Block 1- Mouth and Throat Disorders Flashcards
cold sores are caused by
HSV-1
Can HSV-1 have asymptomatic viral shedding?
yes, pt won’t know when they are passing it on
Epidemiology
of HSV-1
worldwide.
By age 30, 50% of individuals in a high socioeconomic status and 80% in a lower socioeconomic status are seropositive
etiology of hsv
HSV-1 or HSV-2, trigeminal ganglia most often affected by HSV-1 , reactivation more common on mouth area
Risk Factors for hepres simplex
- sun exposure, surgery, stress, fever and viral infection, transmitted by close personal contact “kissing disease”
inoculation of virus is through susceptible mucosal surfaces such as?
- oropharynx, cervix, conjunctiva, small cracks in skin
Primary Infection symptoms of HSV
o Systemic symptoms: Fever, malaise, headache
o Acute herpetic gingivostomatitis lasts 5-7 days
o Maximum viral shedding is in the first 24 hours of the acute illness but may last 5 days
o Viral shedding from saliva (asymptomatic shedding) can last 3 weeks
Recurrent Infection symptoms – once HSV infection has occurred
o Prodromal symptoms
Pain, burning, tingling, pruritus 6 to 53 hours prior to appearance of vesicles
Reactivation by immunodeficiency or stress
Rarely associated with systemic symptoms, doesn’t last as long
what will you find on the physical exam for pts with herpes simplex?
Multiple painful vesicular lesions superimposed upon an inflammatory, erythematous base. They can rupture and cause ulcers.
- Most commonly on vermilion border of the lips
- Local LAD
- Can be associated with Bell’s palsy
Lab and Diagnostic Tests for herpes simplex?
o Viral tissue culture – most definitive (gold standard) – can take fluid out of vesicles for this culture
o Tzanck smear – multinucleated giant cells, not sensitive
o PCR for CSF
o Serologic tests for HSV-IgG- can’t readily distinguish antibody between HSV 1 and 2
Treatment
for herpes simplex
- Medications - No cure, but when started at FIRST onset, may decrease duration of symptoms
o Antivirals: Valacyclovir $ /Famciclovir $»_space; acyclovir most convenient for patients
o For recurrent can prescribe topical creams:
Penciclovir Cream / Acyclovir cream / Abbreva
Valacyclovir or Famciclovir x1day (at prodrome) - Avoid kissing, sharing beverages and food from the same container/utensils, or toothbrushes
What are Apthous Ulcers
- Self-limited painful ulcerations
- Also called “Canker sore” or Aphthous stomatitis
Epidemiology of Apthous Ulcers
slight female predominance, up to 66% pop, all races, typically starting in childhood
History of Apthous Ulcers
- Possible risk factors o Heredity o Oral local trauma o Stress o Vitamin, iron, or folic acid deficiency o Immunodeficiency o Toothpastes containing sodium lauryl sulfate (tartar-control toothpaste) o Tobacco use o Celiac Disease, Behcets, Crohn’s, HIV - Painful recurrent oral ulcers (RAS) MOST common mouth ulcers - They heal in 7-10 days. - They recur at intervals of 1-4 months
what will you find on the Physical exam of Apthous Ulcers
Circular, clearly defined, shallow ulcers covered by gray membrane surrounded by raised border of inflammation
name disorder:
Circular, clearly defined, shallow ulcers covered by gray membrane surrounded by raised border of inflammation
Apthous Ulcers
name disorder:
Multiple painful vesicular lesions superimposed upon an inflammatory, erythematous base. They can rupture and cause ulcers.
Herpes Simplex
treatment of Apthous Ulcers
- Eliminate predisposing factors- avoid spicy, tomato based foods
- Analgesia (many different) , Topical OTC preparations :
Orajel-Ultra Mouth Sore Medicine (benzocaine and menthol)
Magic Mouthwash, “Duke’s Magic Mouthwash” , viscous lidocaine - Promote ulcer healing/prevent recurrence (1st line)
o Triamcinolone 0.1% in Orabase: Apply to ulcer 2–4× daily until healed.
o Amiexanox 5% paste: 0.5 cm applied to ulcer q.i.d. after meals
o Clobetasol 0.05%: 0.5 cm applied to ulcer 2× daily
o Fluocinonide 0.05% gel: 0.5 cm applied to ulcer up to 5× daily - Systemic Therapy
o Prednisone
o Thalidomide
when to refer for Apthous Ulcers?
Follow up with Otolaryngologist or Rheumatologist if lesions have not resolved within 2 weeks
One non healing lesion of Apthous Ulcers are more concerning for ____, multiple recurrent lesions more concerning for rheumatologic or autoimmune disorder
SCC
“thrush” is what disease?
Oral candidiasis
Etiology of Oral candidiasis
Candida albicans
Epidemiology of Oral candidiasis
up to 37% infants
worldwide
M=F
History of Oral candidiasis
- Can be asymptomatic or painful during eating/swallowing Soreness in the mouth and pharynx
o Pain when swallowing: odynophagia
o Difficulty swallowinf: dysphagia - Difficultly swallowing Altered taste
- “cottony” feeling in mouth
- Risk factors: Infants immunodeficiency (HIV/AIDS) Denture use (Denture Stomatitis) Debilitated or have poor oral hygiene History of diabetes undergoing chemotherapy or local irradiation
- Taking corticosteroids (inhaled) or broad-spectrum antibiotics
