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CMV
0%
0/9
EBV
11%
1/9
HIV
HSV-1
89%
8/9
HSV-2
Select Answer to see Preferred Response
This patient is presenting with acute herpetic gingivostomatitis caused by herpes simplex virus type 1 (HSV-1). Acute primary herpes simplex type 1 virus infection often manifests in children ages 6 months to 5 years. The orolabial lesions may last for 10-14 days, but viral shedding can occur as long as 20+ days after initial presentation. The initial presentation can also include fever, malaise, myalgias, and cervical lymphadenopathy. Many initial acute HSV-1 infections are asymptomatic, with evidence of infection only evident at viral reactivation later in life. Usatine et al. discuss nongenital herpes simplex virus type 1 infections. It is usually transmitted during childhood by nonsexual contact. The diagnosis can often be made by observation of the classic vesicular lesions on exam; however, the diagnosis can also be confirmed by culture, PCR, serology, fluorescent antibody testing, or Tzanck smear. Nasser et al. conducted a Cochrane systematic review on the efficacy of acyclovir for treating primary herpetic gingivostomatitis. Only 2 trials with a total of 92 patients were included in this review. There is weak evidence that acyclovir reduces oral lesions, prevents new lesions, decreases difficulty with eating and drinking, and reduces hospital admission. Illustration A shows a patient with acute herpetic gingivostomatitis. Incorrect Answers: Answer 1: Cytomegalovirus (CMV) may cause mononucleosis in immunocompetent patinets; the virus also causes numerous potential infections in immunocompromised patients, including hepatitis, retinitis, colitis, and pneumonia. It is also a TORCH infection that may lead to congenital abnormalities when transmitted perinatally. Answer 2: Epstein-Barr virus (EBV) is the most common causative organism in infectious mononucleosis. Answer 3: This patient's presentation of orolabial vesicular lesions, adenopathy, and fever of acute onset at 5 years of age is not consistent with acute HIV infection. Answer 5: HSV-2 more commonly manifests with genital infection; the majority of orolabial infections are caused by HSV-1.
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