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DRG.

ZAI VI ANI JUNI ANI K, MKES

Infeksi Virus Herpes Simplex
Definisi
Herpes simpleks virus ( HSV ) is the most commen
viral infectious in oral mucosa with , sore mouth,
and painful
Etiologi


Virus Herpes tye 1 dan tipe 2 ( un common)

Klasifikasi
 Primary acute herpetic gingivostomatitis
→children and young adult
 Herpetiformis Sekunder ( Herpetic Stomatitis,
herpes labiasis) → young adult
 Immunocompromised conditions →recurent

Clinical Features
Primary Herpetic gingivostomatitis
 Prodromal symptoms : high fever,
headache, sore mouth, and painful
cervical lymphadenopathy
 Lesions : singel or multiple, small vasicles
that leave round rupture. Shallow coalescing
ulcers
 Location : gingiva, Tongue, lips, palate , and
Buccal mucosa ( Non keratine layer)
 Duration : 6-10 days
Secodary Herpetic Stomatitis
Prodromal symptoms : no
constitutional symptoms
• Lesions : smaller and fewer lesions
• Locations : Hard Palate and
attached gingiva.
Pharyngotonsillar
• Duration : 6-10 days


Histopathology


Herpes Labialis
 Prodromal Symptoms : Burning, Itching, and
mild pain around the affected area
 Lesions : small clustering vesicles that
rupture leaven ulcers that crust
 Location : Vermillion border of the lip and
perioral skin
 Duration : 5 - 8 days

Diagnosis
• The diagnosis is based on the
clinical presentation.
• The definitive criterion for
diagnosing a herpetic infection is
isolation of the virus in tissue
culture
• Sitology : inoculated with the
vesicular fluid ( Titer AR )
• TZank
Differential Diagnosis
 Aphotus Ulcers
 Herpangina
 Hand, Food, and mouth
disease
 Acute Necrotizing
ulcerative gingivitis
 Pemphigoid
 Erythema multiforme
 Pemphigus
 Streptoccal stomatitis
 Gonococcal stomatitis
 Primary and secondary
syphilis
 Traumatic Lesions

Basic Guidelines : Treatment
 Systematic antiviral treatmentis employe if the
patients is immunocompromised or as a
prophylactic regimen in patients who have
frequent recurrences due to known trigger factor.
 Patients should stay in bed for 4-6 days in case
of primary herpetic gingivostomatitis
 Avoiding of spicy and hard foods and tooth
brushing during acute stage is recommended
Topical Treatment

• Primary herpes Gingivostomatitis: Mouth georgle
topical with 0,5 or 1% liposom hidroklorida for
temporary treatment
Herpes labialis: 5% acyclovir cream in carrier
liposom → use for prodromal phase
1,8% Tetrakain cream →6x/day



Therapy sistemik
 Primary herpes Gingivostomatitis: suspensi Acyclovir
15mg/hari atau asiklovir tablet 300 mg 5x/day
for 5 days ( ( 3 days before first onset →reminish
the duration of lesions)
 Acyclovir 800 mg /day→ for profilaksis during
periode of herpes primer.
If patient in immunocompromised conditions ,
dosis ↑↑
 Valaclovir tablet 500 mg or famciclovir 250
mg twise/day for 5 days such as regimen
alternatif .