A Nurse Practitioner's Guide to the Management of Herpes Simplex Virus-1 in Children

Janel M. Drugge, MSM, RN, PNP; Patricia Jackson Allen, MS, RN, PNP, FAAN

Disclosures

Dermatology Nursing. 2008;20(6):455-466. 

In This Article

Overview of the Pathophysiology of HSV-1

HSV infections appear in a variety of areas, involving the skin, eyes, mucous membranes, central nervous system, and genital tract (Enright & Prober, 2004). HSV-1 is one of eight human herpes viruses belonging to a group that includes HSV-1, HSV-2, cytomegalovirus, Epstein-Barr virus, varicella zoster virus, and human herpes viruses types 6, 7, and 8 (Andreae, 2004; Waggoner-Fountain & Grossman, 2004). HSV-1 is a double-stranded DNA-containing enveloped virus that transmits easily between humans and creates specific pathological changes (Behrman, Kliegman, & Jenson, 2007). A primary HSV-1 infection describes the first time an individual is infected with HSV-1 (Yeung-Yue, Brentjens, Lee, & Tyring, 2002) and results from direct contact with an infected person during asymptomatic periods, the prodromal stage, or early onset of disease, and active oral infections, secretions, or lesions (Ensor, 2005; Waggoner-Fountain & Grossman, 2004). Individuals can transfer HSV-1 infections through skin contact or bodily fluids, including "saliva, semen, cervical fluid, or vesicle fluid from active lesions" (Yeung-Yue et al., 2002, p. 250). Primary infections are thought to usually occur at a young age (Stock et al., 2001), possibly due to the sharing of utensils and drinking cups. The HSV-1 infiltrates mucous membranes or exposed skin and transmits down the peripheral sensory neuron to various ganglia, including the trigeminal, facial, and vagus ganglia, where it lays dormant (Brady & Bernstein, 2004). Once an individual is infected with a primary HSV-1 infection, the virus will lay dormant in sensory ganglion neurons for life or until a trigger stimulates an active lesion (Waggoner-Fountain & Grossman, 2004).

Secondary or recurrent infections occur when the virus, lying dormant in the sensory ganglia, is reactivated due to a specific exogenous or endogenous trigger (Yeung-Yue et al., 2002). Latent HSV-1 reactivates, causing recurrent disease in 15% to 40% of individuals (Bader et al., 1978; Raborn & Grace, 1999; Scott, Coulter, & Lamney, 1997). Asymptomatic individuals who have the HSV-1 infection lying dormant in their ganglion nerves can also transmit the infection to another person either as a primary or recurrent infection through viral shedding during direct contact with skin or bodily fluids (Waggoner-Fountain & Grossman, 2004). The time between when the HSV-1 infection enters the body and symptoms first appear ranges from 2 to 14 days in children (Waggoner-Fountain & Grossman, 2004).

HSV-1 lesions remain on the skin and mucous membranes of most healthy children (Yeung-Yue et al., 2002). Newborns, as well as children with various health conditions, including severe malnutrition, immune deficiency, and skin conditions (such as eczema), are more susceptible to having the virus spread through the bloodstream, causing devastating effects (Behrman et al., 2007). In these children, the virus attacks organs, causing drastic changes in fluid and electrolyte levels and the possibility of secondary bacteremia (Behrman et al., 2007).

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