Role of herpes simplex virus reactivation in chemotherapy-induced oral mucositis

Reactivation of oral herpes simplex virus (HSV) is very common in patients receiving cytotoxic chemotherapy or bone marrow transplantation. Numerous studies have shown the incidence rate of reactivation to be between 50% and 90% in these populations. Other studies have attempted to correlate oral mucositis and HSV reactivation. From 37% to 68% of all oral mucositis lesions were culture positive in mixed populations of chemotherapy and bone marrow transplant patients. The lesions that were culture positive tended to be more severe than those that were culture negative. These lesions were also atypical in that they involved any perioral and intraoral surface. Patients receiving cytotoxic chemotherapy should have any mucositis lesions evaluated for HSV, including laboratory testing, and should be treated aggressively with acyclovir. Certain groups, such as bone marrow transplant and leukemia patients who are seropositive, should be considered for acyclovir prophylaxis.