Opryszczka narządów płciowych – nadal istotny problem epidemiologiczny i kliniczny - Epidemiological Review

35=(*/(3,'(0,2/ 3UREOHP\]DNDĪHĔ STRESZCZENIE 2SU\V]F]ND QDU]ąGyZ SáFLRZ\FK RQS MHVW MHG Q\P ] QDMF]ĊVWV]\FK ]DNDĪHĔ SU]HQRV]RQ\FK GURJą NRQWDNWX VHNVXDOQHJR D QDMF]ĊVWV]\P EĊGąF\P SU]\F]\QąRZU]RG]HĔQDU]ąGyZPRF]RZRSáFLRZ\FK :\ZRá\ZDQDMHVWSU]H]KHUSHVVLPSOH[YLUXVW\SX +69 OXE GUXJLHJR +69 5RĞQLH UROD +69 MDNRF]\QQLNDHWLRORJLF]QHJRRQSV]F]HJyOQLHZĞUyG PáRG]LHĪ\ZNUDMDFKUR]ZLQLĊW\FK1DMZDĪQLHMV]ąUROĊ ZV]HU]HQLXVLĊRQSRGJU\ZDEH]REMDZRZHZ\GDODQLH ZLUXVD=DNDĪHQLH+69PLPROHF]HQLDSR]RVWDMHGR NRĔFDĪ\FLD'DQHHSLGHPLRORJLF]QHGRW\F]ąFHRQSVą ZGXĪ\PVWRSQLXQLHSHáQHV]DFXMHVLĊĪHFRQDMPQLHM SU]\SDGNyZRQSSR]RVWDMHQLHUR]SR]QDQ\FKFR Z\QLNDJáyZQLH]QLHGRVWDWHF]QHMGLDJQRVW\NLODERUD WRU\MQHM'RQDMZDĪQLHMV]\FKNRQVHNZHQFMLLSRZLNáDĔ RQSSR]DDVSHNWDPLSV\FKRORJLF]Q\PLQDOHĪ\V\QHU JL]P ] ]DNDĪHQLHP OXG]NLP ZLUXVHP XSRĞOHG]HQLD RGSRUQRĞFLRUD]U\]\NR]DNDĪHQLDSáRGXLQRZRURGND SU]H]FKRUąNRELHWĊZFLąĪ\:SUDF\SU]HGVWDZLRQR QDMZDĪQLHMV]H L DNWXDOQH GDQH GRW\F]ąFH DVSHNWyZ HSLGHPLRORJLF]Q\FK SDWRJHQHW\F]Q\FK NOLQLF]Q\FK RUD]GLDJQRVW\F]Q\FKLOHF]QLF]\FKGRW\F]ąF\FKRQS ABSTRACT *HQLWDOKHUSHVJKLVRQHRIWKHPRVWIUHTXHQWVH[X DOO\WUDQVPLWWHGGLVHDVHVDQGWKHPRVWIUHTXHQWFDXVH RIJHQLWDOXOFHUGLVHDVHV,WVHWLRORJLFDODJHQWLVKHUSHV simplex virusW\SH+69RU+697KHUROHRI +69DVDFDXVHRIJKLVLQFUHDVLQJHVSHFLDOO\DPRQJ adolescents in developed countries. The principal route RILQIHFWLRQZLWK+69LVDV\PSWRPDWLFYLUDOVKHGGLQJ 7KHLQIHFWLRQLVOLIHORQJGHVSLWHWUHDWPHQW7KHGDWD RQWKHSUHYDOHQFHDQGLQFLGHQFHRIJKLVLQFRPSOHWH PDLQO\EHFDXVHRILQVXIILFLHQWODERUDWRU\GLDJQRVWLFV 7KHPRVWLPSRUWDQWFRQVHTXHQFHVRIJKDUHV\QHUJ\ ZLWK WKH LQIHFWLRQ ZLWK KXPDQ LPPXQRGHIILFLHQF\ YLUXVDQGWKHULVNRIIHWDODQGQHRQDWDOLQIHFWLRQGXU LQJSUHJQDQF\DQGGHOLYHU\7KHDXWKRUVSUHVHQWWKH most relevant and current data on the epidemiologi cal, pathogenetic, clinical, diagnostic and therapeutic DVSHFWVRIJK

6áRZD NOXF]RZH RSU\V]F]ND QDU]ąGyZ SáFLRZ\FK

HSLGHPLRORJLDSU]HELHJGLDJQRVW\NDSRZLNáDQLD .H\ ZRUGV JHQLWDO KHUSHV HSLGHPLRORJ\ FRXUVHGLDJQRVLVFRPSOLFDWLRQV $JQLHV]ND%HDWD6HUZLQ(ZD0XVLDáNRZVND%RĪHQD&KRG\QLFND

235<6=&=.$1$5=Ą'Ï:3à&,2:<&+1$'$/,67271<352%/(0

(3,'(0,2/2*,&=1<,./,1,&=1<

*(1,7$/+(53(6(3,'(0,2/2*,&$/$1'&/,1,&$/,668(67,//2)

IMPORTANCE

.OLQLND'HUPDWRORJLLL:HQHURORJLL8QLZHUV\WHWX0HG\F]QHJRZ%LDá\PVWRNX EPIDEMIOLOGIA OPRYSZCZKI 1$5=Ą'Ï:3à&,2:<&+ 2SU\V]F]NĊQDU]ąGyZSáFLRZ\FKRQSZ\ZRáXMą ZROQRUHSOLNXMąFHRUD]Z\ND]XMąFHWURSL]PGRNRPyUHN QDVNyUNDQDEáRQNDLWNDQNLQHUZRZHMZLUXV\KHUSHV sim plex+69W\SXSLHUZV]HJR+69LGUXJLHJR+69 'DQHHSLGHPLRORJLF]QHGRW\F]ąFHRQSVąQLHSHá QHFRZ\QLNDJáyZQLH]QLHGRVWDWHF]QHMGLDJQRVW\NL L]JáDV]DOQRĞFLSU]\SDGNyZ=ZLĊNV]DVLĊOLF]EDRQS Z\ZRáDQ\FKSU]H]+69V]F]HJyOQLHXPáRG]LHĪ\LX NRELHWZNUDMDFKUR]ZLQLĊW\FKQS.DQDG]LH6WDQDFK =MHGQRF]RQ\FKNUDMDFKVNDQG\QDZVNLFKF]HJRSU]\ F]\QąPRĪHE\üPLĊG]\LQQ\PLLQLFMDFMDVHNVXDOQD ZIRUPLHNRQWDNWyZRURJHQLWDOQ\FK=DNDĪHQLH +69ZSRSXODFMLOXG]LGRURVá\FKZ\VWĊSXMHRG ZNUDMDFKUR]ZLQLĊW\FKGROXGQRĞFLZNUDMDFK UR]ZLMDMąF\FKVLĊ :HGáXJGDQ\FK:+2]U]DNDĪRQ\FK+69 E\áRQDĞZLHFLHRNRáRPLOLRQyZPOQRVyE POQNRELHWLPOQPĊĪF]\]QZZLHNXODW &]ĊVWRĞü]DNDĪHĔMHVWQDMZLĊNV]DRNRáRUĪLMHVW QDMZ\ĪV]D Z NUDMDFK UR]ZLMDMąF\FK VLĊ:  U RGQRWRZDQRPOQQRZ\FK]DNDĪHĔ+69X POQNRELHWLPOQPĊĪF]\]Q7\ONRRVyE ZLHRW\PĪHMHVW]DNDĪRQD

$JQLHV]ND%HDWD6HUZLQ(ZD0XVLDáNRZVND%RĪHQD&KRG\QLFND  Nr 3 :86$RGNRĔFDODWRGVHWHNRVyE]DNDĪRQ\FK +69Z]UyVáR6]DFXMHVLĊĪHREHFQLHQDRQS FKRUXMHZW\PNUDMXPOQRVyE:ĞUyGNUDMyZ UR]ZLMDMąF\FKVLĊQDMZ\ĪV]\RGVHWHN]DNDĪRQ\FK+69 Z\VWĊSXMHZ$IU\FHĝURGNRZHMX±NRELHW L±PĊĪF]\]Q:NUDMDFK$PHU\NL3RáXGQLR ZHM]DNDĪHQLH+69VWZLHUG]DVLĊXNRELHW EUDN GDQ\FK GRW\F]ąF\FK PĊĪF]\]Q: SRSXODFML $]MLFKRURERZRĞüZ\QRVL±LMHVWQDMZLĊNV]D ZUHJLRQLH'DOHNLHJR:VFKRGX :NUDMDFKZNWyU\FKGLDJQRVW\NDL]JáDV]DOQRĞü RQSMHVWSURZDG]RQDV\VWHPDW\F]QLHZVSyáF]\QQLNL ]DFKRURZDOQRĞFLPDMąWHQGHQFMHZ]URVWRZH:3RO VFHUHMHVWUDFMĊSU]\SDGNyZRQSUR]SRF]ĊWRZU ZVSyáF]\QQLN ]DSDGDOQRĞFL Z ODWDFK    Z\QRVLáSRQLĪHMQDPLHV]NDĔFyZDOLF]ED ]JáRV]RQ\FKZW\PRNUHVLHSU]\SDGNyZ]PQLHMV]\áDVLĊ R:U]DUHMHVWURZDQRSU]\SDGNL RQSRPQLHMQLĪZU %8'2:$:,586$235<6=&=.,=:<.à(- ,35=(%,(*=$.$ĩ(1,$ :LUXVRSU\V]F]NL]Z\NáHMPDĞUHGQLFĊRNRáR QP VNáDGD VLĊ ] SRMHG\QF]HJR FKURPRVRPX ]DZLH UDMąFHJR GZXQLFLRZ\ NZDV GH]RNV\U\ERQXNOHLQRZ\ RWRF]RQHJRELDáNRZ\PNDSV\GHPSRNU\ZąRUD]JOLNR SURWHLQRZąRWRF]Ną5yĪQLFHZPDWHULDOHJHQHW\F]Q\P +69 L +69 Z\QRV]ą RNRáR   DOH ZSá\ZDMą QD]QDF]ąFHRGUĊEQRĞFLZSU]HELHJX]DNDĪHQLD1DM ZDĪQLHMV]HGODRGPLHQQHMDQW\JHQRZRĞFLVąUyĪQLFH ZEXGRZLHRWRF]NL:\ND]DQRĪH+69PRĪHVSR ZRGRZDüWUDQVIRUPDFMĊQRZRWZRURZą=DSRWHQFMDOQLH RQNRJHQQHZáDĞFLZRĞFL+69RGSRZLDGDIUDJPHQW FKLPHU\F]QHJRJHQXNWyU\NRGXMHWDNĪHSRGMHGQRVWNĊ ZLUXVRZHMUHGXNWD]\U\ERQXNOHRW\GRZHM =DNDĪHQLH+69WUZDGRNRĔFDĪ\FLDLSU]HELHJD ZF]WHUHFKID]DFKZ\OĊJDQLD]DNDĪHQLDSLHUZRWQHJR RNUHVyZEH]REMDZRZ\FKRUD]UHDNW\ZDFMLLQDZURWyZ RSU\V]F]NL 'R]DNDĪHQLDGRFKRG]LSU]H]EH]SRĞUHGQLNRQWDNW RVRE\ Z\GDODMąFHM F]ąVWHF]NL ZLUXVD ] XV]NRG]RQą VNyUąOXEQLHXV]NRG]RQ\PLEáRQDPLĞOX]RZ\PLGUXJLHM RVRE\ZW\PWDNĪHG]LHFNDSU]HFKRG]ąFHJRSU]H]NDQDá URGQ\OXENDUPLRQHJRSLHUVLą3RGF]DVNRQWDNWXVHN VXDOQHJRU\]\NR]DNDĪHQLDNRELHW\SU]H]PĊĪF]\]QĊ MHVWSRQDGF]WHURNURWQLHZ\ĪV]HQLĪPĊĪF]\]Q\SU]H] SDUWQHUNĊFRZ\QLNDPLĊG]\LQQ\PL]UyĪQLFDQDWR PLF]Q\FKF]ĊVWV]HJRZ\GDODQLDZLUXVDSU]H]PĊĪF]\]Q LZLHONRĞFL]DNDĪDMąFHJRLQRFXOXP,QQąGUR JąMHVW]DNDĪHQLHZHZQąWU]PDFLF]QH8ZDĪDVLĊĪH +69PRĪHE\üWDNĪHSU]HQLHVLRQ\]F]ąVWHF]NDPL ĞOX]X Z\G]LHODQHJR SU]H] GURJL RGGHFKRZH D WDNĪH SRĞUHGQLRE\WXMąFNUyWNRQDVNyU]HUąNLSU]HGPLRWDFK 3UDZGRSRGRELHĔVWZRSU]HQLHVLHQLD+69GURJą LQQąQLĪNRQWDNWVHNVXDOQ\MHVWPLQLPDOQH2NUHV Z\OĊJDQLDZ\QRVL]Z\NOHGQL±GQL:UH DNFMLLPPXQRORJLF]QHMQD]DNDĪHQLHQDMZDĪQLHMV]ąUROĊ RGJU\ZDRGSRZLHGĨW\SXNRPyUNRZHJRQDMZF]HĞQLHM ±OLPIRF\W\&'QDVWĊSQLHOLPIRF\W\F\WRWRNV\F]QH &'LQDWXUDONLOOHUV1.PQLHMV]ąSURGXNFMDSU]H FLZFLDáQHXWUDOL]XMąF\FK3HáQDVHURNRQZHUVMDWUZDRG GRW\JRGQLSU]HFLZFLDáDZNODVLH,J0PRJąE\ü REHFQHMXĪGQLRGSRZVWDQLD]PLDQZNODVLH,J* SRGQLDFK2EHFQRĞüSU]HFLZFLDáSU]HFLZNR+69 ZQLHZLHONLPVWRSQLX]DEH]SLHF]DSU]H]]DNDĪHQLHP +69 DOH ]PQLHMV]D QDVLOHQLH REMDZyZ QDWRPLDVW SU]HFLZFLDáDSU]HFLZNR+69Z\GDMąVLĊVNXWHF]QLH FKURQLüSU]HG]DNDĪHQLHP+69 3RGF]DVGáXJLHJRF]DVXZVSyOQHMHJ]\VWHQFMLLHZR OXFML]RUJDQL]PHPF]áRZLHND+69UR]ZLQąáVNXWHF]QH PHFKDQL]P\XPRĪOLZLDMąFHXQLNDQLHQDG]RUXLPPX QRORJLF]QHJRJRVSRGDU]DRUD]ZSá\ZQDMHJRXNáDG LPPXQRORJLF]Q\ ']LĊNL QLP PRĪOLZD MHVW ODWHQFMD RUD]SU]HWUZDQLHLQIHNFMLGRNRĔFDĪ\FLD=DRNUHV\ EH]REMDZRZHRGSRZLHG]LDOQ\MHVWIUDJPHQWJHQRPX ZLUXVD]QDQ\SRGDQJLHOVNąQD]ZąODWHQF\DVVRFLDWHG WUDQVFULSWV:F]DVLHODWHQFMLJHQRPZLUXVDQLH LQWHJUXMHVLĊ]JHQRPHPJRVSRGDU]DDOHZLUXVXOHJD UHSOLNDFMLFKRFLDĪGRVWĊSQHPHWRG\Vą]E\WPDáRF]XáH DE\]EDGDüGR]MDZLVNR 1DRVáDELHQLHRGSRZLHG]LJRVSRGDU]DZVWRVXQNX GR+69PDMąZSá\ZZLUXVRZHFKHPRNLQ\LLFKUHFHS WRU\NWyUHSRZRGXMąQLV]F]HQLHSRSU]H]OL]ĊGRSHá QLDF]DRVáDELHQLHIDJRF\WR]\SUH]HQWDFMLDQW\JHQyZZ REHFQRĞFLF]ąVWHF]HN0+&NODV\,F\WRWRNV\F]QRĞFL OLPIRF\WyZ &' L 1.  %LDáNR ZLUXVD ]QDQH jako LQIHFWHGFHOOSURWHLQ,&3KDPXMHSUH]HQWDFMĊ ELDáHNZLUXVDLZNRQVHNZHQFMLW\ONRQLHZLHONDF]ĊĞü DQW\JHQyZ+69MHVWUR]SR]QDZDQDSU]H]XNáDGLPPX QRORJLF]Q\F]áRZLHND 'RUHDNW\ZDFMLLQIHNFMLGRFKRG]LPLĊG]\LQQ\PL SRGZSá\ZHPF]\QQLNyZPLHMVFRZ\FKZW\PXUD]X QS]DELHJXRSHUDF\MQHJRSURPLHQLRZDQLDXOWUDILR OHWRZHJR OXE RJyOQRXVWURMRZ\FK LPPXQRVXSUHVML VFKRU]HĔSU]HELHJDMąF\FK]SRGZ\ĪV]RQąFLHSáRWąFLDáD PLHVLąF]NLDOHZLĊNV]RĞüF]\QQLNyZRGSRZLHG]LDO Q\FK]DUHDNW\ZDFMĊQLHMHVWSR]QDQD

KLINICZNY OBRAZ OPRYSZCZKI 1$5=Ą'Ï:3à&,2:<&+ 6]HURNLHVSHNWUXPNOLQLF]QH]DNDĪHĔSU]HQRV]R Q\FKGURJąNRQWDNWXVHNVXDOQHJRZW\PUyZQLHĪRQS REHMPXMHEH]SRĞUHGQLHREMDZ\]DNDĪHQLDDWDNĪHMHJR SRZLNáDQLDLRGOHJáHQDVWĊSVWZD2EUD]NOLQLF]Q\REMD ZRZHJRHSL]RGXRQSZ\ZRáDQ\SU]H]+69L+69 MHVW QLH GR RGUyĪQLHQLD QDWRPLDVW RJyOQ\ SU]HELHJ

2SU\V]F]NDQDU]ąGyZSáFLRZ\FK _

Nr 3

]DNDĪHQLDMHVWRGPLHQQ\:\NZLWDPLSLHUZRWQ\PLZ VNyU]HVąSĊFKHU]\NL]JUXSRZDQH]Z\NOHQDUXPLH QLRZ\PSRGáRĪXZEáRQDFKĞOX]RZ\FK±GRPLQXMą QDGĪHUNL OXE Sá\WNLH RZU]RG]HQLD 2EMDZDPL RQS X NRELHWPRĪHE\ü]DSDOHQLHVURPXSRFKZ\OXEV]\MNL PDFLF\XPĊĪF]\]Q±ĪRáĊG]LQDSOHWNDOXEVNyU\SUąFLD LPRV]Q\'RZVSyOQ\FKREMDZyZRQSXREXSáFLQDOHĪą PLQ]DSDOHQLHMDP\XVWQHMF]HUZLHQLZDUJRZHMJDU GáDFHZNLPRF]RZHMRGE\WXOXERGE\WQLF\]DSDOHQLH VNyU\ZRNROLF\QDU]ąGyZPRF]RZRSáFLRZ\FKDX RVyE]XSRĞOHG]RQąRGSRUQRĞFLą±]DSDOHQLHPy]JXOXE RSRQPy]JRZRUG]HQLRZ\FKSáXFZąWURE\SU]Há\NX OXE]DNDĪHQLHUR]VLDQHZNWyU\PĞPLHUWHOQRĞüPRĪH VLĊJDü2EMDZ\LFKQDVLOHQLHRUD]SU]HELHJSLHUZ V]HJRREMDZRZHJRHSL]RGXRQSUyĪQLąVLĊZ]DOHĪQRĞFL RGWHJRF]\MHVWWR]DNDĪHQLDSLHUZRWQHXRVRE\QLH SRVLDGDMąFHMSU]HFLZFLDáSU]HFLZNR+69DQL+69 F]\QDZURWRZHXRVRE\VHURSR]\W\ZQHM7\SRZD SLHUZRWQDREMDZRZDRQSSRSU]HG]RQDMHVWREMDZDPL SURGURPDOQ\PL EyOHP SLHF]HQLHP SDUHVWH]MDPL ]Z\NOHWRZDU]\V]ąMHMREMDZ\RJyOQRXVWURMRZHX  NRELHW L   PĊĪF]\]Q  EyOH JáRZ\ PLĊĞQL SRGZ\ĪV]RQDFLHSáRWDFLDáDORNDOQDOLPIDGHQRSDWLD D]PLDQ\VNyUQRĞOX]yZNRZHVąV\PHWU\F]QHLEROHVQH 8FKRU\FKNRELHWZ\VWĊSXMHG\]XULD3LHUZRWQD RQSZ\ZRáDQDSU]H]+69MHVWF]ĊVWV]DXNRELHWQLĪ XPĊĪF]\]Q8QLHOHF]RQ\FKNRELHWL PĊĪF]\]QPRĪHZWHMID]LHGRMĞüGR]DNDĪHQLDPy]JX +69 OXE RSRQ Py]JRZRUG]HQLRZ\FK +69 8RNRáRSDFMHQWyZ]SLHUZV]\PHSL]RGHP RQSZ\NU\ZDVLĊSU]HFLZFLDáDSU]HFLZNR+69FR ZVND]XMHĪHZLĊNV]RĞüSU]\SDGNyZSLHUZRWQHJR]D NDĪHQLDSU]HELHJDEH]REMDZRZROXEVNąSRREMDZRZR LSR]RVWDMHQLH]GLDJQR]RZDQH2NRáRRVyE ]DNDĪRQ\FKSLHUZRWQLH+69L+69PD QDZURWRZą RQS Z FLąJX  PLHVLĊF\ 1DZURW\ RQS SU]HELHJDMąáDJRGQLHM±EH]REMDZyZRJyOQRXVWURMR Z\FK]PQLHMV]\PLGROHJOLZRĞFLDPLSRGPLRWRZ\PL Z\NZLW\ORNDOL]XMąVLĊMHGQRVWURQQLHLWUZDMąNUyFHM =DUyZQR Z RNUHVDFK ]DNDĪHQLD REMDZRZHJR MDN L EH]REMDZRZHJRGRFKRG]LGRZ\GDODQLDZLUXVD2FHQLD VLĊĪHEH]REMDZRZHZ\GDODQLHZLUXVDPDPLHMVFHX NRELHW]DNDĪRQ\FK+69LX]DNDĪRQ\FK +69DOHMHVWWRQDMZDĪQLHMV]DGURJDV]HU]HQLDVLĊ ]DNDĪHQLD3RODWDFKRGSLHUZRWQHJR]DNDĪH QLDU\]\NRZ\GDODQLDZLUXVDMHVWRPQLHMV]HQLĪ SRGF]DVSLHUZV]\FKPLHVLĊF\1DZ\GDODQLHZLUXVD PDMąUyZQLHĪZSá\ZMHJRV]F]HSLSLHUZRWQDORNDOL]DFMD ]DNDĪHQLD 1DMZDĪQLHMV]HNRQVHNZHQFMHLPRĪOLZHSRZLNáDQLD ]DNDĪHĔ+69PRĪQDXPRZQLHSRG]LHOLüQDSV\FKRVSR áHF]QHLPHG\F]QH:ĞUyGW\FKSLHUZV]\FKVąHPRFMH ]ZLą]DQH]ZLDGRPRĞFLąR]DNDĪHQLXNWyUHSR]RVWDMH QLHZ\OHF]DOQHGRNRĔFDĪ\FLDIUXVWUDFMDLDJUHVMDZ VWRVXQNXGRREHFQHJRSDUWQHUDQLH]DZV]HX]DVDGQLR QDVW\JPDW\]DFMDREQLĪRQDVDPRRFHQDREDZDSU]HG ]DNDĪHQLHPREHFQHJROXESU]\V]á\FKSDUWQHUyZRUD] V]F]HJyOQLHZSU]\SDGNXNRELHWSU]HG]DNDĪHQLHP SáRGXOXEQRZRURGND=DNDĪHQLH+69GRW\F]ąFHQDU]ą GyZPRF]RZRSáFLRZ\FKPRĪHE\üSU]\F]\QąGHSUHVML 'R QDMZDĪQLHMV]\FK NRQVHNZHQFML PHG\F]Q\FK QDOHĪąPRĪOLZRĞü]DNDĪHQLDSáRGXLOXEQRZRURGND SU]H]NRELHWĊFLĊĪDUQąRUD]V\QHUJL]P]]DNDĪHQLHP OXG]NLP ZLUXVHP XSRĞOHG]HQLD RGSRUQRĞFL KXPDQ LPPXQRGHIILFLHQF\YLUXV±+,9

1DMF]ĊĞFLHMGR]DNDĪHQLDG]LHFNDGRFKRG]LZRNUH VLH RNRáRSRURGRZ\P SRGF]DV SU]HFKRG]HQLD SU]H] NDQDáURGQ\LNRQWDNWX]REHFQ\PLZMHJRZ\G]LHOLQLH ZLUXVDPLU]DG]LHMZHZQąWU]PDFLF]QLHRUD]SRGF]DV NDUPLHQLD L SLHOĊJQDFML: 86$  F]ĊVWRĞü ]DNDĪHĔ SáRGyZ L QRZRURGNyZ RSU\V]F]Ną Z\QRVL RG  QD GRQDĪ\Z\FKXURG]HĔDSRQDG MHVW VSRZRGRZDQH SU]H] +69  3U]HFLZFLDáD SU]HFLZNR+69VWZLHUG]DVLĊX±NRELHWFLĊ ĪDUQ\FK:SyáQRFQ\FK:áRV]HFKFLĊĪDUQ\FK MHVW]DNDĪRQ\FK+69Z5]\PLH±:86$ RNRáRFLĊĪDUQ\FKMHVW]DNDĪRQ\FK+69 MHVWQDUDĪRQ\FKQDU\]\NR]DNDĪHQLDRGEH]REMDZRZ\FK SDUWQHUyZNRELHWXOHJDSLHUZRWQHPX]DNDĪHQLX SRGF]DVFLąĪ\ 1DMZLĊNV]HU\]\NRGODSáRGXLQRZRURGNDRNRáR ZLąĪHVLĊ]SLHUZRWQąRQSXFLĊĪDUQHMQDE\Wą ZWU]HFLPWU\PHVWU]HFLąĪ\JG\GRF]DVXSRURGXQLH PRĪQDZ\WZRU]\üRGSRZLHGQLRZ\VRNLHJRPLDQDQHX WUDOL]XMąF\FKSU]HFLZFLDá3U]HELHJWDNLHJR]DNDĪHQLD XNRELHW\MHVW]Z\NOHFLĊĪNL3RPLPRQLVNLHJRU\]\ND QDZURWRZDRQSDWDNĪHEH]REMDZRZHZ\GDODQLHZLUXVD MHVWMHGQDNQDMF]ĊVWV]ąSU]\F]\Qą]DNDĪHĔQRZRURGNyZ =DNDĪHQLHRNRáRSRURGRZHZZLĊNV]RĞFLUR]ZLMD VLĊSRGRELHĪ\FLDG]LHFNDDOHPRĪHZ\VWąSLüZFLąJX W\JRGQLSRSRURG]LH:\UyĪQLDVLĊMHJRWU]\ SRVWDFLNOLQLF]QHRJUDQLF]RQąGRVNyU\RF]XLMDP\ XVWQHM ]DNDĪHQLH RĞURGNRZHJR XNáDGX QHUZRZHJR LUR]VLDQą]]DMĊFLHPQDU]ąGyZZHZQĊWU]Q\FKZNWy UHMĞPLHUWHOQRĞüVLĊJD 6\QHUJL]P]]DNDĪHQLHP+,9RGE\ZDVLĊZGURG]H LQWHUDNFMLEH]SRĞUHGQLHMVáDERSR]QDQHMRUD]SRĞUHGQLR ±SRSU]H]ZSá\ZQDXNáDGLPPXQRORJLF]Q\'DQH HSLGHPLRORJLF]QH ZVND]XMą ĪH RQS ]ZLĊNV]D RNRáR NURWQLHU\]\NR]DNDĪHQLD+,9U\]\NRMHVWMHV]F]H ZLĊNV]HZRNUHVDFKREMDZyZRQS%LDáNDSURGX NRZDQHSU]H]+69PLQ,&3,&3,&3QDVLODMą UHSOLNDFMĊ+,9in vitroSRSU]H]LQGXNFMĊF]\QQLND MąGURZHJR1)ț%:EáRQLHĞOX]RZHMZRNyáNH UDW\QRF\WyZ]DNDĪRQ\FK+69JURPDG]ąVLĊNRPyUNL NWyUHVąSRWHQFMDOQ\PFHOHPGOD+,95HSOLNDFMD+69 ZLąĪHVLĊ]NURWQ\P]ZLĊNV]HQLHPOLF]E\QLHGRMU]D á\FKNRPyUHNGHQGU\W\F]Q\FKLNURWQ\P±HNVSUHVML &&5QDOLPIRF\WDFK&'QDVLODMąFSRGDWQRĞüQD ]DNDĪHQLH+,9:ID]LHUHDNW\ZDFMLLQIHNFML+69

$JQLHV]ND%HDWD6HUZLQ(ZD0XVLDáNRZVND%RĪHQD&KRG\QLFND  Nr 3 ]ZLĊNV]DVLĊZ\GDODQLH+,9OLF]EDZLULRQyZZHNUZL LSU]\VSLHV]DVLĊSURJUHVMD]DNDĪHQLDUHWURZLUXVRZHJR 2EMDZ\RQSSRZRGXMąSU]HUZDQLHFLąJáRĞFLVNyU\LEáRQ ĞOX]RZ\FKRWZLHUDMąFZURWD]DNDĪHQLX+,9=GUXJLHM VWURQ\]ZLĊNV]DVLĊSRGF]DVQLHJRF]ĊVWRĞüUHDNW\ZDFML RQSQDVLODVLĊF]ĊVWRĞüLLORĞüZ\GDODQLD+69SU]HELHJ RQSMHVWFLĊĪV]\FRPRĪHZ\QLNDü]G\VIXQNFMLNRPyUHN 1.:LUXV\RSU\V]NLL+,9]DNDĪDMąin vivo te same NRPyUNL

DIAGNOSTYKA I ZASADY LECZENIA 235<6=&=.,1$5=Ą'Ï:3à&,2:<&+ :\GDMHVLĊĪHSUDZLGáRZHUR]SR]QDQLHRQSQLH SRZLQQRE\üWUXGQHZSU]\SDGNXREHFQRĞFLW\SRZ\FK ]PLDQNOLQLF]Q\FK6]DFXMHVLĊMHGQDNĪHSU]\SDG NyZRQSSR]RVWDMHQLHUR]SR]QDQ\FKOXEUR]SR]QDQ\FK QLHSUDZLGáRZR'LDJQRVW\NDODERUDWRU\MQDSR]ZD ODMąFDQDSRWZLHUG]HQLH]DNDĪHQLDDWDNĪHRGUyĪQLHQLH LQIHNFMLSLHUZRWQHMRGQDZURWRZHMRUD]]UyĪQLFRZDQLH W\SXZLUXVDMHVWV]F]HJyOQLHZDĪQDXNRELHWZFLąĪ\ LLFKSDUWQHUyZ:SU]\SDGNXREHFQRĞFL]PLDQQDOHĪ\ GąĪ\üGRZ\NU\FLDZLUXVDMHJRDQW\JHQXOXEPDWHULDáX JHQHW\F]QHJRPHWRGDPLEH]SRĞUHGQLPLNWyUHVąMHGQDN PDáRF]XáHOXEVNRPSOLNRZDQHLNRV]WRZQHWDE,'LD JQRVW\NDVHURORJLF]QDZ\áąF]QLHWDNDNWyUDSR]ZDOD QDRGUyĪQLHQLH+69RG+69]JRGQLH]SURSRQR ZDQą Z  U PRG\ILNDFMą =DOHFHĔ (XURSHMVNLFK SRZLQQDE\üSU]HSURZDG]RQDZRNUHĞORQ\FKV\WXDFMDFK NOLQLF]Q\FKXSDFMHQWyZ]Z\ZLDGHPQDZURWRZ\FK VFKRU]HĔRNROLFQDU]ąGyZPRF]RZRSáFLRZ\FKV]F]H JyOQLHJG\Z\QLNLPHWRGGLDJQRVW\NLEH]SRĞUHGQLHM Vą XMHPQH SU]\ SLHUZV]\P HSL]RG]LH RQS Z FHOX ]UyĪQLFRZDQLDRSU\V]F]NLSLHUZRWQHMRGQDZURWRZHM XSDUWQHUyZFKRU\FK]RQSZW\PXNRELHWZFLąĪ\ QDZHWEH]Z\ZLDGXZNLHUXQNXRQSV]F]HJyOQLHMHĞOL FKRURZDá QD RSU\V]F]NĊ UyĪQLH XPLHMVFRZLRQą MHM SDUWQHU :\QLN EDGDQLD SRZLQLHQ E\ü ]DZV]H

X]XSHáQLRQ\GRNáDGQ\PSRUDGQLFWZHP3U]HVLHZRZH EDGDQLDVHURORJLF]QHZJUXSDFKU\]\NDQSXRVyE ]DNDĪRQ\FK+,9KRPRVHNVXDOLVWyZQLHZ\GDMąVLĊ E\üX]DVDGQLRQH1DMEDUG]LHMF]Xá\PLVZRLVW\PRGSR ZLHGQLRSRQDGLRGF]\QHPVHURORJLF]Q\P MHVW:HVWHUQEORWDOHQDMF]ĊĞFLHMVWRVRZDQHVąRGF]\Q\ RSDUWHRUHDNFMĊLPPXQRHQ]\PDW\F]Qą6HURNRQZHUVMD PRĪHGRNRQ\ZDüVLĊZFLąJXPLHVLĊF\GODWHJRMHĞOL MHVWWRX]DVDGQLRQHV\WXDFMąNOLQLF]QąQDOHĪ\ZRG SRZLHGQLPRGVWĊSLHF]DVXSRQRZQLH]EDGDüSUyENĊ VXURZLF\:\NU\ZDQLHVZRLVW\FKGOD+69L+69 SU]HFLZFLDáZNODVLH,J0MHVWMDNGRWąGPDáRGRVWĊSQH ZUXW\QRZHMGLDJQRVW\FH /HNLVWRVRZDQHZRQSDF\NORZLUZDODF\NORZLU IDPF\NORZLU ZSá\ZDMą QD ]áDJRG]HQLH L VNUyFHQLH REMDZyZ QLH HOLPLQXMąF ZLUXVD DQL QLH ]PLHQLDMąF QDWXUDOQHJRSU]HELHJX]DNDĪHQLD$E\OHF]HQLHE\áR VNXWHF]QHQDOHĪ\MH]DF]ąüZFLąJXGQLRGSRF]ąWNX REMDZyZOXEZWUDNFLHWZRU]HQLDVLĊZ\NZLWyZ 8 SDFMHQWyZ ] OLF]Eą QDZURWyZ RQS FR QDMPQLHM  ZFLąJXURNXQDOHĪ\UR]ZDĪ\üFLąJáHWUZDMąFHURN OHF]HQLH]DSRELHJDMąFHQDZURWRP /HF]HQLHRQSFLĊĪDUQ\FKEXG]LNRQWURZHUVMHSRQLH ZDĪĪDGHQ]SRZ\ĪV]\FKOHNyZQLH]RVWDá]DUHMHVWUR ZDQ\GRVWRVRZDQLDZFLąĪ\:OHF]HQLXHSL]RGXSLHU ZRWQHMRQSXNRELHWFLĊĪDUQ\FKQDE\WHMSRGF]DVGZyFK SLHUZV]\FKWU\PHVWUyZ]DOHFDVLĊVWRVRZDQLHDF\NOR ZLUX1LHQDOHĪ\VWRVRZDüIDUPDNRWHUDSLLQDZURWRZHM RQSZHZF]HVQHMFLąĪ\8ZV]\VWNLFKSDFMHQWHN ]Z\ZLDGHPRQSWU]HEDUR]ZDĪ\üVWRVRZDQLHDF\NORZL UXRGW\JRGQLDFLąĪ\GRSRURGXFRPRĪH]PQLHMV]\ü F]ĊVWRĞüREMDZRZ\FKHSL]RGyZRQSLEH]REMDZRZHJR Z\GDODQLDZLULRQyZDW\PVDP\PU\]\NR]DNDĪHQLD RNRáRSRURGRZHJR1DMLVWRWQLHMV]ąUROĊZSURILODNW\FH ]DNDĪHĔRGPDWF]\Q\FKSHáQLZLHG]DRQDMZDĪQLHMV]\FK GURJDFK]DNDĪHQLDLĞZLDGRPRĞüU\]\NDMDNLHLQIHNFMD PRĪHQLHĞüGODSáRGXLQRZRURGND&LĊĪDUQDNWyUHM SDUWQHUPDWDNĪHZZ\ZLDG]LHRQSUyĪQLHXPLHMVFR ZLRQą SRZLQQD XWU]\P\ZDü DEVW\QHQFMĊ VHNVXDOQą

7DEHOD, 0HWRG\ODERUDWRU\MQHMGLDJQRVW\NLEH]SRĞUHGQLHMRSU\V]F]NLQDU]ąGyZSáFLRZ\FKZJ 7DEOH, 'LUHFWODERUDWRU\GLDJQRVWLFPHWKRGVLQJHQLWDOKHUSHVDFFWR

Metoda Badany materiał Czułość %

Zalety Wady

Hodowla swoistość ok.100% (komórki nerki embrionów ludzkich lub króliczych)

Zmiany skórne lub śluzówkowe, śluzówka bez zmian, wymaz ze spojówki 70-95 30 >90 „Złoty standard”, typowanie,

ocena oporności na leki

Trudna technicznie, wynik po 2-7 dniach Test Tzanka

swoistość ok. 100%

Zmiany skórne lub śluzówkowe Wymaz ze spojówek

73-100 Szybka, prosta, tania Czułość zależy

od czasu utrzymywania się zmian Wykrywanie antygenów wirusa

(np. metodą ELISA) swoistość ok.80%

Zmiany skórne lub śluzówkowe 41-80 Łatwa, szybka, typowanie wirusa

Wymaga obecności świeżych zmian

Wykrywanie DNA wirusa (PCR, real-time PCR)

swoistość ok. 100%

Płyn mózgowo-rdzeniowy, zmiany skórne i śluzówkowe, niezmieniona błona śluzowa

97-98 Najczulsza, wyniki w ciągu 1-2 dni, typowanie

Brak standaryzacji, wysoki koszt

2SU\V]F]NDQDU]ąGyZSáFLRZ\FK _ Nr 3 WDNĪHZIRUPLHNRQWDNWyZRURLDQRJHQLWDOQ\FKSRG F]DVHSL]RGyZRSU\V]F]NLXSDUWQHUDRUD]NRQLHF]QLH ZWU]HFLPWU\PHVWU]H6WRVRZDQLHSUH]HUZDW\ZPRĪH ]PQLHMV]\üU\]\NRLQIHNFML5R]ZLą]DQLHFLąĪ\FLĊFLHP &HVDUVNLPQDOHĪ\UR]ZDĪ\üXZV]\VWNLFKSDFMHQWHN NWyUHXOHJá\]DNDĪHQLXSRGF]DVWU]HFLHJRWU\PHVWUX V]F]HJyOQLH MHĞOL Z FLąJX  W\JRGQL SU]HG SRURGHP REVHUZXMHVLĊXQLFKREMDZ\NOLQLF]QHRQS 3RGVXPRZXMąFRSU\V]F]NDQDU]ąGyZSáFLRZ\FK MHVWEDUG]RLVWRWQ\PLQDSHZQRZ3ROVFHZGXĪ\P VWRSQLX QLHGRFHQLDQ\P SUREOHPHP ]GURZRWQ\P 1LHGRVWDWHF]QD MHVW SU]HGH ZV]\VWNLP GLDJQRVW\ND ODERUDWRU\MQDFRSU]\F]\QLDVLĊGRWHJRĪHQLHMHVW UR]SR]QDZDQD Z ZLĊNV]RĞFL SU]\SDGNyZ L Z NRQ VHNZHQFML VSU]\MD WR V]HU]HQLX VLĊ ]DNDĪHĔ QLRVąF ]DJURĪHQLDV]F]HJyOQLHGODNRELHWZZLHNXUR]URGF]\P 3,ĝ0,(11,&7:2  5REHUWV&03ILVWHU-56SHDU6-,QFUHDVLQJSURSRUWLRQ RI KHUSHV VLPSOH[ YLUXV W\SH  DV D FDXVH RI JHQLWDO KHUSHVLQIHFWLRQLQFROOHJHVWXGHQWV6H[7UDQVP'LV 

 0DQDYL . 0F0LOODQ$ 2JLOYLH 0 +HUSHV VLPSOH[ YLUXVW\SHUHPDLQVWKHSULQFLSDOFDXVHRILQLWLDODQR JHQLWDOKHUSHVLQ(GLQEXUJK6FRWODQG6H[7UDQVP'LV   1DKPLDV$/HH)%HFNPDQ1DKPLDV66HURHSLGHPLR ORJLFDODQGVRFLRORJLFDOSDWWHUQVRIKHUSHVVLPSOH[YLUXV LQIHFWLRQLQWKHZRUOG6FDQG-,QIHFW'LV  /RRNHU .- *DUQHWW *3 6FKPLG *3$Q HVWLPDWH RI

WKHJOREDOSUHYDOHQFHDQGLQFLGHQFHRIKHUSHVVLPSOH[ YLUXV W\SH  LQIHFWLRQ KWWSZZZZKRLQWEXOOHWLQ YROXPHVHQSULQWKWPO  )OHPLQJ'0F4XLOODQ*-RKQVRQ5LLQ+HUSHVVLP SOH[YLUXVW\SHLQWKH8QLWHG6WDWHVWR1 (QJO-0HG  5XGQLFND,0DMHZVNL66H[XDOO\WUDQVPLWWHGLQIHFWLRQV VLWXDWLRQLVDFDXVHIRUFRQFHUQLQ3RODQG(XUR6XUHYHLOO SSL  KWWSZZZHXURVXUYHLOODQFH RUJ9LHZ$UWLFOHDVS["$UWLFOH,G 

 5XGQLFND , 0DMHZVNL 6 &KRURE\ SU]HQRV]RQH GUR JD SáFLRZą Z 3ROVFH Z  U 3U]HJO (SLGHPLRO 

 /\FNH(9LURORJLFDODVSHFWVRQKHUSHVYLUXVLQIHFWLRQ 6FDQG-,QIHFW'LV6XSSO6

 $XUHOLDQ/+HUSHVVLPSOH[YLUXVW\SHXQLTXHELROR gical properties include neoplastic potential mediated E\WKH3.GRPDLQRIWKHODUJHVXEXQLWRIULERQXFOHRWLGH UHGXFWDVH)URQW%LRVFL

 :DOG$ +HUSHV VLPSOH[ YLUXV W\SH  WUDQVPLVVLRQ ULVNIDFWRUVDQGYLUDOVKHGGLQJ+HUSHV6XSSO $$  0HUW]*%HQHGHWWL-$VKOH\5LLQ5LVNIDFWRUVIRU WKHVH[XDOWUDQVPLVVLRQRIJHQLWDOKHUSHV$QQ,QWHUQ 0HG  .QLSH'05RL]PDQ%+HUSHVVLPSOH[YLUXVHVDQGWKHLU UHSOLFDWLRQ:.QLSH'0+RZOH\30*ULIILQ'(L LQUHG)LHOGVYLURORJ\:\G3KLODGHOSKLD/LSSLQFRWW :LOOLDPV :LONLQV  /RRNHU.-*DUQHWW*3$V\VWHPDWLFUHYLHZRIWKHHSL GHPLRORJ\DQGLQWHUDFWLRQRIKHUSHVVLPSOH[YLUXVW\SHV DQG6H[7UDQVP,QIHFW

14. Croen KD, Ostrove JM, Dragovic L, i in. Latent herpes VLPSOH[YLUXVLQKXPDQWULJHPLQDOJDQJOLDGHWHFWLRQRI DQLPPHGLDWHHDUO\JHQH³DQWLVHQVH´WUDQVFULSWE\LQVLWX K\EULGL]DWLRQ1(QJO-0HG  0pJUHW ) 3UHKDXW & /DIDJH 0 L LQ 0RGXODWLRQ RI

+/$*QG+/$(H[SUHVVLRQLQKXPDQQHXURQDOFHOOV DIWHUUDELHVYLUXVRUKHUSHVVLPSOH[W\SHLQIHFWLRQV +XPDQ,PPXQRO

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linika Dermatologii i Wenerologii UMB 8OĩXUDZLD%LDá\VWRN