Herpes in Children

What is Herpes in Children?

Herpes simplex in children is a disease that affects many tissues and organs of a child, which is accompanied by rashes on the skin and mucous membranes in the form of vesicles. In most cases, treatment is long latent, periodic relapses occur.

Herpes simplex in children, according to the international classification, is divided into:

• herpetic eye disease (divided into anterior uveitis, keratoconjunctivitis, keratitis, iritis, iridocyclitis, dermatitis of the eyelids, conjunctivitis);
• herpetic encephalitis;
• herpetic gingivostomatitis and pharyngotonsonitis;
• herpetic meningitis;
• herpetic vesicular dermatitis;
• herpetic eczema;
• disseminated herpetic disease;
• herpetic infections, unspecified;
• other forms of herpes infections.

Epidemiology
Infection affects children who become infected in the first 3 years of life. Newborns can not become infected with this disease until six months, because they have specific antibodies of the IgG class in the blood. But there are very rare cases when the mother does not have antibodies in her blood, which means that the child also has no antibodies. Then, when a child becomes infected, a generalized form of the disease occurs, a severe course. Most children of 3 years of age have enough antibodies in their blood to protect the body. The number of children with a high level of antibodies to HSV2 increases by 5-7 years of age.

The infection is transmitted and spread by both patients and virus carriers. Routes of transmission: contact, sexual and, presumably, airborne droplets. You can get infected, as for adolescents, with a kiss – through saliva. Also, infection occurs through household items, toys and other objects, which may be the saliva of an infected person. A child may become infected in the womb or at birth in the birth canal.

Diseases occur periodically, in isolated cases throughout the country. But in the winter period (less – in other seasons) small epidemics occur in kindergartens, schools and other children’s groups.

Overcooling, poor sanitary and hygienic conditions, increased insolation, crowding, etc. affect the speed and scale of the spread of herpes.

Causes of Herpes in Children

The herpes simplex virus (denoted by the abbreviation HSV) contains RNA. The diameter of the virion is 120-150 nm. Propagation 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.

Herpes virus is best preserved at low temperature (-70 ° C). It can be inactivated by increasing 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, it can maintain vital activity for about 10 years.

The herpes simplex virus is divided into HSV1 and HSV2. The first group leads to damage to the skin of the face and mucous membranes in the mouth. HSV2 affects the genitals, causing meningoencephalitis. If a child becomes infected with one type of virus, an infection can also occur caused by the second type.

Pathogenesis during Herpes in Children

Infection enters the child’s body through damaged mucous membranes and injured skin. HSV causes rashes in the affected area. In rare cases, the virus from the places of primary localization enters the regional lymph nodes, and even more rarely it enters the bloodstream.

The development of infection further depends on the state of the systems responsible for the immune system. If the forms of herpes are localized, then the process ends only with local manifestations. The virus with blood is introduced into the lungs, liver, spleen or other organs and affects them – this happens with 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 cannot be completely killed, it stays in the body all its life, which is why from time to time there are repetitions of the disease. Relapses occur despite the fact that virus-neutralizing antibodies are present in the blood.

The virus is in the blood, activated by the “starting factor”, for example, from exposure to ultraviolet rays, physical stress, hypothermia. These factors stimulate the formation of prostaglandins and corticosteroid hormones, which affects the release of free viral DNA from cells.

Relapses occur due to weakening of local immunity or due to a genetically determined deficiency of cellular immunity. If the immune control is weakened, the virus freely moves through the cells and between them.

Pathomorphology. Pathological changes depend on the location of the infection. Balloting degeneration of the epithelium occurs, which manifests itself as inflammation in the epidermis in the form of vesicles. The bubble lies on the infiltrated and edematous papillary layer of the dermis.

With generalized forms of the disease, small foci of coagulation 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 pia mater).

A picture of leptomeningitis with and filtration of the membranes and walls of blood vessels by cellular lymphohistiocytic elements is revealed. Changes of the same nature can occur in the lungs, liver, bone marrow, spleen and adrenal cortex.

Symptoms of Herpes in Children

Clinical manifestations
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 allows us to distinguish between these types of lesions:

• eye damage (manifested as blepharoconjunctivitis, conjunctivitis, keratitis, chorioretinitis, etc.);
• damage to the mucous membranes (manifested as stomatitis, tonsillitis, gingivitis, etc.);
• skin lesion (manifested as cold sores of the nose, cold sores of the lips, eyelids of the hands, face, etc.);
• genital herpes (damage to the vulva, penis, urethra, etc.);
• herpetic eczema;
• visceral forms (pneumonia, hepatitis);
• damage to the central nervous system (neuritis, meningoencephalitis, etc.).

The diagnosis usually indicates how common the lesions are (herpes: localized, common, or generalized simple). The course of the disease: acute, abortive, recurrent. An abortive form indicates a rapid, premature cessation of the disease process. A relapsing course indicates a recurrence of the disease in the form of recovery and a new return of symptoms. After the disappearance of clinical manifestations, there are antibodies in the blood, but the virus is present in the body, without manifesting anything. In the case of the activation factor, it manifests itself and affects the same or different human organs.

One of the most common symptoms of herpes in children is mucosal damage. It manifests itself as acute stomatitis or gingivostomatitis. Such a 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 anxiety (newborns and infants). A general malaise appears. The kid refuses food, because it causes pain in the mouth. Parents may notice active salivation and a characteristic bad breath. In young children, body weight decreases, in rare cases, indigestion appears, dehydration is possible.

With damage to the mucous membranes, the mouth inside is swollen and reddish. The mucous membrane is covered with rashes ranging in size from 2 to 10 mm, which look like vesicles. At first they are transparent, and then yellowish contents appear. They burst soon, after bubbles erosion remains. Regional lymph nodes are enlarged and painful (pain on palpation). The disease lasts from 1 to 2 weeks. By 3-5 days, body temperature returns to normal. In some cases, relapses of the disease are possible.

Skin lesions in most cases occur around the mouth, nose and ears. A few days before the appearance of rashes, a burning sensation may appear, as well as itching, tingling, or slight pain. It is worth noting that the fluid in the vesicles that appeared later can be mixed with blood. When the erosion bubbles appearing on the site are tightened, a crust of a brownish-yellowish tint appears. The crusts disappear soon, in their place the skin may be red or slightly pigmented.

Bubbles are often “grouped”, such groups of rashes are surrounded by a zone of hyperemia. The process of formation and drying of the bubbles can last from 10 to 14 days. In some sick children, the bubbles may merge into a large bubble form. After it is opened (burst), in its place a large erosion is formed.

HSV causes localized and widespread skin lesions. Localized are characterized by the fact that the general condition of the patient does not worsen, the temperature is normal. The widespread (disseminated) form is characterized by an acute onset, body temperature reaches 39-40 ° C, which sometimes leads to chills. The general condition of the child worsens, headaches appear, as well as pain in the muscles and joints. At the height of the symptoms, vomiting (or nausea), convulsions occur. At the end of the first day (in rare cases, on the second or third day), herpetic vesicles with a tendency to “group” appear simultaneously on the face, hands and body. 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. It 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 smallpox rash, vacciniform pustulosis, herpetiform eczema, etc.

The incubation period for 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, short-term loss of consciousness. From the first day of the disease, an abundant rash appears, sometimes it can appear only for 2-3 days. Rashes last up to 2-3 weeks. Painful regional lymphadenitis occurs. At first the bubbles are transparent, then they become more cloudy and densified. The elements of the rash on the second day resemble vaccine pustules. Bubbles merge with each other, burst, crusting. In severe cases, the rash leaves scars on the skin. The disease can last a long time, there is a possibility of repeated rashes for 2 or 3 weeks. On day 7-10, body temperature returns to normal, the general condition of the patient improves. After that, the skin begins to clear. 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, which leads to untreated death with untimely treatment and weakness of the body.

Due to the extent of damage to the skin, a secondary bacterial infection is a threat.

Eye damage (ophthalmic herpes) often develops due to infection with the herpes virus. It can manifest itself as an isolated lesion of the eye, but cases of combining lesions of the eye, mucous membranes of the oral cavity and skin are also frequent. Regional lymph nodes increase, follicular, catarrhal or vesicular-ulcerative conjunctivitis develops.

Ophthalmic herpes begins acutely, conjunctivitis, sores or hermetic vesicles appear on the skin of the eyelid near the eyelashes. The course of superficial herpetic keratitis in most cases is benign. Deep disc-shaped herpetic keratitis has a severe course, which often leads to inflammation of the anterior vascular tract.

Etotorpid and often recurring processes. As a result of keratoiridocyclitis, clouding of the cornea and a “drop” in vision may occur. In infants up to 6 months of age, chorioretinitis, cataracts, and uveitis can develop.

Genital herpes is found in older children – adolescents and older. Sexually transmitted. In children of younger age groups, herpes simplex first appears, and the genitals are affected again. In such cases, the virus is “picked up” through the hands on which there is an infection, underwear, towels. It is also possible that the external genitalia will initially be affected. Infection occurs by contact from parents with herpes simplex. The disease most often causes HSV 2.

The clinical manifestations of genital herpes are different. The course in most cases is stubborn and relapsing. Genital herpes in adolescents and children of a different age causes vesicular and erosive-ulcerative rashes on the skin and mucous membrane of the genital organs.

In female patients, 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 vaginal mucosa, clitoris or anus. In male patients, rashes are localized on the inner leaf of the foreskin and the skin of the scrotum. There are also possible cases of a rash on the mucous membrane of the urethra, which turn into rashes on the bladder. The disease is manifested by fever, pain, itching, burning, etc. in areas affected by the disease. More severe than in children, genital herpes occurs in adults. After the symptoms disappear, a prolonged latent virus-carrying is possible, which increases the risk of infection in surrounding children and adults.

Damage to the nervous system in cold sores. The spread of the virus through the bloodstream can lead to brain infection. Damage to the central nervous system may have a course similar to meningoencephapitis, encephalitis, meningitis, meningoencephaloradiculitis. The most common forms of herpes are encephalitis and meningitis, which usually affects newborns and infants.

According to the clinical manifestations, herpetic encephalitis does not differ from other viral encephalitis. In young children, a primary generalized infection often occurs, 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 attacks of vomiting are possible. The child must be watched, then you can notice lethargy and drowsiness, but in some cases – on the contrary – agitation. In the midst of illness, cramps, fainting, paralysis, and even impaired 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 lymphocytic cytosis and increased protein.

Visceral forms are manifested in the form of acute parenchymal hepatitis, pneumonia, and damage to the kidneys and other organs.

Herpetic hepatitis is prevalent mainly among newborns, but also occurs in older children. Usually, hepatitis appears as a result of the generalization of herpes simplex, which results in damage to 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, severe symptoms of intoxication, drowsiness, respiratory distress, shortness of breath, cyanosis, enlarged liver, vomiting, enlarged spleen, etc. Jaundice is not excluded, as with other forms of hepatitis.

Herpetic pneumonia and herpetic focal nephritis are clinically no different from lung and kidney lesions of a different etiology. The disease has a course like a viral bacterial infection. The course is acute or relapsing. Basically – it is relapsing. The disease recurs due to hypothermia or overheating, attachment / activation of viral and bacterial infections. In girls, a period of a new exacerbation of the disease may be the time of menstruation. Relapses usually have a mild course.

Complications of herpes occur when a bacterial infection is attached.

Diagnosis of Herpes in Children

Herpes simplex is determined by doctors according to characteristic vesicle rashes, grouping on the skin and mucous membranes. Laboratory confirmation is carried out by analyzing the presence of the virus in rashes, in skin ulcers, in the blood, in cerebrospinal fluid (PCR method). For the diagnosis of recurrent herpes, detection of high peaks of IgG antibodies or an increase in titer in the dynamics 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, fatal outcomes are not excluded. Particularly difficult prognosis for herpetic encephalitis, meningoencephalitis, and also for congenital herpes and diseases of the newborn.

Herpes Treatment in Children

Localized lesions of the mucous membranes and skin are treated locally – with acyclovir ointment, 5% liniment with cycloferon and other antiviral drugs. Interferon is prescribed in the form of lotions, ointments, rinses of mucous membranes or inhalations. The affected areas of the skin and mucous membranes are treated with 1-2% alcohol solution of brilliant green, 1-3% alcohol solution with a maple blue sword. The oral cavity is treated with a 3% hydrogen peroxide solution, which gives a sanitizing effect for herpetic stomatitis. So that babies can eat without pain, they use local anesthetics – for example, anestezin or lidocaine.

If the temperature is very high, the patient is given ibuprofen. Severe forms of herpes are treated with acyclovir. Combination therapy involves acyclovir + cycloferon.

With a recurring course of the disease, a course of viferon, vitamins B, B2, B12, and pyrogenal is prescribed. Liquid eleutherococcus extract, ginseng tincture, etc. are also prescribed. Specific antiherpetic immunoglobulin and antiherpetic vaccine are also effective for treatment, especially in combination with cycloferon.

In some cases, inducers of interferon are prescribed, for example, cycloferon or anaferon for children. The addition of a bacterial infection means that antibiotic therapy must be added to the treatment. Corticosteroid hormones are contraindicated for the treatment of herpes, but they are connected in severe forms of herpetic encephalitis and meningoencephalitis.

With a recurrent course of herpes, acyclovir is ineffective, use it in a complex manner, along with cycloferon.

Herpes Prophylaxis in Children

Among the preventive measures are the hardening of children and the development of hygiene skills. Infected children are not recommended ultraviolet radiation, physical activity, severe stress.

It is especially important to protect children suffering from eczema and weeping forms of atonic dermatitis. Newborns who have had contact with a person with a cold sore are subject to isolation. If the mother is infected with herpes, and she has rashes on her skin and mucous membranes, she is required to wear a surgical mask when in contact with her child. Until the erosion after the crusts fall off, the infected mother cannot cling to the skin of the baby and kiss it. If there are no herpes lesions on the chest, 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, immunoglobulin (0.2 ml / kg) is administered. If signs of genital herpes are found before childbirth, childbirth should be performed using a caesarean section. But this measure does not 100% exclude the possibility of infection of the newborn.

If the mother had signs of herpes or suspected herpes, newborns should be sent for examination. If they have the herpes virus, children receive treatment with acyclovir. If the born child does not have clinical manifestations of herpes, they are monitored for 1-2 months.