Herpetic whitlow

Herpetic whitlow is a herpes simplex skin infection. It is usually confined to a small area of a fingertip with abrupt onset of redness followed by skin vesicles. Dental and medical workers are at risk for herpes (usually HSV-1) hand infection after exposure to the infected saliva of patients.

CASES/YEAR
7,200 (US); 144,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Viruses
OTHER NAMES
Herpes simplex (HSV) skin infection;
ACUITY
Acute-Moderate
INCUBATION
2-12 days; [CCDM]
INITIAL SYMPTOMS
Usually confined to a small area of a fingertip; Abrupt onset of redness and swelling followed by skin vesicles; [PPID, p. 1838]
PRECAUTIONS
Standard for recurrent; Contact until lesions dry and crusted for primary, severe. [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
Dental and medical workers are at risk for herpes (usually HSV-1) hand infection after exposure to the infected saliva of patients. [CCDM, p. 278] Healthcare workers should be restricted from patient contact and contact with the patient's environment until the lesions heal. [CDC Personnel Health Guidelines] The lesion is difficult to distinguish from a bacterial pustule. Patients may have fever and regional adenopathy. Infections may recur. A similar infection occurs in wrestlers on any part of the body--herpes gladiatorum. [PPID, p. 1838] Lymphangitis and lymphadenitis are rare, but may occur with the primary infection. [5MCC-2020]
DIAGNOSTIC
Culture; PCR to detect DNA; Antigen detection by EIA or IFA; Antibodies take several weeks to develop; [CCDM] The Tzanck smear can be done immediately and will show multinucleated giant cells. [5MCC-2020]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • H lymphadenopathy
  • S entry wound with lymph nodes
  • S lymphadenitis, acute
  • S lymphangitis
  • S papules or plaques
  • S pustule
  • S skin blister or vesicles
  • S ulcer of skin
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Skin or Mucous Membranes (Includes Conjunctiva)
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
  • Work in mouths of patients
TREATMENT
"Acyclovir used orally or intravenously has been shown to reduce shedding of virus, diminish pain, and accelerate healing time in primary and recurrent genital herpes, rectal herpes, stomatitis, and herpetic whitlow." [CCDM, p. 280]
DRUG LINK
Merck Manual: Herpetic Whitlow
REFERENCES FOR CASES/YEAR
1. (US) Annual incidence is about 2.4 cases per 100,000; [5MCC-2020] Calculate: 2.4 x 3000 = 7200 (US);
2. (Global) 20 X US cases/yr;