What is Acute Herpetic Gingivostomatitis?
Acute herpetic gingivostomatitis is the most common disease of the oral mucosa in children caused by the Herpes simplex virus.
Causes of Acute Herpetic Gingivostomatitis
HSV types 1 and 2 belong to the Herpesviridae family, which consists of eight viruses: cytomegalovirus, varicella-zoster virus, Epstein-Barr virus and herpes viruses of types 6, 7 and 8. About 75-90% of the adult population have had herpes simplex. Infection occurs through contact with the ingress of infected saliva on the skin or mucous membranes.
In most cases, the causative agent is HSV type 1, but HSV type 2, which usually affects the skin of the lower half of the body and the mucous membrane of the genital organs, can also cause gingivostomatitis as a result of oral-genital or oral-oral contact.
Herpes simplex is very widespread in nature, its carriers are many healthy people. The contagiousness of the virus is small, however, often the disease occurs in the form of small outbreaks in nurseries, kindergartens.
Infection occurs through airborne droplets, through toys, possibly infecting a child from an adult virus carrier or suffering from recurrent herpes.
Symptoms of Acute Herpetic Gingivostomatitis
The incubation period often lasts from 2 to 6 days, but can last up to 17 days.
Acute herpetic gingivostomatitis, as a rule, children of nursery and younger preschool age, most often from 1 year to 3 years, are ill. In recent years, cases of illness of children 6-10 months, artificially fed from the first months of life.
Generalized form of herpes is possible in a child born by a mother who does not have antibodies to the herpes simplex virus. Infection of such a child, who has not received passive immunity from the mother, leads to the development of severe septic disease with damage to the serous membranes of the brain and internal organs. Extensive necrosis occurs in the oral cavity; most children die.
Herpetic gingivostomatitis is contagious. It occurs acutely with a marked disturbance of the general condition and local symptoms, depending on which emit mild, moderate and severe forms of the disease.
Mild form of acute herpetic gingivostomatitis in children
In the mild form of acute herpetic gingivostomatitis, the general condition of the child is slightly disturbed, the body temperature is subfebrile, less commonly normal, the prodromal period is not always pronounced. The first clinical sign is pain when eating. On examination, the doctor reveals hyperemia and swelling of the mucous membrane of the mouth and separate, as a rule, non-confluent erosion of a round shape with a diameter of 1 to 5 mm, covered with fibrinous bloom. Rash usually one-time, new elements in the following days does not occur, the duration of the disease 4-5 days.
Moderate and severe acute herpetic gingivostomatitis in children
The moderate and even severe form of acute herpetic gingivostomatitis is more commonly diagnosed in children. The onset of the disease is acute, as with most other infectious diseases, the body temperature is above 38 ° C, and in severe cases it can reach 40 ° C, intoxication is pronounced: the child is sluggish, capricious, does not sleep well, complains of headache, the appetite is significantly reduced even before erosions in the mouth. Some children have nausea, vomiting, and stool disorders. Then often catarrhal phenomena join: runny nose, cough, conjunctivitis. Usually, a pediatrician examines a child during this period and in most cases diagnoses an acute respiratory illness. However, upon careful examination of the maxillofacial region, the pediatrician can detect enlarged, painful submandibular, chin, and neck lymph nodes and initial signs of catarrhal gingivitis; the gingival margin is brighter in color than the rest of the mucous membrane of the mouth, the tops of the interdental gingival papillae are not sharp, as is normal, but rounded.
On the 2nd, 3rd, or (rarely) on the 4th day of the disease, on the mucous membrane of the mouth, and often on the red border of the lips and skin of the face, rashes of individual and grouped bubbles with a diameter of 1-3 mm appear. On the skin and lips red border, the stage of the bubble is easily determined, at first the bubbles have transparent contents, after 1–3 days their contents become cloudy, then shrink into a crust. If the bubble cap is damaged, skin erosion is formed. On the mucous membrane of the mouth, the intraepithelial vesicles quickly open and the doctor sees a rounded erosion – afta. Aphthae are sharply painful, they are localized on the tongue, the mucous membrane of the lips, cheeks, less often on the palate, the arms, the gums. With a massive rash, the aphthae merge with each other, forming extensive erosions of various outlines. The mucous membrane of the mouth, free from erosion, swollen, hyperemic, tongue overlaid. The gingival margin is also swollen, hyperemic, and erosion is often formed along the edges of the gum. Salivation increases, but saliva is viscous with an unpleasant odor.
The period of rash lasts 2 – 4 days. The condition of the child remains difficult, some children refuse not only food but also drink, which intensifies intoxication. Of great importance in the pathogenesis of the disease is the secondary infection of erosions with endogenous mixed, primarily coccal, microflora of the oral cavity, which becomes pathogenic in a child weakened by a viral infection. In some children, with a severe form of the disease, a deep necrotic lesion of the oral mucosa develops.
The duration of the disease depends on its severity and the effectiveness of the treatment and lasts 7 to 15 days, the aphthae heal without scarring, the effects of gingivitis last longer. The disease does not recur if sustained immunity is produced. In recent years, many children have relapses of the disease.
Acute herpetic gingivostomatitis should be distinguished from drug-induced stomatitis, erythema multiforme exudative and similar syndromes, diphtheria and other stomatitis in acute infectious diseases.
Severe acute herpetic gingivostomatitis in children (apochid Pospisilla)
Pospisill described the severe form of severe herpes gingvostomatitis in children debilitated by infectious diseases. In this form, erosion occurred not only in the oral cavity and on the skin of the face, but also on the skin of the fingers, including near the nail plates, as well as on the genitals. Abroad, this disease is called Pospisill afotoid.
Treatment of Acute Herpetic Gingivostomatitis
The algorithm of conducting local therapy for herpetic stomatitis.
- Prepare sterile instruments and cotton wool.
- Pour antiseptic solutions into glass crucibles:
– 1.5% solution of hydrogen peroxide;
– 1.0% solution of chloramine;
– 1:5000 solution furatsilina. - Prepare a tray to collect waste material.
- Anesthetize the mucosa with a 10% lidocaine solution or anesthesin suspension in glycerin.
- Take a cotton swab, moisten with an antiseptic solution and process erosion (afty).
- Apply for 10 minutes cotton swabs with antiviral ointments:
– oxolinic;
– tebrofen;
– florenalevaya. - Recommendations:
– take liquid high-grade food;
– drink enough liquid;
– before eating it is necessary to treat the oral mucosa with 5% anesthesin emulsion.
The treatment is carried out 4 times a day. Once a day can be treated with a 0.1-0.5% solution of a proteolytic enzyme (trypsin, chymotrypsin).
All waste material and tools to process 3% solution of chloramine (1 hour).
During the period of extinction of the disease, it is recommended to treat the elements of the lesion with weak antiseptics, and then with keratoplastic agents (an oil solution of vitamin A, rosehip oil, carotolin and vinylinum). In children, the most commonly used solution of furatsilin is 1: 5000 and vinyline. Irrigation with antiseptics in young children is best done while lying on the belly of a rubber pear, substituting a tray.
Due to the fact that the disease is contagious, the child is not allowed to attend children’s institutions.