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Herpetic stomatitis

Definition

Herpetic stomatitis is a viral infection of the mouth, characterized by ulcers and inflammation. These mouth ulcers are not the same as canker sores, which are caused by a different virus.

Alternative Names

Stomatitis - herpetic

Causes, incidence, and risk factors

Herpetic stomatitis is a contagious viral illness, caused by Herpes virus hominis (also herpes simplex virus, HSV). It is seen mainly in young children. This condition is probably a child's first exposure to the herpes virus, and it can result in a systemic illness with high fever (often as high as 104 degrees Fahrenheit), blisters, ulcers in the mouth, and inflammation of the gums.

The inside of the cheeks and tongue frequently develop ulcers 1 - 5 mm in diameter, with a grayish-white base and a reddish perimeter. These ulcers are very painful and cause drooling, difficulty swallowing, and decrease in food intake, even if the patient is hungry.

An adult member of the family may have a cold sore at the time the child develops herpetic stomatitis. More likely, no source for the infection will be discovered. The illness clears up and ulcers are generally healed within 10 days.

Symptoms

• Fever, may precede appearance of blisters and ulcers by 1 or 2 days
• Irritability
• Blisters in the mouth, often on the tongue or cheeks
• Ulcers in the mouth, often on the tongue or cheeks -- these form after the blisters pops
• Swollen gums
• Pain in mouth
• Drooling
• Difficulty swallowing (dysphagia)

Signs and tests

Herpetic stomatitis is normally diagnosed based on its very typical appearance. Laboratory studies are seldom done. Sometimes viral culture and special stains can help with the diagnosis.

Treatment

Herpetic stomatitis can be treated with the acyclovir family of antiviral medications.

A mostly liquid diet, consisting of cool-to-cold, nonacidic drinks should be provided while the child's mouth is very sore.

An oral topical anesthetic (viscous lidocaine) is available for severe pain, but it must be used with care. The anesthetic deadens all sensation and may interfere with swallowing, meaning the child may unknowingly burn the mouth or throat on hot liquids, or choke. In addition, there are rare reports of death from overdosage and misuse of lidocaine.

Expectations (prognosis)

Complete recovery is expected within 10 days without medical treatment. Oral acyclovir may speed up recovery.

Complications

Herpetic keratoconjunctivitis, a secondary herpes infection in the eye, may develop. This is an emergency and can lead to blindness. Dehydration may develop if the child refuses to eat and drink enough because of a sore mouth.

Calling your health care provider

Call your health care provider if your child develops a fever followed by a sore mouth, especially if they begin eating poorly (dehydration can develop rapidly in children).

Prevention

Approximately 90% of the population carries herpes simplex virus. It is difficult to prevent children from picking up the virus at some time during their childhood.

Children should strictly avoid close contact with people who have cold sores (for example, no kissing parents who have active cold sores). Children should also avoid other children with herpetic stomatitis. They should not share utensils, glasses, or food with actively infected people.

Review Date:1/27/2008
Reviewed By:D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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