Herpes Simplex Virus Lesions Research Articles

P-1126. Stratified Approach for Empiric Acyclovir in Neonates Presenting for Sepsis Evaluations

Abstract Background Neonatal herpes simplex virus (HSV) infection is rare but associated with high rates of morbidity. Recent guidelines recommend considering HSV in infants ≤ 21 days of age presenting for sepsis evaluations with certain risk factors. However, limited data exist on the value of these risk factors in stratifying the risk for neonatal HSV.Table 1:Characteristics of Cases and Controls Methods We performed a retrospective case-control study of infants < 42 days of age who presented to Levine Children’s Hospital from 1/1/08 – 12/31/23 for sepsis evaluations to identify infants at low risk for neonatal HSV. We used Firth logistic regression to measure the odds ratio of the presence of high-risk criteria between infants without and those with HSV infection. High risk criteria included skin vesicles, seizures, elevated ALT, thrombocytopenia, CSF pleocytosis, and/or a sepsis-like picture. We matched each case with control patients without neonatal HSV admitted within 45 days of the case. For each case we identified 2 controls from group A, which included patients who tested negative for HSV, and 2 controls from group B, who may or may not have undergone HSV testing, but tested negative if they did (reflecting the general population of infants who present for sepsis evaluations).Table 2:Clinical and Laboratory Presentation of Cases and Controls Results Thirty-two cases and 128 controls (64 in group A and 64 in group B) were identified (Table 1). The mean age of cases was 14.3 days. The majority of cases were female, White, non-Hispanic, and born vaginally at term gestation. Controls, or infants without HSV, had lower prevalence of seizures, skin lesions, CSF pleocytosis, elevated ALT, thrombocytopenia, or sepsis-like picture compared to infants with HSV (Tables 2 – 3). The adjusted odds ratio of a control patient having at least one risk factor was 0.1 (95% CI 0.02 – 0.38) and 0.03 (95% CI 0 – 0.14) for control groups A and B, respectively, compared to cases (Figure 1).Table 3:Prevalence of Risk Factors among Cases and Controls Conclusion Among infants presenting for neonatal sepsis evaluations, those without HSV infection are less likely to present with seizures, skin lesions, elevated ALT, thrombocytopenia, CSF pleocytosis, or a sepsis like picture compared to infants with HSV. The lack of these criteria can be used to guide targeted evaluation and management of neonatal HSV to avoid unnecessary testing and treatment for low-risk infants. Figure 1: Odds Ratio Estimates by Risk Factor for Each Control Group Relative to Cases. Orange bar represents control group A and blue bar represents control group B. Panel A depicts unadjusted odds ratio and panel B depicts adjusted odds ratios. Odd ratios in panel B are estimated from Firth logistic regression models and adjusted for age, race, sex, prematurity, type of delivery, season of admission, history of maternal HSV, and presence of maternal HSV lesions at delivery. Disclosures All Authors: No reported disclosures

Utilization of light-emitting diodes for skin therapy: Systematic review and meta-analysis.

This study investigates the dermatological as well as the esthetic potential of light-emitting diodes (LEDs) by performing a systematic review and meta-analysis. From the electronic databases, 554 articles were assessed; however, only 31 studies were selected after manually screening and eliminating unnecessary studies. The potential effectiveness of LEDs for skin therapies was assessed by evaluating the standardized mean differences (SMDs) and funnel plots of this meta-analysis. It was discovered that both red and blue LED lights play an important role in the treatment of acne vulgaris with an overall statistically significant SMD of -2.42 [-2.64, -2.15] and I2 =17% < 50%. Additionally, other LEDs (e.g., yellow LEDs and near-infrared devices) showed outstanding levels of effectiveness, not only in reducing the lesions of herpes simplex and psoriasis but also in improved skin rejuvenation with highly consistent analytical results (I2 =0% and 33%, respectively). However, the analysis of LED-based skin wound healing and atopic dermatitis treatments exhibited heterogeneity (I2 =85% and 90%) due to the lack of unpublished articles. In conclusion, it is suggested that LEDs are useful for dermatology and could be potential candidates for future cosmetic applications.

Recurrent Aphthous Stomatitis: An Enigmatic Entity and Sign of Systemic Disease.

Recurrent aphthous stomatitis (RAS) is a common oral disease characterized by intermittent eruptions of painful oral ulcerations. Hippocrates first described aphthous stomatitis with the Greek word aphthi meaning "to inflame." RAS affects 10-20% of the population with the incidence being the highest among young adults. The peak age of onset is between 10 and 19 years of age. It has three main forms of presentation. The most common being minor RAS, along with the major and herpetiform types. Many local and systemic factors are associated with RAS pathogenesis. The main concern with oral aphthae in many cases is local pain, which can be severe enough to interfere with eating, speaking, and swallowing. It is important to differentiate RAS from systemic diseases with aphthae-such as Behçet's syndrome and the newly-delineated, autoinflammatory PFAPA (periodic fever with aphthous stomatitis, pharyngitis, and adenitis) syndrome-as well as from other aphthous-like ulcerations like herpes simplex virus (HSV) or Coxsackie oral lesions. The management depends upon the clinical presentation and symptomatology-focusing on analgesic, antimicrobial, and immunomodulatory drugs.

210 Antibody function, antigenic target and glycans determine the transfer of herpes simplex virus (HSV) antibodies (Abs) from mothers to newborns and transfer is altered by SARS-CoV-2

OBJECTIVES/GOALS: Murine and clinical data suggest that antibody-dependent cellular cytotoxicity (ADCC) is associated with greater protection against disseminated neonatal HSV disease. To quantify the relative transfer of Abs with different functions and targets, we conducted a prospective study of mother-infant term and preterm dyads pre and during COVID-19 METHODS/STUDY POPULATION: Total and HSV lysate, glycoprotein D (gD) and glycoprotein B (gB)-specific IgG, IgG1 and IgG3 as well as HSV neutralizing Abs (nAbs) and ADCC were quantified in paired 3rd-trimester pregnant women and their newborns (cord) blood. Transfer ratios (TR) were defined as cord:maternal Ab levels. IgG1 and IgG3 subclass and gD or gB-specific Abs were isolated by column purification and glycan profiles were assessed by mass spectrometry. The study population included 21 term and 15 preterm dyads who were HSV-1 (+/- HSV-2) seropositive enrolled between 2018-2019 (pre-COVID) and 25 additional HSV-1 (+/- HSV-2) seropositive term dyads whose mothers were SARS-CoV-2 PCR and COVID Ab+ at delivery; 14 were asymptomatic and 11 had mild-moderate COVID disease. None of the mothers had active genital HSV lesions during delivery RESULTS/ANTICIPATED RESULTS: Anti-HSV IgG, IgG1 and IgG3 TR were higher in term vs. preterm dyads (p&lt;0.05). The nAb TR was 2.4 in term vs. 0.8 in preterm (p&lt;0.001) but the ADCC TR was &lt; 1.0 for both. To determine if the latter reflected antigenic target, subclass or glycans, we enriched for gD and gB specific and IgG1 and IgG3 Abs. The gD Abs were IgG1 and had only neutralizing activity. In contrast, gB Abs were polyfunctional and included IgG1 and IgG3 but only the IgG1 Abs had ADCC activity. The gD Abs were enriched for glycans associated with an affinity for the neonatal Fc receptor (FcRn); gB Abs expressed glycans associated with both FcRn and FcγRIIIa binding. There was no significant difference in total HSV-specific IgG TR in pre-COVID vs post-COVID dyads but the nAb TR was lower (p=0.018) and ADCC TR higher (p&lt;0.001) in the COVID compared to pre-COVID cohort DISCUSSION/SIGNIFICANCE: HSV ADCC Abs, which may provide greater protection than nAbs against neonatal disease, transfer poorly particularly to preterm newborns. However, in the setting of SARS-CoV-2, the TR of HSV ADCC is significantly higher. This may reflect alterations in the placental architecture and/or glycan composition which is currently being investigated.

The efficacy of photodynamic therapy for herpes simplex lesions in immunocompetent and oncologic individuals

The efficacy of photodynamic therapy for herpes simplex lesions in immunocompetent and oncologic individuals

Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected

Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected

HERPES SIMPLEX VIRUS MASQUERADING AS AN ENDOBRONCHIAL LESION

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Herpes simplex virus (HSV) endobronchial lesions are rarely observed. Case reports describe partially or fully obstructing masses in both immunocompetent and immunocompromised patients. Diagnosis requires both visualization and histological evidence in the absence of malignancy. CASE PRESENTATION: A 68 year-old immunocompetent female with a history of oxygen dependent chronic obstructive pulmonary disease presented to the emergency department for dyspnea and cough. Chest x-ray showed atelectasis of the right lung fields with mediastinal shift towards the right and suggested an underlying pleural effusion. Computed tomography of the chest revealed a large right pleural effusion with near complete atelectasis of the right lung and suspicion for a mass in the right lower lobe. The patient required intubation for hypoxemic respiratory failure and was treated for septic shock and pneumonia. A small bore chest tube was placed and subsequent fluid analysis was consistent with empyema. Culture results were treated with appropriate antibiotics. A bedside bronchoscopy was performed for worsening copious secretions and found a partially obstructing endobronchial lesion in the right posterior basal segment. Biopsy and bronchial lavage washings were sent for analysis. While awaiting results the patient was extubated and improving. Bronchoscopy results yielded HSV-1. The patient was started on acyclovir and made a full recovery. DISCUSSION: To our knowledge all reported endobronchial HSV mass lesions have resulted in HSV pneumonia requiring antiviral treatment. Interestingly, our patient improved clinically prior to positive HSV polymerase chain reaction results and was extubated. Most likely the endobronchial lesion led to post-obstructive pneumonia and eventual empyema. What is truly unique is that the herpetic pseudotumor did not appear to result in a viral pneumonia but instead was the nidus for superimposed secondary bacterial infection. We did initiate acyclovir for one week but the severity of our findings were questioned. Studies have looked at HSV’s presence in upper and lower respiratory tract and have found it is not an uncommon finding. As of yet there is not a clear understanding of its pathogenicity. CONCLUSIONS: HSV is a rare cause of endobronchial mass lesions in immunocompetent adults. The clinical significance of this finding is not fully understood at this time and requires further investigation. *HCA Disclaimer “This research was supported (in whole or part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this presentation represent those of the author and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.” Reference #1: Odani, K., Tachibana, M., Tamashima, R., & Tsutsumi, Y. (2019). Herpes Simplex Virus Pneumonia: Importance of Aspiration Etiology. Case Reports in Pathology, 2019, 1-3. doi:10.1155/2019/7623576 Reference #2: Simoons-Smit, A., Kraan, E., Beishuizen, A., Schijndel, R. S., & Vandenbroucke-Grauls, C. (2006). Herpes simplex virus type 1 and respiratory disease in critically-ill patients: Real pathogen or innocent bystander? Clinical Microbiology and Infection, 12(11), 1050-1059. doi:10.1111/j.1469-0691.2006.01475.x Reference #3: Dantas, G. C., Shoji, H., Hoelz, C., Funari, M. B., & Szarf, G. (2017). Herpes simplex lesion mimicking left upper lobe bronchial tumour. Thorax, 73(1), 94-95. doi:10.1136/thoraxjnl-2017-210026 DISCLOSURES: No relevant relationships Added 05/29/2020 by Leonard Hamera, source=Web Response, value=Grant/Research Support Removed 05/29/2020 by Leonard Hamera, source=Web Response No relevant relationships by Jeffrey Jordan, source=Web Response No relevant relationships by Gaurav Shah, source=Web Response

Oral ulceration and blistering in patients with COVID-19.

Design Case series.Introduction The most common signs and symptoms of SARS-CoV-2 infection include headache, sore throat, hyposmia, hypogeusia, diarrhoea, dyspnoea and pneumonia. Dermatological manifestations have also been reported but few authors have documented oral signs and symptoms. Methods Three cases are reported where oral ulceration or blistering is found in patients with confirmed or suspected COVID-19.Results One patient had serologically confirmed COVID-19, whilst the remaining two cases were only suspected. Two patients reported pain from the palate, whilst the third reported in the tongue. The first two patients had lesions affecting keratinised tissue consistent with herpes simplex lesions but with no history of herpetic infection. The third patient had lesions compatible with erythema multiforme.Conclusions The authors suggest a link between COVID-19 and oral ulceration and blistering, but acknowledge these signs may often go undetected due to a lack of intraoral examination during hospital admission.

Oral vesiculobullous lesions associated with SARS-CoV-2 infection.

Oral vesiculobullous lesions associated with SARS-CoV-2 infection.

Local anesthetic improves individuals affected with herpes simplex type 1 labialis.

Infections caused by the herpes simplex virus 1 (HSV-1), commonly called herpes simplex labialis (HSL), are a public health problem, reaching around 40% of the world's population. Thus, the search for effective therapeutic alternatives in the control of the limitations caused by this virus during the stages of evolution of the disease, is necessary, since they have a direct impact on the quality of life of the patients. The aim of the present study was to evaluate the efficacy of the in situ film precursor semisolid composition in the treatment of herpes simplex lesions in human HSV-1. Ninety-eight (n = 98) patients with HSV-1 were used for this study. The initial exclusion criteria left 81 patients to be considered in the present study. Three applications were performed, the first at time zero (T0) and the other two at 8 and 16 hours, after initial application (T8 and T16). Photographs were taken in the first appointment and 24 and 72 hours after the last application. After the three periods, each patient received a total amount of 90 mg of anesthetic and the prognosis of the patients was followed for 6 months and 1 year after the application. Frequency analysis showed that 40.3% of patients had remission of symptoms 24 hours after the last application. For the present study, the film presented a positive therapeutic potential and an esthetic benefit that is absent in the current products (ointments and gels). The invent presents dosage convenience (only three applications in a 24-hour period) and a low production cost, with a much shorter healing time than that reported using topical antiretrovirals.

Challenges of aciclovir-resistant HSV infection in allogeneic bone marrow transplant recipients

The emergence of herpes simplex virus (HSV) resistance to aciclovir (ACV) has increasingly been reported among hematopoietic stem cell transplant (HSCT) recipients and often associated with extended ACV prophylaxis. Between June 2011 and June 2019, medical records of 532 HSCT recipients with suspected HSV infection were retrospectively analyzed. HSV-1 and HSV-2 positive samples were identified in 47 and 16 patients respectively. Analysis of HSV resistance to antivirals was performed at the Public Health England reference laboratory in London using phenotypic and/or genotypic resistance assays. The prevalence of ACV-resistant HSV accounted for 17% (8/48) of infected HSV-1 cases. All 8 patients received T-cell depleted allogeneic HSCT for hematological malignancies. Half of these patients were male with a median age was 57.5 years (range; 26-63). Chronic Graft versus Host disease (cGVHD) affected 7 patients before HSV-1 diagnosis. HSV-1 infection developed while receiving either intravenous ACV (n = 2) or oral ACV (n = 6 patients) prophylaxis at a median of 373 [range,18-2183] days post-HSCT. ACV resistance was clinically suspected at a median of 25 [range,16-109] days after initial HSV diagnosis and subsequently laboratory confirmed at a median of 25 (range,10-59) days. All patients presented with hemorrhagic oral mucositis refractory to treatment dose ACV. Foscarnet (FOS) treatment was initiated in all 8 patients (pending laboratory confirmation of ACV resistance) with some effect but associated with significant toxicity burden. Four patients presented again with recurrent HSV infection or no resolution. Three with recurrent HSV died from other causes while suffering from persistent oral HSV lesions. A prolonged immunosuppressed state following T-deplete HSCTs alongside extended use of ACV, early onset systemic HSV infection, presence of cGVHD, and treatment toxicities pose a significant challenge to the management of ACV resistant HSV infections and alternative effective antiviral options remains an unmet need in this clinical setting.

Superadded bacterial and fungal infections in oral and genital herpes simplex lesions

Background: Two types of herpes simplex virus (HSV) HSV type 1 (HSV-1) and HSV type 2 (HSV-2) can cause oral and genital infections, respectively. Superadded bacterial and fungal infections of HSV lesions are one of the complications seen in herpes simplex infections. Objective: The study aims to identify the super added bacterial and fungal infections in oral and genital herpes simplex infections. Materials and Methods: This is an observational study carried out at SRM Medical College Hospital and Research Centre, Tamil Nadu, India, from February 2019 to February 2020 after the Institutional Ethical committee approval. Patients with clinically suspected oral and genital herpes infections in all age groups are included in the study excluding neonates and infants. Under aseptic precautions vesicular fluid, blood and wound swabs were collected. Vesicular fluid examined by Tzanck smear for multinucleated giant cells, and Immunoglobulin M enzyme-linked immunosorbent assay performed in positive cases. Superadded bacterial and fungal infections identified using conventional culture and identification methods. Results: In this observational study, a total of 75 patients were screened for oral and genital herpes infection. Thirty-five (46.6%) were clinically positive. Out of the positive cases, Tzanck smear was positive in 17 (48.6%), superadded bacterial and fungal infections are seen in 18 (51.4%). The most common super added infections are Candida albicans 9 (50%), Candida non-albicans 4 (22.2%), Escherichia coli 2 (11%), Staphylococcus 1 (5.6%), Enterococcus 1 (5.6%), and Proteus mirabilis 1 (5.6%). Conclusion: Most common superadded infections associated with oral and genital herpes simplex infections are with Candida species, E. coli, and Staphylococcus.

DIAGNOSTIC CHALLENGES OF ORAL LESIONS IN A PATIENT AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION

Oncohematologic patients after hematopoietic stem cell transplantation (HSCT) are at risk of developing opportunistic oral infections and malignant neoplasms. The objective of this report is to describe 3 diagnostic challenges of oral lesions that affected the same posttransplant patient: an atypical herpes simplex virus lesion in ventral tongue, a gingival actinomycosis infection, and later a leukemic infiltration on the soft palate. A 57-year-old female patient first complained of a progressive and painful sublingual nodule for 3 days at D+35 of HSCT by extranodal natural killer/T-cell lymphoma, and final diagnoses were atypical herpes simplex virus 1 and 2 infection. Two months later, ulcerated lesions in the vestibular and palatal gingival margin of the left upper molars were noted, with final diagnosis of Actinomyces sp infection. Fifteen days later, an erythematous lesion with necrotic center was observed in the soft palate, and the diagnosis was palatal infiltration by extranodal natural killer/T-cell lymphoma.

World Workshop on Oral Medicine VII: Relative frequency of oral mucosal lesions in children, a scoping review.

To detail a scoping review on the global and regional relative frequencies of oral mucosal disorders in the children based on both clinical studies and those reported from biopsy records. A literature search was completed from 1 January 1990 to 31 December 2018 using PubMed and EMBASE. Twenty clinical studies (sample size: 85,976) and 34 studies from biopsy services (40,522 biopsies) were included. Clinically, the most frequent conditions were aphthous ulcerations (1.82%), trauma-associated lesions (1.33%) and herpes simplex virus (HSV)-associated lesions (1.33%). Overall, the most commonly biopsied lesions were mucoceles (17.12%), fibrous lesions (9.06%) and pyogenic granuloma (4.87%). By WHO geographic region, the pooled relative frequencies of the most common oral lesions were similar between regions in both clinical and biopsy studies. Across regions, geographic tongue (migratory glossitis), HSV lesions, fissured tongue and trauma-associated ulcers were the most commonly reported paediatric oral mucosal lesions in clinical studies, while mucoceles, fibrous lesions and pyogenic granuloma were the most commonly biopsied lesions. The scoping review suggests data from the clinical studies and biopsy records shared similarities in the most commonly observed mucosal lesions in children across regions. In addition, the majority of lesions were benign in nature.

Herpes simplex virus of the nose masquerading as invasive fungal sinusitis: A pediatric case series

The management of invasive fungal sinusitis differs greatly from the management of herpes simplex virus (HSV) of the nose in immunocompromised patients. However, the diagnosis may be uncertain and a delay in treatment can lead to mortality. Here we describe the successful medical management of a series of immunocompromised pediatric patients with HSV lesions of the nose with the initial concern for invasive fungal sinusitis. The diagnosis of HSV herpes was supported by positive polymerase chain reaction (PCR) testing of the nasal lesion. To our knowledge, these are the first cases described in the pediatric literature, emphasizing the need to include this entity on the differential.

The Effect of Hormonal Contraception and Menstrual Cycle Timing on Genital Herpes Simplex Virus-2 Shedding and Lesions.

The effect of female sex hormones on herpes simplex virus (HSV)-2 shedding and lesion frequency is poorly understood. Previous studies suggest that hormonal contraception may increase the frequency of HSV-2 shedding. We studied HSV-2 seropositive women who performed daily genital swabbing for HSV DNA and completed diaries for genital lesions and menses. We used Poisson mixed effects models to determine if HSV detection varied throughout the menstrual cycle, or in response to hormonal contraception. We used the Wilcoxon signed-rank test and rank-sum test to determine if lesion frequency differed by cycle phase or hormonal contraceptive use. In 189 women aged 19 to 46 years who collected swabs on 10,715 days and were not using hormonal contraception, HSV-2 DNA was detected on 20.9% of days in the follicular phase and 17.8% of days in the luteal phase (rate ratio, 1.19; 95% confidence interval, 1.03-1.37, P = 0.02). Genital lesions did not differ in the follicular versus luteal phase (12.8% vs. 10.7%, P = 0.07). In analyses of hormonal contraception, including 244 women, HSV-2 DNA was detected on 19.0% of days for women not using hormonal contraception and 18.3% of days for those using hormonal contraception (P = 0.50). Lesions were present on 11.1% of days for women not using hormonal contraception, and 8.7% of days for those using hormonal contraception (P = 0.66). In women with genital HSV-2 infection who are not using hormonal contraception, the follicular phase of the cycle may be associated with a higher frequency of HSV-2 shedding compared to the luteal phase. Lesion frequency is similar during the 2 menstrual phases. Hormonal contraception use was not observed to affect genital HSV-2 DNA detection or lesions.

2078. Adherence to Laboratory Screening Recommendations for Neonatal Herpes Simplex Virus Infection at a Tertiary Children’s Hospital

BackgroundThough American Academy of Pediatrics (AAP) publications detail the precise laboratory evaluation to perform for suspected neonatal herpes simplex virus (HSV) infection, significant practice variability persists. The primary aim of this study was to assess adherence to AAP laboratory testing guidance for neonatal HSV at our hospital. Other aims included: (1) comparing adherence rates for infants tested due to concern for symptomatic infection with those screened due to maternal genital lesion presence at birth and (2) determining the rate of infected infants among those tested.MethodsChart review was performed for infants ≤42 days old hospitalized from February 1, 2013–June 30, 2016 and tested for HSV. Subjects were categorized as asymptomatic neonates born to mothers with active genital HSV lesions at delivery or as symptomatic with concern for neonatal HSV disease. Those tested as outpatients and asymptomatic newborns of mothers with a history of genital HSV but no active lesions at delivery were excluded. Demographics and maternal HSV status were collected. Evaluations were classified as complete or incomplete based on AAP recommendations.ResultsOf 245 subjects, 24 (10%) were asymptomatic newborns of mothers with lesions at delivery, while 221 (90%) were tested due to possible symptomatic disease. Only 4/245 (1.6%) had HSV infection. Complete evaluations were more likely for asymptomatic infants (P < 0.01), but only 27 total subjects (11%) had a complete evaluation. Blood PCR and surface cultures were omitted most frequently—missing from 196 (80%) and 150 (61%) evaluations, respectively. Of those lacking surface cultures, 58 (39%) had surface PCRs. CSF PCRs were not obtained for 118/221 (53%) symptomatic evaluations. No association was found between known maternal history of genital HSV prior to delivery and evaluation completeness (P = 0.19).ConclusionAdherence to AAP testing recommendations for neonatal HSV was poor, though evaluation completeness was more likely for asymptomatic infants of mothers with lesions at delivery than for symptomatic infants. Despite a low incidence of neonatal HSV, education regarding appropriate laboratory testing is needed. Bundling computerized electronic orders for testing may improve adherence.Disclosures All authors: No reported disclosures.

A Rare Case of a Severe Gastrointestinal Bleed From a Herpetic Lesion of the Gastroesophageal Junction

Gastrointestinal bleed (GIB) is a rare manifestation of Herpes Simplex Virus (HSV) lesions in the gastrointestinal tract. In one particular study, GIB only constituted 5.3% of complications of HSV in immunocompetent adults. Even in immunocompromised patients, herpetic esophagitis (HE) is only seen in approximately 5% of those patients that are being treated for hematologic diseases that are malignant. We present a case of a elderly male who presented with a severe GI bleed secondary to a herpetic lesion diagnosed on EGD. This patient is a 77 year old male with past medical history of a previous GIB, chronic lymphocytic leukemia, coronary artery disease status post percutaneous coronary intervention on dual antiplatelet therapy, chronic obstructive pulmonary disorder who presented with respiratory failure. During his hospitalization, he had an episode of coffee ground emesis. He also had an episode of melena resulting in a syncopal episode. During this time, his hemoglobin had dropped from 12.5 to 7.2. He received a unit of packed red blood cells. He was treated with a protonix drip but also maintained his Plavix/Aspirin because of his history of a stent placement. Esophagogastroduodenoscopy showed a clean-based, non-bleeding ulcer at the gastroesophageal junction. Biopsies showed HSV Type I/II and 3+ nuclear and membranous consistent with initial impression of HE. On endoscopy, herpetic esophageal lesions consist of diffuse and shallow ulcerations more commonly in the distal half of the esophagus with necrotic bases, single or multiple lesions, either discrete or coalescent, and, on occasion, covered with pseudomembrane. In this particular case, the ulcer was consistent with literature findings but it was an unlikely culprit for his GIB; this is because it was a clean based ulcer with no active bleeding or visible ulcer. In most cases, HE usually presents with few symptoms such as odynophagia and acute chest pain which makes it more likely to be underdiagnosed. It is imperative to use this case as an example to keep HE high on the differential to expedite care and treatment to avoid the severity of a case such as this one.

Efficacy of Photodynamic Therapy in Oral Herpes Simplex Lesions: Preliminary Results

Efficacy of Photodynamic Therapy in Oral Herpes Simplex Lesions: Preliminary Results

The effect of hormonal contraception and menstrual cycle timing on genital herpes simplex virus-2 shedding and lesions

Background The effect of female sex hormones on herpes simplex virus (HSV)-2 shedding and lesion frequency is poorly understood. Previous studies suggest that hormonal contraception may increase the frequency of HSV-2 shedding. Methods We studied HSV-2 seropositive women who performed daily genital swabbing for HSV DNA and completed diaries for genital lesions and menses. We used Poisson mixed effects models to determine if HSV detection varied throughout the menstrual cycle, or in response to hormonal contraception. We used the Wilcoxon signed-rank test and rank-sum test to determine if lesion frequency differed by cycle phase or hormonal contraceptive use. Results In 189 women aged 19 to 46 years who collected swabs on 10,715 days and were not using hormonal contraception, HSV-2 DNA was detected on 20.9% of days in the follicular phase and 17.8% of days in the luteal phase (rate ratio, 1.19; 95% confidence interval, 1.03-1.37, P = 0.02). Genital lesions did not differ in the follicular versus luteal phase (12.8% vs. 10.7%, P = 0.07). In analyses of hormonal contraception, including 244 women, HSV-2 DNA was detected on 19.0% of days for women not using hormonal contraception and 18.3% of days for those using hormonal contraception (P = 0.50). Lesions were present on 11.1% of days for women not using hormonal contraception, and 8.7% of days for those using hormonal contraception (P = 0.66). Conclusions In women with genital HSV-2 infection who are not using hormonal contraception, the follicular phase of the cycle may be associated with a higher frequency of HSV-2 shedding compared to the luteal phase. Lesion frequency is similar during the 2 menstrual phases. Hormonal contraception use was not observed to affect genital HSV-2 DNA detection or lesions.