The Bite That Keeps On Giving! - Page #4

Working Diagnosis:
Final Diagnosis:
Herpes Gladiatorum

Patient was given prophylactic treatment with Clindamycin for a human bite.

No antiviral treatment were given:
The goals in use of antivirals are to
(1) shorten the clinical course
(2) prevent complications
(3) prevent the development of latency and/or subsequent recurrences
(4) decrease transmission
(5) eliminate established latency

Complete resolution in 12 days

Return to play:
Patient wound was re-dressed daily and never stopped practice or play.

Author's Comments:
Herpes Gladiatorum: (HSVI)
Herpes: simplex is an infection caused by a large, double-stranded, linear deoxyribonucleic acid (DNA) virus belonging to the Herpesviridae family
HSV infection manifests with oral or mucocutaneous lesions, which usually present as clusters of painful, erythematous, vesicular lesions. Primary infections are often accompanied by fever, headache, and malaise
The diagnosis is primarily based on the patient's clinical history and physical examination findings but can be confirmed with laboratory tests, including viral culture, immunofluorescence staining, polymerase chain reaction (PCR), and serologic testing
Medical treatment of HSV infections aims to shorten the duration of attacks, decrease symptoms, reduce recurrences, and limit transmissibility of the virus. Medications effective against HSV include nucleoside analogs.

Editor's Comments:
A herpes culture would have been helpful in this case to confirm the diagnosis. The positive IgG anti-HSV titer is evidence of exposure to HSV at some point, but does not pinpoint this infection as HSV. Given the clinical presentation, I would have been inclined to treat with acyclovir or valacyclovir to help shorten the duration of the lesions and hopefully decrease the opportunity for transmission.

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