HSV-Related Oral Mucositis in Patients With Lymphoma
HSV-Related Oral Mucositis in Patients With Lymphoma
The management of oral mucositis to date has typically been symptom control. The Mucositis Study Group of the Multinational Association for Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) developed clinical practice guidelines for the management of mucositis (Lalla et al., 2008). The guidelines are subdivided into separate sections that focus on nutritional support, pain control, oral decontamination, palliation of dry mouth, management of oral bleeding, and therapeutic interventions for oral mucositis. Table 2 lists management of HSV-related oral mucositis and incorporates MASCC/ISOO guidelines with therapeutic interventions for HSV.
For immunocompetent patients with either oral or genital HSV, treatment with acyclovir or valacyclovir for 7–10 days is recommended (Brady & Bernstein, 2004). Treatment also can be episodic and used at the first sign or symptom of outbreak for 1–5 days to decrease the symptoms of HSV infection, or administered prophylactically to prevent recurrences. Suppressive therapy decreases asymptomatic shedding, reduces transmission of HSV, and enhances healing and pain relief (Brady & Bernstein, 2004).
Immunocompromised patients, such as J.S. in the case study, require timely identification and initiation of antiviral therapy. Therapy can certainly commence prior to report of a positive culture. HSV infection can become disseminated and progress to encephalitis and lesions can develop secondary fungal or bacterial infections. Therapy often includes IV infusion of acyclovir until clinical and hematologic resolution. Clinicians should ensure that pain control and fluid and nutritional support are provided (Negrin et al., 2014).
Treatment
The management of oral mucositis to date has typically been symptom control. The Mucositis Study Group of the Multinational Association for Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) developed clinical practice guidelines for the management of mucositis (Lalla et al., 2008). The guidelines are subdivided into separate sections that focus on nutritional support, pain control, oral decontamination, palliation of dry mouth, management of oral bleeding, and therapeutic interventions for oral mucositis. Table 2 lists management of HSV-related oral mucositis and incorporates MASCC/ISOO guidelines with therapeutic interventions for HSV.
For immunocompetent patients with either oral or genital HSV, treatment with acyclovir or valacyclovir for 7–10 days is recommended (Brady & Bernstein, 2004). Treatment also can be episodic and used at the first sign or symptom of outbreak for 1–5 days to decrease the symptoms of HSV infection, or administered prophylactically to prevent recurrences. Suppressive therapy decreases asymptomatic shedding, reduces transmission of HSV, and enhances healing and pain relief (Brady & Bernstein, 2004).
Immunocompromised patients, such as J.S. in the case study, require timely identification and initiation of antiviral therapy. Therapy can certainly commence prior to report of a positive culture. HSV infection can become disseminated and progress to encephalitis and lesions can develop secondary fungal or bacterial infections. Therapy often includes IV infusion of acyclovir until clinical and hematologic resolution. Clinicians should ensure that pain control and fluid and nutritional support are provided (Negrin et al., 2014).
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