Patient 39: Recurrent Herpes Labialis

Author: Gianpiero Pescarmona
Date: 15/09/2013

Description

1) Definizione del paziente e della storia

sesso:*femminile*
Anno di nascita : 1963
Peso: 78 Statura: 1,78 BMI: 27,3

Anamnesi patologica prossima

Anamnesi patologica remota

6 anni:tonsille
14 anni: trauma da sci
26 anni: aborto al 6 mese
28 anni: inizio cefalea
42 anni: menopausa
etc.

in tal modo la sequenza temporale degli eventi è chiara e il legame con l'età è istintivo.

Anamnesi familiare

2) Le basi molecolari degli eventi descritti, tenendo conto di tutti i sintomi ed utilizzando i link alle informazioni pertinenti

3) Eventuali proposte di terapia, volta al ripristino delle condizioni ottimali

Presentation of the clinical case

Sex: Male
Birth age : 1991
Weight: 67 kg Height: 1,78 m

Pathological history

Frequent manifestation of HSV (one times week)

Past pathological history

Childhood exanathematous diseases
Manifestation of HSV every six months
Eleven years old: car accident
nineteen years old: chrome infection caused by a piercing in left ear lable and slight cervical lymphadenopathy

Subject’s habits and behavior:
-Frequent coffee user (5 times per day)
-Diet rich in carbohydrates and poor in meat and vegetables
-Psychophysical stress (night shift worker)

Drugs: Aciclovir while crisis

Molecular basis

Starting from the hallmark of the patient (frequence’s great increase of the crisis) we can frame the problem connecting it to the infection caused by piercing, which also has caused the cervical lymphadenopathy. Cervical lymphonodes (drain lymphatics vessels at this level, the ears’ one too) becomes bigger since during immune response antigens are presented to B and T lymphocytes in lymphonodes.

! http://upload.wikimedia.org/wikipedia/commons/6/63/Gray602.png!

The infection made positive proteins in acute phase increase as ferritin and haptoglobin and a decrease of negative one’s as transferrin. Presence of hepcidin (produced by the liver in these situations) makes the sideremy decrease: it destroys ferroportin in order to inhibit release of iron by enterocytes and macrophages.

We can suppose the iron’s deplation influenced the activity of lactoferrin too which is contained in neutrophil granulocyte. Lactoferrin has antiviral and bacteriacidal properties (it relates iron’s patogens) so increasing the lymphoacdenpathy.

Luckly the patient is a blood donat so we have his hemotocrit and some serological exams of first level::

ExamResultUnits of measurement
RBC5,1710^12/l
HGB15,1gr/dl
MCV83fL
Total proteins7,8g/dl
Creatinine0,84mg/dl
Cholesterol202mg/dl
Triglycerids112mg/dl
Ferritin70ng/ml
AST31UI/l
ALT42UI/l

Exams show:
- Low level of MCV ,explained by the shortage of iron. This shortage makes the marrow reticulocyts proliferate more and erythrocytes will be smaller the usual.
- Low/Normal level of ferritin
-Borderline levels of transaminases: this means slight ipoxia of hepatocytes.

*Low functionality of the liver (that hydroxylate vitamin D activating them) can explain lymphadenopathy: deficit of this vitamin lead to lower activity by macrophages.

Since these proteins make iron less available for pathogens, they make it less available for human body too. This is a good defense mechanism of the body against an infection. If the person is affected by latent labial herpes infection, it can be harmful: HSV has a ribonucleotide reductase with higher affinity of oxygen the human one. This mean iron depletion helps the manifestation of labial HSV.

This frame was exacerbate by food and social habits of the patient:

-_Abuse of coffee_: cause a absorbition of iron (non haem) in the duodenum.
(Inhibition of non-haem iron absorption in man by polyphenolic-containing beverages.)
-_Diet poor in meat_: first food for daily contribution of iron.
- Immunodepression: stressful events (work\study) help appearance of herpes.
- Lack of sleep : Wikipedia

Therapeutic hints

What causes the higher number of manifestations of HSV is the chronic infection caused by piercing. Taking off the piercing we’ll have a lower symptomatology of the herpes and the lymphadenopathy. An healthy and balanced lifestyle regarding food (specially iron), helps this clinical frame, as a decrease of stress accumulated because of work (and linked lack of sleep for night shifts).
As treatment advice, to avoid iron supplements, it’s necessary a constant control by the GP to not have side affects.
(Iron Overload)
To avoid drugs the let the absorption of iron decrease of iron from the organism (pumps inhibitors).
A livello di dieta:
-Increase iron provision (iron rich food)
- Increase the absorption of iron (increase assumption of C vitamin)
Vit C Role
Avoid substances which decrease absorption of iron(spinach) Spinach and formation of complexes.

Daniele Catalano 2013-03-18

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