HSV-1 most commonly infects the trigeminal ganglia, where it remains latent. If reactivated, it presents as herpes labialis, also known as cold sores. Diagnosis
Histopathology
The histological appearance of a herpetic infection on the mucosa includes degeneration of stratified squamous epithelial cells, the loss of intercellular connections and inflammatory infiltrate around the capillaries of the dermis layer. An intact herpetic vesicle presents as an intraepithelial blister histologically. This vesicle is caused by rupture and distension of the virally epithelial cells by intracellular oedema and coalescence of disrupted cells.Rupturing of the infected cells cause a great number of viral particles to be released, rendering them the ability to affect adjacent epithelial cells and even the sensory axons of the trigeminal nerve. Histologically, these infected cells have an eosinophilic cytoplasm and large, pale vesicular nuclei, appearing swollen under the microscope. The cytoplasms of the infected cells fuse, collectively forming giant cells with many nuclei. The balloon cells and multi-nucleated giant cells can often be identified in smears taken from an intact vesicle or from one which has been recently ruptured.The lamina propria shows a variable inflammatory infiltrate, the density of which depends on the stage and severity of the disease, and inflammatory cells also extend into the epithelium.Cowdry type A bodies are intranuclear inclusion bodies visible under light microscopy. They show electron dense glycoproteins and viral capsids. Both Cowdry type A bodies can both be found in varicella zoster and herpetic gingivostomatitis, making it impossible to distinguish between both eosinophilic bodies.
Signs and symptoms
Current consensus is that atypical anorexia patients are at risk for the same medical complications of anorexia nervosa.Evidence from a study conducted at the University of California San Francisco Eating Disorders Program suggests that atypical anorexia patients are equally likely as anorexia nervosa patients to develop secondary side effects, including bradycardia (decreased heart rate), amenorrhea (stopping of the menstrual period), and electrolyte imbalances. Treatment
Treatment for atypical anorexia is very similar to treatment for anorexia nervosa. Increasing calorie intake to a healthy amount is a crucial part of treatment, but patients with severe atypical anorexia are at risk for refeeding syndrome during early recovery, so it is recommended that they are treated in an inpatient facility and slowly adjusted to increased calorie intake by 100-200 additional calories per day. Treatment may also include a variety of therapies that help a patient deal with the depression, anxiety, and other mental symptoms that arise from the eating disorder.In the US, treatment may be complicated by the need to get health insurance plans to pay. Medical coding may be incorrect on requests or may be rejected because payers incorrectly evaluated it under the separate criteria for anorexia nervosa. Epidemiology
It is difficult to gauge the true prevalence of atypical anorexia pre-2013 because patients were lumped together under the EDNOS diagnosis. Evidence suggests that atypical anorexia is more prevalent than anorexia nervosa, but individuals experiencing it are less likely to receive care.