Herpes gingivostomatitis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Prodrome of fever, | *Prodrome of [[fever]], [[myalgia]]s, and cervical [[lymphadenopathy]]<ref name="Mohan" /> | ||
*Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa) | *Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa) | ||
**Can be extremely painful and → odynophagia | **Can be extremely painful and → odynophagia | ||
| Line 24: | Line 24: | ||
{{HSV-1 antiviral treatment}} | {{HSV-1 antiviral treatment}} | ||
*Analgesia (e.g. | *[[Analgesia]] (e.g. [[acetaminophen]] and/or [[ibuprofen]]) | ||
*PO intake is important | *PO intake is important | ||
**Consider viscous lidocaine before meals<ref name="George" /> | **Consider viscous [[lidocaine]] before meals<ref name="George" /> | ||
==Disposition== | ==Disposition== | ||
Latest revision as of 17:27, 24 September 2019
Background
- Primary HSV-1 infection of lips, gingiva, and tongue
- HSV-2 associated with genital disease
- Usually occurs in childhood[1]
- 90% of population is seropositive by age 40[1]
- Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible
Clinical Features
- Prodrome of fever, myalgias, and cervical lymphadenopathy[2]
- Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa)
- Can be extremely painful and → odynophagia
- Lasts approximately 1-4 weeks without treatment, course shortened with treatment
Differential Diagnosis
Herpes Simplex Virus-1
- Eczema herpeticum
- Herpes gingivostomatitis
- Herpes keratitis
- Herpes labialis (cold sore)
- Herpes simplex encephalitis
- Herpetic whitlow
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
Evaluation
- Clinical diagnosis, based on history and physical exam
- Available laboratory studies (not required for diagnosis)[2]:
- Viral culture (gold standard)
- Direct immunofluorescence
- Tzanck smear (poor specificity)
Management
Anti-viral Treatment
Normal Host
- Options:
- Acyclovir
- 400 mg PO 5x/day (q4hrs while awake) x 5 days, OR
- 40-80mg/kg PO divided in 3-4 doses for 5-7 days, OR
- Can also be used as a cream or oral suspension (swish and swallow)[2]
- Famciclovir 500mg PO BID x 7 days, OR
- Valacyclovir 2gm PO q12 x 1 day
- Acyclovir
Immunocompromised
- Options:
- Acyclovir
- 5 mg/kg IV (over 1 hours) q8h x 7 days, OR
- 400mg PO 5x/day x 14-21 days
- Famciclovir 500mg PO BID x 7 days, OR
- Valacyclovir 500mg PO BID x 5-10 days
- Acyclovir
- Analgesia (e.g. acetaminophen and/or ibuprofen)
- PO intake is important
Disposition
- Discharge if uncomplicated
- Consider admission if immunocompromized, critically ill, or with large necrotic ulcers
See Also
External Links
References
- ↑ 1.0 1.1 1.2 George AK, Anil S. Acute Herpetic Gingivostomatitis Associated with Herpes Simplex Virus 2: Report of a Case. Journal of International Oral Health : JIOH. 2014;6(3):99-102.
- ↑ 2.0 2.1 2.2 Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.