Pediatric emergency medicine trisk 2339 2339
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The most common symptoms are vesicles on an erythematous base. However,
as the vesicles are friable, unroofed painful ulcers may instead be noted on
examination. Painful regional adenopathy is common, especially with the
primary infection. The virus grows readily in standard viral culture. HSV
identified from genital lesions should be typed; while HSV-1 can be
autoinoculated into the genital region from oral infection, sexual abuse needs to
be considered in prepubertal children with genital HSV-2. PCR assays are also
commercially available. Type-specific antibodies do not enable differentiation of
orolabial and anogenital infections and are plagued with both false-negative (in
early infection) and false-positive results.
Antiviral therapy is recommended for patients with initial and recurrent
genital HSV infection to shorten symptom duration and decrease viral shedding.
There are fewer data on the utility of antiviral therapy for mucocutaneous HSV
in immunocompetent hosts. Acyclovir remains the first-line therapy (20 mg/kg
every 6 hours [maximum: 800 mg/dose] for young children and 400 mg three
times daily for postpubertal patients) for 5 to 7 days. An alternative regimen for
older patients who can swallow pills is valacyclovir (1 g twice daily for 7 to 10
days), which may increase adherence given the less frequent dosing interval.
Topical acyclovir is not recommended for herpes labialis or gingivostomatitis.
Contact precautions are recommended for children with mucocutaneous HSV.
Human Immunodeficiency Virus
CLINICAL PEARLS AND PITFALLS
Acute HIV infection presents as a mononucleosis-type illness;
serologies often are negative, and the diagnosis is contingent upon
PCR.
Knowledge of the child’s CD4+ cell count can allow the clinician to
determine which opportunistic infections (OIs) are most likely.
Antiretroviral therapy has a host of potential adverse events, as well as
multiple potential drug interactions that can result in toxicity.
Current Evidence
It is estimated that there are approximately 11,000 children living with HIV in
the United States and 1.8 million globally. While HIV acquired vertically from
mothers to infants has declined in recent years (approximately 100 cases of
perinatal infection are reported annually in the United States), racial disparities
