What Is Oral Herpes?

Oral herpes includes oral herpes simplex, oral herpes zoster, and hand, foot and mouth disease. Oral herpes simplex is caused by herpes simplex virus, which is very common in human infections. The oral cavity, skin, eyes, perineum, and nervous system are often vulnerable areas. Humans are their natural hosts. It can be divided into primary herpes stomatitis and recurrent herpes stomatitis. Primary herpes stomatitis is more common in children, and recurrent herpes stomatitis is more common in adults, mainly as cold sores. Oral shingles is an acute infectious disease caused by the varicella-zoster virus. Hand, foot and mouth disease is an infectious disease caused by enteroviruses. There are more than 20 types of enteroviruses that cause hand, foot and mouth disease. Coxsackie virus A16 (CoxA16) and enterovirus 71 (EV71) are the most common. common. Occurs in children under 3 years old.

Basic Information

English name

herpesofmouth

Visiting department

Stomatology

Common locations

Lips

Common causes

Herpes Simplex Virus, Varicella-Zoster Virus, Enterovirus Type (EV) and CoxA Virus (Ecovirus)

Causes of oral herpes

Herpes simplex

The disease is caused by the herpes simplex virus (HSV) of the DNA virus. Human herpes simplex virus is divided into two types, namely herpes simplex virus type I (HSV-I) and herpes simplex virus type II (HSV-II). In the past, HSV-1 was thought to cause skin and mucosal lesions above the waist, and HSV-2 mainly affected the lower waist. However, many studies have shown that HSV-2 virus is isolated from oral herpes simplex infections and even the mouth of healthy people. May be related to lifestyle variations.

Herpes zoster

The cause of shingles is DNA herpes virus, which is the same as varicella virus, also known as varicella-zoster virus (VZV), which is a neurotropic virus.

3. Hand, Foot and Mouth Disease

Enteroviruses that cause hand, foot and mouth disease include enterovirus type (EV) and Coxsackie virus (CoxA) and Echo virus (Echo). Some serotypes of EV infection cause a greater proportion of severe cases.

Oral herpes clinical manifestations

Oral herpes simplex

(1) Primary herpestic stomatitis is caused by HSV-I, and most often manifests as acute herpes gingivostomatitis. It is more common for children under 6 years, especially from 6 months to 2 years. Adults can also get sick. There are four periods of its onset: prodromal period Before the onset, there is often a history of contact with patients with herpes disease. After the incubation period of 4-7 days, acute symptoms such as fever, headache, fatigue and discomfort, general muscle pain, sore throat, swelling and tenderness of the submandibular and upper cervical lymph nodes appeared. The child was drooling, refusing food, and irritable. After 1 to 2 days, the oral mucosa, attached gingiva, and marginal gingiva were extensively congested and edema. blisters stage The oral mucosa presents clusters of small blisters, similar to the size of a needle, and the blisters are thin, transparent and easily ulcerated, forming superficial ulcers. Erosion period Clusters of small blisters can cause large-area erosion and cause secondary infection. Covered with yellow false film. Similar lesions may also appear on the skin around the lips and mouth. Healing period The erosion surface gradually shrinks and heals. The whole course of disease takes 7 to 10 days.

(2) Recurrent herpetic stomatitis After the healing of the primary herpes infection, recurrent damage occurs. The site of the recurrent infection is near the lips, which is also called recurrent cold sore. The clinical manifestation is that the damage always starts with multiple clusters of blisters. When a lesion recurs, it is always at or near the location where it originally occurred. With prodromal symptoms, the patient may feel slight fatigue and discomfort, and soon it may show symptoms such as itching, increased tension, burning pain, and tingling in the area where recurrence damage is about to occur. Within about a few hours, blisters appeared and there were mild red spots around. Under normal circumstances, blisters can last up to 24 hours and then rupture, erode, and scab. The course of the disease is about 10 days, but secondary infection often delays healing, leaving no scars after healing, but may have pigmentation. Factors that induce relapse include local mechanical stimuli, colds, and sun exposure. Emotional factors can also promote relapse. Although recurrent cold sores are the most common form of the disease, a few recurrences can damage gums and hard palate.

2. Herpes zoster

Oral mucosal damage: It is easy to occur in the trigeminal nerve distribution area, and the blistering time is short. It is mostly ulcerated with shallow edges and superficial ulcers. The surface is covered with yellow pseudomembrane. There will be pain, itching, burning sensation at the site of rash first, and then flushing, cluster miliary papules clustered, distributed along the affected nerves to form a band, and quickly become blisters. The blisters can merge into bullae and blisters. Nervous, the content is clear and transparent, and gradually becomes cloudy or even bloody and purulent. After a few days, the blisters absorb and dry up. After 1 to 2 weeks, the blisters are exfoliated, leaving temporary erythema or pigmentation. Generally, no scar is left, and the damage does not exceed the midline.

3. Hand, Foot and Mouth Disease

Acute onset, fever, maculopapular rash and herpes on the palms or soles of the feet, rash on hips or knees, inflammatory redness around the rash, less fluid in the blister; herpes scattered on the oral mucosa, obvious pain, and some children May be accompanied by cough, runny nose, loss of appetite, nausea, vomiting, and headaches. Severe cases: Patients with clinical manifestations of hand-foot-mouth disease, accompanied by myoclonus or encephalitis, acute delayed paralysis, heart and lung failure, pulmonary edema, etc. Although infants and young children with hand, foot and mouth disease endemic areas do not have the typical manifestations of hand, foot and mouth disease. But there are fever with myoclonus or encephalitis, acute delayed paralysis, heart and lung failure, pulmonary edema and so on.

Oral herpes diagnosis

Morphological diagnosis

Look for inclusions by smears; check for damaged cells with immature virus particles by electron microscopy, or look for virus particles in the blister fluid directly.

2. Immunological examination

Use monoclonal antibodies against HSV antigens to find specific antigens from damaged cells; use HSV antigens and patient serum for antibody detection.

Oral herpes treatment

1. Follow dermatology general nursing routine

2. Recurrent herpes simplex

Available hydrocortisone and neomycin cream, 3% to 5% acyclovir ointment. Those with low cellular immune function can use levamisole; intramuscular injection of polymyocytes and transfer factors can also be used.

3. Oral shingles

(1) General treatment Take plenty of rest and give a digestible diet and plenty of water. Prevent secondary bacterial infections. Do not rub the affected area to prevent the blister from breaking.

(2) Drug treatment Glucocorticoids can reduce the inflammatory response and swelling of the facial nerve in the acute phase, reducing the pressure in the facial nerve bone tube with a fixed diameter, thereby reducing the facial nerve bone tube due to edema and thickening. The degree of compression and microcirculation disorders, therefore, glucocorticoid therapy is the first and main medical treatment for the disease. Diabetes, tuberculosis, stomach ulcers and pregnant women should be used with caution. People with hypertension should pay attention to controlling blood pressure. Antiviral drugs can interfere with herpes virus DNA polymerase and inhibit DNA replication. Acyclovir (aciclovir) is commonly used, but ganciclovir, famciclovir, or vanaciclovir (lovir) can also be used. neurotrophic drugs such as vitamin B ₁ and vitamin B ₁₂ intramuscular injection or oral. Drugs for improving facial microcirculation Use ginkgo biloba extract or other vasodilators to improve microcirculation by intravenous injection or oral administration. Pain Relief Pain Relief Pain Remedy Other transfer factors, normal human immunoglobulin injection.

4. Hand, Foot and Mouth Disease

(1) General treatment If the disease is without complications, the prognosis is generally good, and it usually heals within one week. Mainly symptomatic treatment. Isolate the child first, and the contacts should be disinfected and isolated to avoid cross infection. Symptomatic treatment and oral care. Those with severe oral herpes and ulcers should wash their mouths with light saline or 0.1% chlorhexidine solution. The clothes and bedding should be clean, and the clothes should be comfortable, soft and frequently changed. Shorten your baby's nails and wrap your baby's hands if necessary to prevent scratching the rash. Calamine lotion can be applied at the initial stage of hand and foot rash, and 0.5% iodophor can be applied when herpes is formed or herpes rupture. Babies with rash on their hips should clean their stools at any time to keep their hips clean and dry. You can take antiviral drugs, clearing heat and detoxifying Chinese herbal medicine, and supplementing vitamins B and C.

(2) Treatment of complications Monitor closely the changes of the disease, especially the important organ functions such as brain, lung, and heart; critically ill patients pay special attention to monitoring blood pressure, blood gas analysis, blood glucose and chest radiographs. Pay attention to maintaining water, electrolyte, acid-base balance and protection of important organs. Those with increased intracranial pressure can be given dehydration treatment such as mannitol, and severe cases can be given methylprednisolone and intravenous gamma globulin as appropriate. People who have signs of respiratory failure such as hypoxemia and dyspnea should be treated with mechanical ventilation as soon as possible. Maintain blood pressure stability, and give vasoactive drugs appropriately when necessary. Other severe treatments: if there is DIC, pulmonary edema, heart failure, etc., they should be treated accordingly.

(3) Antiviral drugs

Because antiviral drugs are generally best used 24 to 48 hours before onset. And often when we are diagnosed with hand, foot and mouth disease, we have passed the most effective stage of treatment, and now we do not advocate the use of antiviral drugs.