Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review.

OBJECTIVES: Herpes simplex virus 1 (HSV-1) is the main pathogen responsible for herpes infections. In 13-30% of the cases, primary HSV-1 leads to the primary herpetic gingivostomatitis (PHGS), often a self-limiting infection; however, it can limit the ability to drink/eat with, sometimes, the need for hospitalization. Multiple therapeutic methods have been proposed. This systematic review aims to collect and critically appraise the available evidence about the clinical management of PHGS. MATERIALS AND METHODS: Literature search including three databases (PubMed, Scopus, Embase), study design, and data analysis were performed following PRISMA guidelines, according to the PICO tool (PROSPERO n° CRD42023391386). Risk of bias was assessed with RoB 2 and ROBINS-I. RESULTS: Five studies on a total of 364 patients (average age: 7.6 years) were identified. The treatment regimens were summarized in acyclovir; acyclovir + honey; fluids and analgesic; maalox + diphenhydramine; lidocaine; chlorhexidine (CHX); CHX + ialuronic acid; CHX + Mucosyte®; antimicrobial photodynamic therapy (aPDT); topical antiviral; topical antiviral + aPDT; and others. CONCLUSIONS: Although PHGS is a disease with a high worldwide prevalence, the lack of consensus about therapeutic management indicates gaps in existing evidence. Most of the proposed treatment consists in symptomatic drugs with empiric regimens which are ineffective for the viral replication. The main limit to realize randomized clinical trial is due to the rapid onset and remission of the disease. In fact, the diagnostic delay, estimated in 72 h, decreases the effectiveness of any antiviral drugs. CLINICAL RELEVANCE: Out of the five studies included in this systematic review, only one was able to provide some weak evidence that ACV is an effective treatment, improving healing of oral lesions and reducing duration of symptoms.

Atypical herpetic ulcerations in COVID-19 positive patients: A report of three cases.

Since the global COVID-19 pandemic, numerous reports have been made regarding oral lesions seen in COVID-19 patients. It remains unclear whether or not these are true manifestations of COVID-19. Here we present 3 patients who were hospitalized for COVID-19 and who developed atypical herpetic ulcerations during their treatment with remdesivir (Veklury) and steroids. In healthy patients, recurrent infection by herpes simplex virus (HSV) presents as lesions only on the lips and the attached oral mucosa. Atypical herpetic ulcerations are seen in immunocompromised patients. They present as large, stellate shaped ulcerations with raised borders and may involve movable mucosa. The 3 cases presented in this report resembled the atypical herpetic ulcerations typically seen in patients with immunosuppression. Through our report, we aimed to introduce the possibility of atypical herpetic ulcers in patients being treated for COVID-19, to allow for their timely diagnosis and to raise awareness of the underlying immunocompromised state.

Severe pediatric oral mucositis.

We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.

ACUTE HERPETIC STOMATITIS: CLINICAL MANIFESTATIONS, DIAGNOSTICS AND TREATMENT STRATEGIES.

OBJECTIVE: The aim: To evaluate the recent scientific articles concerning peculiarities of this oral pathology. The goal is to carry out a literature review by evaluating all signs and clinical symptoms related to this disease, so as to provide the clinician with a useful tool for an early diagnosis and treatment of the disease. PATIENTS AND METHODS: Materials and methods: The collection of relevant data were done using the scientific databases Pubmed, Google Scholar. A manual search on Dentistry and Pharmacological sources was also conducted for relevant studies published. The selected key words: ("Herpes virus" OR "HSV") AND ("oral" OR "oral lesions") were used for collecting the data. CONCLUSION: Conclusions: The article presents clinical peculiarities of herpetic stomatitis depending on disease severity and course. Primary herpetic stomatitis appears as spherical clustered vesicles on the gingival and adjacent mucosa. Soon after eruption of elements of lesion they rupture forming painful halo like aphtae / ulcers. Typical symptoms are: pain from ruptured vesicles, lymphadenitis, fever etc. Early diagnosis of disease is important and treatment with antiviral medicaments can modify the course of the disease by reducing symptoms and potentially reducing recurrences. Management of acute herpetic stomatitis include antiviral medicaments intake, maintenance of fluids and electrolytes level in a body. The treatment principles based on etiotropic, pathogenetic and symptomatic therapy are considered in manuscript.

Adolescents and primary herpetic gingivostomatitis: an Italian overview.

AIM: The aim of this study was to investigate the therapies administered to Italian adolescents with primary herpetic gingivostomatitis (PHGS) METHODS: The medical records of 74 adolescents with PHSG were reviewed. The following data were recorded: age, gender, day of onset, type of treatment, lesions' severity, pain scoring, eating, and drinking ability. The oral examination was performed at the first evaluation (T0) and after one week (T1). RESULTS: All patients showed up at the first visit at least 48 h after the onset of symptoms. No patient was prescribed an antiviral therapy. An antibiotic therapy was prescribed in order to prevent secondary bacterial infections. Fifteen patients had been treated with non alcoholic chlorhexidine rinses (group A), 29 patients with non alcoholic chlorhexidine rinses plus hyaluronic acid gel (group B); 30 patients with non alcoholic chlorhexidine rinses plus Mucosyte® (group C). A significant improvement of the pain scoring and lesions' severity was noted in group C. CONCLUSION: In Italian adolescents, PHGS is diagnosed at least 48 h after onset and the antibiotic therapy is widely prescribed in order to prevent overinfections. Among topical therapies, an association of verbascoside and sodium hyaluronhate seems to favour a faster healing.

Severe oral stomatitis due to reactivation of herpes simplex virus type 1 in a methotrexate-treated patient with dermatomyositis.

We herein report a case of a 79-year-old Japanese woman who developed severe oral stomatitis during methotrexate (MTX) treatment for dermatomyositis. She had been treated with MTX (12 mg/week) and prednisolone (5 mg/day) for dermatomyositis for 4 years. She developed painful stomatitis, fever, and pancytopenia. Initially, her symptoms were suspected to be caused by mucosal toxicity of MTX. Therefore, the drug was discontinued, and leucovorin was administered. However, oral stomatitis worsened in a few days, resulting in intolerance of oral ingestion due to severe pain. Polymerase chain reaction revealed the presence of herpes simplex virus type 1 (HSV-1) in oral erosive lesions, and blood examination was positive and negative for anti-HSV IgG and anti-HSV IgM, respectively. Therefore, HSV-1 reactivation-induced oral stomatitis was diagnosed, and acyclovir treatment was started, which promptly improved oral stomatitis. HSV-1 reactivation is usually asymptomatic or results in localized vesicular lesions at the mucocutaneous junction of the lips in immunocompetent individuals. Our case illustrates that HSV-1 reactivation induces severe stomatitis in patients treated with low-dose MTX for autoimmune diseases, not just in those with severe immunosuppressive conditions. Of note, HSV-1 reactivation-induced stomatitis is a diagnostic challenge, especially during MTX treatment.

Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children.

BACKGROUND: Primary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children. METHODS: Between January 2012 and December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected. RESULTS: Among the 282 inpatients, 185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. Forty-six patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on the tonsils, to receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p-values < 0.01). CONCLUSIONS: Meticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can help making the diagnosis of PHGS earlier and subsequently reduce unnecessary prescription of antibiotics.

[Development of a method for evaluating the effectiveness of treatment of children with herpetic stomatitis.]

The high frequency of herpes infection in children determines the need to search for new diagnostic markers, evaluate treatment efficacy and predict relapse of the disease. The purpose of the work is to assess the possibility of using biochemical analysis of oral fluid to assess the effectiveness of treatment of children with acute herpetic stomatitis. In the oral fluid and blood plasma of 28 children of patients with acute herpetic stomatitis in the dynamics of the disease, the content of total protein, proteins of the acute phase of inflammation, as well as the concentrations of calcium, magnesium, copper and zinc was determined spectrophotometrically. Oral fluid and blood plasma of 45 practically healthy children were used as a control. In acute herpetic stomatitis, the content of C-reactive protein, orosomucoid, α1-antitrypsin, ceruloplasmin, prealbumin and microalbumin, as well as magnesium, calcium and zinc, increases in the oral fluid of children, but the level of total protein and transferrin decreases. In this blood plasma, the level of ceruloplasmin, orosomucoid, C-reactive protein, α1-antitrypsin is higher, and zinc is lower than in healthy children. The copper content in the oral fluid and blood plasma of children increases with moderate herpetic stomatitis, and significantly decreases with severe herpetic stomatitis. The degree of changes in the content of the proteins of acute phase of inflammation and indicators of mineral metabolism of the oral fluid and blood plasma of children with a herpetic infection of the oral cavity correlates with the severity of the disease. Highly significant correlations were revealed when comparing the concentrations of proteins of the acute phase of inflammation, electrolytes between the oral fluid and the blood plasma of children with acute herpetic stomatitis. After treatment of children with acute herpetic stomatitis, the content of minerals and proteins of the acute phase of inflammation in the oral fluid returned to normal only with a mild disease severity. A method has been developed for evaluating the effectiveness of treatment of children with acute herpetic stomatitis by determining the content of minerals in the oral fluid. The ratio of copper to calcium in the oral fluid of children more than 45 should be considered an indicator of effective treatment of children with herpetic stomatitis.

Painful ulcers on gingiva, tongue, and buccal mucosa.

We had one clue that helped explain the ulcers in the patient's mouth: He had an accompanying low-grade fever.