Upload
dina-harrington
View
227
Download
0
Tags:
Embed Size (px)
Citation preview
HSV GINGIVOSTOMATITIS
HSV Gingivostomatitis
• Most common manifestation of primary HSV infection children– 13-30%
• Typically HSV-1• Age 6mos – 5yrs– Can occur in adolescents
• Prodromal illness: fever, anorexia, malaise, h/a
HSV Gingivostomatitis
• Transmission: direct contact with infected oral secretions or lesions
• Viral shedding in primary gingivostomatitis: – At least 1wk– Median 3 weeks
• Incubation period– 2days – 2 weeks
• Reactivation through trigeminal ganglion
Complications
• Dehydration (most common)• Herpetic whitlow• Secondary bacterial infection or
bacteremia• Esophagitis• HSV encephalitis• Eczema herpeticum• Lip adhesions
Supportive Care
• Hydration• Pain control• Barrier for lips– Petroleum jelly
• Topical therapies– Magic mouthwash• Various combinations of benadryl, Maalox, Kaopectate,
viscous lidocaine
Treatment
• Oral acyclovir shortens duration of symptoms and viral shedding
• Topical acyclovir not effective• Immunocompromised: IV acyclovir• Prolonged course of disease:– Consider Acyclovir resistance– Use Foscarnet
• Superimposed infection: amoxicillin or clinda
Isolation
• Children in childcare who do not have control of oral secretions should be excluded
• Hospitalized: add contact precautions
Oral Candidiasis
• 60% of healthy individuals harbor Candida in oral cavity– Also skin, intestinal, and vaginal area
• C. albicans accounts for 80% oral isolates– Others: C. glabrata, C. tropicalis
• Infants acquire Candida:– Birth– Postnatally (breast feeding)
• Oral candidiasis (thrush)– 2-5% of healthy newborns
Oral Candidiasis: Setup
• Altered host defense– Infants: immaturity of immune system– HIV & Other immune deficiencies– Diabetes mellitus– Antineoplastic or immunosuppressive drugs– Inhaled corticosteroids
Oral Candidiasis: Setup
• Insult to natural oral flora– Frequent or prolonged antibiotics
• Poor oral hygiene may contribute
Oral Candidiasis
• Symptoms– Asymptomatic– Sore and painful mouth– Burning– Dysphagia– Infants may have decreased PO intake
Pseudomembranous candidiasis (thrush)
• White to yellow plaques and erythema of tongue, soft palate, and buccal mucosa
• Plaques may be wiped off– Raw, erythematous mucosa– Differentiate from “milk curd”
• May also see– Angular chelitis– Fissuring or scaling at corners of mouth
Erythematous candidiasis (atrophic candidiasis)
• Denuded lesions: Palate and dorsum of tongue
• Seen with– Corticosteroids– HIV
Diagnosis
• Clinical diagnosis• Can look for pseudohyphae• If immunocompromised, consider:– Aspergillosis– Cryptococcosis– Histoplasmosis– Blastomycosis– Mucormycosis
Treatment
• Usually responds well to topical agents– Nystatin suspension– 4X daily for 2 wks • (2 days beyond resolution of symptoms)
• Refractory cases or immunocompromised– Fluconazole
Refractory cases
• Children >6y/o with persistent or unexplained frequent relapses, consider immunodeficiency (HIV)
• Maternal colonization or infection in breast fed infants
Herpangina
• Coxsackie Group A• Age 3-10 years• Sudden onset high fever, sore throat,
dysphagia, lesions of post pharynx– Anterior tonsillar pillars, soft palate– 1-2mm vescicles that ulcerate and enlarge to 4mm – Surrounded by erythematous ring (up to 10mm)– Average of 5 lesions
Hand-Foot-Mouth
• Enteroviruses (Coxsackie A and B)– Multiple viruses
• Summer months• < Age 5• Typically self-limited– Low-grade fever?
• Possible aseptic meningitis, encephalitis– Enterovirus 71 (more severe CNS symptoms)
Hand-Foot-Mouth
• Scattered vesicles and ulcerative lesions (4-8mm) throughout oropharynx
• More numerous than herpangina
• Rash hands, fingers, feet, buttocks, groin• May involve palms/soles
HIV Gingivitis
• Generalized linear gingival erythema– Brightly inflamed band of marginal gingiva– Painful, bloody, tissue destruction– Enteric strains and yeast
• Treatment:– Debridement and antimicrobials
Riga-Fede Ulceration
• Ventral surface of tongue in infants• Continual movement of tongue over lower
incisor• Treatment varies– Observation– Smoothing of tooth edge