Viral infections

Dr Philip Marazzi outlines some commonly presented ulcers

Herpes zoster

This image of thoracic herpes zoster illustrates the severe burning pain described by some patients. Treatment with oral antiviral medication should be commenced as soon as possible, preferably within 48 hours of the onset of the rash, to reduce the risk of developing postherpetic neuralgia and shorten the acute stage of the illness.

Wart


Warts are very common. In children they are a nuisance, but in adults they can be a significant source of embarrassment. This was a fairly large example which had been resistant to a range of measures including topical salicylate. Cryotherapy also proved unsuccessful. The patient was reassured, but remained unhappy.

Slapped cheek syndrome


Slapped cheek syndrome, which is often seen in small seasonal outbreaks, rarely causes serious problems in children. Although, like other viral infections, it can be more of a concern in adults. It is caused by a parvovirus B19. It is also known as Fifth's disease or erythema infectiosum. There is no specific treatment and it is likely to resolve within a few days.

Measles


Due to the decreased uptake of the MMR vaccination, measles, which had become quite a rarity, is now reappearing more often in the surgery. It is a notifiable disease. Check the patient for eye signs and Koplik's spots. Serious complications do occasionally occur and parents must be aware of the risks.

Herpes simplex type-1


This cold sore on the lip is caused by herpes simplex type-1. Topical antivirals are usually effective, though occasionally, oral medication may be used acutely, and as a prophylactic measure to prevent recurrent infection.

Herpes simplex type-2


This woman presented with a very sore perineum following a new sexual contact. Swabs confirmed the presence of herpes simplex type-2. She was psychologically devastated by the diagnosis and required careful counselling. It was recommended that she attend a GUM clinic to exclude the presence of any other STIs.

Conjunctivitis


Conjunctivitis is one of the most common infections that GPs see. Conjunctivitis usually has a bacterial cause and may require treatment with antibiotic eye drops. However, in the absence of surrounding cellulitis, most cases will not require any treatment. This patient has a moderately severe case of adenoviral conjunctivitis. It resolved spontaneously in about three weeks.

Glandular fever


This patient presented with a sore throat and was diagnosed with glandular fever. This infection is caused by Epstein-Barr virus. In the past, many patients were given ampicillin or amoxicillin and the subsequent rash that developed was mistakenly labelled as a penicillin allergy. Supportive measures are all that is required and most patients will make a full recovery.

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