A Comprehensive Overview of Epidemiology, Pathogenesis and the Management of Herpes Labialis.

Herpes labialis remains exceedingly prevalent and is one of the most common human viral infections throughout the world. Recurrent herpes labialis evolves from the initial viral infection by herpes simplex virus type 1 (HSV-1) which subsequently presents with or without symptoms. Reactivation of this virus is triggered by psychosocial factors such as stress, febrile environment, ultraviolet light susceptibility, or specific dietary inadequacy. This virus infection is also characterized by uninterrupted transitions between chronic-latent and acute-recurrent phases, allowing the virus to opportunistically avoid immunity and warrant the transmission to other vulnerable hosts simultaneously. This review comprehensively evaluates the current evidence on epidemiology, pathogenesis, transmission modes, clinical manifestations, and current management options of herpes labialis infections.

Evaluation of Allergic Diseases, Symptom Control, and Relation to Infections in a Group of Italian Elite Mountain Bikers.

OBJECTIVES: This study estimates the prevalence of allergic diseases in a group of Italian elite mountain bikers, compares the prevalence of infectious episodes between allergic and nonallergic athletes, and evaluates asthma and rhinitis symptom control in allergic athletes. DESIGN: Two hundred twenty-six Italian nonsmoking mountain bikers received by mail the Allergy Questionnaire for Athletes (AQUA) and completed it. The RhinAsthma Patient Perspective (RAPP) questionnaire was sent to the 108 participants with a positive AQUA score and 104 returned the questionnaire. METHODS: Athletes with an AQUA score ≥5 or <5 were defined AQUA+ (allergic) or AQUA- (nonallergic), respectively. RhinAsthma Patient Perspective questionnaire total score ≥15 was indicative of a poor control of symptoms. RESULTS: Of the 226 athletes, 47.8% were AQUA+, whereas 52.2% were AQUA-. A higher number of AQUA+ athletes reported frequent upper respiratory tract infections (URTIs) and herpes labialis than AQUA- athletes (P < 0.001), and the prevalence of URTI was greater in the subgroup of AQUA+ athletes who trained ≥3 hours per session. According to RAPP questionnaire score, 21.1% of AQUA+ mountain bikers had a poor control of asthma and rhinitis symptoms. CONCLUSIONS: Our study shows a high prevalence of allergy among Italian elite mountain bikers whose asthma and rhinitis symptoms are poorly controlled in about a fifth of the sample. Allergic athletes, mainly those training more than 3 hours per session, are at higher risk of URTI and herpes labialis. Screening programs to detect allergic diseases and to evaluate symptom control in athletes should be strongly encouraged.

Recurrent herpes labialis in the pediatric population: Prevalence, therapeutic studies, and associated complications.

Recurrent herpes labialis (RHL) is an incredibly common condition, though the medical literature evaluating pediatric aspects is limited. This paper assesses prevalence and therapeutic studies of pediatric RHL as well as disease complications. A comprehensive literature search of English-language citations based on PubMed queries of selected terms was performed, with exclusion if methodology was not discussed, or if studies had 10 or fewer patients. RHL prevalence in pediatrics has been assessed by measures of point and periodic prevalence, though methodologic limitations may under- or over-estimate the true prevalence of RHL. Studies have been conducted to evaluate therapeutic safety, tolerability, and efficacy of antivirals in the pediatric population. Pediatric RHL point prevalence ranges from 0.72% to 5.2% depending on the population study and the methodologies used. Pediatric RHL carries a significant public health burden and is often implicated in patients with eczema herpeticum, erythema multiforme, reactive infectious mucositis eruptions, and hypersensitivity reactions. There are few studies that evaluate the rates of occurrence of these sequelae associated with pediatric RHL.

Recurrent herpes labialis and Herpes simplex virus-1 genitalis: what is the link?

BACKGROUND: Recently, Herpes simplex virus (HSV)-1 seroprevalence declined among adolescents, rendering young people lacking HSV-1 antibodies more susceptible to genital HSV-1 acquisition, if sexually exposed. The aim of the present study was to identify the possible risk factors for the development of HSV-1 related Herpes genitalis (HG). METHODS: From January 2012 to December 2015, patients with HG attending three Sexually Transmitted Infections Units in Northern Italy were recruited. A genital swab on the lesions for the search of HSV-1/2 DNA through real time polymerase chain reaction (PCR) and a serum sample for HSV-1/2 specific serology were performed. Moreover, patients were asked whether they had personal history of herpes labialis (HL). Patients with PCR proved HSV-1 HG were included as cases; asymptomatic subjects attending STI Units for a blood check were recruited as controls and were checked for HSV-1/2 serology. RESULTS: The study included 141 cases and 70 controls. Specific HSV-1 antibodies were found in 34.7% of the cases and 67% of the controls. History of recurrent herpes labialis (RHL) was found in 4% of the cases and 31% of the controls. The occurrence of RHL in HSV-1 seropositive patients resulted lower in the case group compared to the control group. CONCLUSIONS: We can speculate about a protective role for RHL against the clinical appearance of HSV-1 HG. The clinical usefulness of our study involved especially the counselling in serodiscordant couples. The presence of HSV-1 antibodies in asymptomatic sexual partners does appear protective for HG manifestation only in presence of RHL history.

Recurrent aphthous stomatitis in 18-year-old adolescents - Prevalence and associated factors: a population-based study.

BACKGROUND: Recurrent aphthous stomatitis is a painful disorder of unknown etiology. It is among the most common oral mucosal lesions with high prevalence among young adults. OBJECTIVES: To conduct a population-based study with 18-year-old army recruiters to assess its prevalence and associated factors in male adolescents. METHODS: Interview during clinical examination in the army. RESULTS: In this group (2,427 interviewed adolescents) there was a RAS prevalence of 24.9%. Smoking, herpes labialis and socioeconomic status correlated with the outcome. STUDY LIMITATIONS: only male adolescents were interviewed. CONCLUSIONS: Our results showed high prevalence of RAS; association with higher economic level and herpes simplex was found. Protective effect of smoking was confirmed.

Recurrent aphthous stomatitis in 18-year-old adolescents - Prevalence and associated factors: a population-based study

Abstract: Background: Recurrent aphthous stomatitis is a painful disorder of unknown etiology. It is among the most common oral mucosal lesions with high prevalence among young adults. Objectives: To conduct a population-based study with 18-year-old army recruiters to assess its prevalence and associated factors in male adolescents. Methods: Interview during clinical examination in the army. Results: In this group (2,427 interviewed adolescents) there was a RAS prevalence of 24.9%. Smoking, herpes labialis and socioeconomic status correlated with the outcome. Study Limitations: only male adolescents were interviewed. Conclusions: Our results showed high prevalence of RAS; association with higher economic level and herpes simplex was found. Protective effect of smoking was confirmed.

Complications and Management of Large Intracranial Vestibular Schwannomas Via the Retrosigmoid Approach.

OBJECTIVE: To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications. METHODS: We selected all patients with large unilateral VS from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30 × 20 mm were defined as large. RESULTS: A total of 1167 patients with VS were included. Gross total tumor resection was achieved in 1006 patients (86.2%). The mortality rate is 0.77%. The facial nerve was preserved anatomically in 1083 cases (92.8%), and the functional valuation of the facial nerve according to postoperative House-Brackmann scale showed 423 patients (36.2%) in grades I-II, 534 cases (45.8%) in grade III, and 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included new hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) in 634 cases (54.3%), disequilibrium in 250 cases (21.4%), labial herpes in 127 cases (10.9%), meningitis in 115 (9.85%) and lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term complications include hearing loss (American Institute of Otolaryngology-Head and Neck Surgery grade D) (75.8%), permanent facial paralysis (11.9%), facial numbness (10.9%), tinnitus (2.96%), chronic headache (2.25%), and taste disturbance (1.43%). CONCLUSIONS: The key factors for reducing surgical complications include careful assessment of the functions of acoustic and facial nerves as well as a thorough understanding of anatomy via the retrosigmoid approach before operation, skillful microsurgical technique, and monitoring of multiple cranial nerves during resection.

Herpes Virus Infections During Treatment With Etanercept in Juvenile Idiopathic Arthritis.

Incidence rates for varicella and herpes zoster were similar in patients with juvenile idiopathic arthritis receiving etanercept/methotrexate (n = 85, 184.9 patient-years [PY]) or methotrexate alone (n = 71, 199.4 PY); no complicated varicella or herpes zoster cases were reported; herpes labialis incidence was higher in patients receiving etanercept/methotrexate versus methotrexate alone (0.38 vs. 0.24 PY).

Impacto de lesiones orales sobre la calidad de vida en pacientes adultos / Impact of oral injuries on the quality of life in patients

Objetivo: Evaluar el impacto de lesiones orales sobre la calidad de vida relacionada con la Salud Oral (CVRSB) en adultos. Materiales y métodos: Estudio analítico transversal, muestra a conveniencia de 292 pacientes, Facultad de Odontología, Universidad de Cartagena, con lesiones orales en los últimos 3 meses y diligenciaron el Índice de Salud Oral General, GOHAI para evaluar CVRSB. Dos examinadores fueron calibrados para evaluar lesiones orales. Fue realizado análisis univariado y multivariado de Regresión de Poisson con varianza robusta y nivel de confianza del 95%. Resultados: 39% (IC 95%: 33-44) de los pacientes presentaron un alto impacto de la CVRSO; 28,7 (DE: 0,45), fue la media del puntaje total GOHAI. La mayoría de las lesiones encontradas fueron lesiones secundarias deprimidas asociadas a dolor (aftas= 24,6%). Casi todas las lesiones orales se asociaron con los puntajes totales GOHAI en el análisis univariado (p<0,05). El modelo final multivariado quedó ajustado así: las úlceras orales presentaron un impacto negativo sobre CVRSO (RR= 1,2, IC 95%:1,1-1,3, p= 0,000), igual que la hiperplasia gingival (RR= 1,2, IC 95%: 1,03-1,4, p= 0,02) y el herpes labial (RR= 1,2, IC 95%: 1,02-1,4, p= 0,02), a diferencia del torus palatino (RR= 0,85, IC 95%:0,7-0,9, p= 0,001), mientras tener trabajo presenta un impacto positivo (RR= 0,91, IC 95%: 0,86-0,97, p= 0,007). El dominio psicosocial fue el más comprometido. Conclusiones: La úlceras orales, hiperplasia gingival y herpes labial presentan un impacto negativo sobre la CVRSO, a diferencia del torus palatino, mientras que el tener trabajo presenta un impacto positivo (AU)

Objective: Assess the impact of oral lesions on the quality of life related to Oral Health (QLROH) in adults. Materials and methods: Transversal analytical study, a convenience sample of 292 patients, Faculty of Dentistry, University of Cartagena, with oral lesions in the last three months and administered the Oral Health Index General, GOHAI to evaluate QLROH. Two examiners were calibrated to evaluate oral lesions. It was conducted univariate and multivariate Poisson regression with robust variance and confidence level of 95%. Results: 39% (95% CI: 33-44) of patients had a high impact of QLROH; 28,7 (SD: 0,45) was the mean total score GOHAI. Most of the injuries found were depressed secondary lesions associated with pain (aphtha= 24,6%). Almost all oral lesions were associated with total scores GOHAI in univariate analysis (p<0.05). The final multivariate model was adjusted as follows: oral ulcers had a negative impact on QLROH (RR= 1,2, 95% CI: 1,1-1,3, p= 0,000), gingival hyperplasia (RR= 1,2, 95% CI: 1,03-1,4, p= 0,02) and herpes labialis (RR= 1,2, 95% CI:1,02-1,4, p= 0,02) unlike the palatal torus (RR= 0,85, 95% CI: 0,7-0,9, p= 0,001), while having a job has a positive impact (RR= 0,91, 95% CI: 0, 86-0,97, p= 0,007). The psychosocial do main was the most compromised. Conclusions: The oral ulcers, gingival hyperplasia and herpes labialis have a negative impact on QLROH, unlike the palatal torus, while having a job has a positive impact (AU)

Associations of HLA-A, HLA-B and HLA-C alleles frequency with prevalence of herpes simplex virus infections and diseases across global populations: implication for the development of an universal CD8+ T-cell epitope-based vaccine.

A significant portion of the world's population is infected with herpes simplex virus type 1 and/or type 2 (HSV-1 and/or HSV-2), that cause a wide range of diseases including genital herpes, oro-facial herpes, and the potentially blinding ocular herpes. While the global prevalence and distribution of HSV-1 and HSV-2 infections cannot be exactly established, the general trends indicate that: (i) HSV-1 infections are much more prevalent globally than HSV-2; (ii) over a half billion people worldwide are infected with HSV-2; (iii) the sub-Saharan African populations account for a disproportionate burden of genital herpes infections and diseases; (iv) the dramatic differences in the prevalence of herpes infections between regions of the world appear to be associated with differences in the frequencies of human leukocyte antigen (HLA) alleles. The present report: (i) analyzes the prevalence of HSV-1 and HSV-2 infections across various regions of the world; (ii) analyzes potential associations of common HLA-A, HLA-B and HLA-C alleles with the prevalence of HSV-1 and HSV-2 infections in the Caucasoid, Oriental, Hispanic and Black major populations; and (iii) discusses how our recently developed HLA-A, HLA-B, and HLA-C transgenic/H-2 class I null mice will help validate HLA/herpes prevalence associations. Overall, high prevalence of herpes infection and disease appears to be associated with high frequency of HLA-A(∗)24, HLA-B(∗)27, HLA-B(∗)53 and HLA-B(∗)58 alleles. In contrast, low prevalence of herpes infection and disease appears to be associated with high frequency of HLA-B(∗)44 allele. The finding will aid in developing a T-cell epitope-based universal herpes vaccine and immunotherapy.

Congenital cerebral palsy and prenatal exposure to self-reported maternal infections, fever, or smoking.

OBJECTIVE: The objective of the study was to investigate the association between maternal self-reported infections, fever, and smoking in the prenatal period and the subsequent risk for congenital cerebral palsy (CP). STUDY DESIGN: We included the 81,066 mothers of singletons born between 1996 and 2003 who participated in the Danish National Birth Cohort. Children were followed up through December 2008. Information on maternal infections, fever, smoking, and other demographic and lifestyle factors during pregnancy were reported by mothers in computer-assisted telephone interviews in early and midgestation. We identified 139 CP cases including 121 cases of spastic CP (sCP) as confirmed by the Danish National Cerebral Palsy Register. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS: Self-reported vaginal infections were associated with an increased risk of CP and sCP (aHR, 1.52; 95% CI, 1.04-2.24; and aHR, 1.73; 95% CI, 1.16-2.60, respectively) and particularly untreated vaginal infections were associated with an increased risk of sCP (aHR, 1.95; 95% CI, 1.16-3.26). Fever was associated with the risk of CP (aHR, 1.53; 95% CI, 1.06-2.21). Smoking 10 or more cigarettes per day during pregnancy was also associated with sCP (aHR, 1.80; 95% CI, 1.10-2.94). There was a modest excess in risk for children exposed to both heavy smoking and vaginal infections. No other self-reported infections were significantly associated with CP. CONCLUSION: Self-reported vaginal infections, fever, and smoking 10 or more cigarettes per day during pregnancy were associated with a higher risk of overall CP and/or sCP.

Diagnosticando e alertando para as enfermidades bucais e cérvico-vaginais / Diagnosing and raising awareness about oral and cervicovaginal diseases

Little is known today about the possible correlations between oral and cervicovaginal diseases although some diseases affect these two regions of the human body. This study extensively investigated the pathologies caused by the Candida fungus and the herpes virus to establish the correlation between oral and cervicovaginal diseases. A questionnaire and a cytopathology test (Pap smear) were used to collect data from 118 women whose mean age was 41.51 years and who lived in the coastal city of Xangri-La, Brazil. Descriptive statistics and the Pearson correlation coefficient were used to analyze data (p=0.3 to p=0.7). The Pearson correlation coefficient showed that 16.9% of the women had oral herpes and oral candidiasis. Of the women who had oral herpes, 10% also had genital herpes, but there was no significant correlation between these diseases (χ2 = 0.255, p = 0.614); of those with oral candidiasis, 15% also had vaginal candidiasis, but there was also no significant correlation between these diseases (χ2 = 0.558, p = 0.455). After the cytopathology (Pap smear) results were reviewed, 45.8% of the women in the sample were referred to a gynecologist. Oral and cervicovaginal diseases, especially those that are sexually transmitted, have gained great importance in public health due to their growing incidence and because they affect women in all age groups. Their sequelae may be irreversible and, therefore, should be considered by dentists that treat women.

Pouco se sabe hoje em dia sobre possíveis correlações entre doenças bucais e as doenças cérvico-vaginais. Pode-se afirmar, contudo, que existem doenças que atingem ambas as regiões do corpo humano. O presente estudo foi direcionado para o aprofundado das patologias geradas por fungos Candida e vírus Herpes, com o objetivo de realizar uma correlação entre a presença e ausência de enfermidades bucais e cervico-vaginais, a partir de dados obtidos através de questionário e do exame citopatológico (Papanicolau) coletado de 118 mulheres, com uma média de idade de 41,51 anos, residentes na cidade litorânea de Xangri-Lá, Rio Grande do Sul. O teste de correlação de Pearson demonstrou que 16,9% das mulheres já tiveram herpes labial e candidíase bucal, sendo as mulheres que já apresentaram herpes labial, 10% apresentaram herpes vaginal, mas o resultado não apresentou correlação signifi cativa entre estas doenças (χ2=0,255; p=0,614) e, das mulheres que apresentaram candidíase bucal, 15% já tiveram candidíase vaginal, mas também não se encontrou correlação significativa entre as mesmas (χ2=0,558; p=0,455). 45,8% das mulheres da amostra foram encaminhados para um ginecologista. As enfermidades bucais e cérvico-vaginais femininas, em especial as sexualmente transmissíveis, adquiriram uma grande importância na área de saúde pública por sua crescente incidência, e, por acometerem mulheres em todas as faixas etárias. Suas sequelas podem ser irreversíveis e, deste modo, torna-se importante à atuação do cirurgião dentista durante o atendimento a estas mulheres no sentido de dar-lhes informações mediante a estas enfermidades bucais.

Public awareness and knowledge of herpes labialis.

Between 20% and 40% of the population is estimated to suffer from episodes of recurrent herpes labialis, although few reports in the literature have addressed the public awareness of this infection in the general population. The aims of this study were to determine the existing level of awareness and knowledge of this disease and to assess the source of this knowledge, the ability of the public to recognize the characteristics of the disease and the behavior of patients with clinical cases of disease manifestation. To this end, 2,000 individuals (961 male and 1,039 female) of 14 years of age and older were surveyed using the ECOcapi system [Eurisko Consumer Omnibus-CAPI (computer-assisted personal interviewing) version]. Eighty-nine percent of those surveyed had some knowledge of herpes labialis; 92% were able to refer to at least one symptom of herpes labialis, 91% were able to identify correctly his infection from pictures, and 45% had experienced personally at least one episode of herpes labialis infection. The majority of the individuals suffering from herpes labialis self-medicated using a topical therapy. Women were found to be affected more commonly by herpes labialis than men [OR 1.42 (1.18-1.70)], and women were also more likely to recognize the disease [OR 1.65 (1.30-2.08)] and to seek medical advice for the condition [OR 1.38 (1.12-1.70)]. In conclusion, herpes labialis is a common and well-known condition, and it is often self-diagnosed correctly, as the prodromal phase and the use of self-medication are very common.

Prevalencia de herpes virus en bolsas periodontales de pacientes asistidos en la Cátedra de Periodoncia de la FOUNNE / Prevalence of herpes virus in periodontal pockets of patients assisted at the Periodontics Department, FOUNNE

El objetivo de este trabajo fue determinar la prevalencia de herpesvirus humano en la enfermedad periodontal en pacientes concurrentes y asistidos en la Cátedra de Periodoncia de la Facultad de Odontología de laUniversidad Nacional del Nordeste y su posible mecanismo histopatológico.El procedimiento fue realizado en el ámbito de la F.O.U.N.N.E., en la Cátedra de Periodoncia lo que se refiere a su faz clínica y en el Laboratorio Central de laProvincia Corrientes la detección microbiológica mediante Nested PCR.Con una población de 30 hombres y mujeres con edades comprendidas entre 25 y 60 años que concurran como pacientes a la Cátedra de Periodoncia de la Facultad de Odontología de la U.N.N.E. La recolección de datos se hizo a través de métodos de observación,validando, como herramientas metodológicas para el área clínica, la sonda periodontal tipo Marquis e imágenes radiográficas periapicales tomadas con la técnica del paralelo del sector o sectores compatibles con diagnóstico clínico de periodontitis. Se procedió, en el sitio de mayor profundidad de bolsa, a introducir tres conos de papel absorbentes estériles para tomar el contenido, estos conos luego fueron introducidos en medios detransporte específicos y derivados inmediatamente al Laboratorio Central de la Provincia de Corrientes, parael desarrollo del método de la reacción en cadena de la polimerasa (P.C.R.) sobre las muestras tomadas a cadapaciente a fin de detectar la presencia de los virus. Resultados: Total de pacientes que constituyeron lamuestra: 30 (100 por ciento). Pacientes con herpesvirus (HVS): 5 (17 por ciento). Pacientes sin presencia viral: 25 (83 por ciento). Los sitios infectados con virus presentaron mayor destrucción de tejidos periodontales comparativamente con sitios no infectados.

Epidemiologic aspects of recurrent herpes labialis among Jordanian University students.

OBJECTIVE: To study the epidemiologic aspects of recurrent herpes labialis (RHL) in a young adult population and to evaluate treatments used by affected patients. METHODS: A cross-sectional survey conducted on a random sample of 1000 students of The University of Jordan, Amman, Jordan between May and September 2008. Subjects with RHL were identified and asked to describe their disease and its management. Chi-square and t-test were used to compare differences between groups. RESULTS: The point prevalence of RHL was 2.3%, annual prevalence was 17%, and lifetime prevalence was 26.4%. The prevalence was related to the place of living, income, and college, but not to gender, marital status, medical history, smoking, or aphthous stomatitis. Eruptions occurred mostly on the left side of the lower lip and systemic upset, stress, and cold weather were the main triggering events. The mean age of onset was approximately 15 years. Of the cases, 51.2% reported at least 2 recurrences annually and 61.7% had positive family history. Nearly one-half of cases have treated the lesions and only 18.2% have used antiviral therapies. Some used lipstick, vaseline, tahini, or toothpaste to cover lesions. Treatment was recommended mostly by relatives and friends, only 26.3% sought treatment advice from medical practitioners. CONCLUSION: A high prevalence of RHL among this population was found. There is a need to educate patients with RHL on treatment options available to reduce their distress and to improve their quality of life.

Detection of herpes simplex virus DNA in plasma of patients with primary but not with recurrent infection: implications for transfusion medicine?

Among the family of herpes viruses, only cytomegalovirus (CMV) and, to a lesser extent, human herpes virus 8 (HHV-8) are of relevance in transfusion medicine. Due to neutropism, herpes simplex viruses (HSV) types 1 and 2 are considered to be of minor relevance. However, several reports gave evidence that a HSV DNAemia might occur and HSV could therefore be transmissible by blood products. The aim of our study was to collect data about prevalence of HSV antibodies among blood donors and to clarify whether HSV DNAemia is possible. HSV antibody states of 653 blood donors were investigated. Blood specimens of 46 patients with primary and recurrent HSV infection were tested for HSV-1 and HSV-2 DNA using TaqMan polymerase chain reaction. In 505 of the 653 blood donors HSV antibodies were detectable, most of which were HSV-1 antibodies. HSV DNA was detected in plasma, but not in peripheral blood mononuclear cells (PBMCs) of seven rather seriously ill patients with primary herpes genitalis. No HSV viraemia was detectable in otherwise healthy patients with recurrent herpes labialis. Thus, HSV DNAemia is possible, but seems to be limited to primary infections and could not be detected in the recurrent infection. Therefore, blood donors with primary herpes infection should be deferred from donation. Blood donors with recurrent HSV infection are probably not at risk of transmitting HSV, but further studies are necessary to prove this hypothesis. Detection of HSV DNA in PBMCs as described formerly could not be confirmed by this study.