Herpetic Whitlow following Herpes labialis infection
An 8-year-old boy presented for treatment with a four-day history of pain and parasthesia in the tight thumb. The child had suffered an outbreak of Herpes labialis six days previously. On examination, the thumb appeared inflamed and swollen, with vesicular eruptions. The most likely cause of the thumb infection was a history of thumb-sucking. However, it could also occur if the child had a prior history of HSV1 or HSV2 infection in genital secretions. The thumb condition is similar to that seen in medical and dental personnel who contract HSV1 infections from their patients.
Herpetic whitlow was first described by Adamson in 1909. In 1959, it was first reported as an occupational hazard for health care workers.2,3 It is often misdiagnosed as a bacterial infection, although herpetic whitlow is caused by herpes simplex virus 1 (HSV-1) in 60 percent of cases and by herpes simplex virus 2 (HSV-2) in the remaining 40 percent of cases1,2. Thumb sucking causes autoinoculation from primary oropharyngeal lesions in children with herpetic gingivostomatitis or herpes labialis. Children and health care workers are usually infected with HSV-11,2,3. In the U.S. the annual incidence of herpetic whitlow is approximately 2.4 to 5,0 cases per 100,000 population.3 Mortality can be assumed to be negligible, but morbidity is increased primarily by bacterial superinfection or to iatrogenic complications caused by incision and drainage following incorrect diagnosis.
Signs and symptoms of herpetic whitlow include edema, erythema, and significant localized tenderness of the infected finger, beginning abruptly.1 The diagnosis of herpetic whitlow is usually based on examination and history, but a variety of laboratory tests are available if definitive diagnosis is required.2 Viral cultures, serum antibody titers, the Tzanck test, and fluorescent antibody testing
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