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Patient Story
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A 4-year-old girl is brought to her pediatrician’s office because of fever and sores in her mouth for the past 2 days. The child is alert, playful and fully oriented, and her doctor notes that she has crusting on her outer lips (Figure 114-1A). The mother pulls back the child’s upper lip to show how her daughter’s gums are inflamed (Figure 114-1B). There are small ulcers on the tip of the tongue (Figure 114-2A) and when the lower lip is pulled down there are obvious ulcers on the mucosa (Figure 114-2B). The doctor easily diagnoses primary herpes gingivostomatitis and determines that the child is drinking fluids but not eating. Her mucous membranes are moist and there are no signs of dehydration. The doctor recommends giving fluids that are nonacidic and somewhat cold (anything that will be tolerated). Oral acyclovir suspension is prescribed three times daily for 7 days. The following day the child the child became afebrile and was tolerating fluids and food better. Within 1 week, she was fully better and able to go back to preschool.

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FIGURE 114-1

Primary herpes gingivostomatitis in a 4-year-old girl. A. Crusting on the lips. B. Gingivitis with significant erythema and swelling of the gums. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 114-2

Primary herpes gingivostomatitis in a 4-year-old girl. A. Small ulcers on the tip of the tongue. B. HSV ulcers inside the lower lip. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Herpes simplex virus (HSV) infection can involve the skin, mucosa, eyes, and central nervous system. HSV establishes a latent state followed by viral reactivation and recurrent local disease. Perinatal transmission of HSV can lead to significant fetal morbidity and mortality.

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Epidemiology
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HSV affects more than 1/3 of the world’s population, with the 2 most common cutaneous manifestations being orolabial herpes (Figures 114-1 and 114-2) and genital (Figures 114-3 and 114-4).1

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FIGURE 114-3

Herpes simplex on the penis with intact vesicles and visible crusts. (Used with permission from Jack Rezneck, Sr., MD.)

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FIGURE 114-4

Vulvar herpes simplex virus at the introitus showing small punched out ulcers. (Used with permission from the Centers for Disease Control and Prevention and Susan Lindsley.)

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HSV-1 infections are transmitted via saliva and are common in children, although primary herpes gingivostomatitis can be observed at any age. Children are most often infected by five years of ...

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