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3. Gastrointestinal disorders
Clinical features
– Primary herpetic gingivostomatitis: m ultiple ves icles o n the o ra l m uco s a a n d lips
w hich
rupture to fo rm pa in ful, yello w is h, a t tim es exten s ive ulcers . L o ca l les io n s a re
us ua lly
a s s o cia ted w ith gen era l m a la is e, regio n a l lym pha d en o pa thy a n d fever.
– Recurrent herpes labialis: clus ters o f ves icles a t the jun ctio n b etw een the lip a n d the
s kin .
In pa tien ts w ith freq uen t recurren ces o r exten s ive fo rm s , co n s id er H IV in fectio n3
(s ee
pa ge 2 1 4 ).
Treatment
Primary herpetic gingivostomatitis
– T rea t pa in : pa ra ceta m o l o r ib upro fen PO .
– In the even t o f s evere les io n s , in a b ility to d rin k a n d s ign ifica n t pa in :
• a d m it the child to ho s pita l (high ris k o f d ehyd ra tio n );
• if the child pres en ts w ithin the firs t 9 6 ho urs o f s ym pto m s o n s et, aciclovir PO
fo r
– In5thtoe e7vednatyos f: s eco n d a ry b a cteria l in fectio n : a m o xicillin PO 7 d a ys .
C hild ren un d er 2 yea rs : 2 0 0 m g 5 tim es per d a y
C hild ren o ver 2 yea rs : 4 0 0 m g 5 tim es per d a y
In im m un o co m pro m is ed pa tien ts : s ee pa ge 2 1 4 .
Recurrent herpes labialis
S po n ta n eo us res o lutio n w ithin 7 to 1 0 d a ys . A n a n tis eptic (chlo rhexid in e o r
po lyvid o n e
io d in e) m a y b e a pplied ; pa ra ceta m o l PO if n eces s a ry.
B o th fo rm s o f herpes a re co n ta gio us : d o n o t to uch les io n s (o r w a s h ha n d s
a fterw a rd s );
a vo id o ra l co n ta ct.
pOhetnhoxeymretihnylfpeencictililion u(pesnccillian uV)sPeOsfo r 1 0 d a ys
T o n s illitis (pa ge 5 3 ), d iphtheria (pa ge 5 5 ), m ea s les (pa ge 1 8 9 ).
F o r s ca rlet fever (s tra w b erry to n gue a s s o cia ted w ith a s kin ra s h):
C hild ren un d er 1 yea r: 2 5 0 m g/ d a y in 2 d ivid ed d o s es
C hild ren fro m 1 to 5 yea rs : 5 0 0 m g/ d a y in 2 d ivid ed d o s es
C hild ren fro m 6 to 1 2 yea rs : 1 g/ d a y in 2 d ivid ed d o s es
A d ults : 2 g/ d a y in 2 d ivid ed d o s es
Clinical features
– Primary herpetic gingivostomatitis: m ultiple ves icles o n the o ra l m uco s a a n d lips
w hich
rupture to fo rm pa in ful, yello w is h, a t tim es exten s ive ulcers . L o ca l les io n s a re
us ua lly
a s s o cia ted w ith gen era l m a la is e, regio n a l lym pha d en o pa thy a n d fever.
– Recurrent herpes labialis: clus ters o f ves icles a t the jun ctio n b etw een the lip a n d the
s kin .
In pa tien ts w ith freq uen t recurren ces o r exten s ive fo rm s , co n s id er H IV in fectio n3
(s ee
pa ge 2 1 4 ).
Treatment
Primary herpetic gingivostomatitis
– T rea t pa in : pa ra ceta m o l o r ib upro fen PO .
– In the even t o f s evere les io n s , in a b ility to d rin k a n d s ign ifica n t pa in :
• a d m it the child to ho s pita l (high ris k o f d ehyd ra tio n );
• if the child pres en ts w ithin the firs t 9 6 ho urs o f s ym pto m s o n s et, aciclovir PO
fo r
– In5thtoe e7vednatyos f: s eco n d a ry b a cteria l in fectio n : a m o xicillin PO 7 d a ys .
C hild ren un d er 2 yea rs : 2 0 0 m g 5 tim es per d a y
C hild ren o ver 2 yea rs : 4 0 0 m g 5 tim es per d a y
In im m un o co m pro m is ed pa tien ts : s ee pa ge 2 1 4 .
Recurrent herpes labialis
S po n ta n eo us res o lutio n w ithin 7 to 1 0 d a ys . A n a n tis eptic (chlo rhexid in e o r
po lyvid o n e
io d in e) m a y b e a pplied ; pa ra ceta m o l PO if n eces s a ry.
B o th fo rm s o f herpes a re co n ta gio us : d o n o t to uch les io n s (o r w a s h ha n d s
a fterw a rd s );
a vo id o ra l co n ta ct.
pOhetnhoxeymretihnylfpeencictililion u(pesnccillian uV)sPeOsfo r 1 0 d a ys
T o n s illitis (pa ge 5 3 ), d iphtheria (pa ge 5 5 ), m ea s les (pa ge 1 8 9 ).
F o r s ca rlet fever (s tra w b erry to n gue a s s o cia ted w ith a s kin ra s h):
C hild ren un d er 1 yea r: 2 5 0 m g/ d a y in 2 d ivid ed d o s es
C hild ren fro m 1 to 5 yea rs : 5 0 0 m g/ d a y in 2 d ivid ed d o s es
C hild ren fro m 6 to 1 2 yea rs : 1 g/ d a y in 2 d ivid ed d o s es
A d ults : 2 g/ d a y in 2 d ivid ed d o s es
