口内炎
- 口内炎は、大変ありふれた病気ですが、ほとんど何もわかっていません。単発のアフタ性口内炎については、製薬会社も儲からないし、人命にかかわらないので、今後も、大規模臨床試験はされないでしょう。
単純ヘルペスによる多発性再発性口内炎
- 口腔全体に、アフタ性口内炎が無数にできる症状(単なる、再発性口唇ヘルペスではないタイプ)。
- これまで、herpes simplex virus (HSV)などのキーワードで調べていたが、「 (acute) herpetic gingivostomatitis (AHGS) 」という用語があるそうで、こちらで調べましょう。
- ヘルペス全体の基本的な知識
- アメリカの家庭用だけど、いろいろ書いてある。:Oral Herpes Family Practice Notebook. http://www.fpnotebook.com/ENT124.htm
- Freeでよめる、よさそうな、レビュー的なケースレポート:Chauvin PJ, Ajar AH. Acute herpetic gingivostomatitis in adults: a review of 13 cases, including diagnosis and management. J Can Dent Assoc. 2002 Apr;68(4):247-51. click
感染年齢 | The main one is during childhood, usually between the ages of 6 months and 5 years, and the second peak occurs in the early 20s. |
成人の初感染は重篤 | In addition, the adult course of primary AHGS is longer and characterized by more severe symptoms than AHGS in children. |
検査についてだけど、よくわからん、どうも、HSVの1か2かまでは、わからないけど、スメアーがよいらしい、水疱擦過物の塗沫(Tzanck smear) | The result of Tzanck testing was positive in 10 of the 13 cases (sensitivity 77%). The culture result was positive in all 13 cases. |
男は、HSV-1が多い | As a result, more men will appear HSV-1 positive. |
潰瘍がなくて歯肉なら、白血病も疑え | If gingival hyperplasia is present without oral vesicles or ulcers, the workup should include routine blood testing (complete blood count with differential count and peripheral blood smear) to rule out any abnormalities suggestive of leukemia. |
抗ウイルス剤はルーチンに使わない(けど、多くの使っている論文がHIV患者などで増えているようだけど) | However, because of its poor gastrointestinal absorption and bioavailability, acyclovir has not routinely been used in the management of AHGS except for the oral suspension administered in a rinse and swallow technique. |
リンスについて | A palliative mouth rinse made by mixing attapulgite (Kaopectate, Johnson & Johnson • Merck, Guelph, Ontario) with diphenhydramine (Benadryl Elixir, Pfizer, Toronto, Ontario) (50:50 by volume) may also be helpful. |
水分の摂取が大切 | The severity and quantity of intraoral lesions may significantly reduce dietary intake and predispose the patient to dehydration. Thus, it is important to balance any decrease in intake with fluids. Either nutritional supplements or a pureed or blended diet is sufficient until the patient can tolerate solids. Most systemic analgesics such as acetaminophen are adequate to manage the associated pain and malaise. |
- Freeで読める、有名そうなレビュー:Simmons A. Clinical manifestations and treatment considerations of herpes simplex virus infection. J Infect Dis. 2002 Oct 15;186 Suppl 1:S71-7. click
- gingivostomatitisの記載は、少しで、Oral acyclovir treatment (acyclovir suspension 15 mg/kg 5 times/day for 7 days) started within the first 3 days of onset of symptoms shortens the duration of all clinical manifestations by about 50% [12]. Most cases of gingivostomatitis go untreated, undiagnosed, or even unrecognized; the condition is not normally considered serious.
- 新しいレビュー(詳細不明):PG Arduino1, SR Porter2 Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management* Oral Diseases Volume 12 Page 254 - May 2006 click
- 有名そうなレビュー(内容は不明):Yeung-Yue KA, Brentjens MH, Lee PC, Tyring SK. The management of herpes simplex virus infections. Curr Opin Infect Dis. 2002 Apr;15(2):115-22. click
- 移植患者に対してだから一般ではないが、低用量の抗ウイルス剤で予防の論文:Engelhard D, Morag A, Or R, Naparstek E, Cividalli G, Ruchlemer R, Aker M, Maayan S, Slavin S. Prevention of herpes simplex virus (HSV) infection in recipients of HLA-matched T-lymphocyte-depleted bone marrow allografts. Isr J Med Sci. 1988 Mar;24(3):145-50. click
- 抗ウイルス剤の治療の論文で、Freeでよめる。:Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ 1997; 314:1800–3. click
- 唾液には、HSV-1,HSV-2より、HHV-6,HHV-7のが多いと、図に書いてあるけど??:Miller CS, Avdiushko SA, Kryscio RJ, Danaher RJ, Jacob RJ. Effect of prophylactic valacyclovir on the presence of human herpesvirus DNA in saliva of healthy individuals after dental treatment. J Clin Microbiol. 2005 May;43(5):2173-80. click
口唇ヘルペスかもしれない文献
- HAEM(ヘルペスに関連した多形性紅斑)と書かれて、AHGSでないけど、写真では、口唇ヘルペスかな。でも良さそうなまとめ(原著論文に基づいてない文章も多い解説だけど)。Freeでよめる。:http://www.emedicine.com/derm/topic137.htm#target3
- Low-dose acyclovir (200 mg qd to 400 mg bid) can be effective for recurrence of HAEM, even in subclinical HSV infection. In children, the dosage of 10 mg/kg/d may be considered.
口唇ヘルペス
- Cold sores(日本語訳として、他のところに口辺ヘルペスとあったので、口唇ヘルペスのことをさすのか、MeSHでは、herpes labialis )について、詳しい。Freeでよめる。:http://www.animated-teeth.com/cold_sores/t1_cold_s...
アフタ性口内炎
- 詳しいサイトで良さそうなまとめ(原著論文に基づいてない文章も多い解説だけど)。:http://www.emedicine.com/ped/topic2672.htm
2006年07月01日(土) 08:52:58 Modified by mxe05064