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처음 발생한 헤르페스 입술 포진에 대한 과거 노출력 확인 위한 혈청검사 - 동대문구 답십리, 전농동, 우리안애 우리안愛 내과

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약 1주일전부터 아랫입술의 점막부위에 농포양상의 수포, 약 3 mm 크기 (아래 예시 사진과 유사)

어제 하나가 작게 추가로 발생

; 주로 발생하는 입술과 피부의 경계는 아니지만 수포성 병변으로 입술헤르페스로 판단할수 있는데...

https://skinsight.com/skin-conditions/orofacial-herpes-simplex-virus-hsv/ 찌릿하거나 이상감각은 수포 발생전에 없었으며, 현재도 쓰리리거나 특별히 증상은 없다. 잇몸이 빨개지고? 첫 증상이며 따라서, 일차 감염력이 불분명하여 상의하여 항체검사를 시행함 (보통 재발의 과거력이 있으며, 임상적(증상/병변의 확인으로) 진단하기에 하지 않는 검사로서, 5년간 처음 시행함) IgM 음성, IgG 양성으로 과거에 감염되어 있다가 재활성화 된것으로 해석할 수 있다.

D654309C HSV IgM Negative (0.85)

Negative < 0.90 Index Equivocal : 0.90-1.09 Index Positive ≥ 1.10 Index-

D654209C HSV Type 1 IgG Positive(1.18)

Negative < 0.60 COI Borderline 0.60-0.99 Positive ≥ 1.00-

By age group, the pooled mean was lowest at 55.5% (n = 37; 95% CI, 47.5%–63.4%) in individuals aged <20 years, followed by 67.9% (n = 48; 62.4%–73.3%) in those aged 20–39 and 87.5% (n = 44; 83.4%–91.1%) in those aged ≥40 years. In meta-regression, age was the major predictor of seroprevalence. 같은 나이대에 항체 보유율은 70%에 육박

It is important to note that HSV-1 infection is frequently asymptomatic (첫 감염시 무증상인 경우가 흔하다). When symptoms do occur, there is a wide range of clinical presentations including orolabial herpes, herpetic sycosis (HSV folliculitis), herpes gladiatorum, herpetic whitlow, ocular HSV infection, herpes encephalitis, Kaposi varicelliform eruption (eczema herpeticum), and severe or chronic HSV-1 infection.

HSV-1 is the most common culprit of orolabial herpes (a small percent of cases are attributed to HSV-2). It is important to note that orolabial HSV-1 infection is most commonly asymptomatic. When there are symptoms, the most common manifestation is the “cold sore” or fever blister. In children, symptomatic orolabial HSV-1 infections often present as gingivostomatitis that leads to pain, halitosis, and dysphagia. In adults, it can present as pharyngitis and a mononucleosis-like syndrome.[17]

Symptoms of a primary orolabial infection occur between three days and one week after the exposure. Patients will often experience a viral prodrome consisting of malaise, anorexia, fevers, tender lymphadenopathy, localized pain, tenderness, burning, or tingling prior to the onset of mucocutaneous lesions. Primary HSV-1 lesions usually occur on the mouth and lips. Patients will then demonstrate painful grouped vesicles on an erythematous base. These vesicles exhibit a characteristic scalloped border. These vesicles may then progress to pustules, erosions, and ulcerations. Within 2 to 6 weeks, the lesions crust over and symptoms resolve.[18]

Although the symptoms can be severe, most primary HSV-1 infections are asymptomatic. Retrospective studies demonstrate that only 20 to 25 percent of patients with HSV-1 antibodies and 10 to 20 percent of those with HSV-2 antibodies have a history of oral-labial or genital infections. Viral shedding can lead to unsuspected transmission to others via contact with secretions or mucous membranes.

1형 HSV항체 양성인 경우 단지 20~25%에서 증상이 있는 감염이 있었던 것으로 보고되고 있다 (무증상 항체 양성자가 많다).

출처; uptodate

Transmission

HSV-1 is mainly transmitted via contact with the virus in sores, saliva or surfaces in or around the mouth. Less commonly, HSV-1 can be transmitted to the genital area through oral-genital contact to cause genital herpes. It can be transmitted from oral or skin surfaces that appear normal; however, the greatest risk of transmission is when there are active sores. 정상으로 보이는 구강점막이나 피부로 전파될 수 있으나 병변이 있을 때가 위험도가 높다. People who already have HSV-1 are not at risk of reinfection, but they are still at risk of acquiring HSV-2.



동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연



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