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Herpes simplex Herpes simplex (Greek: ἕρπης - herpes, lit. "creeping") is a viral disease caused by both Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever blisters, infects the face and mouth. Oral herpes is the most common form of infection. Genital herpes, known simply as herpes, is the second most common form of herpes. Herpes simplex Classification • Herpes simplex is divided into two types: HSV type 1 and HSV type 2.[2] HSV1 primarily causes mouth, throat, face, eye, and central nervous system infections, while HSV2 primarily causes anogenital infections.[2] However, each may cause infections in all areas.[2] Signs and symptoms • HSV infection causes several distinct medical disorders. Common infection of the skin or mucosa may affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands (herpetic whitlow). More serious disorders occur when the virus infects and damages the eye (herpes keratitis), or invades the central nervous system, damaging the brain (herpes encephalitis). Patients with immature or suppressed immune systems, such as newborns, transplant recipients, or AIDS patients are prone to severe complications from HSV infections. HSV infection has also been associated with cognitive deficits of bipolar disorder,[3] and Alzheimer's disease,[4] although this is often dependent on the genetics of the infected person. Herpetic gingivostomatitis • Herpetic gingivostomatitis is often the initial presentation during the first herpes infection. It is of greater severity than herpes labialis which is often the subsequent presentations. Herpes labialis • Infection occurs when the virus comes into contact with oral mucosa or abraded skin. Herpes genitalis • When symptomatic, the typical manifestation of a primary HSV-1 or HSV2 genital infection is clusters of inflamed papules and vesicles on the outer surface of the genitals resembling cold sores. Herpes esophagitis • Symptoms may include painful swallowing (odynophagia) and difficulty swallowing (dysphagia). It is often associated with impaired immune function (e.g. HIV/AIDS, immunosuppression in solid organ transplants). Treatment • There are several antivirals that are effective for treating herpes including: aciclovir (acyclovir), valaciclovir (valacyclovir), famciclovir, and penciclovir. Aciclovir was the first discovered and is now available in generic. Prognosis • Many HSV-infected people experience recurrence within the first year of infection.[5] Prodrome precedes development of lesions. Prodromal symptoms include tingling (paresthesia), itching, and pain where lumbosacral nerves innervate the skin. Prodrome may occur as long as several days or as short as a few hours before lesions develop. Beginning antiviral treatment when prodrome is experienced can reduce the appearance and duration of lesions in some individuals. During recurrence, fewer lesions are likely to develop, lesions are less painful and heal faster (within 5–10 days without antiviral treatment) than those occurring during the primary infection.[5] Subsequent outbreaks tend to be periodic or episodic, occurring on average four to five times a year when not using antiviral therapy. Herpes zoster • Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox which generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection. Despite the similarity of name, herpes zoster is not the same disease as herpes simplex, although both the varicella zoster virus and herpes simplex virus belong to the same viral subfamily (Alphaherpesvirinae). Signs and symptoms • The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis.[5][9] These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia ("pins and needles": tingling, pricking, or numbness).[10] The pain may be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.[11] Development of the shingles rash Day 1 Day 2 Pathophysiology Progression of herpes zoster. A cluster of small bumps (1) turns into blisters (2). The blisters fill with lymph, break open (3), crust over (4), and finally disappear. Postherpetic neuralgia can sometimes Diagnosis • Laboratory tests are available to diagnose herpes zoster. The most popular test detects VZV-specific IgM antibody in blood; this only appears during chickenpox or herpes zoster and not while the virus is dormant.[23] In larger laboratories, lymph collected from a blister is tested by polymerase chain reaction for VZV DNA, or examined with an electron microscope for virus particles.[24] Herpes zoster on the chest Prevention • In the United Kingdom and other parts of Europe, population-based varicella immunization is not practised. The rationale is that until the entire population could be immunized, adults who have previously contracted VZV would instead derive benefit from occasional exposure to VZV (from children), which serves as a booster to their immunity to the virus, and may reduce the risk of shingles later on in life.[33] The UK Health Protection Agency states that, while the vaccine is licensed in the UK, there are no plans to introduce it into the routine childhood immunization scheme, although it may be offered to healthcare workers who have no immunity to VZV.[34] Treatment • The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia.[ Analgesics • People with mild to moderate pain can be treated with over-the-counter analgesics. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks may also reduce pain.[38] Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia Antivirals • The drugs are used both as prophylaxis (for example in AIDS patients) and as therapy during the acute phase. Antiviral treatment is recommended for all immunocompetent individuals with herpes zoster over 50 years old, preferably given within 72 hours of the appearance of the rash.[39] Complications in immunocompromised individuals with herpes zoster may be reduced with intravenous acyclovir. In people who are at a high risk for repeated attacks of shingles, five daily oral doses of acyclovir are usually effective.[1] Steroids • Orally administered corticosteroids are frequently used in treatment of the infection, despite clinical trials of this treatment being unconvincing. Nevertheless, one trial studying immunocompetent patients older than 50 years of age with localized herpes zoster, suggested that administration of prednisone with aciclovir improved healing time and quality of life Prognosis • The rash and pain usually subside within three to five weeks, but about one in five patients develops a painful condition called postherpetic neuralgia, which is often difficult to manage. In some patients, herpes zoster can reactivate presenting as zoster sine herpete: pain radiating along the path of a single spinal nerve (a dermatomal distribution), but without an accompanying rash. This condition may involve complications that affect several levels of the nervous system and cause multiple cranial neuropathies, polyneuritis, myelitis, or aseptic meningitis. Other serious effects that may occur in some cases include partial facial paralysis (usually temporary), ear damage, or encephalitis. Influenza • Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses), that affects birds and mammals. The most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness/fatigue and general discomfo Types of virus • In virus classification influenza viruses are RNA viruses that make up three of the five genera of the family Orthomyxoviridae:[18] • Influenzavirus A • Influenzavirus B • Influenzavirus C Influenzavirus A • This genus has one species, influenza A virus. Wild aquatic birds are the natural hosts for a large variety of influenza A. Occasionally, viruses are transmitted to other species and may then cause devastating outbreaks in domestic poultry or give rise to human influenza pandemics.[21] The type A viruses are the most virulent human pathogens among the three influenza types and cause the most severe disease Influenzavirus B • This genus has one species, influenza B virus. Influenza B almost exclusively infects humans[22] and is less common than influenza A. The only other animals known to be susceptible to influenza B infection are the seal[24] and the ferret.[25] This type of influenza mutates at a rate 2–3 times slower than type A[26] and consequently is less genetically diverse, with only one influenza B serotype. Influenzavirus C • This genus has one species, influenza C virus, which infects humans, dogs and pigs, sometimes causing both severe illness and local epidemics.[29][30] However, influenza C is less common than the other types and usually only causes mild disease in children. Signs and symptoms • Symptoms of influenza can start quite suddenly one to two days after infection. Usually the first symptoms are chills or a chilly sensation, but fever is also common early in the infection, with body temperatures ranging from 38-39 °C (approximately 100-103 °F).[53] Many people are so ill that they are confined to bed for several days, with aches and pains throughout their bodies, which are worse in their backs and legs Symptoms of influenza may include: • • • • • • • • • • Fever and extreme coldness (chills shivering, shaking (rigor)) Cough Nasal congestion Body aches, especially joints and throat Fatigue Headache Irritated, watering eyes Reddened eyes, skin (especially face), mouth, throat and nose Petechial Rash[54] In children, gastrointestinal symptoms such as diarrhea and abdominal pain,[55][56] (may be severe in children with influenza B)[57] Treatment • People with the flu are advised to get plenty of rest, drink plenty of liquids, avoid using alcohol and tobacco and, if necessary, take medications such as acetaminophen (paracetamol) to relieve the fever and muscle aches associated with the flu.[109] Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during an influenza infection (especially influenza type B), because doing so can lead to Reye's syndrome, a rare but potentially fatal disease of the liver.[110] Since influenza is caused by a virus, antibiotics have no effect on the infection; unless prescribed for secondary infections such as bacterial pneumonia. Antiviral medication can be effective, but some strains of influenza can show resistance to the standard antiviral drugs acquired immunodeficiency syndrome • is a disease of the human immune system caused by the human immunodeficiency virus History • AIDS was first reported June 5, 1981, when the U.S. Centers for Disease Control (CDC) recorded a cluster of Pneumocystis carinii pneumonia (now still classified as PCP but known to be caused by Pneumocystis jirovecii) in five homosexual men in Los Angeles.[14] In the beginning, the CDC did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.[15][16] They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981 Signs and symptoms • The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungi and parasites that are normally controlled by the elements of the immune system that HIV damages. Cause • Sexual transmission Blood products Perinatal transmission Pathophysiology • The pathophysiology of AIDS is complex, as is the case with all syndromes.[95] Ultimately, HIV causes AIDS by depleting CD4+ T helper lymphocytes. This weakens the immune system and allows opportunistic infections. T lymphocytes are essential to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4+ T cell depletion differs in the acute and chronic phases Cells affected • The virus, entering through which ever route, acts primarily on the following cells:[101] • Lymphoreticular system: – – – – CD4+ T-Helper cells Macrophages Monocytes B-lymphocytes • Certain endothelial cells • Central nervous system: – – – – Microglia of the nervous system Astrocytes Oligodendrocytes Neurones – indirectly by the action of cytokines and the gp-120 disease staging system • Stage I: HIV infection is asymptomatic and not categorized as AIDS • Stage II: includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections • Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis • Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS. Prevention • The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.[115] Anti-retroviral treatment of infected patients also significantly reduces their ability to transmit HIV to others, by reducing the amount of virus in their bodily fluids to undetectable levels. Body fluid exposure • Health care workers can reduce exposure to HIV by employing precautions to reduce the risk of exposure to contaminated blood. These precautions include barriers such as gloves, masks, protective eyeware or shields, and gowns or aprons which prevent exposure of the skin or mucous membranes to blood borne pathogens. Frequent and thorough washing of the skin immediately after being contaminated with blood or other bodily fluids can reduce the chance of infection Mother-to-child • Current recommendations state that when replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breast-feeding their infant. However, if this is not the case, exclusive breastfeeding is recommended during the first months of life and discontinued as soon as possible.[134] It should be noted that women can breastfeed children who are not their own; see wet nurse. Antiviral therapy • Current treatment for HIV infection consists of highly active antiretroviral therapy, or HAART.[139] This has been highly beneficial to many HIV-infected individuals since its introduction in 1996 when the protease inhibitorbased HAART initially became available.[13] Current optimal HAART options consist of combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. Abacavir – a nucleoside analog reverse transcriptase inhibitor Prognosis • Without treatment, the net median survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype,[8] and the median survival rate after diagnosis of AIDS in resource-limited settings where treatment is not available ranges between 6 and 19 months, depending on the study.[164] In areas where it is widely available, the development of HAART as effective therapy for HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the life expectancy for a newly diagnosed HIV-infected person to about 20 years Recurrent aphthous stomatitis • An aphthous ulcer (pronounced /ˈæfθəs/ af-thəs), also known as a canker sore, is a type of mouth ulcer which presents as a painful open sore inside the mouth[1] or upper throat characterized by a break in the mucous membrane. Its cause is unknown, but they are not contagious. Aphthous ulcer Classification • Aphthous ulcers are classified according to the diameter of the lesion. Minor ulceration • Minor aphthous ulcers indicate that the lesion size is between 3–10 mm (0.1–0.4 in). The appearance of the lesion is that of an erythematous halo with yellowish or grayish color. Pain that affects quality of life is the obvious characteristic of the lesion. When the ulcer is white or grayish, the ulcer will be extremely painful and the affected lip may swell. They may last about 2 weeks. Major ulcerations • Major aphthous ulcers have the same appearance as minor ulcerations, but are greater than 10 mm in diameter and are extremely painful. They usually take more than a month to heal, and frequently leave a scar. These typically develop after puberty with frequent recurrences. They occur on movable non-keratinizing oral surfaces, but the ulcer borders may extend onto keratinized surfaces. Herpetiform ulcerations • This is the most severe form. It occurs more frequently in females, and onset is often in adulthood. It is characterized by small, numerous, 1–3 mm lesions that form clusters. They typically heal in less than a month without scarring. Supportive treatment is almost always necessary Signs and symptoms • Aphthous ulcers usually begin with a tingling or burning sensation at the site of the future aphthous ulcer. In a few days, they often progress to form a red spot or bump, followed by an open ulcer. Large aphthous ulcer on the lower lip Causes • The exact cause of many aphthous ulcers is unknown but citrus fruits (e.g., oranges and lemons), physical trauma, stress, lack of sleep, sudden weight loss, food allergies, immune system reactions,[5] and deficiencies in vitamin B12, iron, and folic acid[6] may contribute to their development. Prevention • Oral measures • Regular use of non-alcoholic mouthwash may help prevent or reduce the frequency of sores. Informal studies suggest that mouthwash may help to temporarily relieve pain.[24] • In some cases, switching toothpastes can prevent aphthous ulcers from occurring, with research looking at the role of sodium dodecyl sulfate (sometimes called sodium lauryl sulfate, or with the acronymes SDS or SLS), a detergent found in most toothpastes. Using toothpaste free of this compound has been found in several studies to help reduce the amount, size, and recurrence of ulcers.[25][26][27] • Dental braces are a common physical trauma that can lead to aphthous ulcers and the dental bracket can be covered with wax to reduce abrasion of the mucosa. Avoidance of other types of physical and chemical trauma will prevent some ulcers, but, since such trauma is usually accidental, this type of prevention is not usually practical. Nutrition • Zinc deficiency has been reported in people with recurrent aphthous ulcers.[28] The few small studies looking into the role of zinc supplementation have mostly reported positive results particularly for those people with deficiency,[29] although some research has found no therapeutic effect Treatment • A number of different treatments exist for apthous ulcers including: analgesics, anesthetics agents, antiseptics, anti-inflammatory agents, steroids, sucralfate, tetracycline suspension, and silver nitrate.[31] Amlexanox paste has been found to speed healing and alleviate pain.[32] • Suggestions to reduce the pain caused by an ulcer include: avoiding spicy food, rinsing with salt water or over-the-counter mouthwashes, proper oral hygiene and non-prescription local anesthetics.[33] Active ingredients in the latter generally include benzocaine,[34] benzydamine or choline salicylate,[35] and phenol Foot-and-mouth disease • Foot-and-mouth disease or hoof-andmouth disease (Aphtae epizooticae) is an infectious and sometimes fatal viral disease that affects cloven-hoofed animals, including domestic and wild bovids. The virus causes a high fever for two or three days, followed by blisters inside the mouth and on the feet that may rupture and cause lameness. Ruptured oral blister in diseased cow. • Foot-and-mouth disease is a severe plague for animal farming, since it is highly infectious and can be spread by infected animals through aerosols, through contact with contaminated farming equipment, vehicles, clothing or feed, and by domestic and wild predators.[1] Its containment demands considerable efforts in vaccination, strict monitoring, trade restrictions and quarantines, and occasionally the elimination of millions of animals. • Susceptible animals include cattle, water buffalo, sheep, goats, pigs, antelope, deer, and bison. It has also been known to infect hedgehogs, elephants,[1][2] llama, and alpaca may develop mild symptoms, but are resistant to the disease and do not pass it on to others of the same species.[1] In laboratory experiments, mice and rats and chickens have been successfully infected by artificial means, but it is not believed that they would contract the disease under natural conditions.[1] Humans are very rarely affected. • The virus responsible for the disease is a picornavirus, the prototypic member of the genus Aphthovirus. Infection occurs when the virus particle is taken into a cell of the host. The cell is then forced to manufacture thousands of copies of the virus, and eventually bursts, releasing the new particles in the blood. The virus is highly variable,[3] which limits the effectiveness of vaccination. Clinical signs • The incubation period for foot-and-mouth disease virus has a range between 2 and 12 days.[6] The disease is characterized by high fever that declines rapidly after two or three days; blisters inside the mouth that lead to excessive secretion of stringy or foamy saliva and to drooling; and blisters on the feet that may rupture and cause lameness. Adult animals may suffer weight loss from which they do not recover for several months as well as swelling in the testicles of mature males, and in cows, milk production can decline significantly. Though most animals eventually recover from FMD, the disease can lead to myocarditis (inflammation of the heart muscle) and death, especially in newborn animals. Some infected animals remain asymptomatic, but they nonetheless carry FMD and can transmit it to others. Ruptured blisters on the feet of a pig Foot-and-mouth disease • Humans can be infected with foot-and-mouth disease through contact with infected animals, but this is extremely rare. Some cases were caused by laboratory accidents. Because the virus that causes FMD is sensitive to stomach acid, it cannot spread to humans via consumption of infected meat, except in the mouth before the meat is swallowed. In the UK, the last confirmed human case occurred in 1966,[10][11] and only a few other cases have been recorded in countries of continental Europe, Africa, and South America. Symptoms of FMD in humans include malaise, fever, vomiting, red ulcerative lesions (surface-eroding damaged spots) of the oral tissues, and sometimes vesicular lesions (small blisters) of the skin. Economic and ethical issues • Epidemics of FMD have resulted in the slaughter of millions of animals, despite this being a frequently nonfatal disease for adult animals (2-5% mortality), though young animals can have a high mortality Treatment • In severe foot and mouth disease in debilitated children with concomitant diseases of patients hospitalized in other cases are isolated at home in the disappearance of clinical symptoms. Aphthae in the mouth obroblyuyut a cotton swab soaked 4% solution of silver nitrate (silver nitrate) or 3% solution of hydrogen peroxide required frequent mouthwashes 0.1% solution of potassium permanganate, 0.25% solution of novocaine. Any damage to the eyes appoint sulfatsil-sodium (albutsyd). Apply vitamins, antihistamines. When complications - antibiotics. Treatment • Patients with foot and mouth disease be hospitalized for at least 14 days. Appointed by the diet, in the mechanical and chemical terms possible sparing mucous (semi digestible food 5-6 times a day in small portions, before taking a patient give 0.1 g anestezina), drink plenty of liquids. Sometimes resorted to feeding through a tube. Of paramount importance is the oral health care. Thank you for attention