Herpesvirus infections in children: modern treatment options

Types of herpes in children

It is worth distinguishing between herpes simplex viruses type 1. This is the most well-known type of herpes simplex virus, which appears on a child's lip and is characterized by a general malaise, sometimes with a slight fever. Oral ulcers are most common in children aged 1-2 years, but they can appear in people as young as at any age and at any time of the year.

A crust on the lip of a child with herpes. Photo: victoriafly / freepik.com

The second type of herpes is genital, which manifests itself in a similar way. During childbirth, if the mother suffers from genital herpes, the baby may become infected as it passes through the birth canal. The manifestations of this type of herpes in children are more complex than in adults. Children may suffer from herpetic sore throat and stomatitis.

Herpes virus type 3 (varicella zoster virus) in children during primary infection causes chickenpox; in the secondary manifestation of the virus, the disease occurs as herpes zoster (shingles).

Chickenpox. Photo: freepik.com

Herpes type 6 in children causes roseola infantile, a pink maculopapular rash. It mainly affects children under the age of 2 years. First, a fever develops, then the temperature decreases within 3-6 days. After the temperature drops, an exanthema appears on the skin - pink maculopapular rashes 1-3 mm in size, turning pale when pressed (this is one of the distinctive signs; for the same rubella, the rash does not turn pale after pressure). They may disappear within a few hours or may persist for up to several days. The rash is localized mainly on the body, spreading to the neck, face and limbs

Infantile roseola. Photo: (Public Domain)

Herpetic viruses of types 4, 5, 6 can cause infectious mononucleosis - an acute infectious disease characterized by fever, sore throat, enlarged lymph nodes, liver and spleen, lymphocytosis, and the appearance of atypical mononuclear cells in the peripheral blood.

Cytomegalovirus, a member of the herpesvirus type 6 family, is one of the most common viruses. Children usually become infected with cytomegalovirus infection in early childhood, for example, in a nursery or kindergarten. Transmission of cytomegalovirus can only occur through direct contact with an infected person. In addition, children can be infected with the virus during fetal development. The infected environment is blood, urine, saliva and other biological substrates. Typically, cytomegalovirus in healthy children is asymptomatic or accompanied by minor symptoms similar to those of mononucleosis and disappearing after a few days or weeks.

Enlarged lymph nodes in the neck of a child with infectious mononucleosis. Photo: GMS current topics in otorhinolaryngology, head and neck surgery / Open-i (CC BY-NC-ND 3.0)

Human herpesvirus type 6 and type 7 during primary infection causes neonatal exanthema in infants. Only a specialist can accurately diagnose a child’s health condition.

Causes of herpes

All variants of herpes infection occur against the background of the activity of the virus of the same name of different types. Since upon initial penetration into the human body the pathogen no longer leaves it, it is important to know the factors that can provoke the activation of the disease:

• hypothermia;
• seasonal colds;
• any conditions that provoke a decrease in immune defense (poor nutrition, hypovitaminosis and others);
• exacerbation of chronic somatic diseases;
• contact with an infected patient.

The virus is transmitted by airborne droplets, so it is extremely difficult to completely prevent a child from encountering pathogenic particles.

Herpes in infants

Herpes in children can be more complex than in adults. Herpes is an insidious infection; herpes in an infant can cause severe damage to the nervous system and internal organs. When the visual organs are damaged, keratitis, phlebothrombosis, chorioretinitis, and iridocyclitis occur. If the ENT organs are damaged, sudden deafness, herpetic sore throat and damage to the inner ear may occur. Damage to the cardiovascular system manifests itself in the form of myocarditis, atherosclerosis and myocardiopathy. If the herpes virus penetrates the central nervous system, there is a risk of encephalopathy, meningitis, and nerve plexuses are affected. Herpes can also lead to schizophrenia and depressive disorders. On the part of the reproductive system, reproductive function, urethritis, prostatitis (in men), colpitis, endometritis and chorionitis (in women) are possible.

Cold

The first symptoms of a cold most often manifest themselves in the form of a sore and sore throat, nasal congestion, runny nose, sneezing, and cough. They usually occur 2–3 days after exposure to a virus (usually rhinovirus). The child may look lethargic, complain of increased fatigue, headaches and muscle pain, eat poorly or refuse to eat at all, and have a fever.

There is no specific treatment for colds (there are no proven effective drugs). To relieve headaches, muscle pain, and reduce high fever, the child can be given paracetamol or ibuprofen (children over 3 months).

Attention: aspirin should not be given to children! The dosage of such medications should be recommended by a doctor. Always follow the instructions for the drug if a quick consultation with a pediatrician is not possible.

There is no evidence that over-the-counter antihistamines and decongestants (decongestants) provide relief in children under 6 years of age. Moreover, medications containing decongestants can cause unwanted side effects in young children, ranging from increased excitability and hallucinations to abnormal heart rates, especially in infants.

It is very important that during illness the child drinks a lot (the best option is clean drinking water, but you can offer what he likes best - juices, compotes). Ventilate the room regularly, use a humidifier, and rinse the child's nose with saline solution. Children over 1 year of age can be given honey (no more than half a teaspoon); rubbing the chest with menthol ointments to relieve cough is not recommended for children under 2 years of age. Cough lozenges or tablets are recommended for children over 4 years of age; a small child may choke on them. Do not use multi-ingredient over-the-counter cold and cough medicines if your child is under 6 years of age. They are ineffective and can cause serious side effects. The use of such drugs is questionable in principle, but it is also important to understand that they may contain paracetamol and lead to an overdose if you have already given it to a child.

For colds in children, the use of alternative treatments (echinacea, etc.), increased doses of zinc or vitamin C has been proven ineffective. They do not relieve or reduce symptoms and can cause severe side effects in young children.

If your child's condition does not improve after 3 days from the onset of symptoms, make an appointment with your pediatrician. An examination is necessary to exclude other diseases (streptococcal infection, sinusitis, bronchitis, pneumonia) and prescribe adequate treatment.

See your doctor immediately if you have the following symptoms: cough with a lot of mucus, difficulty breathing, severe weakness, vomiting, dehydration, severe sore throat, fever of 39 °C or more, fever for 24 hours or longer, abdominal pain, pain in the ears, enlarged cervical lymph nodes.

Herpes symptoms

Symptoms of herpes in children are traditional: there may be fever, fatigue, muscle pain, and irritability. Pain, burning, tingling and itching occur at the site of future infection rashes. The rash is accompanied by subsequent ulceration and the formation of wounds. Children tend to scratch wounds until they bleed, constantly touch them, and tear off the crusts that have formed, which complicates healing and prolongs its duration. At best, simple herpes on a child's lip heals within a few days. Ulcers can also occur in the mouth: on the gums, the front of the tongue, the inside of the cheeks, the throat and the roof of the mouth. The gums may be slightly swollen, red, and may bleed. They may also spread down the chin and neck. The lymph nodes in the neck often become swollen and painful. In children, the herpes virus can infect the mucous membrane of the throat with the formation of small ulcers and a grayish coating on the tonsils. Because the ulcers are painful, it may be difficult to eat or drink. A sick child should not eat solid or hot foods during the period of oral herpes. If the wound is constantly injured, healing may take two weeks or more. Parents need to control this process.

Treatment

If herpes is detected in a child, the following treatment is prescribed. These are antiviral drugs (tablets and ointments), immunostimulants, and interferons are also prescribed. The method of use - tablets, ointments or even injections - is determined exclusively by the attending physician. The dosage is prescribed individually for each little patient. Self-medication in this case is extremely dangerous and can lead to tragic consequences. You must strictly follow all doctor's instructions to avoid further complications.

Let's talk in detail about medications that can be prescribed to infants:

• drugs to suppress infection;
• immunomodulators and immunostimulants;
• antipyretics and pain relievers (suppositories, suspensions);
• antihistamines;
• antiseptics;
• antibacterial agents if microbial infections have joined the virus;
• To heal and dry wounds and ulcers on the body, brilliant green and sulfur-based ointments are prescribed.

Also, if a child has symptoms such as convulsions due to herpes, then anticonvulsant medications are prescribed. To relieve itching on a child's skin, decoctions of medicinal herbs are used. This is chamomile, calendula. You can also use rosehip oil, etc. Such products will not only remove discomfort on the skin where there is a rash, but will also help the wounds heal faster and relieve inflammation.

The baby needs to drink plenty of fluids. If a mother feeds her baby with breast milk, then she needs a balanced and proper diet. You should consume foods rich in vitamins and microelements. As auxiliary measures, isolation of the newborn from contact with strangers and maintaining the personal hygiene of mother and baby at a high level are used. Care must also be taken to ensure that the baby does not scratch the affected areas. To do this, use clothes that cover the baby's fingers. It is sold in special stores for newborns. They also use so-called scratch pads, hand pads, etc.

Treatment of herpes in children

To treat herpes infection, antiviral drugs, immunostimulants, and interferons are used. Treatment of infection must begin at the first suspicion of the disease, recovery depends on this, advanced infection becomes chronic or recurrent, and the likelihood of complications increases. Treatment of herpes in children is aimed at minimizing the manifestation of symptoms and suppressing the activity of the virus. For this purpose, antiviral drugs are used - ointments and tablets that relieve itching and pain. It is necessary to take large amounts of fluid, as well as antipyretics when body temperature rises to high levels.

Photo: MedPortal

An antiviral drug used for herpes infection is acyclovir. This drug can be used either as an intravenous injection or as tablets. The method of administration of the drug depends on the severity of the disease and its form. The drug is administered intravenously at a dosage of 30-60 mg/kg of the child’s body weight, orally – 90 mg/kg. Taking the drug should be divided into 3-4 parts. This drug can also be used externally in the form of an ointment. It must be applied to the affected areas of the skin and mucous membranes 4-5 times a day.

Immunostimulating drugs help the child’s body fight the virus more effectively and prevent the virus from infecting new areas of the mucous membranes and internal organs. For treatment, you can use immunostimulating drugs such as Immunal, Groprinosin, Arpetol.

Interferons help destroy viruses and prevent them from multiplying uncontrollably. They can be used both in tablet form and in the form of suppositories. Suppositories are inserted into the child's anus 2 times a day for 5 days, the course is repeated 2-3 times with a break of 5 days.

If the disease recurs quite often, you need to contact an immunologist who will give qualified advice that can significantly increase the immunity of a weakened child. Among other things, treatment of herpes in children should be supervised by a doctor, since only a specialist can calculate the correct dosage that is safe for the child’s body.

The herpes virus, once in a child’s body, remains in it for life, periodically exacerbating, causing temporary discomfort. The main task of parents is to help the child, strictly following the instructions of the pediatrician. When solving an existing problem, special attention is paid to maintaining hygiene and providing the baby with individual means, such as a towel, soap, and a washcloth. The child should wash his hands more often. If there is herpes in the mouth, the child should not be allowed to injure herpes sores.

Diagnosis of herpes

"SM-Doctor" is a multidisciplinary clinic specializing in providing high-quality medical services to children of any age. Diagnosis of herpetic infections in our center is carried out according to the standards used in leading clinics in Europe and the world. Our specialists establish a preliminary diagnosis at the stage of the initial examination of the child. Depending on the severity of the clinical picture, the necessary auxiliary diagnostic procedures are selected:

• a set of standard laboratory tests (general blood test, urine test, blood “biochemistry”, etc.);
• specific serological tests (ELISA) to detect antibodies to a specific type of virus in the patient’s blood;
• Polymerase chain reaction (PCR) is a highly informative diagnostic method that allows you to detect the presence of a virus in a child’s body with up to 99% accuracy.

"SM-Doctor" is a multidisciplinary center. Thanks to this, if necessary (for example, if complications develop), our patients can be examined by a wide range of specialists in different fields. If the attending physician, in addition to infection, suspects a pathology of internal organs and systems, he refers the sick child for consultation with a cardiorheumatologist, ophthalmologist, neurologist and others. In a short period of time, the child receives a full range of diagnostic services aimed at identifying any abnormalities in the functioning of the body.

Sources

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Flu

An annual flu vaccination is the most reliable way to prevent severe disease and complications (otitis media, pneumonia) of the disease.

Vaccination of children against influenza is permitted from the age of six months.

Influenza is an acute respiratory viral disease caused by influenza viruses (usually types A or B; type C rarely causes serious symptoms). It is very easily transmitted from person to person, as confirmed by annual epidemics of the disease. People with the flu are most contagious in the 24 hours before symptoms appear and until symptoms subside (about a week).

The flu can be confused with a cold, but most often it is more severe. Symptoms - fever, chills, headache and muscle pain, runny nose, sore throat, cough, ear pain, loss of appetite, weakness, nausea, vomiting, diarrhea - appear approximately 2 days after exposure to the virus.

Most children with the flu recover at home, but if the disease is severe or has complications, they will need hospital treatment.

There are no effective cures for the flu; it is necessary to ensure that the child drinks plenty of fluids and is not dehydrated, gets plenty of rest and sleep; in general, the same tactics are followed here as with any ARVI. To relieve flu symptoms (reduce fever and reduce pain), you can use paracetamol or ibuprofen, rinse your nose with saline solution (for infants, saline solution is dripped into the nose, an aspirator is used to remove nasal discharge), and monitor the level of humidity in the room.

Important: antibiotics are not used to treat influenza and other acute respiratory viral infections.

Seek immediate medical attention if symptoms worsen, severe cough, difficulty breathing, fever in children under 3 months of age that lasts longer than 3 days, headache that does not go away with paracetamol or ibuprofen, stiff neck ( meningeal symptom).

More details

Flu

Herpes aphthous stomatitis

In children under 5 years of age, herpes simplex can affect the mouth, gums, and tongue (herpes aphthous stomatitis). In this condition, the mucous membrane of the oral cavity turns red, swells, the child begins to drool, small superficial ulcerations (aphthae) appear once within 1–2 days - single or grouped, the child becomes irritable, his gums swell, he complains of pain, loses appetite. The temperature usually rises (can reach 40°C) 1-2 days before the above symptoms.

After 3–14 days from the onset of symptoms, the child’s condition returns to normal, the temperature decreases, aphthae heal, inflammation and pain decrease, and appetite appears. With a more severe course, a repeated increase in temperature, aphthae may appear again, and the cervical and submandibular lymph nodes become enlarged. Recovery in this case may take up to 10 days. A complication of herpes aphthous stomatitis can be the transition of the disease to a recurrent form. The addition of a bacterial infection can cause otitis media, bronchitis or pneumonia.

Treatment of herpes aphthous stomatitis is aimed at eliminating symptoms (lowering temperature, pain relief with paracetamol or ibuprofen, drinking plenty of fluids, rest). Rinsing with aseptic solutions, the use of local anesthetics, antiviral ointments for treating aphthae (acyclovir), steroids in the form of gels and pastes are prescribed. Local treatment with lidocaine-based anesthetic ointments should not be administered to young children.

Infectious mononucleosis

Another disease of viral etiology with severe “cold” symptoms. The main causative agent of infectious mononucleosis is the Epstein-Barr virus (rarely other viruses). The infection spreads through saliva.

The disease is typical for adolescents and young adults (the so-called “kissing disease”), but young children can also become infected with infectious mononucleosis through contact with objects touched by an infected person (for example, through dishes). Most adults already have antibodies to IM because they have been exposed to the infection, so they are immune and do not get sick. In people with a weakened immune system due to concomitant pathologies or organ transplantation, MI can cause serious complications and other diseases (anemia, meningitis, encephalitis, myocarditis, etc.).

Symptoms of MI appear approximately 4–6 weeks after infection and may develop slowly and not all at the same time. They include severe sore throat, weakness, fatigue, fever, loss of appetite, enlarged neck and axillary lymph nodes, inflammation of the tonsils with white plaque, headache, muscle pain, skin rashes, abdominal pain, enlarged spleen or liver.

Most patients recover within 2–4 weeks of onset of symptoms, but some continue to experience symptoms of MI (eg, fatigue, enlarged lymph nodes, splenomegaly, hepatomegaly) for several weeks or even months.

The disease is diagnosed based on symptoms, their duration and specificity, as well as a physical examination. A blood test for antibodies to the Epstein-Barr virus and a general blood test to determine the level of leukocytes (prescribed if necessary) help confirm the diagnosis.

The symptoms of MI are quite unpleasant and cause significant discomfort to the patient, but the disease goes away on its own, without treatment or any consequences. Drinking plenty of fluids, rest and a healthy diet are recommended. To relieve symptoms (sore throat, headache, muscle pain, fever), it is recommended to use paracetamol or ibuprofen, or gargle with salt water. The addition of a secondary infection (streptococcal, for example) requires the use of antibacterial drugs. If the airways are severely narrowed and there is difficulty breathing, corticosteroids may be prescribed. To reduce the risk of rupture of the capsule of an enlarged spleen or liver, it is recommended to avoid exercise, heavy lifting, and contact sports for at least a month, or until the liver and spleen return to normal size.