Definisi

• Herpes simplex  penyakit

infeksi akut yg banyak menyerang
manusia.
• Nongenital herpes simplex virus
type 1  sering pada mukosa
oral/bibir (herpes labialis)
 immunologically shielded state until reactiva
ngs by neurons to ganglia where the triggered spontaneously or by a number of differen
mains present in a non-replicating
phase, herpes DNA is detectable, Patofisiologi
e.g., exposure to ultraviolet light, mechanical traum
dietary factors, and immunosuppression.(Figure 5)
not produced. Reactivation of the
en HSV
• HSV switches to a replicative
invasi & replikasi di neuron
s a •result ofdiaganglion
Laten numbersensory
of factors
dorsal root
sue injury from trauma or sunburn,
ssion.2 Infeksi HSV-1 oral

direaktivasi dari ganglia sensorik trigeminal

s type 1 (HSV-1) and HSV-2 are
mukosa facial, oral, labial, orofaringeal & okular
ry and recurrent mucocutaneous
st herpetic infections
• Infeksi are transmitted
primer muncul 2-20 hari setelah
o otherskontak
through direct contact with
dg penderita
dy fluids, e.g., vesicular exudates,
• Transmisi
ds. Following exposure,
– Kissing  melalui the virionsmucous
membran
Retrograde axoplasmic transport of the HSV following

mediated– by envelop-related viral Figure 5: - Retrograde axoplasmic

reactivation transport of
Handuk  melalui kulit following reactivation
 d entry into the cytoplasm, it loses When the HSV is reactivated, newly produced
e process known as un-coating and spread from infected neurons by anterograde axo
is transported into the host-cell transport to mucocutaneous sites causing recurrent h
ell nucleus, the viral genome is infection.3 (Figure 6)
• Infeksi recurrent
requires the generation of protein
– Stimulus
oside triphosphates, which are
new viral • genome
Stress by viral
xt step, the new• Demamviral genome is
•
which subsequently is matahari
Paparan translocated
• Suhu synthesized
The viral proteins ekstrem by
assembled with • Radiasi ultraviolet viral
the duplicate
• Imunosuppresan
ollowed by maturation, a process
ormed virions •totrauma
become infectious.
c effect – ofVirus dorman
HSV-1 anddlmHSV-2
beberapa lama
– HSV-1
ed by general oral munculof1-6
disintegration kali per tahun
host
egress of –infectious viral
Gejala lebih unitsdan
pendek intoringan
onment. The newly synthesized Anterograde axoplasmic transport of the HSV following
Figure 6: - Anterogradeprimaryaxoplasmic
infection transport of th
fect other epithelial cells or enter
Stages of the viral life cycle and potential targets for antiviral agents
Manifestasi Klinis
• Primary oral HSV-1
– Demam prodormal
– Lesi mulut
– Limfadenopati submandibula & cervical
– Tidak nafsu makan
• Lesi
– Vesikel
– Nyeri
– Pada bibir, gingiva, palatum, atau lidah
– Sembuh dalam 10-14 hari
• Herpes labialis recurrent
– tingling
– pain
– paresthesias
– itching
– burning
• Lesi
– Vesikel  clusters
– Dasar eritematous
– Ulserasi  krustae
– Healing 3-4 hari
– Re-epitelisasi 7-8 hr
 Diagnosis
• Anamnesis – Riwayat Penyakit
• Lesi  tidak spesifik
• Kultur virus  sensitif (50%)
– Swab vesikel dg scapel/jarum steril
– simpan dlm viral transport media  lab
• PCR  lebih sensitif
– asymptomatic viral shedding
• Serologi
– Antibodi IgG  spesifik pd minggu pertama infeksi
• direct fluorescent antibody testing
– air-dried specimens
– 80 %HSV +
• Tzanck test
– scraping vesikel  staining  multinucleated giant cells
– Sensitif 40 – 77%
Diagnosis Banding
Penatalaksanaan Herpes Labialis
 Natural Remedies for Herpes simplex
• Diet  rendah gula • Vitamin E
• Lysine – Me(-) nyeri
– Mengurangi rekurensi – Membantu healing

• Vitamin C • Litium
– inaktivasi virus – menghambat replikasi HSV-1
– mempercepat healing
• Zinc
– inhibisi selektid DNA polimerase virus
 menghambat replikasi HSV-1
– Profilaksis herpetic outbreaks
CASE REPORT
• Laki-laki usia 24 th datang ke poli gigi & mulut dg
keluhan utama luka di bibir bawah dan terasa nyeri
sejak 3 hari yll. Lesi diawali demam. Riwayat penyakit
keluarga (-)
• General examination dBN, vital sign dBN.
• Pemeriksaan ekstraoral
– submandibular lymph nodes:
palpable
• Pd kedua sisi (kanan & kiri)
• Mobile
• Tender
• Konsistensi lunak
Multiple shallow ulcers in relation to lower labial mucosa
• Pemeriksaan intraoral
– multiple shallow ulcers
• Di mucosa labial inferior
• Ukuran < 0,5 cm
• Lesi eritematous
• Diagnosis
– acute herpetic gingivostomatitis

• differential diagnosis
– herpetiform apthous stomatitis
– acute necrotising ulcerative gingivitis
– allergic stomatitis
– erythema multiforme
– ulcers due to chemotherapy
• Antiseptik topical &
anaesthetic 3-4 kali
perhari
• Paracetemol selama 5
hari
• Multivitamin
TERIMAKASIH