EXAM 4 Oral Pathology Related Viral Infections Flashcards
humans are the only natural reservoir for ___
human herpes virus (HHV)
T or F:
all 8 types of HHV cause primary infection and remain latent within specific cell types for life
true
primary latency resides in CD4 T lymphotes
HHV virus is shed in ___ or ___
saliva or genital secretions
what is HHV-8?
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
reactivation of HSV is also called what?
secondary, recurrent, or recrudescent infection
what percent of primary herpes virus infections (initial exposure) are asymptomatic?
80%
after initial exposure, the herpes virus is taken up by the ___ and transported to associated ___. what state does this describe?
- sensory nerves
- sensory ganglia
- describes the latent/dormant state
- most common site of latency is the trigeminal ganglion
HSV-1
in the case of symptomatic primary infections, ___ affects clinical presentation.
age
- younger - gingivostomatitis
- 18+ pharyngotonsillitis
what is the most common pattern of primary HSV infection?
- acute herpetic gingivostomatitis
- 90% due to HSV-1
- most cases occur before age 5
describe mucosa affected by acute herpetic gingivostomatitis
- 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
with acute herpetic gingivostomatitis, can both moveable and attached oral mucosa be affected?
- 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
what are the initial symptoms of pharyngotonsillitis?
sore throat, fever, headache
what is pharyngotonsillitis caused by?
HSV1 or HSV2
describe the clinical presentation of pharyngotonsillitis
- 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
descrive recurrent herpes simplex
- 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
___% of US are infected with HHV by age 5
90%
HHV infection can present as an asymptomatic primary infection, or can be ___
a red macular/slightly papular eruption
what is the specific pattern created by HHV6?
roseola
HHV7 produces a similar lesion
HHV recurrences can result in widespread ___ infection
multiorgan
what are some factors that can lead to recurrent herpes?
age, stress, pregnancy, allergies, trauma, illness, ultraviolet light (the only condition to unequivocally induce lesions experimentally), immunosuppression
recurrent intraoral herpes simplex is almost always on what type of tissue?
keratinized, bound mucosa (palate, attached gingiva)
describe the cycle of recurrent herpes simplex intraoral lesions
- 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
___ is a less common HSV1 presentation characterized by infection of the thumb or fingers
herpetic whitlow
___ is a less common HSV1 presentation found in wrestlers or rugby players with contaminated abrasions
herpes gladiatorum or scrumpox
___ is a less common HSV1 presentation over the bearded region of the face into minor injuries created by daily shaving
herpes barbae
T or F:
patients with chronic skin conditions may develop diffuse, life-threatening infection
true
termed eczema herpeticum or kaposi’s varicelliform eruption
newborns can be affected via infected birthcanal (usually which type of HSV?)
HSV2
what is the clinical presentation of HSV?
- strong presumptive diagnosis
- cytologic smear
- tissue biopsy
- serologic testing is positive 4-8 days after initial exposure
what is the treatment for primary herpetic gingivostomatitis?
- 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
what is ramsay hunt syndrome?
- VZV
- cutaneous lesions of the external auditory canal
- involvement of ipsilateral face and auditory nerves
- facial paralysis, hearing deficits, vertigo
what are oral lesions associated with VZV?
- occur with trigeminal nerve involvement
- present on movable or boudn tissue
- lesions extend to midline and stop
describe VZV ocular involvement
- 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
