EXAM 4 Oral Pathology Related Viral Infections

Question 1

humans are the only natural reservoir for ___

Answer 1

human herpes virus (HHV)

Question 2

T or F:

all 8 types of HHV cause primary infection and remain latent within specific cell types for life

Answer 2

true

primary latency resides in CD4 T lymphotes

Question 3

HHV virus is shed in ___ or ___

Answer 3

saliva or genital secretions

Question 4

what is HHV-8?

Answer 4

kaposi’s sarcoma herpesvirus

• primary infection via sexual contact, especially in homosexual males
• primary infection is asymptomatic in normal immune systems
• also associated with a variety of lymphomas and castleman’s disease

Question 5

reactivation of HSV is also called what?

Answer 5

secondary, recurrent, or recrudescent infection

Question 6

what percent of primary herpes virus infections (initial exposure) are asymptomatic?

Answer 6

80%

Question 7

after initial exposure, the herpes virus is taken up by the ___ and transported to associated ___. what state does this describe?

Answer 7

• sensory nerves
• sensory ganglia
• describes the latent/dormant state
  
  • most common site of latency is the trigeminal ganglion

Question 8

HSV-1

in the case of symptomatic primary infections, ___ affects clinical presentation.

Answer 8

age

• younger - gingivostomatitis
• 18+ pharyngotonsillitis

Question 9

what is the most common pattern of primary HSV infection?

Answer 9

• acute herpetic gingivostomatitis
• 90% due to HSV-1
• most cases occur before age 5

Question 10

describe mucosa affected by acute herpetic gingivostomatitis

Answer 10

• pinhead vsicles
  
  • rapidly collapse and form small, red lesions
  • initial lesions enlarge and develop central areas of ulceration covered by yellow fibrin
  • adjacent ulcerations coalesce

Question 11

with acute herpetic gingivostomatitis, can both moveable and attached oral mucosa be affected?

Answer 11

• yes, but this is not the case with recurrences
• in all cases, the gingiva is enlarged, painful, and extremely erythematous
• involvement can spread past the labial mucosa and onto the vermillion and perioral skin
• self inoculation of fingers, eyes, and genitals can occur - leading infectious cause of blindness

Question 12

what are the initial symptoms of pharyngotonsillitis?

Answer 12

sore throat, fever, headache

Question 13

what is pharyngotonsillitis caused by?

Answer 13

HSV1 or HSV2

Question 14

describe the clinical presentation of pharyngotonsillitis

Answer 14

• numerous small vesicles develop on tonsils and posterior pharynx
  
  • rapidly rupture to form shallow ulcerations which coalesce
  • diffuse, gray-yellow exudate forms over the ulcers

Question 15

descrive recurrent herpes simplex

Answer 15

• can occur anywhere along the surface epithelium supplied by the involved ganglion
• most common site of recurrence for HSV-1: vermilion border and adjacent skin of the lips
  
  • herpes labialis
  • cold sore
  • fever blister - 40% of US have a history of herpes labialis, prodrome (“tingling”) 24h before lesion

Question 16

___% of US are infected with HHV by age 5

Answer 16

90%

Question 17

HHV infection can present as an asymptomatic primary infection, or can be ___

Answer 17

a red macular/slightly papular eruption

Question 18

what is the specific pattern created by HHV6?

Answer 18

roseola

HHV7 produces a similar lesion

Question 19

HHV recurrences can result in widespread ___ infection

Answer 19

multiorgan

Question 20

what are some factors that can lead to recurrent herpes?

Answer 20

age, stress, pregnancy, allergies, trauma, illness, ultraviolet light (the only condition to unequivocally induce lesions experimentally), immunosuppression

Question 21

recurrent intraoral herpes simplex is almost always on what type of tissue?

Answer 21

keratinized, bound mucosa (palate, attached gingiva)

Question 22

describe the cycle of recurrent herpes simplex intraoral lesions

Answer 22

• pesions begin as 1-3mm vesicles
• rapidly collapse to form a cluster of erythematous macules that coalesce
• damaged epithelium is lost
• central, yellowish area of ulceration
• heals in 7-10 days

Question 23

___ is a less common HSV1 presentation characterized by infection of the thumb or fingers

Answer 23

herpetic whitlow

Question 24

___ is a less common HSV1 presentation found in wrestlers or rugby players with contaminated abrasions

Answer 24

herpes gladiatorum or scrumpox

Question 25

___ is a less common HSV1 presentation over the bearded region of the face into minor injuries created by daily shaving

Answer 25

herpes barbae

Question 26

T or F:

patients with chronic skin conditions may develop diffuse, life-threatening infection

Answer 26

true

termed eczema herpeticum or kaposi’s varicelliform eruption

Question 27

newborns can be affected via infected birthcanal (usually which type of HSV?)

Answer 27

HSV2

Question 28

what is the clinical presentation of HSV?

Answer 28

• strong presumptive diagnosis
• cytologic smear
• tissue biopsy
• serologic testing is positive 4-8 days after initial exposure

Question 29

what is the treatment for primary herpetic gingivostomatitis?

Answer 29

• antivirals introduced early can reduce severity and frequency of recurrent infeciton
• antivirals introduced within 3d can greatly accelerate clinical resolution
• once therapy is initiated, no new lesions develop
• rinse and swallow acyclovir suspension: 15mg/kg up to adult dose of 200mg 5x/d for 5d

Question 30

what is ramsay hunt syndrome?

Answer 30

• VZV
• cutaneous lesions of the external auditory canal
• involvement of ipsilateral face and auditory nerves
  
  • facial paralysis, hearing deficits, vertigo

Question 31

what are oral lesions associated with VZV?

Answer 31

• occur with trigeminal nerve involvement
• present on movable or boudn tissue
• lesions extend to midline and stop

Question 32

describe VZV ocular involvement

Answer 32

• may cause significant morbidity
• if the tip of the nose is involved, it is a sign ocular infection may occur
• referral to ophthalmologist is mandatory if pt experiences these lesions