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.

Terapias oncoespecíficas en pacientes con virus del herpes simple bucal / Oncospecific therapies in patients with herpes simplex virus

Se efectuó un estudio descriptivo y transversal de 25 pacientes con cáncer infectados por el virus del herpes simple bucal, quienes tenían el sistema inmunológico deteriorado debido al tratamiento oncoespecífico, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero de 2014 hasta igual mes de 2016, a fin de evaluar los resultados del diagnóstico clínico y citopatológico de esta afección. En la casuística prevalecieron el sexo masculino, el dolor como sintomatología clínica, el bermellón del labio inferior como el sitio de mayor incidencia y la quimioterapia como la modalidad terapéutica de mayor reactivación de este agente viral. La citología exfoliativa confirmó la presencia de células epiteliales gigantes multinucleadas con cuerpos de inclusiones intranucleares y necrosis de células infectadas, respectivamente, siendo estos los hallazgos microscópicos más significativos

A descriptive and cross-sectional study of 25 patients with cancer infected by the oral herpes simplex virus was carried out. They had the immunologic system damaged due to oncospecific treatment, assisted in the stomatological service of the Specialties Polyclinic of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2014 to the same month in 2016, in order to evaluate the results of the clinical and cytopathologic diagnosis of this disorder. In the case material the male sex and pain as clinical symptomatology, the vermilion of the lower lip as the place of more incidence and chemotherapy as the therapeutic modality of this viral agent higher reactivation prevailed. The exfoliative cytology confirmed the presence of multinucleous giant epithelial cells with bodies of intranuclear inclusions and infected cells necrosis, respectively, being these the most significant microscopic findings

Placa infiltrada en labio superior de paciente con mieloma múltiple / Indurated plaque on the upper lip of a patient with multiple myeloma

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Estomatitis herpética y coinfección HIV-1 y P. Jiroveci en una adolescente: informe de un caso / Herpetic stomatitis and HIV-1 and P. Jiroveci co-infection in a female adolescent: report of a case

La infección por el HIV-1 cursa con enfermedades oportunistas asociadas. En referencia a los virus herpes, la asociación más conocida es con el HVS-2. La coinfección HIV-1, HVS-1 y P. jiroveci constituye un cuadro clínico de alta morbilidad y baja frecuencia. Caso clínico: una paciente de 17 años de edad fue derivada a la consulta con sintomatología compatible con gingivoestomatitis herpética recurrente resistente a la terapia con aciclovir p.o. 200 mg cada 5 hs y tratada con amoxicilina-clavulánico p.o. (875 mg-125 mg) cada 12 hs por 20 días. Al ingreso presentaba adenitis cervical, odinofagia, disnea, fiebre (38.2ºC), pulso: 120/min, presión arterial: 120/75 mm Hg, frecuencia respiratoria: 24/min y deterioro generalizado. Se solicitó hacer la serología para el HIV y estudio RX de tórax. La serología para HIV-1 resultó positiva y los valores de CD4+ y carga viral fueron 320/mm3 y 25.000 copias/ml, respetivamente. El estudio RX de tórax reveló neumonía por P. jiroveci que se confirmó posteriormente por fibrobroncoscopía. Se realizó el tratamiento farmacológico de la infección herpética con foscarnet (i.v) 60mg /kg cada 12 hs. durante 3 días, mientras que la neumonía se trató con trimetropima 160 mg y sulfametoxazol p.o. 800 mg cada 6 horas durante 14 días. La remisión de la sintomatología bucal se oservó a los 15 días postratamiento. Conclusión: la población femenina adolescente evidencia una mayor vulnerabilidad biológica y social en relación a la transmisión del HIV. El odontólogo responsable deberá calibrarse en el reconocimiento y diagnóstico precoz de las manifestaciones bucales de dicha infección viral. Ante la presencia de cepas de HVS-1 aresistentes deberá contemplarse la posibilidad de otras infecciones oportunistas simultáneas

Clinical assessment of disease severity in recurrent aphthous stomatitis.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases in many parts of the world. However, there is very limited published clinical evidence for the therapies used in this condition. This could be partly due to the difficulty in evaluating the efficacy of oral ulcer treatment objectively. In this paper, we present a method for assessing and monitoring the severity of oral ulcers before and after treatment. METHODS: Six ulcer characteristics, number, size, duration, ulcer-free period, site and pain, were used to generate an ulcer severity score (USS). The scores for 223 RAS patients were determined, and 79 were scored again after 3-month therapy with topical betamethasone. RESULTS: The scores for the minor RAS group were between 18 and 43 (mean 29.2 ± 5.3). The mean score in the major ulcers group (range: 28-60, mean 39.9 ± 6.1) was significantly greater than in the minor group (P < 0.001). The herpetiform recurrent ulcers score range was wide (range: 18-57, mean 36.6 ± 8.4). The mean severity score decreased significantly after treatment (P < 0.001). CONCLUSIONS: The USS was indicative of the disease activity in recurrent oral ulceration. It helped in assessing the efficacy of therapy, as the change in the numerical score reflected the change in ulcer severity in response to treatment. This tool may well prove to be of value in clinical management, research and in clinical trials.

Heterogeneity and evolution of thymidine kinase and DNA polymerase mutants of herpes simplex virus type 1: implications for antiviral therapy.

BACKGROUND: Infections caused by acyclovir-resistant isolates of herpes simplex virus (HSV) after hematopoietic stem cell transplantation (HSCT) are an emerging concern. An understanding of the evolutionary aspects of HSV infection is crucial to the design of effective therapeutic and control strategies. METHODS: Eight sequential HSV-1 isolates were recovered from an HSCT patient who suffered from recurrent herpetic gingivostomatitis and was treated alternatively with acyclovir, ganciclovir, and foscavir. The diverse spectra and temporal changes of HSV drug resistance were determined phenotypically (drug-resistance profiling) and genotypically (sequencing of the viral thymidine kinase and DNA polymerase genes). RESULTS: Analysis of 60 clones recovered from the different isolates demonstrated that most of these isolates were heterogeneous mixtures of variants, indicating the simultaneous infection with different drug-resistant viruses. The phenotype/genotype of several clones associated with resistance to acyclovir and/or foscavir were identified. Two novel mutations (E798K and I922T) in the viral DNA polymerase could be linked to drug resistance. CONCLUSIONS: The heterogeneity within the viral populations and the temporal changes of drug-resistant viruses found in this HSCT recipient were remarkable, showing a rapid evolution of HSV-1. Drug-resistance surveillance is highly recommended among immunocompromised patients to manage the clinical syndrome and to avoid the emergence of multidrug-resistant isolates.

[State of local immunity in herpetic stomatitis patients].

It was set by us, that at intensifying of herpetic stomatititis of mucous membrane of oral cavity for patients the deficit of lysozyme and antibodies of class is marked A in the mixed saliva. At what the degree of expressed of the exposed violations of local immunity correlated with frequency of relapses of viral infection and its duration.

The impact of oral herpes simplex virus infection and candidiasis on chemotherapy-induced oral mucositis among patients with hematological malignancies.

The aim of this study was to evaluate the influences of oral candidiasis and herpes simplex virus 1 (HSV-1) infections in chemotherapy-induced oral mucositis (OM). The medical records of 424 consecutive patients with hematological malignancies who had received chemotherapy at a medical center in Taiwan from January 2006 to November 2007 were retrospectively reviewed. The results of swab cultures of fungus and HSV-1 for OM were correlated with associated clinical features. Younger age, myeloid malignancies, and disease status other than complete remission before chemotherapy were significantly correlated with the development of OM. Risks of fever (p < 0.001) and bacteremia were higher in patients with OM. Among 467 episodes of OM with both swab cultures available, 221 were non-infection (47.3%) and 246 were related to either fungal infections, HSV-1 infections, or both (52.7%); of the 246 episodes, 102 were associated with fungal infections alone (21.8%), 98 with HSV-1 infections alone (21%), and 46 with both infections (9.9%). Patients who had received antifungal agents prior to OM occurrence tended to have HSV-1 infection (p < 0.001). Our results suggest that Candida albicans and HSV-1 play an important role in chemotherapy-induced OM in patients with hematological malignancies.

[Improvement of treatment of inflammatory diseases in oral cavity].

In order to determine the anti-pathogenic clinical efficacy of cycloferon liniment in the combined treatment of herpetic stomatitis and periodontitis, medical examination and treatment of these disorders have been carried out in a group of 80 patients. It is established that the use of cycloferon liniment in the combined treatment of herpetic stomatitis and periodontitis decreases the infectious load in parodontal recess, reduces the manifestations of local inflammation, normalizes the immunity indices, and decreases the level of endogenous intoxication, which ensures the acceleration of recuperation processes and lowers the frequency of recurrences.

Aphthous ulcers.

Aphthous ulcers are one of the most common oral diseases worldwide. Their clinical presentation is characterized by multiple, recurrent, small, round, or ovoid ulcers with circumscribed margins and erythematous haloes present in different sizes. Oral lesions similar to aphthous ulcers may be present in several systemic diseases. This article will summarize the differential diagnosis of aphthous ulceration, with emphasis on a practical guide for the management of recurrent aphthous ulceration, including topical and systemic therapy.

Herpetic geometric glossitis in an immunocompetent patient with pneumonia.

Herpetic geometric glossitis is an uncommon, clinically distinctive presentation of oral herpes simplex virus infection that affects the tongue. All published reports have been in patients who are immunocompromised. We present an immunocompetent woman with viral pneumonia who developed painful linear fissures on the back of the tongue suggestive of herpetic geometric glossitis. The diagnosis was confirmed by both biopsy specimen and immunohistochemistry. As in other cases, the patient promptly responded to treatment with antiviral therapy. The morphology, laboratory findings, and similarities to herpetic corneal dendrites are discussed. Herpetic geometric glossitis should no longer be considered as a diagnosis only in immunosuppressed individuals, but in immunocompetent persons as well.

Primary herpetic gingivostomatitis in children and adults.

OBJECTIVES: To investigate if the onset of primary herpetic gingivostomatitis (PHG) is shifting toward an adult age and compare the clinical characteristics of PHG between children and adults. METHOD AND MATERIALS: The charts of patients diagnosed with PHG in an oral medicine clinic in Bucharest, Romania, over a 10-year period were revisited. Diagnosis was based on history, clinical data, and laboratory confirmation (Tzanck cytology, polymerase chain reaction [PCR], or immunofluorescence). Seventy-three cases (38 females, 35 males) were included. The age range was between 22 months and 53 years, with a mean age of 18.6 years. All patients were healthy with no suspicion of HIV infection or immunodeficiency. RESULTS: Nearly 48% (47.94%) of the sample were in the young adult group. General symptoms (fever, malaise, and lymphadenopathy) were equally present in children and adults. The most involved areas were the gingiva, vermilion border, and tongue. No differences in the extent of lesions were observed between children and adults. Inflammatory gingivitis and pharyngotonsillitis were more frequent in children than in adults although their frequency was less than expected. CONCLUSIONS: PHG was more frequently observed in young adults than in children. No significant differences between children and adults in the severity of infection were observed. Most of the patients presented widespread lesions.

Gengivoestomatite herpética aguda / Acute herpetic gingivostomatitis: report of a case

Gengivoestomatite Herpética Aguda (GEHA) representa uma doença infecto-contagiosa causada pelo vírus herpes simples. Revela relevante freqüência entre as crianças de zero a seis anos de idade, apresentando sintomatologia prodrômica e manifestação clínica autolimitada entre dez a quatorze dias. O conhecimento desta patologia por parte do cirurgião dentista é de fundamental importância, em decorrência do potencial de contaminação, morbidade e baixa no estado geral do paciente, somadas às possíveis complicações, observadas, sobretudo, em pacientes imunocomprometidos ou imunologicamente imaturos.

Acute Herpetic Gingivostomatitis (AHG) is an infect-contagious disease caused by a virus called Herpes simplex. This illness demonstrates important frequency among very young children (varying age from 0 to 6), presenting specific symptoms and auto-limited clinical manifestations during a period of ten to fourteen days. The knowledge of the referred pathology is of fundamental importance to the dentist, even more its contamination levels, morbidity and down general patient health condition plus the possible adversed progression of the AHC in immunocompromised or immunologic immature patients.