In the immunocompromised host, HSV is capable of causing local infection, characterized by extensive local involvement (e.g., eczema herpeticum) or chronic herpetic ulcers, or widespread systemic infection, characterized by widespread mucocutaneous vesicles, pustules, erosions, and ulcerations, associated with signs of pneumonia, encephalitis, hepatitis, as well as involvement of other organ systems, usually occurring in an immunocompromised host. (See also Nongenital Herpes Simplex Virus Infection, above; Sexually Transmitted Diseases: Herpes Simplex Virus: Genital Infections.
Causes
60 to 80% of HSV-seropositive transplant recipients and patients undergoing chemotherapy for hematologic malignancies will experience reactivation of HSV. After viremia, disseminated cutaneous or visceral HSV infection may occur. Factors determining whether severe localized disease, cutaneous dissemination, or visceral dissemination will occur are not well defined.
Diagnosis
Clinical suspicion confirmed by Tzanck smear, positive HSV antigen detection, or isolation of HSV on viral culture.
Treatment
Systemic Antiviral Therapy See Herpes Simplex Virus Infection.
Prevention
Acyclovir prophylaxis for seropositive patients undergoing bone marrow transplantation. induction therapy for leukemia, or solid organ transplantation: acyclovir, 5 mg/kg IV q8h or 400 mg PO tid, from the day of conditioning, induction, or transplantation for 4 to 6 weeks suppresses both HSV and VZV reactivation.
References