Gingivostomatitis herpetica B00.2

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Aphthae infectious; Gingivostomatits in children; Herpetic gingivostomatitis; Infectious aphthae; Mouth rot; recurrent aphtous stomatitis; stomatitis aphthosa; stomatitis maculo-fibrinosa

Definition
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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.

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

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Clinical features
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After unspecific prodromi (incubation period 3-10 days) acutely occurring, numerous, aphthous, in places confluent erosions and flat ulcerations of the oral mucosa, preferably in the vestibulum oris.
Gingivitis with inflammatory reddened, swollen, slightly bleeding mucosa.
Sometimes pronounced general symptoms such as fatigue, vomiting, fever.
Painful swelling of the regional lymph nodes.
Gingivostomatitis herpetica in adults is mainly observed in immunocompromised patients.

Differential diagnosis
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Erythema exsudativum multiforme; hand-foot-mouth disease; M. Behçet; diphtheria; habitual aphthae.

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

Complications: Rare meningoencephalitis herpetica

External therapy
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Mouth rinses with stomatological preparations such as camomile extracts (e.g. Kamillosan), 5% dexpanthenol (e.g. Bepanthen solution, R066 ) or painkillers (e.g. Acoin solution or periodontal mouth ointment). Healing mostly within 1 week.

Internal therapy
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Virustatics like acyclovir (e.g. Zovirax) 3 times/day 5 mg/kg bw/day i.v.
To avoid secondary infections, if necessary, broad-spectrum antibiotics such as doxycycline (e.g. Vibravenous) initial 200 mg/day i.v., subsequent days 100 mg/day i.v. Children 4 mg/kg bw/day i.v.
High-calorie liquid food (e.g. Meritene). If necessary, parenteral fluid intake.

Notice! Ensure sufficient fluid intake!

Progression/forecast
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Favourable, mostly scarless healing within 1 week.

Note(s)
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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.

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