Complications And Prognosis

Ocular infection resulting from autoinoculation during acute herpetic gingivostomatosis or asymptomatic oropharyngeal infection is not an uncommon complication of HSV-l infection in children. The condition manifests as unilateral follicular conjunctivitis or as an acute herpetic keratoconjunctivitis with dendritic corneal ulcers, and can recur in as many as 25% of patients. HSV-1 infection can be associated with progressive scarring of the cornea and has been a leading infectious cause of blindness (20).

Types of skin infection complicating HSV-1 infection include eczema herpeticum, herpetic whitlow, and herpes gladiatorum. Eczema herpeticum occurs in patients with underlying dermatitis, skin breakdown (such as occurs with burns), and pemphigus. Herpetic whitlow is an infection of the fingers at or near the cuticle or at a break in the skin. The condition is associated with exposure to saliva and is observed most commonly in health-care workers and in children. Herpes gladiatorum manifests as scattered skin lesions and is most often observed in wrestlers exposed to infectious saliva.

Visceral infection resulting from viremia with and without skin lesions can infect many organs to cause esophagitis, adrenal necrosis, interstitial pneumonitis, cystitis, arthritis, and hepatitis. Hepatitis is often associated with blood dyscrasia that produces intravascular coagulation.

Herpes simplex encephalitis accounts for 10% to 20% of all cases of acute necrotizing encephalitis in the United States. The condition most often occurs after primary infection and, as has been suggested, by reinfection with a different strain of HSV-1. Herpes simplex encephalitis produces nonspecific findings: headache, meningeal irritation, altered mental status, and seizures. In affected patients, magnetic resonance imaging (MRI) often shows focal necrosis of the temporal and orbital frontal region. This necrosis causes symptoms of anosmia, memory loss, and olfactory hallucinations. PCR imaging is the most sensitive noninvasive method of showing HSV-1 DNA. Untreated patients have an estimated mortality rate of 70%. Even with treatment, patients with herpes simplex encephalitis have a high incidence of neurological sequelae (6).

Complications associated with cranial polyganglionitis vary widely according to the nerve or nerves affected. Corneal ulceration is not uncommon in patients with Bell's palsy. Late complications of Bell's palsy include mid-face contracture with synkinesis and begin at three to four months after the facial nerve has degenerated and begun to regenerate (9).

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