There are many diseases by viruses and far too many to begin to cover them all. Our discussion will relate only to a few diseases which are similar to Herpes and sometimes confused with it. All the diseases which I shall mention have the common factor of being caused by viruses (or thought to be so caused) and to have a latent phase in which nothing seems to happen except the virus particles drowse in nerve tissues. Some of the problems are often so mild that they do not even let the person who has the disease know that a sickness has occurred. Others of this group can cause death. Examples of these diseases are Herpes zoster (“shingles”), infectious mononucleosis, poliomyelitis, and cytomegalo virus disease.
HERPES ZOSTER (“SHINGLES”)
Herpes zoster is often confused with Herpes genitalis and labialis because of its unfortunate name, but it is an entirely separate disease. Shingles is caused by a virus called varicella. (Sometimes it is called the varicella-zoster virus.) It is entirely different from the herpes simplex hominus virus. However, the confusion is intensified by the similarity in the symptoms and findings.
The signiﬁcance of Herpes zoster is that it usually occurs in age groups considerably older than those of Herpes simplex virus disease. In persons of more advanced years, the condition can be a devastating source of continuing distress. Though it is ordinarily seen in those of mature years, this is not always the case. I had the disease while I was in undergraduate university. The recovery time in younger patients is often much shorter than in the elderly.
Shingles is characterized by an area of localized pain and eruption along the skin distribution of sensory nerves. The virus that causes shingles also causes chicken pox. Like Herpes, the virus enters the body and hides in nerve tissue, but this time the hiding place is inside the sensory nerve roots that emerge from the spinal cord. The virions embed themselves in the those nerve cells. Eventually some trigger may cause the virions to begin to replicate and, in turn, the nerve ﬁlaments. The endings of those nerves (where they supply the skin surface) begin to pain an eventually to blister. Extremely localized areas of body are then involved.
The rash is often preceded by two or three days of fever and a burning of the skin. This sensation is not unlike the burning feeling of severe and localized sunburn. Next small red blister appear. These vesicles at ﬁrst contain clear ﬂuid which soon turns to a turbid milky appearance. In about ﬁve to ten days the vesicles begin to dry. However, in some persons the healing is delayed and the blisters join together. This coalescence forms large, painful, and inflamed areas.
The pain is often severe, particularly in people of more mature years. In the elderly, it often transpires that the healing process is slow and the lesions persist for months or even become permanent. This type of problem occurs when there is stimulation of the exquisitely sensitive nerve endings, those tiny nerve ﬁlaments which terminate in our skin surface and supply to our brain the most important information that something is wrong. When the nerve ﬁlaments, called neurons, are continuously irritated by the virus, permanent scarring may occur. Unfortunately, there is no medication that will heal permanently damaged sensory nerve endings. Unalterable pain often results. Occasionally surgery is advised for the interruption of the nerve tracts which supply the affected areas.
The area of the trunk is the most frequent site of the lesions
About ﬁfteen percent of the blisters of the disease occur on the scalp and face.
Two “common knowledge” bits of information about Herpes zoster are false. One is that “If the sores wrap completely around you, you will die.” You won’t. Even such a symptom is rare. IN thirty years of medical practice I have never seen such a case.
The other is that shingles renders a person immune to further attacks of shingles. It doesn’t. But the chance of getting it again is no greater than it was before the first attack. IN this way the disease differs dramatically from that of Herpes simplex.
Another curious fact is that children can be infected with chicken pox from someone having Herpes zoster, and older people apparently may become infected with zoster by contacting children with chicken pox. However, there does not appear to be much transmission of shingles between adults.
It cannot be stressed strongly enough that grandparents and others who have shingles must not contact children and especially infants who have never had chicken pox.
A severe complication of the disease of chicken pox is that which occurs when a mother contracts the disease during her pregnancy. Herpes zoster may be a life complicating condition of the baby when it is born.
INFECTIOUS MONONUCLEOSlS (“THE KISSING DISEASE”)
Like Herpes virus disease, mono is usually a problem of younger people. The cause is probably a Herpes-like virus, but this has not been absolutely proven. The disease is probably transferred from one individual to an a other in a manner similar to the Herpes virus: on drinking glasses, by kissing someone who is infected, using someone else’s toothbrush, razor, or cosmetics. It can be easily transferred to another person by smoking a cigarette someone else has lit—or passing a roach of marijuana from person to person. Borrowing a friend’s stick is a particularly bad idea. This advice holds true Herpes as well as mono.
This disease is characterized by headache, sore throat, enlarged lymph nodes, and fatigue. Severe involvement may cause a transient generalized rash, enlargement of the spleen, and tenderness of the liver. Diagnosis is made by the clinical picture with confirmation by the laboratory. Lymphocytes that have normal shape are found in blood specimens and also speciﬁc blood test may be positive.
Mono usually is a benign disease and the patient covers completely without treatment except for rest and care of the symptoms.
CYTOMEGALIC INCLUSION DISEASE
This condition is a virus disease that may occur congenitally and later in life. It is characterized by changes in infected cells. These cells enlarge and contain a prominent inclusion body, a structure which is often temporary and is seen as a constituent of the cytoplasm of the cell. In this disease, the ﬁnding of the inclusions seems to be diagnostic of the problem.
The congenital infection is manifest by fever, inflammation of the liver (hepatitis), jaundice or a yellow tinge to the skin, and purpura, a hemorrhagic state which is characterized by patches of purplish discoloration caused by local bleeding into the tissues and mucous membrane.
The postnatal-acquired infection often is asymptomatic but it may produce many of the same symptoms seen in the newborn. The human cyytomegaloviruses are related to the Herpes viruses in the way they react in the laboratory and by their liking for a long latent period in their attack upon humans Some of these ubiquitous viruses may cause the host to secrete virus in the urine or saliva for months. The ‘in virus may be cultured from the cervix and human milk. Contact with fresh blood from individual that do not appear to be infected may produce the disease in susceptible individuals.