Gingivostomatitis herpetica B00.2

Manifestation of a primary infection with the herpes simplex virus type 1 in the form of an acutely occurring aphthous oral mucosa inflammation. Neonatal manifestations usually occur from mother to child, more rarely through infectious contacts. Otherwise, droplet infections (sneezing, coughing, speaking) or contact with infectious saliva occur.

Almost exclusively occurring in infants up to the age of 5 years. Less frequently in adulthood (see fig.).

After unspecific prodromes (incubation period 3-10 days), acute onset of numerous, aphthous, locally confluent erosions and shallow ulcerations of the oral mucosa, preferably in the vestibule oris.

Gingivitis with inflammatory reddened, swollen, slightly bleeding mucosa.

Partially pronounced general symptoms such as fever, exhaustion, vomiting.

Painful regional lymphadenitis.

Gingivostomatitis herpetica in adults is rare. It is observed mainly in immunosuppressed patients.

Erythema exsudativum multiforme: usually combined with multiforme skin manifestations.

Herpangina Zahorsky due to Coxsackie A virus infection.

Hand-foot-mouth disease: always combined with blistering of the hands/feet.

M. Behçet

Diphtheria

habitual aphthae.

Secondary bacterial infection, involvement of fingers, upper lip, nasal entrance (further inoculation of the virus by smear infection).

Complications: Rare meningoencephalitis herpetica

Mouth rinses with stomatological agents such as chamomile extracts (e.g. Kamillosan), 5% dexpanthenol (e.g. Bepanthen solution, R066 ) or analgesic preparations (e.g. Acoin solution or periodontal mouth ointment).

Healing usually within 1 week.

Virustatics such as aciclovir (e.g. Zovirax): 5x200mg/day for 10 days; for herpes encephalitis 3x10 mg/kg bw/day i.v. for 2 weeks.

Alternative: Famciclovir (^Famvir®): 3x250 mg/day for 5 days (oral).

Age alternative: Valaciclovir (^Valtrex® ): 2x500mg/day for 10 days (orally).

To prevent secondary infections, broad-spectrum antibiotics such as doxycycline (e.g., Vibravenous) initially 200 mg/day i.v., subsequent days 100 mg/day i.v. Children 4 mg/kg bw/day i.v., if necessary.

High-caloric liquid nutrition (e.g. Meritene). Parenteral fluid administration if necessary.

Reminder. Ensure sufficient fluid intake!

Favorable in localized disease; usually scarless healing within 1 week.

The infectious disease is contagious. The virus excretion usually lasts for 7 days in untreated persons (max. 12 days). During this time contact with other small children should be avoided.

An analogous clinical picture can also appear in girls and young women as vulvovaginitis herpetica.

1. Chen CK edt al (2012) Herpetic gingivostomatitis with severe hepatitis ina previously healthy child. J Microbiol Immunol Infect 45: 324-325
2. Mohan RP et al (2013) Acute primary herpeticgingivostomatitis. BMJ Case Rep doi:10.1136/bcr-2013-200074
3. Nevet A et al (2014) C-Reactive protein levels inchildren with primary herpetic gingivostomatitis. Isr Med Assoc J 16:700-702
4. Podder I (2014) Herpetic gingivostomatitis. Indian Pediatrist 51:764