Tatalaksana infeksi herpes simpleks virus tipe-1 dan necrotizing ulcerative stomatitis pada anak dengan anemia aplastik<p></p>Management of type-1 herpes simplex virus infection and necrotising ulcerative stomatitis in children with aplastic anaemia<p>

Abstract

ABSTRAKPendahuluan: Necrotizing ulcerative stomatitis (NUS) merupakan penyakit inflamasi pada rongga mulut, ditandai oleh ulser nekrosis akut, berkembang cepat serta menyebabkan kerusakan masif pada jaringan. NUS dapat berkembang dari kondisi necrotizing ulcerative gingivitis (NUG) dan necrotizing ulcerative periodontitis (NUP). NUS dapat disertai infeksi lain, salah satunya infeksi herpes simplex tipe 1 (HSV-1). Infeksi HSV-1 dan NUS pada anak dengan anemia aplastik jarang ditemukan. Anemia aplastik merupakan kelainan hematologi, ditandai dengan hipoplastik/aplasia sumsum tulang dan pansitopenia, sehingga menurunkan resistensi host terhadap infeksi. Gingivostomatitis herpetik primer memudahkan perkembangan bakteri komensal seperti bakteri Fusiform, Spirochetes dan Pseudomonas aeruginosa menjadi patogen pada kondisi imunosupresif sehingga meningkatkan progresivitas penyakit periodontal menjadi NUS. Tujuan laporan kasus ini adalah menjelaskan tatalaksana infeksi HSV-1 dan NUS pada anak dengan anemia aplastik. Laporan kasus: Seorang anak perempuan usia 3 tahun dengan diagnosis anemia aplastik dan febrile neutropenia, dirujuk oleh divisi Hematologi-onkologi anak Rumah Sakit Dr. Hasan sadikin (RSHS) Bandung dengan keluhan pembengkakan pada bibir dan stomatitis. Hasil pemeriksaan darah menunjukan adanya pansitopenia dan pemeriksaan anti HSV-1 IgG reaktif. Diagnosis terkait kondisi bibir dan mulut pasien adalah Infeksi HSV-1 dan NUS. Tatalaksana yang dilakukan adalah debridement dengan Hidrogen peroksida 1,5% (H2O2 1,5%), kontrol plak dengan chlorhexidine digluconate 0,12% dan multivitamin. Pembengkakan mulai membaik setelah 3 hari debridement serta memberikan hasil yang signifikan setelah 1 bulan perawatan. Simpulan: Tatalaksana berupa peningkatan oral hygiene dan terapi antiseptik dapat memperbaiki kondisi infeksi HSV-1 dan NUS, khususnya pada pasien dengan kondisi imunosupresif seperti anemia aplastik.Kata kunci: febrile neutropenia; stomatitis; herpes simpleks; anemia; spirochetes ABSTRACTIntroduction: Necrotising ulcerative stomatitis (NUS) is an inflammatory disease of the oral cavity, characterised by acute necrotising ulcers, proliferating, and causing massive tissue damage. NUS can be developed from necrotising ulcerative gingivitis (NUG) and necrotising ulcerative periodontitis (NUP). NUS can be accompanied by other infections, such as herpes simplex type 1 (HSV-1) infection. However, HSV-1 and NUS infections in children with aplastic anaemia are rare. Aplastic anemia is a haematological disorder characterised by hypoplastic/bone marrow aplasia and pancytopenia, reducing the host's resistance to infection. Primary herpetic gingivostomatitis facilitates the development of commensal bacteria such as Fusiform bacteria, Spirochetes and Pseudomonas aeruginosa to become pathogens under immunosuppressive conditions, thereby increasing the progression of periodontal disease to NUS. This case report aims to describe the management of HSV-1 and NUS infections in children with aplastic anemia. Case report: A 3-year-old female child diagnosed with aplastic anaemia and febrile neutropenia was referred by the paediatric haematology-oncology division of Dr Hasan Sadikin Hospital (RSHS) Bandung with complaints of swelling of the lips and stomatitis. Blood test results showed pancytopenia and reactive anti-HSV-1 IgG examination. The diagnosis related to the patient's lips and mouth condition was HSV-1 and NUS infection. The treatment is debridement with 1.5% hydrogen peroxide (H2O2 1.5%), plaque control with 0.12% chlorhexidine digluconate and multivitamins. After three days of debridement, the swelling started to improve and gave significant results after one month of treatment. Conclusion: Management of improving oral hygiene and antiseptic therapy can improve the condition of HSV-1 and NUS infections, especially in patients with immunosuppressive conditions such as aplastic anemia.Keywords: febrile neutropenia; stomatitis; herpes simplex; anaemia; spirochetes

ACV with/without IVM: a new talk on intestinal CDX2 and muscular CD34 and Cyclin D1 during Trichinella spiralis infection

“…ACV is a guanine nucleoside analog at which the presence of viral thymidine kinase enzyme determines its activation into ACV triphosphate. In turn, activated ACV acts as a competitive inhibitor of the viral DNA polymerase enzyme and a chain terminator in the synthesis of the viral DNA, therefore hampering the virus ( Lefaan et al ., 2022 ). Interestingly, thymidine kinases were highly detected in T. spiralis in both adult and larva stages ( Wińska et al ., 2005 ).…”