Herpes simplex

Letztmals aufdatiert: 2021-10-07

Autor(en): Anzengruber, Navarini

Fieberbläschen, cold sore, Gletscherbrand, Herpes simplex recidivans, Herpes simplex recidivans in loco.

Häufigste Reaktivierung bei reduzierter Abwehr mit HSV. Bei Rezidiven an der selben Stelle spricht man von einem Herpes simplex recidivans in loco.

Hohe Durchseuchung der Bevölkerung, allerdings stetig abnehmend. Seroprävalenz bei HSV-1 bis 90%, bei HSV-2 10-40%.

  • Inkubationszeit: 2-5 Tage
  • Schwächung des Immunsystems (fieberhafte Infekte, psychische und physische Stressoren, Menstruation), UV-Exposition

Vor Auftreten der ersten Hautveränderungen, Spannungsgefühl. Bläschen auf erythematösen Grund, gegebenenfalls . Lymphadenopathie, Im Verlauf Aufplatzen und Verkrustung, mit anschliessender Abheilung (ca. nach 7-14 Tagen), meist perioral auftretend, jedoch auch an anderen Lokalisationen möglich.

Klinische Manifestation HSV-1    HSV-2   
Gingivostomatitis    

Genitale Läsionen

++ +++
Übriges Integument +++ +++
Keratoconjunctivitis +++ (+)
Retinitis + (+)
Ösophagitis ++ +
Pneumonitis ++ +
Hepatitis ++ +
Encephalitis (Erwachsene) +++ +
Encephalitis (Neugeborene) + ++
Myelitis + ++
Erythema multiforme +++ +
     

 

  • Klinik
  • ggf. Biopsie
  • EM
  • Kultur
  • PCR
  • Microtrack
  • Meningismus ausschliessen
  • Ekzema herpeticatum
  • Keratoconjunctivitis herpetica
  • Erythema exsudativum multiforme
  • Bei immunsupprimierten Patienten können Ulzera und Hämorrhagien auftreten
  • Ausbildung eines Lymphödems nach langjährigen Rezidiven möglich (Elephantiasis nostras)

USB Standard

Allgemeine Massnahmen

  • UV-Schutz
  • Alle Virusstatika sind nur während der Replikationsphase wirksam, sodass ein frühzeitiger Beginn essentiell ist

Topische Therapie

Topische Virostatika (nützen wenig, nicht empfohlen)

  • Im Bläschenstadium ist eine austrocknende Therapie zu empfehlen, z.B. mittels Zink-haltigen Schüttelmixturen
  • Im Krustenstadium: Bepanthen plus Crème
  • Schleimhautbefall: Kamillenextrakt
    • Anw.: 3-mal tgl. oder öfters
    • >6 Jahre: In 1 Glas warmes Wasser ½ Kaffeelöffel
    • 1-6 Jahre: 1, 5 ml in 1 L Wasser 1x tgl.

Systemische Therapie 

Primär bei schweren Verläufen und in den ersten 72h solange noch Vesikel entstehen

  • Bei rezidivierendem Herpes simplex (wenige als 6 Episoden jährlich)

    • Valaciclovir (Valtrex®) 2 x 500 mg pro Tag p.o. während 5 Tagen oder 2x2g an einem Tag

  • Bei rezidivierendem Herpes simplex (mehr als 6 Episoden jährlich)

    • Suppressionstherapie Valaciclovir (Valtrex®) 1 x 500 mg/d p.o.; evtl. bei mehr als 10 Rezidiven: 2 x 250 mg/d p.o.

  • Bei schwerer Gingivostomatitis
    • Aciclovir (Zovirax®) 5 x 15 mg/kg KG pro Tag p.o. während 5 Tagen oder 3 x 400 mg pro Tag für 7 – 10 Tage

Analgetika

  • NSAR

 

  1. Herpes Simplex Virus, in SpringerReference. Springer Science + Business Media.
  2. Seroprevalence of Herpes Simplex Virus Type 2 Among Persons Aged 14-49 Years - United States, 2005-2008, in PsycEXTRA Dataset. American Psychological Association (APA).
  3. Herpes simplex virus infection, in SpringerReference. Springer Science + Business Media.
  4. Guidelines for the management of herpes simplex virus in pregnancy. International Journal of Gynecology & Obstetrics, 2009. 104(2): p. 167-171.
  5. Anderson, B.J., Valacyclovir to expedite the clearance of recurrent herpes gladiatorum. Clin J Sport Med, 2005. 15(5): p. 364-6.
  6. Anderson, B.J., et al., Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-Day Wrestling Camp: A 10-Year Review. Clin J Sport Med, 2015.
  7. Arvin, A.M., R.J. Whitley, and K.M. Gutierrez, Herpes Simplex Virus Infections, in Infectious Diseases of the Fetus and Newborn Infant. 2006, Elsevier BV. p. 845-865.
  8. Bacon, T.H., et al., Activity of penciclovir in antiviral assays against herpes simplex virus. J Antimicrob Chemother, 1996. 37(2): p. 303-313.
  9. Bagdades, E.K., et al., Relationship between herpes simplex virus ulceration and CD4+ cell counts in patients with HIV infection. AIDS, 1992. 6(11): p. 1317-1320.
  10. Ban, F., et al., Analysis of herpes simplex virus type 1 restriction fragment length polymorphism variants associated with herpes gladiatorum and Kaposi's varicelliform eruption in sumo wrestlers. J Gen Virol, 2008. 89(Pt 10): p. 2410-5.
  11. Becker, T.M., et al., Grappling with herpes: herpes gladiatorum. Am J Sports Med, 1988. 16(6): p. 665-9.
  12. Belongia, E.A., et al., An outbreak of herpes gladiatorum at a high-school wrestling camp. N Engl J Med, 1991. 325(13): p. 906-10.
  13. Brice, S.L., et al., Examination of non-involved skin, previously involved skin, and peripheral blood for herpes simplex virus DNA in patients with recurrent herpes-associated erythema multiforme. J Cutan Pathol, 1994. 21(5): p. 408-412.
  14. Cernik, C., The Treatment of Herpes Simplex Infections<subtitle>An Evidence-Based Review</subtitle>. Arch Intern Med, 2008. 168(11): p. 1137.
  15. Corey, L., Genital Herpes Simplex Virus Infections: Clinical Manifestations, Course, and Complications. Annals of Internal Medicine, 1983. 98(6): p. 958.
  16. Corey, L., et al., A Trial of Topical Acyclovir in Genital Herpes Simplex Virus Infections. New England Journal of Medicine, 1982. 306(22): p. 1313-1319.
  17. Corey, L. and A. Wald, Maternal and Neonatal Herpes Simplex Virus Infections. New England Journal of Medicine, 2009. 361(14): p. 1376-1385.
  18. Darragh, T.M., et al., Identification of herpes simplex virus DNA in lesions of erythema multiforme by the polymerase chain reaction. Journal of the American Academy of Dermatology, 1991. 24(1): p. 23-26.
  19. Efstathiou, S. and C.M. Preston, Towards an understanding of the molecular basis of herpes simplex virus latency. Virus Research, 2005. 111(2): p. 108-119.
  20. Erlich, K.S., Foscarnet Therapy for Severe Acyclovir-Resistant Herpes Simplex Virus Type-2 Infections in Patients with the Acquired Immunodeficiency Syndrome (AIDS). Annals of Internal Medicine, 1989. 110(9): p. 710.
  21. Erlich, K.S., et al., Acyclovir-Resistant Herpes Simplex Virus Infections in Patients with the Acquired Immunodeficiency Syndrome. New England Journal of Medicine, 1989. 320(5): p. 293-296.
  22. Flagg, E.W. and H. Weinstock, Incidence of Neonatal Herpes Simplex Virus Infections in the United States, 2006. PEDIATRICS, 2010. 127(1): p. e1-e8.
  23. Gilbert, S. and E. McBurney, Use of Valacyclovir for Herpes Simplex Virus-1 (HSV-1) Prophylaxis After Facial Resurfacing: A Randomized Clinical Trial of Dosing Regimens. Dermatologic Surgery, 2000. 26(1): p. 50-54.
  24. Greenspan, D., et al., Oral mucosal lesions and HIV viral load in the Women's Interagency HIV Study (WIHS). J Acquir Immune Defic Syndr, 2000. 25(1): p. 44-50.
  25. Ibanez, J.P., et al., Sirolimus in chronic allograft nephropathy in pediatric recipients. Pediatr Transplant, 2007. 11(7): p. 777-80.
  26. Kakabadze, T., et al., Oral lesions in HIV-positive patients in Georgia. Georgian Med News, 2008(165): p. 60-5.
  27. Kaplowitz, L.G., Prolonged continuous acyclovir treatment of normal adults with frequently recurring genital herpes simplex virus infection. The Acyclovir Study Group. JAMA: The Journal of the American Medical Association, 1991. 265(6): p. 747-751.
  28. Kokuba, et al., Erythema multiforme lesions are associated with expression of a herpes simplex virus (HSV) gene and qualitative alterations in the HSV-specific T-cell response. Br J Dermatol, 1998. 138(6): p. 952-964.
  29. Kokuba, H., L. Aurelian, and J. Burnett, Herpes Simplex Virus Associated Erythema Multiforme (HAEM) is Mechanistically Distinct from Drug-Induced Erythema Multiforme: Interferon-γ is Expressed in HAEM Lesions and Tumor Necrosis Factor-α in Drug-Induced Erythema Multiforme Lesions. Journal of Investigative Dermatology, 1999. 113(5): p. 808-815.
  30. Langenberg, A.G.M., et al., A Prospective Study of New Infections with Herpes Simplex Virus Type 1 and Type 2. New England Journal of Medicine, 1999. 341(19): p. 1432-1438.
  31. Mahler, V. and G. Schuler, Therapie von Varizella-Zoster- und Herpes-simplex-Virus-bedingten Erkrankungen. Der Hautarzt, 2001. 52(5): p. 464-473.
  32. Mark, Karen E., et al., Rapidly Cleared Episodes of Herpes Simplex Virus Reactivation in Immunocompetent Adults. The Journal of Infectious Diseases, 2008. 198(8): p. 1141-1149.
  33. Martins, T.B., et al., Comparison of a Multiplexed Herpes Simplex Virus Type-Specific Immunoglobulin G Serology Assay to Immunoblot, Western Blot, and Enzyme-Linked Immunosorbent Assays. Clinical and Vaccine Immunology, 2008. 16(1): p. 55-60.
  34. Mercolini, F., et al., Congenital disseminated HSV-1 infection in preterm twins after primary gingivostomatitis of the mother: case report and review of the literature. Z Geburtshilfe Neonatol, 2014. 218(6): p. 261-4.
  35. Meulener, M. and B.L. Smith, Herpes gladiatorum with ocular involvement in a mixed martial arts fighter. Cutis, 2011. 87(3): p. 146-7.
  36. Mirfazaelian, H. and Y. Daneshbod, Herpes gladiatorum. Emerg Med J, 2013. 30(11): p. 892.
  37. Nagot, N., et al., Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus. New England Journal of Medicine, 2007. 356(8): p. 790-799.
  38. Ono, F., et al., CD34+ Cells in the Peripheral Blood Transport Herpes Simplex Virus DNA Fragments to the Skin of Patients with Erythema Multiforme (HAEM). Journal of Investigative Dermatology, 2005. 124(6): p. 1215-1224.
  39. Ozcan, D., et al., Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. Clin Transplant, 2013. 27(5): p. 742-8.
  40. Parent, D., [Oral ulcerations]. Rev Med Brux, 2011. 32(4): p. 210-8.
  41. Peña, K.C., et al., Genital Herpes Simplex Virus Type 1 in Women: Detection in Cervicovaginal Specimens from Gynecological Practices in the United States. J. Clin. Microbiol., 2009. 48(1): p. 150-153.
  42. Pereira, F.A., Herpes simplex: Evolving concepts. Journal of the American Academy of Dermatology, 1996. 35(4): p. 503-520.
  43. Pope, L.E., et al., The anti-herpes simplex virus activity of n-docosanol includes inhibition of the viral entry process. Antiviral Research, 1998. 40(1-2): p. 85-94.
  44. Rappersberger, K., Infections with herpes simplex and varicella-zoster virus in pregnancy: clinical manifestations in the mother, fetus and newborn – therapeutic options. Hautarzt, 1999. 50(10): p. 706.
  45. Salvini, F., et al., Chronic Ulcerative Herpes Simplex Virus Infection in HIV-Infected Children. AIDS Patient Care and STDs, 1997. 11(6): p. 421-428.
  46. Sauerbrei, A. and P. Wutzler, Herpes simplex and varicella-zoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 2: Varicella-zoster virus infections. Med Microbiol Immunol, 2006. 196(2): p. 95-102.
  47. Shim, T., et al., Atypical Presentation of Genital Herpes Simplex (HSV-2) in Two Patients with Chronic Lymphocytic Leukemia. Acta Dermato Venereologica, 2014. 94(2): p. 246-247.
  48. Siegal, F.P., et al., Severe Acquired Immunodeficiency in Male Homosexuals, Manifested by Chronic Perianal Ulcerative Herpes Simplex Lesions. New England Journal of Medicine, 1981. 305(24): p. 1439-1444.
  49. Spruance, S.L., Penciclovir Cream for the Treatment of Herpes Simplex Labialis. JAMA, 1997. 277(17): p. 1374.
  50. Toro, J.R., et al., Topical cidofovir for the treatment of dermatologic conditions: verruca, condyloma, intraepithelial neoplasia, herpes simplex and its potential use in smallpox. Dermatologic Clinics, 2003. 21(2): p. 301-309.
  51. Vanpouille, C., et al., A New Class of DualTargeted Antivirals: Monophosphorylated Acyclovir Prodrug Derivatives Suppress Both Human Immunodeficiency Virus Type 1 and Herpes Simplex Virus Type 2. The Journal of Infectious Diseases, 2010. 201(4): p. 635-643.
  52. Wald, A., Effect of Condoms on Reducing the Transmission of Herpes Simplex Virus Type 2 From Men to Women. JAMA, 2001. 285(24): p. 3100.
  53. Wauters, O., E. Lebas, and A.F. Nikkels, Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections. Journal of the American Academy of Dermatology, 2012. 66(6): p. e217-e227.
  54. Weston, W.L., Herpes Simplex Virus–Associated Erythema Multiforme in Prepubertal Children. Arch Pediatr Adolesc Med, 1997. 151(10): p. 1014.
  55. Weston, W.L. and S.L. Brice, Atypical forms of herpes simplex–associated erythema multiforme. Journal of the American Academy of Dermatology, 1998. 39(1): p. 124-126.
  56. Whitley, R.J. and B. Roizman, Herpes simplex virus infections. The Lancet, 2001. 357(9267): p. 1513-1518.
  57. Wutzler, P., Antiviral Therapy of Herpes simplex and Varicella-zoster Virus Infections. Intervirology, 1997. 40(5-6): p. 343-356.
  58. Xu, F., et al., Trends in Herpes Simplex Virus Type 1 and Type 2 Seroprevalence in the United States. JAMA, 2006. 296(8): p. 964.
  59. Yuan, W., A. Dasgupta, and P. Cresswell, Herpes simplex virus evades natural killer T cell recognition by suppressing CD1d recycling. Nature Immunology, 2006. 7(8): p. 835-842.