Herpes gingivostomatitis: Difference between revisions
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==Background== | ==Background== | ||
*Primary [[HSV-1]] infection of lips, gingiva, and tongue | *Primary [[HSV-1]] infection of lips, gingiva, and tongue | ||
**HSV-2 associated with genital disease | |||
[[File:Herpesgingiva.jpg|thumb|Herpes gingivostomatitis of mouth]] | |||
==Clinical Features== | ==Clinical Features== | ||
*Prodrome of fever, myalgias, and cervical adenopathy<ref name="Mohan" /> | |||
*Painful vesicular lesions of mucocutaneous areas | *Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa) | ||
* | **Can be extremely painful and → odynophagia | ||
*Lasts approx 2-4 weeks without treatment, course shortened with treatment | *Lasts approx 2-4 weeks without treatment, course shortened with treatment | ||
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{{HSV-1 DDX}} | {{HSV-1 DDX}} | ||
== | ==Diagnostic Evaluation== | ||
*Clinical diagnosis, based on history and physical exam | |||
*Available laboratory studies (not required for diagnosis)<ref name="Mohan">Mohan RPS, Verma S, Singh U, Agarwal N. Acute primary herpetic gingivostomatitis. BMJ Case Reports. 2013;2013:bcr2013200074. doi:10.1136/bcr-2013-200074.</ref>: | |||
**Viral culture (gold standard) | |||
**Direct immunofluorescence | |||
**Tzanck smear (poor specificity) | |||
==Management== | ==Management== | ||
*[[Acyclovir]] 40-80mg/kg PO divided in 3-4 doses for 5-7 days | ''Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible'' | ||
*PO intake is | *Antiviral drug | ||
**[[Acyclovir]] 40-80mg/kg PO divided in 3-4 doses for 5-7 days | |||
***Can also be used as a cream or oral suspension (swish and swallow)<ref name="Mohan" /> | |||
**Valacyclovir (significantly higher bioavailability than acyclovir) | |||
**Famciclovir | |||
*Analgesia (e.g. Acetaminophen and/or Ibuprofen) | |||
*PO intake is important | |||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
Revision as of 02:27, 8 September 2015
Background
- Primary HSV-1 infection of lips, gingiva, and tongue
- HSV-2 associated with genital disease
Clinical Features
- Prodrome of fever, myalgias, and cervical adenopathy[1]
- Painful vesicular and/or ulcerative lesions of mucocutaneous areas (non-keratinized mucosa)
- Can be extremely painful and → odynophagia
- Lasts approx 2-4 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
Diagnostic Evaluation
- Clinical diagnosis, based on history and physical exam
- Available laboratory studies (not required for diagnosis)[1]:
- Viral culture (gold standard)
- Direct immunofluorescence
- Tzanck smear (poor specificity)
Management
Treatment does not affect dormant virus in nerve ganglions → recurrent disease remains possible
- Antiviral drug
- Analgesia (e.g. Acetaminophen and/or Ibuprofen)
- PO intake is important
Disposition
- Discharge