Otolaryngology Book

http://www.fpnotebook.com/

Oral HerpesAka: Herpes Simplex Virus, Cold Sore, Herpes Labialis, Herpes Simplex Stomatitis, Acute Herpetic Mucositis, Oral HSV, Orolabial Herpes, HSV I, Primary Herpetic Gingivostomatitis, Herpes Gingivostomatitis, Fever Blister

Advertisement

  1. See Also
    1. Genital Herpes
    2. Neonatal Herpes Simplex Virus
  2. Epidemiology
    1. Prevalence: 15-45% in United States
  3. Pathophysiology
    1. Etiology: HSV I or HSV II
    2. HSV lies dormant after initial infection
      1. Distributed in the trigeminal ganglion
      2. Reactivation with triggers as described below
  4. Symptoms
    1. Primary (Initial) HSV I: Usually asymptomatic
      1. Fever, chills
      2. Cervical Lymphadenopathy
      3. Ulcers deep in mouth on Gingival surface
    2. Secondary (Later) HSV I (Recurrent labial lesions)
      1. Provocative factors for recurrence
        1. Stress
        2. Febrile illness
        3. Sunlight (ultraviolet)
        4. Fatigue
        5. Menses
      2. Lesions form along vermillion border
        1. Fever Blisters form on outer vermillion border
        2. Cold Sores form on inner lip
      3. Course
        1. Prodrome: Itch, burn, or tingling for 12-36 hours
        2. Vesicle forms
        3. Vesicle ruptures, ulcerates and crusts in 48 hours
        4. Lesion heals in 7-14 days
  5. Signs
    1. Grouped Vesicles on erythematous base
    2. Forms on epithelial surface at vermillion border edge
    3. Vesicular lesions rupture to form painful Ulceration
  6. Differential Diagnosis
    1. Differs from Aphthous Ulcers in that:
      1. Found on keratinized (bound-down) intraoral mucosa
      2. Vesicles rupture into coalescing ulcers
    2. HSV lesions are anterior compared with:
      1. Herpangina
      2. Hand Foot and Mouth Disease
  7. Labs: Rapid Giemsa (Dif-Quik) stain
    1. Multinucleated giant cells
  8. Management
    1. Systemic Antiviral agents
      1. Acyclovir (not FDA approved)
        1. Dose: 15 mg/kg (max: 200 mg) PO 5x/day for 7 days
        2. Shortens first HSV infection by 6 days in children
        3. Amir (1997) BMJ 314:1800
      2. Famciclovir (not FDA approved)
        1. Shortens healing time by 2 days in UV-induced cases
        2. Spruance (1999) J Infect Dis 179:303
      3. Valacyclovir (FDA approved for age 12 and older)
        1. Adult dose: 2 g PO bid for one day
    2. Topical Antivirals
      1. General
        1. Reduce healing time by 0.7 days
      2. Penciclovir (Denavir) 1% Cream
      3. Docosanol (Abreva)
    3. Magic Mouthwash
      1. Indicated for analgesia
  9. References
    1. Colgan (2003) Am Fam Physician 67(4):757

Herpes Labialis (C0019345)

Definition (MSH)Herpes simplex, caused by type 1 virus, primarily spread by oral secretions and usually occurring as a concomitant of fever. It may also develop in the absence of fever or prior illness. It commonly involves the facial region, especially the lips and the nares. (Dorland, 27th ed.)
Definition (NCI)A lesion caused by type 1 or type 2 herpes simplex virus, involving the oralfacial region.
ConceptsDisease or Syndrome (T047)
MSHD006560
EnglishCold sore, Cold sores, Fever blister, Fever Blisters, FEVER SORE, herpes febrilis, Herpes Labialis, Herpes simplex labialis, Labial Herpes Simplex
Spanishherpes labial
Parent ConceptsHerpesviridae Infections (C0019372), Herpes Simplex Infections (C0019348), Lip Diseases (C0023760), Virus Diseases (C0042769), Non-Neoplastic Oral Cavity Disorder (C1335025), Oral herpes simplex infection (C0341012), Infective dermatosis of lip (C1274152), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, CST, DXP, MEDLINEPLUS, MSH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Simplexvirus (C0206558)

Definition (MSH)A genus of the family HERPESVIRIDAE, subfamily ALPHAHERPESVIRINAE, consisting of herpes simplex-like viruses. The type species is HERPESVIRUS 1, HUMAN.
Definition (NCI)HSV is a nuclear replicating, icosahedral, enveloped DNA virus. The HSV envelope contains at least 8 glycoproteins. The matrix or tegument which contacts both the envelope and the capsid contains at least 15-20 proteins. There are two types of HSV - Type 1 and Type 2. The Type 1 virus causes cold sores. Most people get Type 1 infections during infancy or childhood. The Type 2 virus causes genital sores. Most people get Type 2 infections following sexual contact with an infected person.
ConceptsVirus (T005)
MSHD018139
EnglishGenus Simplexvirus, Herpes labialis Virus, Herpes labialis Viruses, Herpes Simplex Virus, Herpes Simplex Viruses, Herpesvirus, Herpesvirus hominis, HS - Herpes simplex, HSV, HSV - Herpes simplex virus, Human Herpesvirus 1, human herpesvirus 1 group, Human herpesvirus 1 group virus, Simplexvirus, Simplexviruses
Spanishgenero Simplexvirus, grupo del virus del herpes simple, simplexvirus, virus del grupo del virus 1 del herpes humano, virus simplex
Parent Conceptsalphaherpesvirus (C0682451), Alphaherpesvirinae (C0206557), Herpesviridae (C0019369), Ambiguous concept (C1274012), Outdated concept (C1274014)
SourcesAOD, CSP, LNC, MSH, MTH, NCBI, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree