Microscopic evaluation, viral culture, serology, and PCR are all clinically useful for diagnosing HSV infection.
- Regardless of the detection method, the sensitivity is greater for vesicular rather than ulcerative mucosal lesions, in primary rather than recurrent disease, and in immunocompromised rather than immunocompetent pts.
- PCR is most sensitive for detection of HSV and should be used whenever possible.
- A Tzanck smear (Giemsa-stained scrapings from the base of lesions) to detect giant cells or intranuclear inclusions characteristic of both HSV and VZV infections has a low level of sensitivity; its use requires clinicians skilled in this technique.
- Serologic tests can be used to demonstrate prior exposure to HSV; no reliable IgM detection method for defining acute HSV infection is available.
Treatment: Infections with Herpes Simplex Viruses - Table 99-1 details antiviral chemotherapy for HSV infection.
- - All antiviral agents licensed for use against HSV inhibit the viral DNA polymerase.
- - Acyclovir can crystallize in the renal parenchyma, causing transient renal insufficiency; this drug should be given over the course of 1 h to a well-hydrated pt.
- - Acyclovir-resistant strains of HSV are rare but have been identified, primarily in immunocompromised pts. In general, these isolates are also resistant to valacyclovir and famciclovir, which have similar mechanisms of action.
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