Clinical features of gingivostomatitis due to primary infection of herpes simplex virus in children

BMC Infect Dis. 2020 Oct 20;20(1):782. doi: 10.1186/s12879-020-05509-2.

Abstract

Background: Primary 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.

Methods: Between 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.

Results: Among 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).

Conclusions: Meticulously 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.

Keywords: Children; Clinical manifestation; Herpes simplex virus; Primary herpetic gingivostomatitis.

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • C-Reactive Protein / analysis
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Early Diagnosis
  • Female
  • Fever
  • Gingivitis / diagnosis*
  • Herpes Simplex / diagnosis*
  • Herpes Simplex / drug therapy
  • Herpes Simplex / virology
  • Herpesvirus 1, Human / immunology*
  • Herpesvirus 1, Human / isolation & purification
  • Humans
  • Infant
  • Leukocytosis
  • Male
  • Oral Ulcer / diagnosis*
  • Pharyngitis / diagnosis*
  • Retrospective Studies
  • Stomatitis, Herpetic / diagnosis*
  • Stomatitis, Herpetic / drug therapy
  • Stomatitis, Herpetic / virology
  • Tonsillitis / diagnosis*

Substances

  • Anti-Bacterial Agents
  • C-Reactive Protein