35 Ulcers and erosions: Infections

Figure 35.1 Acute necrotizing gingivitis.

Figure 35.2 Secondary syphilis.

Figure 35.3 Rash of secondary syphilis.

Figure 35.4 Syphilis 20 ×.

Herpesviruses and many other viruses can cause mouth ulceration (see Chapters 9 and 10) typically in children, and present with multiple ulcers and an acute febrile illness. EBV can also cause ulceration (see Chapter 60). Acute necrotizing gingivitis is a bacterial infection seen mainly where hygiene and/or nutrition are poor or in HIV/AIDS, especially in resource-poor areas. Chronic bacterial (e.g. syphilis, tuberculosis), fungal (e.g. histoplasmosis) and parasitic (e.g. leishmaniasis) infections may cause chronic ulceration, mainly in adults, again especially in resource-poor areas and in HIV/AIDS.

Hand, foot and mouth disease (HFM; vesicular stomatitis with exanthem)

Definition: Oropharyngeal vesicles and ulcers, with vesicles on hands and/or feet.

Prevalence (approximate): Uncommonly reported.

Age mainly affected: Children; epidemics common in Asia and Australia. Sometimes seen in immunocompromised adults.

Gender mainly affected: M = F.

Etiopathogenesis: Picornaviridae (Coxsackie virus A16 usually, but A5, A7, A9 and A10 or B9, or other enteroviruses).

Diagnostic features

History

Oral: Infection may be subclinical. The incubation period is up to a week.

One or two days after fever onset, painful mouth sores develop.

Extraoral: Fever, headache, malaise, anorexia, diarrhea.

Clinical features

Oral: Shallow, painful, small ulcers mainly on tongue or buccal mucosa.

Extraoral: Non-itchy rash develops over 1–2 days on the palms of the hands and soles of the feet, sometimes also on buttocks and/or genitalia. The rash is of flat or raised red spots, sometimes with small, painful vesicles.

Differential diagnosis: Herpetic stomatitis; herpangina.

Investigations

This is a clinical diagnosis. Serology is confirmatory but rarely required.

Management

No specific treatment is available. Mouth lesions can be treated symptomatically. Skin vesicles heal />

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