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OPath Block 2 > 5. Viral Infections 1 > Flashcards

5. Viral Infections 1 Flashcards

1
Q

What is the immunopathogenesis during the early acute phase HIV infection?

A

Self limiting illness within weeks (immunocompetent)

High levels of virus production, viremia and reduction of CD4+ T cells

Seroconversion: production of anti-HIV ABs (used for clinical screening for HIV infection)

at end, CD4 numbers return to normal

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2
Q

What is the immunopathogenesis during the middle clinical latent period of HIV infection?

A

Stage relative containment of the virus

continue HIV replication at low levels

continue CD4 cell loss

asymptomatic , some may have persistent lymphadenopathy and minor opportunistic infections

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3
Q

What is the immunopathogenesis during the final crisis phase of HIV infection?

A

Break down of host defensive system

Profound loss of CD4+ cells

full blown AIDS

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4
Q

How is HIV transmitted?

A

Sexual

Parenteral

Mother to infant

Body fluids such as semen and blood are usually source of infection

Saliva of HIV pts contain virus but transmission via saliva is rare

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5
Q

What are the EC-Clearinghouse Classifications of oral manifestations of HIV disease in adults?

A

Group 1: oral and maxillofacial lesions strongly associated with HIV infection

Group 2: less commonly associated with HIV infection

Group 3: seen in HIV infection

Group 1 manifestations are rare outsideo f HIV setting

Group 2 and 3 can be seen with HIV pts but also non-HIV pts

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6
Q

What are the group 1 HIV oral manifestations?

A

Candidiasis

Oral hairy leukoplakia

Kaposi’s sarcoma

Non-hodgkin’s lymphoma

Periodontal dz

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7
Q

What is the most common intraoral manifestation of HIV infection?

A

oral candidiasis

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8
Q

most common agent of oral candidiasis?

A

Candida albicans

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9
Q

What is an inidication of a patient’s immunosuppression when sen with oral candidiasis?

A

low CD4

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10
Q

how to lower oral candidiasis frequency in HIV pt?

A

HAART

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11
Q

What is the most common EBV related lesion in HIV pts?

A

Oral hairy luekoplakia

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12
Q

S/S of Orla hairy leukoplakia?

A

Faint or thickened white vertical streaks that do not rub off usually on lateral tongue

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13
Q

histopathology of oral hairy leukoplakia?

A

Hyperkeratosis and layer of balloon cells in upper spinous layer

Detect EBV by immunohistochemistry or insitu hybridization

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14
Q

Oral hairy leukoplakia Tx

A

Not needed

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15
Q

What is kaposi’s sarcoma?

A

Systemic malignant vascular tumor caused by HHV-8/KSHV

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16
Q

Kaposi’s sarcoma appearance?

A

Red to purple skin or mucosal lesions with or without internal involvement

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17
Q

What are the 4 subtypes of kaposi’s sarcoma?

A

Classic subtype: Western world

African endemic subtype: Sub-saharan Africa

Latrogenically immunosuppressed subtype: transplant pts

Epidemic AIDS related subtype

18
Q

Kaposi’s sarcoma classic subtype S/S

A

middle-aged and elderly men of Mediterranean or European descent

Relatively indolent

Affects lower extremities but stays on skin. does not spread internally

19
Q

Laposi’s sarcoma African endemic subtype S/S

A

Mostly young patients (<40)

begin in lower extremities but expand ot other areas

20
Q

Kaposi’s sarcoma AIDs related subtype S/S

A

Agressive

spreads to various parts of the body including internal organs

21
Q

What is the most common malignancy in HIV pts?

A

Kaposi’s sarcoma

22
Q

how does HIV associated Kaposi’s sarcoma manifest?

A

multiple lesions of the skin, oral mucosa and viscera

23
Q

How does HIV related kaposi’s sarcoma appear in the mouth?

A

Start as purple macular lesions and later develops into nodules

invade bone

affects palate (most common), tongue and gingiva

24
Q

Dx of oral HIV related Kaposi’s sarcoma

A

Biopsy is necessary

Will see vascular proliferation

Presence of HHV8

25
Q

What is the second most common malignancy in HIV?

A

Non-hodgkin’s lymphoma

26
Q

Pathogen involved in NHL?

A

EBV

27
Q

S/S of HIV associated NHL

A

Extranodal lymphoma esp in the CNS

OUtside of HIV pts, NHK will not be involved in extranodal sites

28
Q

What are the 3 paterns of HIV associated periodontal dz?

A

Linear gingival erythema

  • band of erythema involving free gingival margin

Necrotizing ulcerative ginigivitis/mucositis

  • Ulceration/necrosis of one or more interdental papillae without loss of periodontal attachment
  • only gingiva or surrounding soft tissue is involved

Necrotizing ulcerative periodontitis

  • gingival ulceration/necrosis associated with rapid progressive loss of periodontal attachment
  • multiple isolated defects often are seen in contrast with the diffuse pattern associated with typical chronic periodontitis
29
Q

What is HIV associated salivary gland dz?

A

Salivary gland enlargement associated with HIV

30
Q

Which salivary gland is most commonly involved in HIV associated salivary gland dz?

A

Parotid gland

Common result = xerostomia

31
Q

How does diffuse infiltrative lymphocytosis syndrome cause hiv associated salivary gland dz?

A

Persistent circulating CD8+ lymphocytosis (to fight virus) is accompanied by lymphocytic infiltration in various organs

salivary gland = most common organ involved in infiltration

Syndrome is associated with high risk of B cell lymphoma - pts need to be monitored

32
Q

What are common perioral manifestations of HPV infection?

A

Verruca vulgaris (common wart)

Oral squamous papilloma (cauliflower appearance)

33
Q

How do perioral manifestations of HPV infectoin in HIV pts differ from non HIV pts?

A

cluster of nodules (multiple exophytic papillary nodules)

Unusual variants of HPV (type of HPV present in lesion is different from non HIV pts–HPV strains that dont normally cause lesions)

34
Q

How does HAART affect HPV infectoin lesions?

A

Increased prevalence of lesions

35
Q

How do aphthous ulcerations differ in HIV pts vs non HIV pts?

A

Increased frequency to develop all forms of apthous ulcer

Unlike normla pts, most HIV pts develop major or herpetiform ulcers which are abnormal for normal pts ulcer on all tissue not just nonkeratinized

36
Q

What is molluscum contagiosum?

A

Infection of the skin caused by poxvirus

37
Q

How does molluscum contagiosum affect immunocompetent pts?

A

Children

Small dome shaped papules with a central depression center

self limiting

38
Q

How does molluscum contagiosum affect HIV pts?

A

Hundreds of lesions occasionally obtaining large size

Little tendency to undergo spontaneous resolution

39
Q

How does HIV affect oral squamous cell carcinoma?

A

tumor has same risk factors in HIV pts as in normal population but tends to occur at a younger age

40
Q

What kind of drugs are used in HAART?

A

Reverse transcriptase inhibitor

protease inhibitor

integrase inhibitor

CC5 inhibitors

OPath Block 2 (10 decks)

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