Herpes infection is caused by viruses of the Herpesviridae group and is characterized by damage to the skin, mucous membranes, eyes, and nervous system. In 1999, WHO declared a pandemic of herpesvirus infections, which emphasizes the medical and social significance of this problem in the world. The high incidence of herpesvirus infections, according to experts, will determine the future of infectious pathology in the foreseeable future. Susceptibility to infection does not depend on age or gender. All types of herpes can cause severe illness in adults and children. Herpes viruses can infect various human organs and systems, so herpes can be considered as a general systemic disease of the body.
- Types of herpes viruses
- Severe consequences of HSV infection
- Effect on the nervous system
- Psycho-emotional state during relapses of herpes
- The role of immunity in the occurrence of HSV relapses
- Systemic disease
- What is the treatment like?
- Treatment protocols of the Ministry of Health of the Russian Federation
Types of herpes viruses
In the modern world, people already understand that a “cold” on the lips is far from the only “harmless” manifestation of a herpetic infection. In order to better understand the problem, let’s clarify how many types of herpes there are. Eight serotypes are known to science today. These are herpes simplex viruses (HSV) types 1 and 2, Varicella Zoster virus (causes chickenpox and shingles), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpes viruses 6, 7- 1st and 8th types. 1
Chicken pox. Caused by herpes virus type 3, transmitted by airborne droplets. Symptoms of chickenpox: moderate fever and intoxication, rashes on the skin and mucous membranes in the form of papules. The disease is extremely contagious. Susceptibility to chickenpox is almost absolute, which causes a high incidence in childhood, after which strong immunity remains. Despite acquired immunity, the virus is present in the body for life in a latent state in the nerve ganglia. When the body weakens, even after many years, its activation may occur in the form of herpes zoster. In a typical mild form, the general condition of those infected is satisfactory, while in a moderate condition, the temperature rises to 38.5-39ºC and there is a profuse rash. The rash period is 4-5 days, sometimes longer. In severe cases, the patient's general condition is significantly impaired. In extreme heat up to 39.5-40ºC, the symptoms of intoxication are pronounced - headache, weakness, irritability, sleep disturbances, lack of appetite, vomiting and loose stools are possible.
Infectious mononucleosis is caused by the Epstein-Barr virus, also known as herpes virus type 4. The disease mainly affects children and can be both a cause and a consequence of decreased immunity. Chronic infection caused by the Epstein-Barr virus is characterized by a long, relapsing course and the presence of clinical and laboratory signs of viral activity. The disease can present with a variety of symptoms ranging from weakness and fatigue, body aches to rashes and cough, dizziness, depression and asthenia. At the peak of infection, the temperature rises. Epstein-Barr virus can lead to the development of the following diseases:
– Filatov’s disease (infectious mononucleosis);
– Hodgkin's disease (lymphogranulomatosis);
– damage to the lymph nodes,
– formation of neoplasms;
– immune deficiency;
– systemic hepatitis;
– damage to the brain and spinal cord (multiple sclerosis) and others.
Herpes simplex in adults (HS). The cause of the disease is infection with HSV-1 or HSV-2. The disease manifests itself as an itchy rash in the form of grouped or single blisters ranging in size from one to several millimeters on the skin and/or mucous membranes, accompanied by swelling and redness. In severe cases, the infection can affect internal organs. The disease becomes chronic and can recur. These viruses remain in the body forever, sometimes coexisting with other members of the group.
Once on the mucous membrane or in the upper respiratory tract, the virus actively multiplies. Infection occurs when biological fluids containing the virus come into contact with mucous membranes, for example during intimate contact, through kissing, or through dirty hands. It is possible to transfer the virus from a herpetic lesion to other places, for example, from the oral cavity to the conjunctiva of the eye, to the genital area, to any part of the body through microdamage to the skin. There is a small chance that the virus can be transmitted through the air through saliva.
Symptoms
Herpetic lesions of the trigeminal nerve are characterized by sudden symptoms. The main sign of the presence of the disease is persistent, persistent pain at the site of the herpetic lesion. Pain may be:
- spicy;
- burning;
- pulsating;
- aching;
- shooting.
Which doctor treats herpes
Herpes is a contagious disease of viral etiology, manifesting itself in the form of painful blistering rashes of various locations.
The sensitivity of the area that was affected by shingles may significantly increase or, conversely, decrease. Allodynia begins to develop when pain makes itself felt in situations that did not cause it before. For example:
- while dressing;
- in the presence of a draft;
- when touched;
- while combing.
A few days after being infected with the virus, the following symptoms appear:
- severe throbbing headaches
- body aches
- elevated temperature;
- general weakness of the body;
- pain on the face.
In most cases, this condition is regarded by patients as the development of a viral disease. However, after a few more days, new signs of the pathological condition begin to make themselves felt. These include:
- itching in the temporal region and behind the ears;
- swelling of one half of the face;
- increased headaches ;
- rashes on the mucous membranes and in the trigeminal nerve area.
The spread of the rash is observed over 7-14 days. After this, the bubbles dry out, their surface becomes covered with a crust, which subsequently disappears on its own.
Severe consequences of HSV infection
Along with common manifestations of infection on the lips, mouth, nose, face, buttocks and genitals, herpes can affect internal organs, meninges, nerves, causing such severe conditions as meningitis, encephalitis, neuritis, meningoencephaloradiculitis, cause bronchitis, pneumonia , damage to lymphocompetent organs: liver, spleen, pancreas and even sepsis. Some of the criteria for infectious encephalitis - inflammation of the brain - are disturbances in the mental or mental status of the patient, fever, convulsions, neurological symptoms, and changes in the ECG.
How does herpes affect the nervous system?
Each type of herpes virus is associated with certain lesions of the nervous system: HSV-1 with meningoencephalitis, Varicella-Zoster - most often causes uncomplicated herpetic meningitis, it is very tropic to the cerebellum, so post-varicella complications (cerebellitis) may occur in children. Herpesviridae viruses carry out their activity in epithelial cells and nerve cells. Through the blood and lymph flow, HSV spreads throughout the body. In a short period of time (about three hours), the virus penetrates the nerve ganglia, where it remains in a latent state. HSV-1, which mainly affects the mucous membrane of the oral cavity, nasopharynx, lips, is constantly located in the vascular endothelium, vascular nerve bundles, sensory ganglia of the trigeminal nerve and other cranial nerves. HSV-2, which causes predominantly damage to the genitals, perineum, anal area, lower extremities, and buttocks, “lives” in the ganglia of the lumbosacral spine. HSV-1 can spread along the optic and olfactory nerves and subsequently penetrate into the central nervous system. In the nerve ganglia, the virus becomes inaccessible to the cells responsible for protecting the body from aggressors. Since the virus is able to spread from an infected cell to neighboring ones, bypassing the intercellular space, it avoids contact with antiviral antibodies. In the acute stage, the virus leaves the cell it destroys and passes into the blood, where it becomes available to phagocytes. In addition to affecting the nervous system, herpesvirus infections cause an imbalance in the interferon system and inhibit the cellular and phagocytic reactions of the body. It is believed that herpes indirectly has a negative effect on the state of the cardiovascular system, provoking the formation of plaques and blood clots due to damage to the vascular walls and the production of more cholesterol.
The role of immunity in the occurrence of HSV relapses
Cellular immunity plays an important role in the development of the disease. Exacerbations may be associated with a decrease in local immunity during operations, injuries, sexual contact with damage to the mucous membrane, the use of certain drugs, intensive facial treatment during cosmetic anti-aging procedures, sunburn, and so on. A significant role in the pathogenesis of herpes is played by deficiency of interferons, the level of which can be reduced by ten to twenty times compared to normal.iii. According to the results of studies, a decrease in the production of interferons was noted in the foci of herpetic lesions themselves. Allergy sufferers usually have a more severe infection.
Diagnostics
The pathology is quite painful and can result in such unpleasant consequences as distortion of facial features. Therefore, it is extremely important to carry out timely diagnostics to identify the disease and promptly begin to take measures to eliminate it.
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To examine the inflammatory process of the trigeminal nerve, you need to consult a neurologist. The diagnosis is made based on the results of the studies, the manifestation of symptomatic signs and palpation of the affected facial area.
Magnetic resonance imaging has also been widely used to detect the disease. This method allows you to determine the root cause of the disease: compression of the sciatic nerve, the presence of tumors, sclerosis.
Only on the basis of all the research results obtained can a specialist make a final diagnosis and select effective methods of therapy.
Systemic disease
Recently, there has been an increase in herpes-associated diseases. It is worth noting that this is not only a skin disease - a herpes infection is a systemic disease of the body. Radiculitis associated with herpetic lesions of the nervous structures of the lumbar and sacral spine can worsen after colds and/or hypothermia. The pain can radiate to the legs, buttocks, and perineum. Viral etiology is confirmed by the fact that in addition to severe, long-term pain in the lumbar region, sacrum, and buttocks, patients develop characteristic herpetic rashes. HSV can be one of the causes of facial paralysis and inflammation of the trigeminal nerve. According to experts, hypothermia activates the virus, which is dormant in the ganglia of the trigeminal nerve.iv
Isolation and identification of HSV
In specialized virology laboratories, HSV is isolated using the culture method. Its essence lies in the fact that the material for research (the contents of herpetic eruptions, human secretions) is placed on specially grown cells in which the virus begins to multiply. Then, after 5 days, the presence of HSV is determined by characteristic changes. Thus, we can say for sure that this disease is of a herpetic nature.
To identify the causative agent of HSV, the polymerase chain reaction (PCR) method is widely used, which makes it possible to find out what type of herpes virus is present in the body. The material for research is taken with a special brush from the rash sites. The PNR method is highly sensitive and is performed within 24–48 hours.
What is the treatment like?
The goals that need to be addressed through therapy are: suppressing the replication of the virus, reducing symptoms and pain, shortening the period of illness, and preventing the development of complications. Since herpes is a recurrent disease, the list of tasks includes reducing relapses and increasing the intervals between them. One of the drugs that may be recommended is VIFERON Suppositories. According to the instructions for adults, for herpes infection, a dosage of 1,000,000 IU is used (500,000 IU for pregnant women) according to the scheme: 1 suppository 2 times a day after 12 hours every day for 10 days or more for recurrent infection; according to clinical indications, therapy can be continued. VIFERON Ointment and VIFERON Gel are used as local therapy.
A small amount of ointment is gently rubbed onto the affected skin area three to four times a day. Duration of therapy is from five days to a week. A small strip of gel is applied with a cotton swab or spatula to the previously dried affected surface three to five times a day for five to six days. If necessary, the course can be continued until clinical manifestations cease. It is recommended to start treatment immediately when the first symptoms appear on the skin and mucous membranes (pain, itching, tingling, swelling and redness of the skin). If the disease is recurrent, then it is preferable to start treatment before symptoms appear or at the very beginning (in women, relapses may be associated with the menstrual cycle). Patients are prescribed a gentle regime; water procedures are not recommended. To relieve symptoms, antihistamines, antipyretics and antiseptic drugs are prescribed to treat skin lesions. After an illness, you can undergo a course of detoxification.
Trigeminal nerve
Trigeminal nerve: symptoms of inflammation and treatment methods
Inflammation of the trigeminal nerve does not threaten the patient’s life, but becomes a real test of fortitude.
The disease is accompanied by painful symptoms and significantly impairs the quality of life. Anxious anticipation of paroxysms of trigeminal neuralgia provokes depression, and some people experience suicidal thoughts. Insomnia is a typical condition for this pathology, which can be caused by both severe pain and deterioration of the emotional background. Among the accompanying changes are decreased performance, fatigue, and frequent headaches. The publication discusses the main causes of trigeminal neuralgia, clinical signs and features of diagnosing the disease, and the main methods of medical and surgical care. The possibilities and methods of treating trigeminal neuralgia using physiotherapeutic methods and folk remedies will be considered.
Trigeminal Nerve: Relationship Between Anatomy and Symptoms
The trigeminal facial nerve forms the fifth pair of cranial nerves (cranial nerves). It contains not only afferent sensory fibers, but also motor fibers. Sensory fibers provide superficial and proprioceptive (deep) sensitivity and transmit information to the brain from the skin of the entire face, mucous membranes of the eyes, nose and mouth, muscle and connective tissue structures, teeth and bones of the facial skeleton. Motor fibers go to the masticatory muscles.
Nervus trigeminus received its name due to the peculiarities of its anatomical structure. It is formed by three branches. The first is the orbital nerve. The second is called the maxillary nerve, and the third is the mandibular nerve.
The orbital, also the first branch of the nervus trigeminus, contains only sensory fibers. There are no motor neurons in its composition. The innervation zone includes the frontal zone, temples, eyebrow, upper eyelid, cornea and conjunctiva. Accordingly, with neuralgia of the ophthalmic branch, pain, numbness of the skin and paresthesia are localized in the forehead, eyebrows and eyelids. There may be a weakening or loss of reflexes, the adductor arc of which passes as part of the superior branch (suprabrow reflex, corneal reflex).
The second branch, like the first, contains exclusively sensory afferent fibers. The endings of sensory neurons are directed to the cheekbones and cheeks, wings and back of the nose, and lower eyelids. They also transmit signals from the mucous membrane of the nasal passages, maxillary bone, upper lip and upper teeth. With neuralgia of the second branch, pain, numbness of the skin and paresthesia are concentrated in the central part of the face on the right or left (the pain is always one-sided). Pain in the teeth of the upper row is typical.
The third branch, or mandibular nerve, contains not only sensory fibers, but motor (motor) neurons. This branch transmits information from the lower part of the face - the chin and mandibular bone, teeth, lower lip. Motor fibers transmit signals and coordinate the movements of many masticatory muscles and their antagonists. Also, the efferent fibers of the inferior branch go to the temporal muscle.
When the mandibular branch of the trigeminal nerve is affected, the epicenter of pain, skin numbness, hyperesthesia and paresthesia is located in the lower third. One of the symptoms is weakening or loss of the mandibular reflex. And since the lower branch also contains axons of motor neurons, an attack of neuralgia can be accompanied by motor disorders - spasm or paralysis of the muscles of the masticatory group and their antagonists.
Causes of trigeminal neuralgia
The pathogenesis of trigeminal neuralgia involves compression of one of its branches. The cause of root compression may be infection and inflammation, abnormal location or pathology of blood vessels; less commonly, the cause of compression is a tumor. Trigeminal neuralgia can be a symptom of multiple sclerosis. The following changes in the body and pathological conditions contribute to the development of inflammation of the trigeminal nerve:
- Hypothermia.
- Acute or chronic stress.
- Weakening of the immune system.
- Nervous fatigue and exhaustion.
- Hormonal imbalances.
- Chronic sinusitis, frontal sinusitis.
- Vascular pathology.
- Head injuries.
- The presence of foci of chronic infection in the body.
Very often, the true cause of trigeminal neuralgia is diseases of the oral cavity and teeth. In this regard, odontogenic inflammation of the trigeminal nerve is separately distinguished, which is secondary, and the cause of which is dental pathology. With single-gene neuralgia, as a rule, the maxillary or mandibular branch is affected, and among the symptoms of the disease there is a painful toothache.
Note. In 95% of cases with neuralgia n. trigeminus affects the 2nd or 3rd branches! This indicates a close connection between pathology and dental diseases.
Odontogenic neuralgia of the trigeminal nerve develops with the following dental diseases and anomalies of the development of the dentofacial system:
- Caries.
- Pulpitis.
- Periodontal disease, inflammation of periodontal tissue.
- Gingivitis.
- Osteomyelitis of the jaw bone.
- Retained and dystopic teeth.
- Poor quality dentures.
If you have inflammation of the trigeminal nerve, you must undergo an examination by a dentist to identify the above and other dental diseases. It is extremely important to sanitize foci of chronic infection - cure pulpitis, periodontitis, treat carious teeth, remove retained and dystopic teeth, replace low-quality orthopedic structures (prostheses).
For many patients, oral sanitation has helped to completely cure inflammation of the trigeminal nerve. It is also necessary to undergo an examination by an otolaryngologist, diagnose the paranasal sinuses, and treat chronic sinusitis or sinusitis.
Trigeminal nerve: clinical picture of the disease
The key clinical sign of inflammation of the trigeminal nerve is severe pain. The specifics of pain (localization, character) may differ, but one thing remains unchanged. The pain is always excruciating. Paroxysmal attacks “paralyze” and knock you out of the usual rhythm of life. They can be short-term, lasting no more than a few minutes, and the pain in this case is often shooting in nature. The second option is a constant burning, drilling or cutting pain that exhausts a person for 2-3 days.
Any manipulation on the face can provoke a paroxysm of neuralgic pain. Women, who for some unknown reason suffer much more often from this disease, often provoke a paroxysmal attack by applying decorative cosmetics, and men by shaving. The trigger factor for an attack of trigeminal pain can be even a normal conversation, washing with cool water, or hygiene procedures for caring for the oral cavity or facial skin.
Triggers are actions that provoke the return of paroxysmal pain. They are, as a rule, preceded by some events that happened shortly before that affected the general condition of the body. The true cause of exacerbation of inflammation of the trigeminal nerve can be hypothermia, exacerbation of herpes, colds, nervous fatigue and stress, even eating certain foods (fatty, spicy foods, chocolate, garlic).
The localization of pain depends on which branch is affected by the pathological process. With compression and inflammation of the orbital branch, pain in the upper third of the face dominates in the clinic; with damage to the middle root - in the upper jaw, upper teeth, and cheekbones. When the lower branch is compressed, the epicenter of pain is often localized in the teeth of the lower jaw. In addition, inflammation of the third branch is characterized by motor disturbances - spasm or paralysis of the masticatory muscles on the affected side.
Since the trigeminal nerve innervates one half of the face, pain, paresthesia and motor disorders are always unilateral. The patient complains of pain only on the right or only on the left. Because of this, slight or pronounced facial asymmetry often develops. With neuralgia of the lower branch, there may be a weakening of the bite on the affected side.
The trigeminal nerve contains sensory fibers that are part of the adductor arc of some reflexes. In this regard, with this disease, a decrease or loss of superciliary, corneal or mandibular reflexes is often observed. This symptom is detected during an examination of the patient by a neurologist.
Diagnostics
A preliminary diagnosis of inflammation of the trigeminal nerve is made by a neurologist based on the clinical picture, which includes:
- attacks of acute pain of a burning or shooting nature;
- unilateral localization of pain;
- numbness of the skin, tingling sensation or “pins and needles” on the affected side;
- weakening of reflexes;
- motor disorders with damage to the 3rd branch of the trigeminal nerve;
- vasomotor and secretory disorders (lacrimation, increased salivation).
To confirm the diagnosis, identify the cause of the disease, accurately determine the location of compression and differential diagnosis with other neurological diseases, instrumental examinations are prescribed:
- Computed tomography or MRI of the brain.
- X-ray of the facial skeleton.
- Angiography.
- Electromyography.
- Other.
Inflammation of the trigeminal nerve: treatment methods
The main objectives in the treatment of the trigeminal nerve are pain relief and complete cessation of paroxysms of neuralgic pain. To solve the problems, therapeutic and surgical approaches are used, as well as massage and physiotherapy. Treatment with folk remedies can be used as an additional, but not the main method.
Drug therapy
Drug treatment is carried out using strong painkillers, as well as anti-epileptic drugs. Carbamazepine, an anticonvulsant, helps relieve pain. Muscle relaxants and anti-neurotic drugs may be included in treatment regimens. In severe cases, narcotic analgesics are prescribed.
Painkillers from the NSAID group are ineffective for trigeminal neuralgia. Only the attending physician can prescribe strong analgesics and other drugs, and therefore the patient should contact a qualified specialist as soon as possible.
To reduce swelling and inflammation, hormones from the group of corticosteroids (Diprospan, Hydrocortisone) are included in the treatment protocols for the trigeminal nerve. Corticosteroids have a strong anti-exudative (anti-edematous) and anti-inflammatory effect, due to which rapid positive dynamics are achieved. Antihistamines can be used as an additional antiexudative and anti-inflammatory agent.
Neuroprotectors are also used in treatment to improve the nutrition of nerve cells and promote their recovery. If there are foci of chronic infection, antibiotics are prescribed. When exacerbation of labial herpes occurs, antiviral drugs are prescribed. Treatment regimens often include vitamin injections, vascular medications, antidepressants, tranquilizers and sedatives.
Rehabilitation of foci of chronic infection is mandatory. It is necessary to undergo diagnostics at the dentist, treat existing diseases of the teeth (caries, pulpitis), gums and periodontal tissues. If the diagnosis of neuralgia reveals chronic sinusitis, you need to undergo treatment from an otolaryngologist.
Surgery
In cases where the cause of paroxysmal attacks is compression of the root by a tumor or pathologically altered vessel, surgical treatment is performed. Its goal is to decompress nerve fibers, which is achieved by removing a tumor or moving a blood vessel. For decompression purposes, the nerve root can be isolated from surrounding tissues using a special protective sleeve.
If decompression is impossible or ineffective, surgical treatment has a different goal - complete cessation of impulse transmission along the fibers of the affected nerve. For this, a radiosurgery method can be used, which involves destruction of the sensory nerve, radiofrequency rhizotomy (destruction of the root using electromagnetic influence) or balloon compression.
Additional treatments
Additional methods of therapy include massage, physiotherapy and folk remedies. Massage improves blood circulation and helps reduce swelling, which increases nerve compression during inflammation. Physiotherapeutic procedures include electro- and phonophoresis, ultrasound, pulsed currents, and electromagnetic pulses. Reflexology can have a good effect.
At home, you can use the following traditional medicine recipes:
- Rinse your mouth with a decoction or infusion of chamomile. Rinsing has a minor effect in case of infectious etiology, but does not have an analgesic effect.
- Rubbing fir oil into the area of most severe pain. Can be repeated several times throughout the day to slightly reduce pain. It will not be possible to completely relieve the pain syndrome.
- Rubbing the skin of the affected area of the face with black radish juice. Has a weak analgesic effect.
- Healing clay: apply medicinal clay diluted in vinegar to the affected area. Used as an anti-inflammatory agent.
- Apply marshmallow infusion compresses to the painful area of the face for 30 minutes 1-2 times a day.
The trigeminal nerve is located deep, and traditional medicine cannot have a direct effect on inflamed and swollen tissues. The measures listed above are mainly distracting and auxiliary in nature; they cannot significantly alleviate the patient's condition. Therefore, if trigeminal neuralgia worsens, you should seek qualified help as soon as possible.
You can learn more about the methods of treating neuralgia and inflammation of the trigeminal nerve at the Galaktika clinic (Moscow).