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Leung AKC, Lam J, Barankin B, Leong KF, Hon KL. Roseola Infantum: An Updated Review. Curr Pediatr Rev 2022; 20:CPR-EPUB-127686. [PMID: 36411550 DOI: 10.2174/1573396319666221118123844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Roseola infantum is a common viral disease that occurs during childhood worldwide. OBJECTIVE The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of roseola infantum. METHODS A search was conducted in April, 2022, in PubMed Clinical Queries using the key terms "roseola infantum" OR "exanthem subitum" OR "sixth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Roseola infantum is a viral illness characterized by high fever that lasts 3 to 4 days, followed by the sudden appearance of rash at defervescence. The disease occurs most frequently in children between 6 months and 2 years of age. Human herpesvirus-6 (HHV-6) is the major cause of roseola infantum, followed by HHV-7. Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of the caregivers or other close contacts. Characteristically, the rash is discrete, rose-pink in color, circular or elliptical, macular or maculopapular, measuring 2 to 3 mm in diameter. The eruption is first seen on the trunk. It then spreads to the neck and proximal extremities. Typically, the rash blanches on pressure and subsides in 2 to 4 days without sequelae. Most children look well otherwise and appear to be happy, active, alert, and playful. The diagnosis is mainly clinical. Febrile seizures occur in 10 to 15 % of children with roseola infantum during the febrile period. In general, serious complications are rare and occur more often in individuals who are immunocompromised. There is no specific treatment. An antipyretic may be used to reduce fever and discomfort. CONCLUSION Roseola infantum is generally a benign and self-limited disease. Failure to recognize this condition may result in undue parental fear, unnecessary investigations, delay in treatment for conditions that mimic roseola infantum and complications from roseola infantum, unnecessary treatment of roseola infantum per se, and misuse of healthcare expenditure.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences University of British Columbia, Vancouver, British Columbia
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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Guillouet C, Riou MC, Duong LT, de La Dure-Molla M, Fournier BPJ. Oral lesions of viral, bacterial, and fungal diseases in children: A decision tree. Front Pediatr 2022; 10:937808. [PMID: 35958174 PMCID: PMC9358008 DOI: 10.3389/fped.2022.937808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Oral mucosal lesions are common in the pediatric population and, apart from traumatic and tumoral etiologies, they can be symptoms of viral, bacterial, fungal or parasitic diseases. Yet, pediatricians and pediatric dentists find it challenging to reach a diagnosis and provide appropriate care when facing lesions of the masticatory or lining mucosa, of the hard or soft palate, of the tongue or salivary glands. Here, we propose a decision tree for the diagnosis of the most frequent viral, bacterial, and fungal diseases starting from their oral lesions in children. By first focusing on describing the elementary lesion itself before its localization and characteristics, it aims to guide the practitioner toward the diagnosis and any necessary complementary exams. To generate this tool, we conducted a literature review of the childhood viral, bacterial, fungal and parasitic diseases with oral mucosal symptoms. For each of the 42 reported diagnoses-20 viral, 9 bacterial, 5 fungal, and 8 parasitic-we collected the infection mechanism and agent(s), the oral lesions and their description, the associated systemic signs and the incidence/prevalence. In fine, our decision tree indexes the 28 diseases for which epidemiological data was available, mainly in Europe and the United States.
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Affiliation(s)
- Charlotte Guillouet
- Laboratory of Embryology and Genetics of Human Malformations, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France.,Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France
| | - Margot C Riou
- Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France
| | - Lucas T Duong
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France.,AP-HP, Charles Foix Hospital, Oral Surgery Department, Paris, France.,Gustave Roussy, Paris-Saclay University, Department of Head and Neck Surgical Oncology, Villejuif, France
| | - Muriel de La Dure-Molla
- Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Benjamin P J Fournier
- AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France.,Université Paris Cité, Dental Faculty, Department of Oral Biology, Paris, France
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Miyamoto M, Ishii J, Yoshihara S. An 11-month-old boy with uvulo-palatoglossal junctional ulcers. Paediatr Child Health 2021; 26:392-393. [PMID: 34777655 DOI: 10.1093/pch/pxab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/09/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manabu Miyamoto
- Department of Pediatrics, Nasu Red Cross Hospital, Tochigi, Japan.,Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Junpei Ishii
- Department of Pediatrics, Nasu Red Cross Hospital, Tochigi, Japan.,Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
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Drago F, Ciccarese G, Merlo G, Trave I, Javor S, Rebora A, Parodi A. Oral and cutaneous manifestations of viral and bacterial infections: Not only COVID-19 disease. Clin Dermatol 2021; 39:384-404. [PMID: 34517997 PMCID: PMC7849469 DOI: 10.1016/j.clindermatol.2021.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.
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Affiliation(s)
- Francesco Drago
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy.
| | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, Alessandria, Italy
| | - Ilaria Trave
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Sanja Javor
- Dermatology Unit, Galliera Hospital, Via Mura delle Cappuccine 14, Genoa, Italy
| | - Alfredo Rebora
- DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
| | - Aurora Parodi
- Dermatology Unit, Ospedale Policlinico San Martino, Largo R. Benzi, Genoa, Italy; DI.S. Sal., Section of Dermatology, University of Genoa, Via Pastore 1, Genoa, Italy
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Hernández Vigueras S, Donoso Zúñiga M, Jané-Salas E, Salazar Navarrete L, Segura-Egea JJ, Velasco-Ortega E, López-López J. Viruses in pulp and periapical inflammation: a review. Odontology 2015; 104:184-91. [PMID: 25796386 DOI: 10.1007/s10266-015-0200-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/31/2015] [Indexed: 12/16/2022]
Abstract
The presence of viruses in endodontic disease has been studied in the last decade. Their presence is associated with periapical radiolucency and with clinical findings, such as pain. The aim of this review is to analyze the scientific evidence currently published about viruses in pulp and periapical inflammation, and its possible clinical implications. A literature review was carried out using the Medline/Pubmed database. The search was performed, in English and Spanish, using the following keyword combinations: virus AND endodontic; virus AND periapical; virus AND pulpitis; herpesvirus AND periapical; papillomavirus AND periapical. We subsequently selected the most relevant studies, which complied with the search criterion. A total of 21 articles were included, of which 18 detected the present of viruses in the samples. In 3 of the studies, viral presence was not found in the samples studied. The Epstein-Barr virus was found in about 41 % of cases compared to controls, in which it was present in about 2 %. The main association between viruses and endodontic pathosis is between Cytomegalovirus and Epstein-Barr virus; these are found in 114 of the 406 samples of different endodontic pathosis. Some evidence supports that the Epstein-Barr virus is present in a significant number of endodontic diseases, without exact knowledge of their action in these diseases.
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Affiliation(s)
- Scarlette Hernández Vigueras
- Faculty of Medicine, School of Dentistry, Universidad Austral de Chile, Valdivia, Chile.,PhD Program in Odontology Science, Faculty of Dentistry, University of Barcelona, Barcelona, Spain
| | - Manuel Donoso Zúñiga
- Faculty of Medicine, School of Dentistry, Universidad Austral de Chile, Valdivia, Chile
| | - Enric Jané-Salas
- Department of Odonto-Stomatology, School of Dentistry, University of Barcelona, Barcelona, Spain
| | - Luis Salazar Navarrete
- Laboratory of Molecular Biology and Pharmacogenetics, Department of Basic Science, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | | | | | - José López-López
- Department of Odonto-Stomatology, School of Dentistry, University of Barcelona, Barcelona, Spain. .,Department of Odontostomatology, Pabellón de Gobierno 2ª Planta, Bellvitge University Campus, C/Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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Lerman MA, Laudenbach J, Marty FM, Baden LR, Treister NS. Management of oral infections in cancer patients. Dent Clin North Am 2008; 52:129-53, ix. [PMID: 18154868 DOI: 10.1016/j.cden.2007.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The myelosuppressive and mucosal-damaging consequences of cancer and cancer therapies place patients at high risk for developing infectious complications. Bacterial, fungal, and viral infections are all commonly encountered in the oral cavity, contributing to both morbidity and mortality in this patient population. Prevention, early and definitive diagnosis, and appropriate management are critical to ensure optimal treatment outcomes. With the majority of cancer patients treated as outpatients in the community setting, oral health care professionals play an important role in managing such infectious complications of cancer therapy.
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Affiliation(s)
- Mark A Lerman
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Abstract
Many viral infections exhibit cutaneous lesions. Recognition of the exanthems associated with these infections and the broader clinical scenarios in which they occur can lead to more rapid diagnosis and appropriate treatment for affected patients.
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Affiliation(s)
- Jonathan A Dyer
- Department of Dermatology, University of Missorui, Columbia, MO, USA.
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Abstract
Human herpesvirus 6 (HHV-6) exists as distinct variants HHV-6A and HHV-6B. The complete genomes of HHV-6A and HHV-6B have been sequenced. HHV-6B contains 97 unique genes. CD46 is the cell receptor for HHV-6, explaining its broad tissue tropism but its restricted host-species range. HHV-6 utilizes a number of strategies to down-regulate the host immune response, including molecular mimicry by production of a functional chemokine and chemokine receptors. Immunosuppression is enhanced by depletion of CD4 T lymphocytes via direct infection of intra-thymic progenitors and by apoptosis induction. Infection is widespread in infants between 6 months and 2 years of age. A minority of infants develop roseola infantum, but undifferentiated febrile illness is more common. Reactivation from latency occurs in immunocompromised hosts. Organ-specific clinical syndromes occasionally result, but indirect effects including interactions with other viruses such as human immunodeficiency virus type 1 and human cytomegalovirus or graft dysfunction in transplant recipients may be more significant complications in this population. Recent advances in quantitative PCR are providing additional insights into the natural history of infection in paediatric populations and immunocompromised hosts.
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Affiliation(s)
- D H Dockrell
- Division of Genomic Medicine, University of Sheffield School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, UK
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