197.4 📌 章末速蚘

  • HSV-1 + HSV-2: dsDNA, latency in sensory ganglia
  • Recurrence triggers: stress, UV, illness, immunosuppression
  • Orolabial (HSV-1 mostly), genital (HSV-2 majority, HSV-1 rising young), neonatal, encephalitis (temporal lobe), keratitis (dendritic), eczema herpeticum, proctitis, esophagitis
  • Dx: PCR (lesion / blood / CSF) > serology / Tzanck / culture
  • Encephalitis: HSV-1, temporal lobe, MRI/EEG/PCR; acyclovir 10 mg/kg IV q8h × 14-21d
  • Neonatal: SEM / CNS / Disseminated; acyclovir 20 mg/kg IV q8h × 14-21d
  • Orolabial/Genital: valacyclovir oral (acute or suppression)
  • Pregnancy: acyclovir 36 wk gestation for recurrent + Cesarean if active
  • Keratitis: trifluridine + oral acyclovir; NO topical steroid
  • Resistance (TK mutation): foscarnet / cidofovir / pritelivir (Phase 3)
  • Vaccines in development (gB2/gD2, mRNA)