7: Viral Infections Flashcards
What are six members of the herpetoviridae family?
HSV-1, HSV-2, Varicella Zoster (HSV-3), EBV (HSV-4), CMV, Kaposi Sarcoma
Which is oral herpes? Genital?
HSV-1; HSV-2
T/F. Most of those with primary herpetic gingivostomatitis show signs.
F. Only ~12% are symptomatic
Other than the oral lesions, what are five other signs of primary herpetic gingivostomatitis?
Fever (103-105F), nausea, anorexia, irritability, cervical lymphadenopathy
What are two ways HSV-1 is spread?
Infected saliva or active perioral lesions
When is the only time HSV-1 presents on the lips and gums?
Primary infection
What is the only thing that has been proven to induce herpetic lesions after infection?
UV light
What are six general things that can reactivate HSV-1?
UV light, emotional stress, trauma, respiratory illness, systemic disease, malignancy
What is the primary HSV-1 infection age range?
Young (6mo-5yr) with the highest incidence in 2-3 year olds due to day care
What are four characteristics of the mouth lesions in primary HSV-1 infection?
Distinctive punched-out erosions, enlarged gingival, erythematous, can be anywhere in the mouth (almost always on lip)
Where does secondary HSV-1 infection most commonly present and what is it called?
Vermillion border and adjacent skin of lips; herpes labials (aka cold sore/fever blister)
What are four herpes labials symptoms?
Pain, burning, itching, local warmth
What is the herpes labialis course?
6-24 hrs: Prodromal stage
2+ Days: Vesicles rupture and crust
7-10 days: healing
What pathology may have cases that are preceded by a symptomatic recurrence of HSV?
Erythema multiforme (3-10 days earlier)
What are three characteristics of HSV-1 and 2 histology?
Ballooning degeneration, Tzanck cells, multinucleate giant cells
What are three topical anti-virals for HSV-1? Three systemic?
1: Acyclovir, docosonal, penciclovir
2. Acyclovir (200mg), Famciclovir (125mg), Valcyclovir (500mg)
What is the holistic approach for HSV-1 tx?
L-lysine 500mg
T/F. You can only give treatment during prodromal stage.
T. If given during vesicle rupture, you are too late and anti-virals will not help healing.
When is HSV-2 most dangerous?
During the delivery of a baby
Why do women have more risks of getting an STD?
Anatomy
When is the primary infection of chicken pox? Its other name? Adult reactivation’s name?
5-9yo, Varicella Zoster (HSV-3); shingles
How long is the incubation period for varicella zoster and where does the rash typically begin?
10-21 days; face and trunk
How long is a person contagious with chicken pox?
2 days before exanthema and until all the pustules crust
What is the classic findings of reactivated loser and in what age?
Pt over 60, pain along nerve from back to front, then get lesions that scab in the area that look like shingles
Where does Herpes Zoster remain latent (dormant)? HSV-1 dormancy?
Dorsal spinal ganglion (transported up sensory nerves); trigeminal nerve
What is the histology of HSV-1? Describe
Tzanck cells: free floating epithelial cell in any intraepithelial vesicle
What is the vaccine for Herpes Zoster? Other tx?
Live attenuated varicella zoster virus for adults; capsaicin may provide relief
Is Herpes Zoster painful? Unilateral or bilateral?
Painful and unilateral
Syndrome associated with Herpes Zoster (Shingles) that is a combination of cutaneous lesions of the external auditory canal and involvement of the ipsilateral facial and auditory nerves leading to facial paralysis, hearing defects, vertigo?
Ramsay-Hunt Syndrome
Symptomatic disease form exposure to Epstein-Barr Virus (HHV-4)
Infectious mononucleosis
When is Epstein Barr Virus (HHV-4) symptomatic: children or young adults?
Young adults; children do not display symptoms
Infectious Mononucleosis (Epstein Barr Virus/HHV- 4) symptoms (6)?
Fever, Lymphadenopathy, Tonsilitis, Pharyngitis
Hepatosplenomegaly & rash (less frequent)
2 tests that confirm Epstein Barr Virus?
Paul-Bunnell heterophil antibody & Indirectimmunofluorescent test for EBV-specific
antibodies
2 tx’s for Epstein Barr Virus? Prognosis?
Non-aspirin antinpyretics and NSAIDS & No contact sports if enlarged spleen; good- will usually resolve itself in 4-6 weeks
What virus can reside latently in salivary gland cells, endothelium, macrophages, and lymphocytes? What % of pt have symptoms?
CMV (HHV-5); 10%
What are 3 Enteroviruses of dental significance?
Herpangina, hand-foot-and-mouth disease, Acute Lymphonodular pharyngitis
Most well-known enterovirus infection?
Hand-foot-and-mouth disease
What enterovirus does not have skin lesions but pt may have a sore throat, dysphagia or fever? Why the sore throat?
Herpangina; ulcerated lesions occur on posterior oropharnyx
What is the course of herpangina?
Red macules that ulcerate into 2-4mm ulcer; 2-6 oral lesions of soft palate and tonsillar pillar that heal in 7-10 days
How is HFM disease different from herpangina?
Will have oral lesions, but HFM will also have skin rash and oral lesions ass’d with flu-like symptoms; also the oral lesions in HFM will be numerous and can be anywhere in the oral cavity
In HFM diease, which comes first, the oral lesions or skin lesions?
Oral lesions
What Enterovirus is characterized by 1-5 yellow to dark pink nodules on the soft palate and tonsillar pillars representing hyperplastic lymphoid tissue?
Acute Lymphonodular pharyngitis
Does ALP ulcerate?
No
How do we diagnose enteroviruses?
Clinical presentation
Treatment of Enteroviruses?
Self-limiting, so direct therapy toward symptomatic relief w/ non-aspirin anti-pyretics and topical anesthetics
)Infection produced by a paramyxovirus that has largely been controlled with vaccines
Measles/rubeola
What is the most distinctive oral manifestion of Rubeola/Measels in its initial stage? Define.
Koplik’s spots: mucosal erythema w/ numerous small blue-white macules within
What are the Pathoneumonic histologic cells for Measels?
Warthin Finkeldey Giant Cells
This sounds like the virus that causes normal measles, but this is a mild viral illness produced by a Togavirus, and has capacity to cause birth defects
Rubella/ German Measles
What is the classic triad of congenital rubella syndrome?
Deafness, heart disease, and cataracts
What virus is spread via respiratory droplets and infectious from 2 days before symptoms until 4 days after appearance of rash?
Measles/Rubeola
This is a virus also caused by a Paramyxovirus, but this causes a diffuse disease of exocrine glands. Which gland does it most commonly affect?
Mumps/endemic parotitis; the Parotic salivary glands being the best known site of involvement
What is a clinical symptom of Mumps/Endemic Parotitis?
Pain during initial parotid enlargement, then pain w/ chewing and salivation
What is the 2nd most common place, beside the Parotid, that can swell due to Mumps/Endemic Parotitis?
Testicles (Epididymoorchitis)
What are oral infections associated with Human immunodeficiency Virus (HIV)?
Candidiasis, HIV ass’dKaposi’sSarcoma, and HIV ass’d Oral Hairy Leukoplakia
WhatdoesHIV-associatedKaposi’sSarcoma look like?
Multiple lesions of skin and oral mucosa. Brown or reddish purple that do no blanch under pressure
What are the common oral areas for HIV associated Kaposi’sSarcoma?
Hard palate, gingiva and tongue
