Supportive care and antiviral treatments in primary herpetic gingivostomatitis: a systematic review.

OBJECTIVES: Herpes simplex virus 1 (HSV-1) is the main pathogen responsible for herpes infections. In 13-30% of the cases, primary HSV-1 leads to the primary herpetic gingivostomatitis (PHGS), often a self-limiting infection; however, it can limit the ability to drink/eat with, sometimes, the need for hospitalization. Multiple therapeutic methods have been proposed. This systematic review aims to collect and critically appraise the available evidence about the clinical management of PHGS. MATERIALS AND METHODS: Literature search including three databases (PubMed, Scopus, Embase), study design, and data analysis were performed following PRISMA guidelines, according to the PICO tool (PROSPERO n° CRD42023391386). Risk of bias was assessed with RoB 2 and ROBINS-I. RESULTS: Five studies on a total of 364 patients (average age: 7.6 years) were identified. The treatment regimens were summarized in acyclovir; acyclovir + honey; fluids and analgesic; maalox + diphenhydramine; lidocaine; chlorhexidine (CHX); CHX + ialuronic acid; CHX + Mucosyte®; antimicrobial photodynamic therapy (aPDT); topical antiviral; topical antiviral + aPDT; and others. CONCLUSIONS: Although PHGS is a disease with a high worldwide prevalence, the lack of consensus about therapeutic management indicates gaps in existing evidence. Most of the proposed treatment consists in symptomatic drugs with empiric regimens which are ineffective for the viral replication. The main limit to realize randomized clinical trial is due to the rapid onset and remission of the disease. In fact, the diagnostic delay, estimated in 72 h, decreases the effectiveness of any antiviral drugs. CLINICAL RELEVANCE: Out of the five studies included in this systematic review, only one was able to provide some weak evidence that ACV is an effective treatment, improving healing of oral lesions and reducing duration of symptoms.

Non-late-onset neutropaenia following treatment of multiple sclerosis with ocrelizumab / Neutropenia de aparición no tardía tras el tratamiento con ocrelizumab para la esclerosis múltiple

Late-onset neutropaenia is defined as an absolute neutrophil count of <1.5 × 103 cells/μL starting > 4 weeks after the last dose of rituximab, in the absence of other identifiable causes.Late-onset neutropaenia is a rare adverse reaction to rituximab (observed in approximately 5% of patients). Rheumatic diseases constitute the main indication for rituximab; in these patients, neutropaenia appears after a mean of > 28 days.Ocrelizumab is another monoclonal antibody that binds to CD20 (a glycosylated phosphoprotein mainly expressed on the membranes of B-lymphocytes); in January 2018, it was approved for the treatment of relapsing-remitting and primary progressive multiple sclerosis.We present a case of neutropaenia following intravenous infusion of ocrelizumab in a patient with primary progressive multiple sclerosis who presented with neutropaenic fever, herpetic stomatitis, and ecthyma gangrenosum only 20 days after infusion.(AU)

La neutropenia de aparición tardía se define como un recuento absoluto de neutrófilos < 1,5 × 103/μl que se produce > 4 semanas después de la última dosis de rituximab, precedido por un recuento de neutrófilos normal y sin otra causa identificable. Es una complicación rara del tratamiento con rituximab, habiéndose observado en aproximadamente el 5% de los pacientes tratados, siendo las enfermedades reumáticas su principal indicación, con un tiempo medio hasta el desarrollo de la neutropenia de al menos 28 días. El ocrelizumab, al igual que el rituximab, es un anticuerpo monoclonal dirigido a CD20, una fosfoproteína glicosilada de membrana que se encuentra predominantemente en los linfocitos B y que se aprobó en enero de 2018 para el tratamiento de la esclerosis múltiple remitente recurrente y la esclerosis múltiple progresiva primaria. Se describe un caso de neutropenia después de la infusión de ocrelizumab en un paciente con esclerosis múltiple progresiva primaria que presentó neutropenia febril, estomatitis herpética y ectima gangrenoso solo 20 días después de la infusión.(AU)

Atypical herpetic ulcerations in COVID-19 positive patients: A report of three cases.

Since the global COVID-19 pandemic, numerous reports have been made regarding oral lesions seen in COVID-19 patients. It remains unclear whether or not these are true manifestations of COVID-19. Here we present 3 patients who were hospitalized for COVID-19 and who developed atypical herpetic ulcerations during their treatment with remdesivir (Veklury) and steroids. In healthy patients, recurrent infection by herpes simplex virus (HSV) presents as lesions only on the lips and the attached oral mucosa. Atypical herpetic ulcerations are seen in immunocompromised patients. They present as large, stellate shaped ulcerations with raised borders and may involve movable mucosa. The 3 cases presented in this report resembled the atypical herpetic ulcerations typically seen in patients with immunosuppression. Through our report, we aimed to introduce the possibility of atypical herpetic ulcers in patients being treated for COVID-19, to allow for their timely diagnosis and to raise awareness of the underlying immunocompromised state.

Severe pediatric oral mucositis.

We initially suspected primary herpetic gingivostomatitis. But the patient's lab work, persistent fever, and cough led us in a different direction.

Efficacy of antimicrobial photodynamic therapy versus antiviral therapy in the treatment of herpetic gingivostomatitis among children: Aa randomized controlled clinical trial.

AIM: The aim of the present study was to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to topical antiviral therapy for the treatment of children having herpetic gingivostomatitis. MATERIALS AND METHODS: 45 individuals (age group 12-18 years) with herpetic gingivostomatitis (HG) were divided into three groups on the basis of provision of treatment. (a) Group A: topical anti-viral therapy (TAT) (n = 14, mean age = 17.0 years) (b) Group B: antimicrobial photodynamic therapy (aPDT) (n = 15, mean age =17.7 years) and (c) Group C: topical anti-viral therapy + adjunctive aPDT (n = 16, mean age = 18.0 years) respectively. Pain scores [visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ)] were assessed and HSV-1 was quantified. ENZYME LINKED IMMUNOSORBENT ASSAY (ELISA) was used to compute the pro-inflammatory cytokine including interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The analysis of the mean values and inter group comparisons were evaluated with the Mann-Whitney test. The Friedman test was used to establish the comparison of the changes observed in HSV quantification, pain scores, and pro-inflammatory cytokines. ANOVA tests were employed for the quantification of differences observed at follow-ups. The assessments for the clinical trial were done at baseline, immediate after post-op, two, and four weeks, and three and six months respectively. RESULTS: According to the analysis of the data obtained after the clinical assessment, the three groups reported a decrease in the pain scores, HSV-1 quantification and levels of the pro-inflammatory cytokines. However, Group C (TAT + aPDT) reported improvement in the observed parameters which was statistically significant in comparison to Group A (TAT) and Group B (aPDT) respectively. CONCLUSION: Antimicrobial photodynamic therapy (aPDT) in conjunction with topical antiviral therapy (TAT) helped in reducing the pain scores and pro-inflammatory cytokine levels in herpetic gingivostomatitis among children.

ACUTE HERPETIC STOMATITIS: CLINICAL MANIFESTATIONS, DIAGNOSTICS AND TREATMENT STRATEGIES.

OBJECTIVE: The aim: To evaluate the recent scientific articles concerning peculiarities of this oral pathology. The goal is to carry out a literature review by evaluating all signs and clinical symptoms related to this disease, so as to provide the clinician with a useful tool for an early diagnosis and treatment of the disease. PATIENTS AND METHODS: Materials and methods: The collection of relevant data were done using the scientific databases Pubmed, Google Scholar. A manual search on Dentistry and Pharmacological sources was also conducted for relevant studies published. The selected key words: ("Herpes virus" OR "HSV") AND ("oral" OR "oral lesions") were used for collecting the data. CONCLUSION: Conclusions: The article presents clinical peculiarities of herpetic stomatitis depending on disease severity and course. Primary herpetic stomatitis appears as spherical clustered vesicles on the gingival and adjacent mucosa. Soon after eruption of elements of lesion they rupture forming painful halo like aphtae / ulcers. Typical symptoms are: pain from ruptured vesicles, lymphadenitis, fever etc. Early diagnosis of disease is important and treatment with antiviral medicaments can modify the course of the disease by reducing symptoms and potentially reducing recurrences. Management of acute herpetic stomatitis include antiviral medicaments intake, maintenance of fluids and electrolytes level in a body. The treatment principles based on etiotropic, pathogenetic and symptomatic therapy are considered in manuscript.

Adolescents and primary herpetic gingivostomatitis: an Italian overview.

AIM: The aim of this study was to investigate the therapies administered to Italian adolescents with primary herpetic gingivostomatitis (PHGS) METHODS: The medical records of 74 adolescents with PHSG were reviewed. The following data were recorded: age, gender, day of onset, type of treatment, lesions' severity, pain scoring, eating, and drinking ability. The oral examination was performed at the first evaluation (T0) and after one week (T1). RESULTS: All patients showed up at the first visit at least 48 h after the onset of symptoms. No patient was prescribed an antiviral therapy. An antibiotic therapy was prescribed in order to prevent secondary bacterial infections. Fifteen patients had been treated with non alcoholic chlorhexidine rinses (group A), 29 patients with non alcoholic chlorhexidine rinses plus hyaluronic acid gel (group B); 30 patients with non alcoholic chlorhexidine rinses plus Mucosyte® (group C). A significant improvement of the pain scoring and lesions' severity was noted in group C. CONCLUSION: In Italian adolescents, PHGS is diagnosed at least 48 h after onset and the antibiotic therapy is widely prescribed in order to prevent overinfections. Among topical therapies, an association of verbascoside and sodium hyaluronhate seems to favour a faster healing.

Como tratar a gengivoestomatite herpética primária?

O dentista deve proceder orientações quanto à dieta, baseada em alimentos que não exijam mastigação (pastosos), ingestão frequente de bebidas frias e evitar alimentos salgados/condimentados, a fim de aliviar a sintomatologia dolorosa, além da necessidade de repouso e antitérmicos. Soluções a fim de limpar a área afetada, com auxílio de gaze, para remoção do biofilme acumulado, e minimizar a ocorrência de infecções oportunistas (bacterianas e fúngicas), como enxaguatórios à base de digluconato de clorexidina (0,12%) sem álcool, ou ainda, a mistura de água filtrada com bicarbonato de sódio, devem ser recomendadas, em razão da intensa dor ocasionada pelas vesículas, que irão se romper, sendo recobertas por ulcerações também extremamente doloridas. Pode-se ainda prescrever a solução tópica de VASA (violeta de genciana a 2% – 3mL, anestésico lidocaína sem vasoconstritor – 1,5 mL, sacarina – 0,5mL e água destilada- 25mL), preparada em farmácia de manipulação em frascos conta-gotas de 30mL, a qual deve ser aplicada, com auxílio de gaze ou fralda de pano limpa, 3 vezes ao dia, 15 a 30 minutos antes das refeições ^(1,2).

O uso de antivirais, como o aciclovir comprimido 200mg, pode ser prescrito nas fases iniciais da infecção, onde o dentista irá orientar aos pais de crianças com idade igual ou superior a 2 anos, que macerem um comprimido e o dissolva em líquidos gelados, de 4 em 4 horas, 5 vezes ao dia por 5 dias, omitindo-se a dose noturna, a fim de reduzir a duração das ulcerações orais e a dificuldade de ingestão de alimentos em crianças⁽³⁾. O laser de baixa potência (terapia de fotobiomodulação e fotodinâmica), se acessível, constitui-se num importante adjunto no tratamento da gengivoestomatite herpética primária pois reduz significativamente a dor na cavidade bucal, devolvendo o bem-estar à criança e ao seu núcleo familiar⁽⁴⁾.

EFFECTІVENESS OF LASER THERAPY ІN COMPLEX TREATMENT OF HERPETIC STOMATITIS.

OBJECTIVE: The aim: The purpose of research is to improve the effectiveness of treatment by applying laser in complex treatment in patients with herpetic stomatitis. PATIENTS AND METHODS: Materials and methods: Were examined 47 people (22 men and 25 women) with acute herpetic stomatitis. The patіents' age was from 20 to 72 years. All patients underwent immunological tests such as (T-lymphocytes (CD3 +), T-helpers (CD4 +), cytotoxic T-lymphocytes (CD8 +), the content of immunoglobulins IgM, IgG, IgA and slgA in saliva to assess the іmmunological reactivity of the organism. RESULTS: Results: Clinical observations have shown that when using laser therapy, the results of treatment were better than in the control group. Positive dynamics was observed as early as 1-2 days after the start of laser use and was more pronounced when used in the early stages of the disease. The use of the laser promoted a more rapid suspension of new lesions, a decrease in pain syndrome, and a more rapid regression of herpetic lesions. We have found significant improvements in the arameters of cellular and humoral іmmunity in patients of the main group. CONCLUSION: Conclusions: Treatment of herpetic stomatitis is relevant and requires further improvement and the search for new methods. The use of a laser in the complex treatment of herpetic stomatitis has a positive effect on the course and іmmunological status of patients with herpetic stomatіtis. The manifestations of the disease healed faster, and the pain syndrome was less severe. Duration between іllness and treatment decreased on 19.7% and 26%. It is advіsable to include the method of treatment using a laser in the complex therapy of herpetic stomatitis.

Prevalence and Likelihood Ratio of Six Objective Signs among Good Responders to Natrum muriaticum: Multi-centre Observational Assessment.

BACKGROUND: The reliability of homeopathic prescriptions may increase through resource to objective signs and guiding symptoms with significant positive likelihood ratio (LR). We estimated LR for six objective signs attributed to the homeopathic medicine Natrum muriaticum (Nat-m). METHODS: In this multi-centre observational assessment, we investigated the prevalence of six signs in the general patient population and among good responders to Nat-m in daily homeopathic practice. Next, we calculated LR for these six signs. RESULTS: Data from 36 good responders to Nat-m and 836 general population patients were compared. We found statistically significant positive LR (95% confidence interval) for signs such as lip cracks (1.94; 1.15 to 3.24), recurrent herpes (2.29; 1.20 to 4.37), hairline eruptions (2.07; 1.03 to 4.18), and dry hands (2.13; 1.23 to 3.69). CONCLUSIONS: Objective signs with significant positive LR might increase the reliability of homeopathic prescriptions. Further studies are warranted to confirm the validity of this approach.