Herpes simplex orofacial infection
Herpesviral vesicular dermatitis | |
Herpes lesion on upper lip and face |
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Herpes simplex orofacial infection On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
- Infection by HSV-1 is the most common cause of herpes that affects the face and mouth (orofacial herpes), although within the recent years an increase in oral HSV-2 infections has been reported.[1]
Epidemiology
- Based on a study, lifetime prevalences of herpes simplex orofacial infection are 42.1% and 32.4%, in women and men, respectively. Moreover HSV1 prevalence was estimated 50.3%.[2]
- Another study reported herpes simplex infection rate approximately 70-80% in low socioeconomic status and 40%-60% in high socioeconomic status individuals. [3]
- Prevalence of HSV-1 estimated as 57.7% in US population. [4]
Clinical Presentations
- A majority of primary HSV-1 infections occur during childhood and if the virus comes into contact with the mucosa or abraded skin, it can cause acute herpetic gingivostomatitis (inflammation of the cheek's mucosa and gums) within 5–10 days. Some other symptoms may also develop, including fever and sore throat, and painful ulcers may appear.[1]
- Prodromal symptoms often precede a recurrence, which typically begins with reddening of the skin around the infected site, with eventual ulceration to form fluid-filled blisters that affect the lip (labial) tissue and the area between the lip and skin (vermillion border).[1] [5]
- Primary HSV infection in adolescents frequently manifests as severe pharyngitis with lesions developing on the cheek and gums. Some individuals develop difficulty in swallowing (dysphagia) and swollen lymph nodes (lymphadenopathy).[1] Primary HSV infections in adults often presents as pharyngitis similar to that observed in glandular fever (infectious mononucleosis), but gingivostomatitis is less likely. The symptoms of primary HSV infection generally resolve within two weeks.[1]
Disease Progression And Recurrence
- Transmission of HSV-1 usually occurs via direct contact with skin lesions or body fluids of the involved patient.[6]
- Once a primary oral HSV-1 infection has resolved, the HSV enters the nerves surrounding the primary lesion, migrates to the cell body of the neuron, and becomes latent in the trigeminal ganglion. In some patients, the virus reactivates to cause recurrent infection; which is more common with HSV-1 than HSV-2 oral infection.[1] [7]
- The recurrent infection is thus often called herpes simplex labialis. Rare occasions of reinfections occur inside the mouth (intraoral HSV stomatitis), affecting the gums, alveolar ridge, hard palate, and the back of the tongue. This may be accompanied by herpes labialis.[1] [8]
- It seems that some factors are responsible for recurrent herpes simplex infection due to decreasing the cell mediated immunity (either antigen dependent or no antigen dependent). the following list contains some of these factors:[9][10]
- Other viral infections with fever
- Fatigue
- Menstural period
- Stress
- Local trauma
- Ultraviolet light
- Local injury due to high temprature or frostbite
- Oral herpes is spread by direct contact with an active sore in an infected person, for instance, by kissing. However, the virus can be transmitted through the skin in the absence of a lesion.
- Oral herpes and cold sores can sometimes be confused with canker sores.
Differential diagnosis
Herpes simplex orofacial infection must be differentiated from other diseases causing oral lesions such as leukoplakia and herpes simplex virus infection.[11]
Disease | Presentation | Risk Factors | Diagnosis | Affected Organ Systems | Important features | Picture |
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Diseases predominantly affecting the oral cavity | ||||||
Oral Candidiasis |
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Localized candidiasis
Invasive candidasis |
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Herpes simplex oral lesions | ||||||
Aphthous ulcers |
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Squamous cell carcinoma |
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Leukoplakia |
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Melanoma |
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Fordyce spots |
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Burning mouth syndrome |
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Torus palatinus |
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Diseases involving oral cavity and other organ systems | ||||||
Behcet's disease |
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Crohn's disease |
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Agranulocytosis |
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Syphilis[14] |
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Coxsackie virus |
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Chicken pox |
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Measles |
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Associated Conditions
- Leukemia:[17][18]
- Herpes simplex orofacial infection has been reported in 40% of patients with acute leukemia.
Treatment
Acyclovir
- Based on a double-blind, placebo controlled, randomized trial done on patients with recurrent herpes simplex orofacial infection showed efficacy of 5% acyclovir cream containing propylene glycol in reducing the period of vesiculation (P = 0.016), healing time (P = 0.022) and itching duration.[19] [17]
- Another study done on 703 patients with herpes simplex keratitis demonstrated the effectiveness of acyclovir therapy for 12 months in lowering the chance of recurrent herpes simplex orofacial infection, including the ocular infection. [20]
Future or Investigational Therapies
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Bruce AJ, Rogers RS (2004) Oral manifestations of sexually transmitted diseases. Clin Dermatol 22 (6):520-7. DOI:10.1016/j.clindermatol.2004.07.005 PMID: 15596324
- ↑ Malvy D, Ezzedine K, Lançon F, Halioua B, Rezvani A, Bertrais S; et al. (2007). "Epidemiology of orofacial herpes simplex virus infections in the general population in France: results of the HERPIMAX study". J Eur Acad Dermatol Venereol. 21 (10): 1398–403. doi:10.1111/j.1468-3083.2007.02302.x. PMID 17958848.
- ↑ Chayavichitsilp P, Buckwalter JV, Krakowski AC, Friedlander SF (2009). "Herpes simplex". Pediatr Rev. 30 (4): 119–29, quiz 130. doi:10.1542/pir.30-4-119. PMID 19339385.
- ↑ Xu F, Sternberg MR, Kottiri BJ, McQuillan GM, Lee FK, Nahmias AJ; et al. (2006). "Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States". JAMA. 296 (8): 964–73. doi:10.1001/jama.296.8.964. PMID 16926356.
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ Sen P, Barton SE (2007). "Genital herpes and its management". BMJ. 334 (7602): 1048–52. doi:10.1136/bmj.39189.504306.55. PMC 1871807. PMID 17510153.
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ Herpes Online: Exploring the "H" Community, pages 1-4 American Social Health Association 1996 Access date: 2007-03-29
- ↑ Vestey JP, Norval M, Howie S, Maingay J, Neill WA (1989). "Variation in lymphoproliferative responses during recrudescent orofacial herpes simplex virus infections". Clin Exp Immunol. 77 (3): 384–90. PMC 1542042. PMID 2553308.
- ↑ Oakley C, Epstein JB, Sherlock CH (1997). "Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 84 (3): 272–8. doi:10.1016/s1079-2104(97)90342-5. PMID 9377190.
- ↑ Scully C (1989). "Orofacial herpes simplex virus infections: current concepts in the epidemiology, pathogenesis, and treatment, and disorders in which the virus may be implicated". Oral Surg Oral Med Oral Pathol. 68 (6): 701–10. doi:10.1016/0030-4220(89)90159-x. PMID 2556674.
- ↑ Ann M. Gillenwater, Nadarajah Vigneswaran, Hanadi Fatani, Pierre Saintigny & Adel K. El-Naggar (2013). "Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!". Advances in anatomic pathology. 20 (6): 416–423. doi:10.1097/PAP.0b013e3182a92df1. PMID 24113312. Unknown parameter
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ignored (help) - ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)
- ↑ title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
- ↑ Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE (2000). "Individual and community risks of measles and pertussis associated with personal exemptions to immunization". JAMA. 284 (24): 3145–50. PMID 11135778.
- ↑ Ratnam S, West R, Gadag V, Williams B, Oates E (1996). "Immunity against measles in school-aged children: implications for measles revaccination strategies". Can J Public Health. 87 (6): 407–10. PMID 9009400.
- ↑ 17.0 17.1 Barrett AP (1986). "A long-term prospective clinical study of orofacial herpes simplex virus infection in acute leukemia". Oral Surg Oral Med Oral Pathol. 61 (2): 149–52. doi:10.1016/0030-4220(86)90177-5. PMID 3515270.
- ↑ Barrett AP (1988). "Chronic indolent orofacial herpes simplex virus infection in chronic leukemia: a report of three cases". Oral Surg Oral Med Oral Pathol. 66 (3): 387–90. doi:10.1016/0030-4220(88)90251-4. PMID 3050711.
- ↑ Van Vloten WA, Swart RN, Pot F (1983). "Topical acyclovir therapy in patients with recurrent orofacial herpes simplex infections". J Antimicrob Chemother. 12 Suppl B: 89–93. doi:10.1093/jac/12.suppl_b.89. PMID 6355055.
- ↑ "Acyclovir for the prevention of recurrent herpes simplex virus eye disease. Herpetic Eye Disease Study Group". N Engl J Med. 339 (5): 300–6. 1998. doi:10.1056/NEJM199807303390503. PMID 9696640.