Snapshot A 22-year-old man presents to his primary care physician for a sore throat and oral lesions. He said his symptoms began a few days ago and have progressively worsened. Initially, his symptoms were associated with fever and submandibular lymphadenopathy. He endorses having sexual intercourse with multiple female partners without the use of condoms. Physical examination is notable for a perioral papulovesicular lesion without any genital lesions. Introduction Classification an enveloped, double-stranded linear DNA virus from the Herpesviridae family Epidemiology incidence more commonly affects the oral mucosa Transmission respiratory secretions saliva Pathogenesis herpes simplex virus (HSV) 1 inoculates the mucosal surfaces of skin and makes its way to the sensory dorsal root ganglion, where it lies dormant reactivation of HSV 1 from dormancy leads to vesicle formation, pustulations, ulcerations, and scabbing involving the mucosa of the face mouth lips oropharynx eye various triggers can reactivate HSV 1 from dormancy emotional stress immunodeficiency fever menstruation sunlight trigeminal nerve manipulation dental extractions Associated conditions HSV encephalitis Bell palsy erythema multiforme ezcema herpeticum esophagitis Prognosis lesions are typically self-limiting in healthy patients herpetic episodes are more severe and have a longer duration in immunocompromised patients Presentation Symptoms/physical exam gingivostomatitis keratoconjunctivitis esophagitis fever pharyngitis painful vesicular lesions Studies Making the diagnosis this is a clinical diagnosis based on the patient's history and appearance perioral papulovesicular lesions Tzank smear demonstrates multinucleated giant cells (intranuclear eosinophilic Cowdry A inclusions) seen in HSV 1, HSV 2, and VZV infections Real-time HSV PCR assay confirms the diagnosis Differential Aphthous ulcers differentiating factors these ulcers are never preceded by vesicles and only appear on nonkeratinized mucosal surfaces (e.g., inner surfaces of the lips and buccal mucosa Treatment Medical acyclovir, famciclovir, or valacyclovir indications immunocompromised patients patients with frequent outbreaks Complications HSV encephalitis Pneumonitis HSV esophagitis
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.MC.15.75) A 5-year-old boy is brought to his pediatrician by his mother with complaints of a sore mouth and fevers over the past several days. The mother reports that she noted blisters on the inside of the boy's mouth, prompting her to bring him to the office for evaluation. His vital signs are as follows: T 38.9 C, HR 102, BP 100/65, RR 22, SpO2 99%. Physical examination reveals the findings shown in Figure A and is also notable for palpable cervical lymphadenopathy. Infection with which of the following organisms is responsible for this patient's presentation? Tested Concept QID: 106724 FIGURES: A Type & Select Correct Answer 1 Herpes simplex virus type 1 62% (30/48) 2 Herpes simplex virus type 2 0% (0/48) 3 Epstein-Barr virus 12% (6/48) 4 Coxsackie A virus 17% (8/48) 5 Human herpes virus type 6 4% (2/48) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept (M1.MC.15.75) A 26-year-old female presents to her family physician with concern for a lesion that recently developed on her lip (Figure A). She states that a similar episode occurred 'a year or so ago', and the lesion gradually dissipated over a few days without any treatment. She denies any recent sick contacts but does report that she has been under a good amount of stress recently at work to meet various deadlines for a project she is working on. Which of the following best describes the infecting organism in this patient's presentation? Tested Concept QID: 106737 FIGURES: A Type & Select Correct Answer 1 Positive sense, single-stranded RNA virus 25% (41/164) 2 Negative sense, single-stranded RNA virus 15% (24/164) 3 Nonenveloped virus 12% (20/164) 4 Host cell nuclear membrane-derived envelope 30% (50/164) 5 Host cell plasma membrane-derived envelope 8% (13/164) M 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK