Symptoms
Oral thrush, or primary gingivostomatitis herpetica, occurs primarily in children between 6 months and 5 years of age and in young adults around 20 years of age and may also affect older adults. It manifests itself in the following symptoms, among others: Swollen cervical lymph nodes, aphthoid lesions and ulcerations in the mouth and around the lips, cold sores, inflamed, red, swollen to bloody gums (gingivitis, gingival hyperplasia), pain, bad breath, profuse salivation, irritability, feeling sick, headache, respiratory infection, and low-grade fever. The small vesicles initially present on the tongue, oral mucosa, gums, and palate quickly break open and develop into ulcers (ulcerations) that flow into each other and are covered by a yellow-gray fibrin membrane. Children may not eat or drink because of the lesions in the mouth and severe pain. The severity of symptoms and the course is variable. Lesions may persist for 1-3 weeks. Link: Images at dermis.net
Causes
Oral thrush is the initial manifestation of infection with herpes simplex virus 1 (HSV-1) in the oral cavity. Less commonly, HSV-2 can also cause the disease. The virus is usually transmitted through direct contact, e.g. with the skin or saliva. The disease is highly contagious. Therefore, for example in day care centers, it can spread rapidly and local outbreaks can occur. The incubation period is about 1-26 days. It should be noted that the majority of primary infections with HSV-1 are asymptomatic, i.e. without noticeable symptoms. Therefore, oral thrush is the exception and not the rule.
Complications
Possible complications include carryover to the eyes, dehydration, and, in the worst cases, encephalitis (inflammation of the brain). Because the viruses remain latent in the body, they can be reactivated regularly and cause cold sores (see there).
Diagnosis
Diagnosis is made in medical treatment on the basis of the clinical picture and with laboratory chemistry methods. Other conditions, such as aphthae or oral thrush, may cause similar symptoms and must be excluded during diagnosis.
Nonpharmacologic treatment
It is important that patients consume adequate fluids to avoid dehydration. Parenteral administration may be indicated if fluid deficiency is imminent. The food supplied should be mild, cool, liquid to semisolid (e.g., porridges, mashed bananas, mashed potatoes, pasta) to avoid additional irritation. Hot, sour and hot foods such as tomatoes, lemons, onions, chili or vinegar should be avoided! To prevent infection, contact with other children in day care centers should be avoided. Health professionals must also protect themselves from infection with appropriate measures (gloves, possibly protective goggles).
Drug treatment
Analgesics such as acetaminophen or ibuprofen and local anesthetics or other topical agents are used for symptomatic treatment of pain. In severe cases, opioids may also be indicated. Nucleoside analogues such as aciclovir or related agents are causally active against herpes viruses. According to a 2008 Cochrane analysis, there is weak scientific evidence for the efficacy of oral aciclovir. If therapy is considered, it should be started as early as possible. Various herbal medicines can be tried for pain relief, for example, tannins (e.g., black tea, oak, bilberry) or mucilages (mallow, marshmallow). We do not know whether disinfectants applied to the skin and mucosa, such as chlorhexidine and povidone–iodine, affect disease progression or reduce transmission. Food replacement with high-calorie foods, sip feeds, or electrolyte replacement solutions is an option if insufficient food and fluids are consumed because of the pain. Mouth rinses can be effective in relieving irritation and pain. In the United States, a mixture of diphenhydramine and an antacid (Maalox) has often been used topically. Because of the potential adverse effects of 1st-generation antihistamines, we do not consider this therapy to be recommended. Not all of the listed drugs are suitable for children.
