Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Pediatrics, Chang Gung Memorial Hospital, No.5, Fu-Hsin Street, Kweishan, 333, Taoyuan, Taiwan.
BMC Infect Dis. 2020 Oct 20;20(1):782. doi: 10.1186/s12879-020-05509-2.
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.
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.
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/uL) 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).
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.
儿童原发性疱疹性龈口炎（PHGS）虽然通常是自限性的，但在临床上可能与细菌性和肠病毒性咽炎相似。我们进行了一项研究，以确定儿童 PHGS 的临床特征。
在 2012 年 1 月至 2016 年 12 月期间，从病毒学实验室日志中确定了一家医疗中心 282 名年龄小于 19 岁、经细胞培养证实单纯疱疹病毒（HSV）感染的住院患者。回顾性收集临床数据。
在 282 名住院患者中，有 185 例被认为是 PHGS，并纳入分析。99.5%的患者有发热。发热的平均持续时间为 5.11±2.24 天，最长为 17 天。常见的口腔表现包括口腔溃疡（84.3%），口腔前后部同样存在（65.4%与 63.2%）、牙龈肿胀和/或出血（67.6%）以及覆盖扁桃体的渗出物（16.8%）。白细胞增多（白细胞计数>15,000/μL）见于 52 例患者（28.1%），血清 C 反应蛋白水平>40mg/L 见于 55 例患者（29.7%）。65 例患者（35%）在入院时被诊断为 PHGS，他们在前口腔有溃疡的可能性明显更高（76.1%与 26.7%），牙龈肿胀/出血的可能性明显更高（76.2%与 7.5%，所有 p 值均<0.001），抗生素治疗的可能性明显更低（16.9%与 36.7%，p 值<0.01）。46 例（25%）出院时未被诊断为 PHGS 的患者明显更有可能在扁桃体上有渗出物，接受抗生素治疗，且明显不太可能出现牙龈肿胀/出血和口腔溃疡（所有 p 值均<0.01）。
仔细识别儿童牙龈肿胀/出血和前口腔溃疡的特定口腔表现有助于更早做出 PHGS 的诊断，从而减少不必要的抗生素处方。
