Herpes simplex infections of the digits

Recurrent herpes simplex virus type 2 infection of the hand complicated by persistent lymphoedema

A 33-year-old, immunocompetent woman had recurrent herpes simplex virus reactivation of the right hand presenting with a cellulitis-like picture. She continued to have monthly debilitating recrudescences for more than 3 years until an adequate dosage of prophylactic antiviral therapy was achieved. After 2 years of repeated episodes she had chronic dull pain and developed persistent acquired lymphoedema of the left hand and forearm, which is an extremely rare complication. This case highlights the need for herpes simplex infection of the hand to be included in the differential diagnosis of bacterial cellulitis in order for appropriate and prompt therapy to be achieved.

Pediatric herpetic hand infections

Fourteen cases of pediatric herpetic hand infection were admitted over a 15-year period. Five cases were documented by viral culture, four by Tzanck smear; the remainder were diagnosed on clinical grounds. The natural history of herpetic hand infections is similar in adult and pediatric populations. Adult infections are most frequently found in medical and dental personnel; pediatric infections are most common in children between 5 months and 6 years of age. Whereas adult infections are usually the result of exogenous occupational or sexual exposure, 11 (80%) of 14 pediatric cases exhibited coexistent oral lesions. Treatment in all cases is nonsurgical; resolution is complete within 3 to 4 weeks. Antibiotics are indicated only in the advent of bacterial superinfection.

Herpes simplex virus infection of the hand

The first episode of herpes simplex virus (HSV) infection of the hand can occur in association with infection at another site, such as primary HSV-1 gingivostomatitis. Autoinoculation is the likely route of transmission. The attacks are usually solitary and last about 14 days. A first episode that results from exogenous inoculation may be severely inflammatory and may last up to 28 days. The majority of cases are recurrent infections and most often occur in adults with HSV-2 infection.

Herpetic Whitlow of the Digits

Herpes simplex viral infection of the digits, also known as herpetic whitlow, is a rather common hand problem encountered in dental and medical personnel. Treatment is controversial. This report summarises the author’s successful experience in a series of ten patients using a non-operative local care technique, supplemented when indicated by a systemic antiviral agent.

Herpes simplex virus infection of the hand. A profile of 79 cases

Seventy-nine cases of herpes simplex (HSV) infection of the hand were documented by viral culture over a 40-month period. A marked bimodal age distribution was found with 32 cases occurring in adults aged 21 to 30 years and 16 occurring in children less than 10 years old. The infection most commonly occurred on the fingers (69 percent) and thumb (21 percent). All 20 herpes simplex type 2 (HSV-2) isolates came from patients over 20 years old. All of the 13 specimens that were typed after isolation from patients under 20 years old were herpes simplex type 1 (HSV-1). Only seven of the 49 adult cases were identified in health care professionals. In this series, HSV infection of the hand occurred in 2.4 cases per 100,000 population per year. In adults, women with recurrent infections from HSV-2 and a history compatible with genital herpes predominated. In children, a primary HSV-1 infection associated with gingivostomatitis was common.

Autoinoculation herpes of the hand in a child with recurrent herpes labialis

Herpes simplex virus infections involving the fingers and hands have been reported primarily in medical and dental personnel. A 10-year-old boy is described who presented with herpes simplex virus infection of his left hand two weeks after resolution of an episode of recurrent herpes labialis. Since herpes simplex infections of the fingers and hands may be confused with a variety of other more common conditions, clinicians should be alert to this possibility when diagnosing vesiculopustular lesions of the hands, particularly in medical and dental personnel and in patients with histories of recurrent herpes simplex infections elsewhere. A need for greater patient awareness of the potential for herpes simplex virus autoinoculation is also stressed.

Herpetic whitlow: an occupational disease of practicing dentists

Recurrent herpes simplex virus lesions of fingers, hand, or eyes are suspected to be encountered in health practitioners in greater frequency than in the general population. To determine whether an increased risk of disease contraction coincident to practicing dentistry exists and to determine the magnitude of risk, a survey of dentists practicing in the state of Michigan was conducted. An age and sex matched nondentist patient from each respondent's practice provided a control population. Frequency of herpes labialis and herpes infection of the eye were found be lower in dentists than in the control population. Conversely, herpetic whitlow was found to be more frequent in practicing dentists than in the control population. If the occurrence of herpes labialis in each of the two groups is taken as the reference point, the frequency of herpetic whitlow is significantly higher among practicing dentists than among the control population (P less than .01).

Herpetic whitlow

Three patients with herpetic whitlow are presented. Virus typing revealed herpes simplex virus type 1 in two and type 2 in one of the cases. There is a high risk of infection among medical personnel.

Herpetic whitlow: herpetic infections of the digits

Ten cases of herpes simplex infections of a digit were observed during a 3 year period. The diagnosis was confirmed in seven cases by culture or tests of serum antibodies. In three cases the clinical characteristics were sufficient to suggest the diagnosis. Medical and dental personnel are particularly prone to develop this affliction; their occupations are a frequent clue to the diagnosis. Nonsurgical treatment of this self-limited entity is recommended.

Primary and recurrent herpetic whitlow

Herpetic whitlow has been reported as a cross-infection among personnel working in clinics or hospitals. Vesicles or bullae suggest the diagnosis; confirmation is by virus isolation. Eight cases in medical personnel whose duties included contact with the oral cavity of infected patients were seen within a period of 3 years. The disease started as a paronychia in 3 instances, but involvement of the pulp space was the rule. Radiating pain along the C7 distribution was noted in 4 patients. Numbness and hypoesthesia following the acute episode were observed in one patient. Two individuals suffered recurrent attacks of herpetic whitlow at the same site.