Viral infections of the mouth

Question 1

Explain the clinical presentation of Herpes simplex virus and the treatment thereof

Answer 1

Primary infection: Asymptomatic or as gingivostomatitis
- Gingivostomatitis: painful erythematous palatal +/- ginvival lesions - vesicles 2-3mm can become painful ulcers
- Primary infections in adults: Pharyngotonsillitis

Recurrent infections due to reactivation
- Herpes Labialis: reactivation due to immunosuppression
- Lesions most often at mucocutaneous junction of lip

Treatment:
- Symptomatic in mild cases
- HSV antivirals for prolonged symptoms

Question 2

Explain the clinical features of Varicella-Zoster virus and the treatment thereof

Answer 2

Primary infection:
- Intra-oral vesicles on tonhue, buccal mucosa, gingiva, palate, oropharynx
- Generally not very painful

Reactivated infection:
- Head and neck area: Visicles on one side of face or in oral mucosa of one of trigeminal nerve divisions
- May be confused with recurrent HSV

Treatment:
- Supportive and symptomatic
- High dose oral acyclovir reccomended for both primary and recurrent infections in immunocompromised patients

Question 3

Explain the clinical presentation of Coxsackie virus infections (Herpangina, Hand foot and mouth disease) and treatment

Answer 3

Herpangina:
- Affects children
- Sudden onset fever, malaise, sore throat followed by vesicles, ulcerations, diffuse erythema on soft palate and tonsillar areas
- Systemic symptoms settle in 2-3days

Hand foot and mouth disease
- Common in children 1-5years
- Low grade fever and malaise
- Vesicular eruption on hard palate aswell as palms and feet

Treatment:
- Usually self limiting
- Symptomatic treatment: Non-aspirin antipyretics, topical anaesthetics