Infeksi herpes simpleks virus 1 rekuren dengan faktor predisposisi stres emosionalRecurrent herpes simplex virus 1 infection with predisposing factors of emotional stress

Abstract

Pendahuluan: Infeksi Herpes Simpleks Virus 1  (HSV 1) pada rongga mulut merupakan suatu penyakit yang diawali gejala prodromal yaitu demam diikuti munculnya vesikel pada wajah, mukosa mulut, dan bibir. HSV 1 bersifat laten di dalam tubuh  dan dapat rekuren yang dipicu oleh paparan sinar matahari, stres emosional, kondisi imunosupresi, kelainan hormonal dan trauma saraf. Laporan kasus ini bertujuan untuk membahas infeksi HSV 1 rekuren intraoral  (RIH) dengan faktor predisposisi stres emosional. Laporan kasus: Seorang perempuan 35  tahun datang   ke poli Ilmu Penyakit Mulut didiagnosis RIH sejak 3 bulan sebelumnya  dengan keluhan sariawan di lidah dan tenggorokan yang didahului  demam. Ekstra oral tidak ditemukan kelainan sedangkan  intra oral terdapat ulser, dasar kekuningan, tepi ireguler, dikelilingi eritem di lateral lidah kiri, palatum posterior, orofaring  dan gingiva disertai rasa sakit. Hasil pemeriksaan darah anti HSV 1 Ig G reaktif dengan nilai 21,3 pada kunjungan dan 31,4 setelah terjadi kekambuhan. Setelah dilakukan anamnesis yang mendalam,stres emosional diduga sebagai pemicu RIH, dimana musibah yang dialami pasien mengakibatkan stres emosional yang memicu berulangnya RIH. Terapi farmakologis berupa asiklovir sistemik, obat kumur khlorheksidine glukonat, vitamin B₁₂ serta asam folat, sedangkan pengelolaan  stres  diberikan sebagai  terapi non farmakologi. Infeksi  sembuh setelah 3 minggu. Selain terapi farmakologi, pasien ini diberikan motivasi untuk  mengelola stres, terbukti pengelolaan stress dapat mempercepat penyembuhan RIH. Simpulan: Infeksi HSV 1 rekuren intraoral  (RIH) dengan faktor predisposisi stres emosional dapat sembuh dengan terapi farmakologi berupa pemberian antivirus, obat kumur dan vitamin dan terapi non farmakologi pengelolaan stres dalam bentuk self suggestion menunjukkan perbaikan lesi pada minggu kedua dan sembuh pada minggu ketiga.

Kata kunci: Infeksi herpes simpleks virus 1 rekuren, stres emosional, tata laksana kasus.

ABSTRACT

            Introduction: Herpes simplex virus 1 (HSV 1) infection in the oral cavity is a disease that begins with a prodromal symptom which was a fever followed by the appearance of vesicles on the face, oral mucosa, and lips. HSV 1 is latent in the human body and can be recurrently triggered by sun exposure, emotional stress, immunosuppression conditions, hormonal abnormalities, and nerve trauma. This case report was aimed to discuss the recurrent intraoral HSV 1 (RIH) infection with predisposing factors of emotional stress. Case report: A 35-years-old woman who came to the Oral Medicine Clinic was diagnosed with RIH for 3 months before with the chief complaint of oral thrush on the tongue and the throat preceded by a fever. No extraoral abnormalities were found, while intraoral examination results found an ulcer, with the yellowish base, irregular edge, surrounded by erythema lateral to the left tongue, posterior palate, oropharynx, and gingiva, and accompanied with the soreness. The result of anti-HSV 1 Ig G reactive blood tests was 21.3 at the visit and 31.4 after the recurrence. After a thorough anamnesis, emotional stress was considered as the RIH trigger, where a disaster experienced by the patient resulted in emotional stress that triggered the RIH recurrence. Pharmacological therapy was performed in the form of administration of the systemic acyclovir, chlorhexidine gluconate mouthwash, vitamin B12, and folic acid; while stress management was also given as a non-pharmacological therapy. The infection was resolved after 3 weeks. In addition to pharmacological therapy, the patient was given the motivation to manage her stress, and the stress management was proven to accelerate the RIH healing. Conclusion: Recurrent intraoral HSV 1 (RIH) infection with emotional stress as a predisposing factor can be cured with pharmacological therapy in the form of administration of antiviral, mouthwash, and vitamins, with addition of self-suggestion stress management as the non-pharmacological therapy, which were proven to improve the lesions in the 2^nd week and recover in the 3^rd week.

Keywords: Herpes simplex virus 1 infection, emotional stress, case management.