Chapter 7 Flashcards
What is the only natural reservoir for HHV?
Humans, HHV stands for human herpes virus!
What are the types of HHV?
HHV-1, HHV-2, VZV, EBV, CMV, HHV-6, HHV-7, KSHV
Where are lesions typically seen in HSV-1?
Lesions are typically above the waist, specifically, perioral lesions
What condition has been able to induce HHV-1 lesions experimentally?
UV light exposure
What term describes a symptomatic primary infection in younger populations?
Acute herpetic gingivostomatitis
How is HHV-2 transmitted?
Sexual contact
Are primary infections of HHV-1 and HHV-2 usually asymptomatic or symptomatic?
80% are usually asymptomatic
After initial exposure or HHV-1 and HHV-2, where is the virus transported to?
The virus is taken up by the sensory nerves and transported to associated sensory ganglia (latent state).
What is the primary site of latency for herpes?
Trigeminal ganglion
What are the terms that describe reactivation of herpes virus?
Secondary infection, recurrent infection or recrudescent infection
What is the most common site of recurrence for HHV-1?
Vermillion border and adjacent skin of the lips.
What is other names for HHV-1 when it occurs adjacent skin of the lips?
Herpes labialis, cold sore, fever blister
True or False: 40% of people in the US has a history of herpes labialis
True
Describe the prodrome of HHV-1?
Pain, burning, itching, tingling 6-24 hours before the lesion develops. Symptoms are most severe in the first 8 hours.
Describe the appearance of HHV-1/2 lesions.
Multiple, small, erythematous papules (fluid filled vesicles) that rupture and crust with 2 days.
How long does it take for HHV-1/2 to heal?
7-10 days
How many HHV-1/2 outbreaks does a majority of people experience a year?
2 outbreaks a year
How long is the HHV-1/2 virus actively replicating for?
2 days. Mechanical rupture of intact vesicles releases the virus and can result in spreading the lesion
Where do recurrent intraoral lesions usually occur?
Almost always on keratinized, bound mucosa (palate, attached gingiva)
At what age does acute herpetic gingivostomatitis usually occur?
Most cases occur before 5 years old
True or False: Both movable and attached oral mucosa can be affected by acute herpetic gingivostomatitis.
True, both movable and attached mucosa can be affected by acute herpetic gingivostomatitis.
In acute herpetic gingivostomatitis, self-inoculation of ________, _______, and _______ can occur.
Fingers, eyes and genitals
What term describes primary herpes in patients 18 years and older?
(Acute herpetic?) Pharyngotonsillitis
What are the initial symptoms of herpetic pharyngotonsillitis?
Sore throat, fever, headache
What term describes a herpes infection of the thumb or fingers?
Herpetic whitlow
What term describes a herpetic infection found in contaminated abrasions of wrestlers or rugby players?
Herpetic gladiatorum or scrumpox
What term describes a herpes infection created by shaving?
Herpes barbae
What location of HSV-1 is a concern for ocular involvement?
The tip of the nose (ocular involvement of herpes is actually the leading infectious cause of blindness in the US)
What term describes a life threatening infection caused by extensive herpetic cutaneous vesicular eruption that arises from pre-existing skin disease?
Eczema herpticum or Kaposi’s varicelliform eruption
What are the histopathologic features of HHV?
Multinucleation, ballooning degeneration (Acantholysis, nuclear clearing, nuclear enlargement) Tzanck cells (free floating)
How is HHV diagnosed?
Clinical presentation, cytologic smear, tissue biopsy, serologic testing(has to be 4-8 days after exposure)
How is HHV treated?
Antivirals (acyclovir)
What virus causes chicken pox?
Varicella-Zoster Virus aka HHV-3
How is VZV spread?
Through air droplets or direct contact with active lesions
At what age do most cases of VZV occur?
Between the ages of 5-10
After initial VZV infection, where does the virus establish latency?
Dorsal spinal ganglia
What are some predisposing factors for reactivation of VZV?
Immunosuppression, radiation, malignancies, increasing age, alcohol abuse, emotional or physical stress
What is the syndrome associated with VZV?
Ramsay Hunt Syndrome
Describe Ramsay Hunt Syndrome.
Cutaneous lesions of the external auditory canal, facial paralysis, hearing deficits, vertigo
What virus causes infectious mononucleosis?
Epstein Barr virus aka HHV 4
What are some other lesions which demonstrate EBV?
Oral hairy leukoplakia, lymphomas (African’s Burkitt lymphoma), Nasopharyngeal carcinoma
Approximately how many adults are infected with EBV?
Up to 95% of adults
How is infectious mononucleosis diagnosed?
Presence of Paul Bunnel heterophil antibodies
What are the signs of infectious mononucleosis?
Prodrome 2 week before, fatigue, malaise, anorexia, fever, lymphadenopathy, oral lesions (petechiae on hard palate, NUG)
What virus can reside in salivary glands, endothelium, macrophages and lymphocytes?
Cytomegalovirus aka HHV 5
Approximately, what percentage of CMV infections are asymptomatic?
Almost 90%
What are the common symptoms of CMV infection?
Fever, joint and muscle pain, shivering, chronic mucosal ulcerations
In what population is CMV common?
AIDS patients
What are the classifications of enteroviruses?
Echoviruses, Caxsackievirus, Poliovirus
What are the 3 disease caused by the coxsackievirus that are important to oral health care professionals?
Herpangina, hand/foot/mouth disease, acute lymphonodular pharyngitis
How are enteroviruses spread?
Crowding and poor hygiene, fecal-oral route; during acute phase, it can be transmitted through saliva or respiratory droplets
True or False: infection with one strain of enteroviruses confers immunity
True, infection with one strain of enteroviruses confers immunity
What age group(s) are commonly affected by enteroviruses?
Nearly half of reported cases occur in infants younger than 1, 85% occur in patients younger than 20
Describe herpangina
Skin rash, 2-6 oral lesions in the posterior mouth, along with sore throat, fever and dysphagia
Describe the ulcerations seen in herpangina
Begin as red macules that form fragile vesicles that rapidly ulcerate; ulcerations are 3mm in diameter
Describe hand-foot-and-mouth disease
Skin rash and oral lesions associated with flu like symptoms
Describe the oral lesions seen in hand-foot-and-mouth disease
Resemble ulcerations of herpangina, but larger (up to 1 cm), and more numberous (up to 30); buccal mucosa, labial mucosa, and tongue
True or False: Lesions seen in hand-foot-and-mouth disease heal without crusting
True, lesions seen in hand-foot-and-mouth disease heal without crusting
Describe acute lymphonodular pharyngitis
Sore throat, fever, mild headache, with 1-5 yellow to dark pink nodules in the posterior mouth that represent hyperplastic lymphoid aggregates
How are infections caused by enteroviruses diagnosed?
Diagnosis can be made from clinical manifestations, infection is self limiting
What is another name for measles?
Rubeola is another name for measles
What virus causes measles/rubeola?
Paramyxovirus
When do most cases of measles arise?
In winter
How is measles spread?
Through respiratory droplets
What is the incubation period for the paramyxovirus?
10-12 days
How long are measles infectious?
Infectious from 2 days before symptoms and 4 days after rash appears
In measles, what is responsible for the rash formation?
Vasculitis
How long does measles last?
Nine-day measles, 3 stages with 3 days
What is the 1st stage of measles?
3 C’s + fever
Coryza, cough, conjunctivitis
What term describes multiple areas of mucosal erythema with numerous, small, blue-white macules (grains of slat on a red background) and is associated with the 1st stage of measles?
Koplik’s spots (pathognomic for measles)
What do Koplik’s spots represent?
Foci of epithelial necrosis
What is the 2nd stage of measles?
Fever continues + maculopapular, erythematous (morbilliform) rash
How does the rash first begin and spread in the 2nd stage of measles?
Face first, then a downward spread from trunk to extremities
What is the 3rd stage of measles?
Fever ends + rash fades, replaced by brown pigmentary staining
What is another name for rubella?
German measles is another name for rubella
What virus causes rubella?
Togavirus
What is the greatest importance to remember about Rubella?
It has the capacity to induce birth defects (congenital rubella syndrome)
What is the incubation time of the togavirus?
2-3 weeks
When are patients with rubella contagious?
1 week before rash to 5 days after its development
How long does rubella last?
3 day measles
What is the most common complaint seen in rubella?
Arthritis, other symptoms are mild
What term describes small, discrete, dark-red papules on the palate in some cases of rubella?
Forchheimer’s sign
What is congenital rubella syndrome?
Deafness, heart disease, cataracts
What is another name for mumps?
Epidemic parotitis
What is mumps?
Mumps is a disease of the exocrine glands
What is the best known site of involvement in cases of mumps?
Salivary glands
What do glands exhibit in cases of mumps?
Edema and lymphocytic infiltration
What is the incubation period for mumps?
2-4 weeks
When are patients with mumps contagious?
Contagious from 1 day before clinical appearance to 2 weeks after resolution
What might 25% or postpubertal males experience during mumps infection?
Epididymorchitis
What might 25% or first trimester women experiency during mumps infection?
Spontaneous abortions
How is mumps treated?
Palliative treatment
How effective is the MMR vaccine?
Very! 95%
What does HIV and AIDS stand for?
Human immunodeficiency virus, and acquired immunodeficiency syndrome
Where is the HIV found?
In bodily fluids
How is HIV spread?
Through sexual contact, parenteral exposure to blood, transmission from mother to fetus
What cell does HIV target?
CD4+ helper T lymphocyte
What are the 3 stages of HIV/AIDS?
Acute self limited viral syndrome; asymptomatic period; final symptomatic period
What are the 5 oral manifestations most strongly associated with HIV infection?
Candidiasis, Oral hairy leukoplakia, Kaposi’s sarcoma, Non-Hodgkin’s lymphoma, periodontal diseases
How many HIV and AIDS patients present with candidiasis?
1/3 of HIV patients and 90% of AIDS patients
Oral hairy leukoplakia is a sign of severe _____ ______ and ______ _____ in HIV and AIDS patients.
Severe immune depression and advanced disease
What is the most common EBV related lesion in AIDS patients?
Oral hairy leukoplakia
Describe oral hairy leukoplakia
White mucosal plaque that does not rub off, usually occurs bilaterally, on the lateral border of the tongue
What term describes a multifocal neoplasm of vascular endothelial cell origin?
Kaposi’s sarcoma
What virus causes Kaposi’s sarcoma?
HHV-8
What percentage of patients with Kaposi’s sarcoma have oral lesions?
70%, in 20% of patients the oral cavity is the primary site of involvement
What locations are commonly affected by Kaposi’s sarcoma?
Hard palate, gingiva and tongue
In Kaposi’s sarcoma, is a biopsy required?
Yes
Describe a few characteristics associated with Non-Hodgkin’s Lymphoma
Up to 5% of HIV infected patients, presents as a high grade/aggressive disease = widespread involvement and short survival times
What are the 3 atypical patterns of periodontal disease associated with HIV?
Linear gingival erythema, necrotizing ulcerative gingivitis, necrotizing ulceratice periodontitis
What is linear gingival erythema?
Gingivitis that doesn’t respond to improved plaque control and has a greater degree of erythema
How is linear gingival erythema treated in HIV patients?
Systemic antifungals
How is NUG and NUP treated? in HIV patients
Debridement, antimicrobials, immediate follow up and long term maintenance
