some studies report HSV type 6 as possible reason development of B-cell lymphoma. In children, the virus causes roseola infantum, which is accompanied by fever and rash. Symptoms of multiple sclerosis are:

• impaired coordination of movements;
• depression;
• fatigue;
• disturbance of tactile sensations and sensitivity.

Then they are added:

• swallowing disorders;
• double vision;
• cramps and muscle spasms;
• fecal and urinary incontinence;
• erectile dysfunction.

HSV types 7 and 8

HSV-7 is very often found together with herpes virus type 6. It is considered a likely root cause of chronic fatigue syndrome and some cancers. Accompanied by the following symptoms:

• weakness;
• increased fatigue;
• excessive suspiciousness;
• insomnia;
• elevated body temperature that lasts for more than six months;
• chronic depression.

Diagnosed by detection of antibodies to the virus and PCR.

HSV type 8 is found in patients with Kaposi's sarcoma. Associated with almost all types of this disease and leads to it within 3–10 years. In addition, the virus causes other oncological diseases: Castleman disease and primary lymphoma.

• Kaposi's sarcoma is a cancer characterized by the formation of tumors from degenerated blood vessels;
• with primary lymphoma, the serous membranes are predominantly affected; the disease is characterized by the accumulation of fluid in the cavities of the body, which contains cancer cells;
• Castleman's disease is manifested by enlargement of the lymph nodes of the neck, lungs, and subclavian lymph nodes.

Treatment of herpes virus infection

It is impossible to completely recover from herpes virus infection. Antiviral drugs suppress the division of DNA and RNA of the virus. Drugs in this group are ineffective during the carrier period. Three types of drugs are used to treat infections caused by the herpes virus:

1. Acyclovir.
2. Valaciclovir.
3. Famciclovir.

They are available in the form of injections, ointments and tablet form. Treatment should be carried out only during the period of virus activity; If the rashes have already crusted over, nothing needs to be treated. If the infection occurs primarily, then it is worth adding tablets to the ointments. It must be taken into account that antiviral drugs, except Acyclovir, destroy the cells of the human body.

Relapses are treated depending on the frequency of their occurrence. If the rash occurs more than six times a year, viral suppression therapy is recommended. Acyclovir is safe for the treatment of herpesvirus infection in children and women while pregnant. Women who are carriers of HSV type 2 are recommended to take Acyclovir for prophylaxis for one to two weeks before giving birth (to reduce the risk of infection of the fetus during passage through the birth canal).

Some traditional medicines, as well as immunomodulators, are also used in the treatment of herpes.