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An atypical oral presentation of herpes simplex virus infection in a 49-year-old woman after orthotopic liver transplantation is reported.
JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Both HSV-1 and HSV-2 cause fluid-filled blisters or lesions, which carry virions, or infectious particles. The main difference between HSV-1 and HSV-2 is their preferred sites of transmission and infection. Next, we'll look at how the herpes simplex viruses are spread and how their symptoms can be treated.
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Description: Herpes simplex infection is a common disease that, when clinical signs are present, show striking and distinct oral features. Etiology: Oral infection is caused by members of the human herpesvirus (HHV) family, herpes simplex type 1 (HSV-1, HHV-1) or, to a lesser extent, herpes simplex type 2 (HSV-2, HHV-2). Treatment: The primary infection may be treated effectively by NSAIDS and antiviral medications if administered within the initial 72 hours.
Differential diagnosis: Herpes simplex is often distinct in its presentation and readily diagnosed. Etiology: Herpes zoster is caused by the varicella-zoster virus (VZV), a member of the human herpesvirus family (HHV-3).
Treatment: A vaccine for herpes zoster is currently available and recommended for those with a history of varicella-zoster infection.
Prognosis: For the immune competent and those spared post-herpetic neuralgia, the prognosis is generally favorable. Pseudomembranous candidiasis: sometimes known as “thrush,” is characterized by the development of white, curd- or plaque-like deposits that are easily removable. Erythematous candidiasis: is simply characterized by erythema and shows a number of recognized forms, including denture stomatitis and central papillary atrophy. Central papillary atrophy: was previously diagnosed under the term median rhomboid glossitis and thought to represent a developmental abnormality of the dorsal surface of the tongue. Hyperplastic candidiasis (candidal leukoplakia): is an uncommon form of infection that may be difficult to differentiate from the more serious process, leukoplakia. Treatment: Typically, outbreaks are superficial and effectively treated with topical antifungal agents such as Nystatin oral suspension or clotrimazole oral troches. Differential diagnosis: It may be necessary to differentiate denture stomatitis from allergy to dental materials. Description: Angular cheilitis is a chronic condition affecting the commissural areas of the mouth.
Treatment: Topical agents, such as a formulation of hydrocortisone and iodoquinol, are often effective in resolving the lesions of angular cheilitis. Differential diagnosis: The condition is typically unique in its presentation and easily diagnosed based upon the clinical features.
Description: Atrophic glossitis, also known as “smooth tongue” is one of the most frequent tongue conditions associated with systemic disease and requires thorough evaluation.
Etiology: Atrophic glossitis may be due to xerostomia, with or without co-existing candidiasis, that is often caused by medication use or a systemic disease such as Sjogren’s disease. Clinically, the differential diagnosis included chronic hyperplastic candidiasis, nodular leukoplakia of undetermined etiology, and malignant neoplasm. These blisters last from a week to a month, becoming open sores that crust over with scabs.
HSV-1 generally results from oral contact, and the blister outbreaks are contained to the lips, mouth and face.
Herpes Simplex Virus Type 1, also known as HSV-1, is the strain of Herpes that causes oral herpes or sores that are most common around the mouth or on the lips. Most people can feel the onset of a herpes lesion or cold sore because the area usually tingles right before the blister becomes visible. At Clear Gear, we believe that prevention is the best medicine and Clear Gear Sports Spray can help in the prevention of some of the most horrendous diseases and illnesses out there. For the immunocompromised patient, however, the infection may be characterized by substantial morbidity, necessitating early therapeutic intervention. For milder cases, or those without significant oral ulceration, infectious mononucleosis may be considered, since tender lymphadenopathy is often a component of both diseases.
For those experiencing the recurrence, antiviral medications are sometimes effective in shortening the duration of the outbreak, especially when initiated within the first 3 days.
However, in mild cases, the symptoms may mimic neurological conditions such as trigeminal neuralgia.

Systemic agents, such as fluconazole, may be used in patients who experience recurrences or in cases that are refractory to the standard treatments.
For the immunocompromised, the prognosis is more dependent upon their immune status than candidiasis infection.
However, a thorough clinical history will often assist the clinician in differentiating the two conditions. It is within the spectrum of diseases associated with candidiasis infection, although a concomitant bacterial component is often present. Some vitamin or iron deficiencies are sometimes associated with a similar clinical presentation.5. The mucosa of the tongue is characterized by a smooth appearance, which is due to atrophy of filiform papillae, with an underlying pink to reddish color and may be painful. The decreased amount of saliva and protecting factors change the local immunity of the oral tissues facilitating the overgrowth of the fungus. An excisional biopsy revealed herpesvirus infection, and immunoperoxidase staining confirmed herpes simplex virus infection.
The outbreak following the initial infection (usually a few days to a few weeks afterward) is usually the worst -- the ones after that are less painful. The infection lies in a cluster of nerve cells near the ear called the trigeminal ganglion.
The HSV-1 virus has even been known to be transmitted from the mother to a baby during childbirth, however, this occurrence rate is quite low. Primary herpes simplex: Most primary infections are asymptomatic and occur during childhood. It is necessary for patients to maintain adequate hydration.Recurrent herpes infection may also be treated effectively, if therapy is initiated at the earliest point of the outbreak. Other considerations might include hand, foot and mouth disease, herpangina or erythema multiforme.2. Post-herpetic neuralgia can also be problematic for a year or more in a small percentage of patients.
Contact dermatitis may also be considered, although the discomfort associated with herpes zoster is not typically associated with this condition.3. Patients may complain of sensitivity to spicy foods or bad taste, but symptoms are typically mild. The area covered by the prosthesis is erythematous and tends to clearly follow the outline of the denture or partial denture. While any mucosal surface may be involved, the anterior buccal mucosa is a relatively common site. It is important to remember that the treatment of denture stomatitis is not limited to elimination of the organism from the oral cavity. Hyperplastic candidiasis is often difficulty to differentiate from the more serious premalignant lesion, leukoplakia.
Systemic diseases associated with atrophic glossitis include sarcoidosis, syphilis, kwashiorkor and celiac disease. This report describes the clinical and histologic appearance of these lesions and the course and treatment of the patient. HSV-2 generally results from genital contact with blisters in the genitals, anus and inner thighs, and it lives in nerve cells in the sacral ganglion, near the base of the spine. Urinating can be extremely painful when having an outbreak of HSV-2 as the urine hits the open sores. There are instances where Herpes Simplex Virus Type 1 has caused Herpes Simplex Virus Type 2, but HSV-1 is mostly contained to the lips and mouth and is a separate and distinct virus. There is no known cure for the Herpes Simplex Virus and once you contract it, it stays in the body for life lying dormant and waiting for the next catalyst to trigger an outbreak. A regimen of high-dose, short duration valacyclovir has shown some efficacy, even aborting the outbreak in some patients when initiated during the prodromal period. Herpes zosterDescription: Herpes zoster is the recurrent outbreak associated with the virus that causes chicken pox. Other therapeutic regimens may include systemic medications such as tricyclic antidepressants, anticonvulsants or gabapentin. CandidiasisDescription: Candidiasis refers to infection with the dimorphic fungal organism, Candida albicans. Pseudomembranous candidiasis is seen most commonly in infants, the immunocompromised or patients undergoing corticosteroid therapy.
Typically asymptomatic, denture stomatitis is often diagnosed during routine dental visits. For these patients, re-evaluation after appropriate antifungal therapy will typically result in the accurate diagnosis.4.

Lesions have a tendency to wax and wane, although they may be present for years without treatment. It may also be associated with medication use, such as antibiotics or inhaled corticosteroids used for treatment of asthma which can lead to Candida infection. Early after infection, some people experience prodrome, a tingling, itching feeling that occurs in an area where blisters will shortly develop. HSV-1 infections can also spread to the eyes (herpes keratitis), face and chest (herpes gladiatorum), and fingers and thumbs (herpetic Whitlow). HSV-1 is easily transmitted through oral secretions (saliva) or through contact with sores on the skin. Oral manifestations are characterized by painful ulcerations that involve both keratinized and nonkeratinized mucosal surfaces (gingivostomatitis). The virus is a member of the human herpesvirus family and, like other herpes viruses, primary infection ends in latency. The infection is primarily superficial, although rare invasive or disseminated cases may be seen in the severely immunocompromised. Without treatment, the area of papillary atrophy may progress to involve the entire dorsal surface of the tongue. In rare cases, it can spread to the brain and cause herpes encephalitis or Molliet's meningitis, types of brain inflammation that can result in death. This means that anyone who has shared a kiss or an object that touched the infection itself like a toothbrush, fork, spoon, lipstick, etc., can contract the virus. There has been some research associating herpes simplex viruses with Alzheimer's and Bell's palsy, although definitive links haven't yet been proved. It is definitely worth noting that both The HSV-1 and the HSV-2 virus can be spread even when there are no sores present. Occasionally, the infection occurs later in life and in an adult may manifest as a pharyngotonsillitis. Under conditions favorable to the organism, such as broad spectrum antibiotic therapy, corticosteroid therapy or xerostomia, transformation to the hyphael form and progression to an infectious state may occur. These are some scary statistics and that’s precisely why Clear Gear Sports Spray is designed to kill viruses like the one that causes Herpes Simplex Virus Type 1. After resolution of the primary varicella-zoster infection, the virus resides in the dorsal spinal ganglia. Clear Gear Sports Spray can be used in a variety of applications such as treating shared objects in schools or on athletic gear.
Secondary or recurrent herpes simplex: Recurrent herpes affects a small number of patients infected with the virus. Transplant Proc 25 1935–19379.Saliba F, Eyraud D, Samuel D, et al (1993) Randomized controlled trial of acyclovir for the prevention of cytomegalovirus infection and disease in liver transplant recipients. Most people carrying the HSV-1 usually experience bouts or occurrences of outbreaks followed by periods of dormancy. Intraoral lesions are typically limited to the keratinized mucosa and are typically only mildly symptomatic, in contrast to those of the primary outbreak. The typical symptoms of an HSV-1 outbreak include blisters on the mouth or any other affected area.
Recurrent herpes labialis may occur spontaneously or be triggered by such stimuli as sunlight, trauma or systemic infection. J Oral Pathol Med 2005 34: 397-400Herpes simplex virus infectionNeville BW, Damm DD, Allen CM, Bouquot JE.
It often begins with a prodromal period of a few hours and is characterized by a “tingling” or “itching” sensation.
While symptoms typically resolve along with resolution of the exanthem, a number of unfortunate patients continue to experience pain, a condition known as post-herpetic neuralgia. The outbreak progresses to the development of numerous vesicles, which quickly rupture, leaving an amber or honey-colored crust. The oral lesions or herpes zoster will follow a similar unilateral anatomic distribution and be characterized by painful ulcerations of the mucosa. The frequency of outbreaks is highly variable from patient to patient, with some experiencing recurrences quite regularly. Dent Clin North Am 47:517-532, 2003Herpes zosterBarrett AP, Katelaris CH, Morris JGL et al.

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