07 Viral infections

Question 1

herpes virus

Answer 1

-herpes simplex virus 1 and 2 (HHV 1 & 2) -vericella zoster virus (HHV 3) -epstein-barr virus (HHV 4) -cytomegalovirus (HHV 5) -kaposi’s sarcoma (HHV 8)

Question 2

HSV 1

Answer 2

-1/3 shed viral particles without present lesion -only UV light exposure proven to induce lesions -other potential inducers: age, stress, pregnancy, allergy, trauma, illness, menstruation, malignancy

Question 3

herpes labialis

Answer 3

-pain, burning, itching, tingling, warmth, erythemia -prodromal signs 6-24hrs before lesions -vesicles rupture and crust within 2 days

Question 4

acute herpetic gingivostomatitis

Answer 4

-6 months to 5 years -abrupt onset -fever, nausea, anorexia, irritability, mouth lesions

Question 5

primary herpetic gingivostomatitis

Answer 5

-punched out erosions -enlarged gingiva -erythematous

Question 6

herpes histology

Answer 6

-ballooning degeneration -tzanck cells -multinucleated giant cells

Question 7

vericella zoster virus

Answer 7

-chicken pox primary infection -10-21 day incubation -rash begins on face/trunk -erythema, vesicle, pustule, hardened crust -contagious from 2 days prior to vesicles until all lesions crust -more serious in adults and secondary infections

Question 8

shingles

Answer 8

-reactivated VSV -latency in dorsal spinal ganglion -reactivated by radiation, malignancies, age, alcohol abuse, trauma, immune suppression, cytotoxic drugs -acute ganglionitis with neural necrosis, severe neuralgia -intense pain followed by rash -cutaneous or mucosal lesions -pain felt as burning, throbbing, itching, stabbing

Question 9

vericella zoster therapy

Answer 9

-antivirals effective during first 72 hours after first vesicle -capsaicin, maybe corticosteroids -attenuated vericella vaccine for elderly

Question 10

ramsay hunt syndrome

Answer 10

-cutaneous lesion of external auditory canal with involvement of ipsilateral facial and auditory nerves -facial paralysis, hearing defects, vertigo -usually doesn’t cross midline -oral lesions can be present

Question 11

infectious mononucleosis

Answer 11

-epstein-barr virus -asymptomatic in childhood, symptomatic in young adults -fever, fatigue, sore throat, swollen lymph nodes -hepatosplenomegaly and rash less common -increased WBC count and high lymphocytes -paul bunnell heterophil ab

Question 12

cytomegalovirus

Answer 12

-latent in salivary glands, endothelium, macrophages, lymphocytes -90% asymptomatic -xerostomia of infected gland -pneumonia, gastroenteritis

Question 13

enterovirus

Answer 13

-poliovirus, coxsackievirus A & B, echovirus, enterovirus -dental significance: herpangina, hand-foot-mouth disease, acute lymphonodular pharyngitis

Question 14

herpangina

Answer 14

-sore throat, dysphagia, fever, cough, rhinorrhea, anorexia, vomitting, diarrhea, headache -most mild/subclinical -oral lesions and tonsilar pillars -red macules form vesicles that ulcerate

Question 15

hand-foot-mouth disease

Answer 15

-skin/oral lesions with flu like symptoms -oral lesions first, skin lesions on hands and feet -oral lesions like herpangina but more numerous and any oral tissue

Question 16

measles (rubeola)

Answer 16

-respiratory droplets -infectious from 2 day before symptoms to 4 days post rash appearance -10-12 day incubation -fever, malaise, coryza, conjunctivitis, cough -rash follows for 4-7 days -face down to extremities -koplik’s spots on buccal/labial mucosa (blue-white macules) -warthin-finkeldey giant cells

Question 17

rubella (german measles)

Answer 17

-mild illness can cause birth defects -vaccine 1969 -congenital rubella syndrome: classic triad of deafness, heart disease, cataracts -can cause patent ductus arteriosus

Question 18

mumps (endemic parotitis)

Answer 18

-paromyxovirus, vaccine 1967 -salivary gland changes, especially parotid -pain during enlargement, increased during chewing and salivary stimulation -epididymoorchitis 25% males -swollen salivary glands and other oral lesions