Paper II — 2022 February (2019 Scheme)

Paper II

2022 February (2019 Scheme) · 100 marks · 180 min

Question

List risk factors that can lead to disseminated herpes infection and the common manifestations seen.

Q84 marksShort Answers

Risk factors for disseminated herpes infection:

Immunocompromised states — HIV/AIDS, organ transplant recipients on immunosuppressive therapy, haematological malignancy, chemotherapy.
Neonates — particularly those exposed during vaginal delivery to a mother with active genital herpes (primary maternal infection carries the highest risk of neonatal transmission and disseminated disease).
Extensive skin disease — e.g., atopic dermatitis/eczema (risk of eczema herpeticum, a widespread cutaneous dissemination).
Malnutrition and other states of general immune debility.
Pregnancy (relative immunomodulation).

Common manifestations of disseminated herpes infection:

Neonatal disseminated HSV disease — multi-organ involvement including liver, lungs, and CNS, with high mortality if untreated.
Eczema herpeticum — widespread vesicular/pustular skin eruption superimposed on pre-existing eczematous skin.
Herpetic hepatitis — a severe, potentially fulminant manifestation in immunocompromised/neonatal disease.
Herpetic encephalitis/CNS involvement — as part of disseminated disease or in isolation.
Disseminated mucocutaneous lesions — widespread vesicular lesions beyond the typical localized oral/genital distribution.
Herpetic pneumonitis — in severely immunocompromised hosts.