Examination of the oral mucosa and peripheral blood cells of patients withrecurrent aphthous ulceration for human herpesvirus DNA

Objective. The purpose of this study was to exam the oral mucosa and periph eral blood cells of patients with recurrent aphthous ulceration (RAU) for t he presence of the following human herpesviruses: herpes simplex Viruses 1 and 2, varicella tester virus, Epstein-Barr virus, cytomegalovirus, human h erpesvirus-6, and human herpesvirus-7. Study design. Fifty-eight subjects with RAU and 10 control subjects were re cruited at an academic referral center and enrolled in this prospective, no nrandomized, case-controlled study. Each of the subjects with RAU was seen during an acute episode, and swab specimens from lesional (RAU-acute/lesion ) and clinically normal (RAU-acute/normal) oral mucosa were obtained. Each of 2 subjects with RAU was evaluated during more than one acute episode. Th ree subjects with RAU were seen between active episodes, and swab specimens were taken from clinically normal (RAU-convalescent) oral mucosa. Swab spe cimens from clinically normal (control/normal) oral mucosa were obtained fr om the control subjects. Peripheral blood specimens were obtained from subj ects with RAU and control subjects at the time the swab specimens were perf ormed; Through use of polymerase chain reaction, all swab and peripheral bl ood specimens were examined for the presence of human herpesvirus DNA. Stat istical significance was determined by means of chi(2) analysis. Results. Herpes simplex virus and human herpesvirus-6 were found in a highe r percentage of mucosal specimens from the control subjects (herpes simplex virus, 4/10; human herpesvirus-6, 519) than from the subjects with RAU (RA U-acute/lesion: 3/45 herpes simplex virus, 13/53 human herpesvirus-6; RAU-a cute/normal: 7/48 herpes simplex virus, 9/53 human herpesvirus-6). No diffe rence was demonstrated between RAU-acute/lesion, RAU-acute/normal, and RAU- convalescent mucosal specimens for any of the human herpesviruses. Differen t human herpesviruses were identified from individual subjects with RAU dur ing subsequent episodes of disease. Epstein-Barr virus (6/35), human herpes virus-6 (3/40), and human herpesvirus-7 (7/43) were detected in the periphe ral blood mononuclear cells during acute RAU but not in RAU-convalescent or control peripheral blood mononuclear cells. Conclusions. The detection of human herpesvirus DNA from the oral mucosa an d peripheral blood mononuclear cells of patients with RAU appears to repres ent normal viral shedding rather than a direct causal mechanism in this dis order.