Herpes gingivostomatitis

B00.2

DESCRIPTION

Inflammation of the mouth structures with ulcers (which may be of various numbers and sizes), caused by Herpes simplex virus infection. The normal course of the disease is 7–10 days.

DIAGNOSTIC CRITERIA

Clinical

  • General inflammation of the mouth with multiple small ulcers on the buccal mucosa, palate, anterior tonsillar pillars, tongue, inner lips and gingival margins.
  • Fever, malaise and dysphagia.
  • Tender, enlarged cervical lymph nodes.

GENERAL AND SUPPORTIVE MEASURES

  • Maintain adequate nutrition and hydration by encouraging fluid and food intake – use bland foods and fluids as they cause less pain.
  • If oral nutrition cannot be maintained use oral/nasogastric and/or IV fluids, if necessary.

MEDICINE TREATMENT

  • Chlorhexidine 0.2%, 10 mL as a mouthwash or gargle, 12 hourly.
    • Do not swallow.

For pain:

  • Paracetamol, oral, 15 mg/kg/dose 6 hourly.
    OR
  • Ibuprofen, oral, 5–10 mg/kg/dose 6 hourly after meals.

If more than minor fever blisters:

  • Aciclovir, oral, 250 mg/m2 /dose 6 hourly for 7 days (or per kg dose equivalent below)
    • If > 1month to 1 year old: 12.5 mg/kg/dose.
    • If > 1 year to 6 years old: 10 mg/kg/dose.
    • If > 6 years to 12 years old: 6 mg/kg/dose.

LoE: III[1]

If very severe infection, consider:

  • Aciclovir, IV, 250 mg/m2 /dose 8 hourly for 7 days (per kg dose equivalent below)
    • If > 1 month to 1 year old: 12.5 mg/kg/dose.
    • If > 1 year to 6 years old: 10 mg/kg/dose.
    • If > 6 years to 12 years old: 6 mg/kg/dose.
      Change to oral as soon as possible.

For very painful oral herpes in children > 2 years:

  • Lidocaine (lignocaine) 2% gel applied every 3 to 4 hours.
    • Apply a thin layer on the affected areas only.
    • Do not exceed 3 mg/kg dose, i.e. maximum 0.15 mL/kg of 2% gel.

REFERRAL

  • Herpes gingivostomatitis not responding to therapy.
  • Disseminating disease, especially if associated with encephalopathy or increasing liver span.