IPLab:Lab 8:HSV Glossitis
During the course of a postmortem examination of a 58-year-old female, the tongue was noted to have a number of multiple shallow ulcers. This was an incidental finding and not related to the patient's primary disease process.
Eight types of herpes viruses, belonging to three groups, have been isolated from humans:
- neurotropic alpha-group viruses, including HSV-1, HSV-2, and varicella-zoster (VZV);
- lymphotropic beta-group viruses, including CMV, human herpes virus 6 (which causes exanthem subitum, a benign rash of infants), and human herpes virus 7 (which is not yet associated with a specific disease); and
- gamma-group virus, EBV.
This ulcerative glossitis is likely caused by herpes simplex virus 1 (HSV-1).
All HSV lesions are marked by formation of large pink-to-purple (Cowdry type A) intranuclear inclusions that contain intact and disrupted virions. These inclusions push the host cell chromatin to the edges of the nucleus. Although cell and nuclear size increase only slightly, herpes virus produces inclusion-bearing multinucleated syncytia, which are diagnostic in smears of blister fluid (Tzanck test).
Herpes viral proteins insert into the host cell’s plasma membrane and directly damage the membrane's integrity.
During a primary herpetic infection, the herpes virus invades nerve endings in the mucosa, travels up the axons of these nerves, and infects regional ganglia.
Following the primary infection, the patient becomes asymptomatic for a period--being infected by the virus but not showing clinical manifestations is known as latency.
However, occasionally the latent virus residing in a ganglion can become reactivated, descend the axon, and reinfect the area served by that particular ganglion.
- eMedicine Medical Library: Herpes Simplex
- eMedicine Medical Library: Herpes Simplex in Emergency Medicine
- Merck Manual: Herpes Simplex Virus (HSV) Infections
- Edell AR, Cohen EJ. Herpes simplex and herpes zoster eye disease: presentation and management at a city hospital for the underserved in the United States. Eye Contact Lens 2013 Jul;39(4):311-4.
Related IPLab Cases