Herpetic stomatitis

Definition

Herpetic stomatitis is a viral infection of the mouth that causes 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.

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.

Symptoms

• Blisters in the mouth, often on the tongue or cheeks
• Decrease in food intake, even if the patient is hungry
• Difficulty swallowing (dysphagia)
• Drooling
• Fever (often as high as 104° Fahrenheit) may occur 1 -2 days before blisters and ulcers appear
• Irritability
• Pain in mouth
• Swollen gums
• Ulcers in the mouth, often on the tongue or cheeks -- these form after the blisters pop

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.

While the mouth is very sore, the child should be put on a mostly liquid diet of cool-to-cold, nonacidic drinks.

An oral topical anesthetic (viscous lidocaine) is available for severe pain, but it must be used with care because the anesthetic deadens all feeling. It may interfere with swallowing, and can possibly cause the child to burn the mouth or throat on hot liquids, or choke. In addition, there are rare reports of death from overdose or misuse of lidocaine.

Expectations (prognosis)

The child should recover completely 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.

References

Lingen MW. Head and neck. In: Kumar V, Abbas AK, Fausto N, Aster JC, eds. Robbins and Cotran Pathologic Basis of Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 16.