Abstract
BackgroundPrimary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. We conducted a study to define the clinical features of PHGS in children.MethodsBetween January 2012 and December 2016, 282 inpatients aged less than 19 years with cell culture-confirmed herpes simplex virus (HSV) infection in a medical center were identified from the virologic laboratory logbook. Clinical data were retrospectively collected.ResultsAmong the 282 inpatients, 185 cases were considered as PHGS and were included for analysis. Fever was present in 99.5%. The mean duration of fever was 5.11 days (±2.24) with the longest being 17 days. Common oral manifestations included oral ulcers (84.3%), which equally resided in the anterior and posterior part of the oral cavity (65.4% vs. 63.2%), gum swelling and/or bleeding (67.6%), and exudate coated tonsils (16.8%). Leukocytosis (WBC count > 15,000/uL3) was noted in 52 patients (28.1%) and a serum C-reactive protein level > 40 mg/L in 55 patients (29.7%). Fixty-five patients (35%) were diagnosed with PHGS on admission and were significantly more likely to have ulcers over the anterior oral cavity (76.1% vs. 26.7%) and gum swelling/bleeding (76.2% vs. 7.5%, p-value all < 0.001) on admission and were significantly less likely to receive antibiotic treatment (16.9 vs. 36.7%, p-value < 0.01) than others. Forty-six patients (25%) undiagnosed as PHGS on discharge were significantly more likely to have exudate coated on the tonsils, to receive antibiotic treatment and significantly less likely to have gum swelling/bleeding and oral ulcers (all p-values < 0.01).ConclusionsMeticulously identifying specific oral manifestations of gum swelling/bleeding and ulcers over the anterior oral cavity in children can help making the diagnosis of PHGS earlier and subsequently reduce unnecessary prescription of antibiotics.
Highlights
Primary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically
Of the 282 herpes simplex virus isolates, all were identified as herpes simplex virus type 1 (HSV-1)
During the course of hospitalization, oral manifestations increased significantly in children in the Late Diagnosis group and the differences of oral manifestations between the Early and Late Diagnosis groups became statistically insignificant. Compared with those in the other two groups, children in the Other Diagnosis group were significantly more likely to have exudate coated on the tonsils and significantly less likely to have gum swelling/ bleeding and oral ulcers
Summary
Primary herpetic gingivostomatitis (PHGS) in children, though usually self-limited, might mimic bacterial and enteroviral pharyngitis clinically. Children infected with HSV may manifest many non-specific and systemic symptoms, including fever, headache, irritability, anorexia, and malaise. Among the HSV-infected related diseases in children, primary herpetic gingivostomatitis (PHGS) is the most representative clinical manifestation in a proportion of around 13–30% [7, 8]. The clinical symptoms/signs of enteroviral infection include high fever and oral ulcers, which are similar to initial presentations of PHGS and may lead to a clinical dilemma to differentiate these two infectious disease entities at the first glance. To clearly define the clinical features of PHGS in children would be important to make a precise diagnosis of these patients for the appropriate initial treatment
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