1 / 31

March 4, 2011

March 4, 2011. 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.

cid
Download Presentation

March 4, 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. March 4, 2011

  2. HSV gingivostomatitis

  3. 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

  4. 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

  5. Complications • Dehydration (most common) • Herpetic whitlow • Secondary bacterial infection or bacteremia • Esophagitis • HSV encephalitis • Eczema herpeticum • Lip adhesions

  6. Supportive Care • Hydration • Pain control • Barrier for lips • Petroleum jelly • Topical therapies • Magic mouthwash • Various combinations of benadryl, Maalox, Kaopectate, viscous lidocaine

  7. 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

  8. Isolation • Children in childcare who do not have control of oral secretions should be excluded • Hospitalized: add contact precautions

  9. Oral candidiasis

  10. 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

  11. Oral Candidiasis: Setup • Altered host defense • Infants: immaturity of immune system • HIV & Other immune deficiencies • Diabetes mellitus • Antineoplastic or immunosuppressive drugs • Inhaled corticosteroids

  12. Oral Candidiasis: Setup • Insult to natural oral flora • Frequent or prolonged antibiotics • Poor oral hygiene may contribute

  13. Oral Candidiasis • Symptoms • Asymptomatic • Sore and painful mouth • Burning • Dysphagia • Infants may have decreased PO intake

  14. Pseudomembranouscandidiasis (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

  15. Erythematouscandidiasis(atrophic candidiasis) • Denuded lesions: Palate and dorsum of tongue • Seen with • Corticosteroids • HIV

  16. Diagnosis • Clinical diagnosis • Can look for pseudohyphae • If immunocompromised, consider: • Aspergillosis • Cryptococcosis • Histoplasmosis • Blastomycosis • Mucormycosis

  17. 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

  18. Refractory cases • Children >6y/o with persistent or unexplained frequent relapses, consider immunodeficiency (HIV) • Maternal colonization or infection in breast fed infants

  19. Herpangina

  20. 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

  21. Herpangina • Typically self limited • May be associated with aseptic meningitis

  22. Hand-foot-mouth

  23. 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)

  24. 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

  25. HIV gingivitis

  26. HIV Gingivitis • Generalized linear gingival erythema • Brightly inflamed band of marginal gingiva • Painful, bloody, tissue destruction • Enteric strains and yeast • Treatment: • Debridement and antimicrobials

  27. Riga-fede ulceration

  28. Riga-Fede Ulceration • Ventral surface of tongue in infants • Continual movement of tongue over lower incisor • Treatment varies • Observation • Smoothing of tooth edge

  29. Geographic tongue

  30. Geographic Tongue(Benign Migratory Glossitis) • Chronic, recurring • Lesions • Pink to red • slightly depressed • Irregular, elevated, white to yellow borders • Areas of dekeratinization and desquamation of filiform papilla • Typically asymptomatic • Reassure

More Related