Exam 5-INFECTIVE stomatitis-VIRAL Flashcards
What are the 4 types of viral infections we discussed that can cause stomatitis?
1.HPV 2.HHV 3.Coxsackie A 4.ParaMYXOvirus
What are the 3 most common manifestations of Human Papilloma Virus? What is a 4th, less common manifestation?
1.Papilloma 2.Verruca Vulgaris 3.Condylomata acuminatum 4.Focal epithelial hyperplasia
What type of virus is HPV?
DNA yo
What are the 2 virus-es causing infective stomatitis that are DNA virus-es?
1.HPV 2.HHV
A papilloma is most likely the manifestation of which 2 types of HPV?
HPV 6 and 11
Which HPV manifestation is described as a virus-induced benign proliferation of stratified squamous epithelium?
Papilloma
What is the most common age range for manifestations of a Papilloma (HPV 6 and 11)?
30 to 50 years
What is the most common area in the oral cavity for a Papilloma? What are 2 other common sites?
1.Soft Palate 2.tongue 3.lips
A papilloma can be described as White/red/normal color “__________” shaped and ________ (because of the least amount of resistance for the hyperplasia to go to the surrounding air)
“cauliflower” ….. exophytic
What are the three forms of a papilloma?
Nodule, sessile, or pedunculated
Papillomas are typically small, but they can grow large…up to ___ cm
3cm
What is the most common HPV subtype that produces Verruca Vulgaris?
HPV 2 (2 V’s!)
Which form of HPV is known as “common wart”?
Verruca Vulgaris
What are the three most common oral locations for verucca vulgaris?
- Vermillion Border 2. Labial mucosa 3.Anterior tongue
Which HPV lesion can be described as Pink/white nodule with rough, pebbly surface and is usually less than 5 mm?
A common wart, verruca vulgaris
What is the name of enlarged cells with cytoplasmic clearing and which type of virus is it associated with?
KOIL-O-cytes…HPV 2 (verruca vulgaris)
Common warts can be histologically described as large ________ granules
kerato-hyaline granules
Well this can be confusing, which common manifestations is caused by HPV 6 and 11 (among others), but is NOT a papilloma? Who is affected by it the most?
Condyloma A-cumin-a-tum…teenagers and young adults
What are the three most common locations in the oral cavity for Condyloma Acuminatum?
- Labial Mucosa 2.Soft palate 3.lingual frenum
What is the most common mode of transmission for a condyloma acuminatum? How long does it take to incubate?
Sexual transmission and 1-3 months
What are the 4 MAIN (not all) HPV subtypes associated with Condyloma Acuminatum? Which 2 are associated with an increased risk of MALIGNANT transformation?
HPV 6,11,16,18….16 & 18 associated with malignant transformation
Condyloma acuminatum fften occur in _______ and not quite as exophytic and papillary as papillomas or vurruca
CLUSTERS
What is the nickname for focal epithelial hyperplasia?
Heck’s Disease
What is the official name for “Heck’s Disease”?
Focal Epithelial Hyperplasia
Hmmm which HPV condition am I describing??? Multiple soft, flattened papules clustered together…
Focal epithelial hyperplasia (Heck’s disease)
Which two HPV subtypes are responsible for FOCAL EPITHELIAL HYPERPLASIA (Heck’s Disease)?
HPV 13 and 32
Which HPV manifestation is most common in children often malnourished and in poor living conditions and was 1st described in Native Americans (IN NEW MEXICO) and Eskimos?
Focal Epithelial hyperplasia (Heck’s disease) (HPV 13 and 32)
What are the three most common locations for focal epithelial hyperplasia? What are the two types of cells HISTOLOGICALLY?
1.Labial 2.Buccal and 3.Lingual MUCOSA…K-OI-LO-cytes and MIT_OS_OID cells. (mitosioid-cells in which the nuclear DNA has fragmented, resulting in a cell that appears as if it is undergoing mitosis)
In general, HPV is identified by DNA ______ hybridization, immunohistochemical analysis, and PCR
in situ
What can sometimes spur spontaneous regression of an HPV outbreak? (like focal epithelial hyperplasia)
improving living conditions
What are the two most common culprits for HPV induced cervical and oropharyngeal cancer? ALSO what is the incidence of THROAT cancer today caused by HPV?
HPV 16 and 18…75%
Since its important, going beyond the major two HPV types that cause cancer, what are those two and the additional types (4) found to cause it?
16, 18, 6, 11, 30s, 50s.
Humans are natural reservoirs of which virus? Once you have it, it never goes away, just remains dormant and latent…
Human Herpes Virus
What are the 5 HHVirus-es that have oral manifestations?
1.Herpes Simplex 2.Veracella-Zoster 3.Epstein-Barr 4.CytoMegaloVirus 5.HHV-8 (kaposi’s sarcoma)
Which HSV virus usually causes ORAL infections?
HSV 1 (food goes in mouth first)
Which HSV usually causes GENITAL infections with about 20% crossover?
HSV-2 (food comes out body second)
More than ___% of PRIMARY HSV infections are ASYMPTOMATIC
90%
Which HSV related condition has a very ACUTE onset and is USUALLY in children 6mo-5y/o? (but can happen in adults like Dr. W’s story about the 37 y/o woman)…
Acute Herpetic GingivoStomatitis
Which HSV condition can be described with fever, lymphadenopathy, nausea, irritability Painful, erythematous gingiva and tiny (1–3 mm) coalescing vesicles progress to widespread, multiple sharply marinated ulcers
of oral mucosae and skin around mouth & lips?
Acute herpetic gingivoStomatitis
In adults Acute Herpetic GingivoStomatitis may present as _____________ and it heal SPONTANEOUSLY in HOW long?
pharyngotonsillitis…1-2 weeks
Recurrent HSV infection occurs in ___-___% of the US popluation
15-45%
Where does a recurrent HSV infection chill during its LATENT state?
the TRIGEMINAL GANGLION
Along with these STIMULI that trigger a recurrent HSV infection, What are 3 more?? Old age, pregnancy, allergy, trauma, illness…
ultraviolet light, emotional stress, dental therapy!
What are the symptoms of pain, burning, or tingling called that come before a recurrent HSV infection?
Prodromal
What is the official name for a recurrent HSV infection sometimes called a “cold sore” or a “fever blister”?
herpes labialis
What is the common name for Herpes Labialis?
a cold sore or a fever blister
Where do recurrent HSV infections appear? Where do they NOT appear??
Appear at jxn of Vermillion and skin…NOT on the mucosa (that is an apthous ulcer)
Intra-orally recurrent HSV lesions are LIMITED to ________ mucosa that is BOUND to BONE…therefore these TWO areas:
KERITINIZED….hard palate and gingiva
How long does it typically take for a recurrent HSV infection to subside?
7-10 days
What is the condition in the fingers and eyes when an HSV infection can spread to a dental provider?
Herpetic Whitlow
Histologic examination shows __________, infected epithelial cells (viral cytopathic effect)
multinucleated
How long does it take for HSV antibodies to show up in blood after initial exposure?
4-8 days
INTERESTING: At any time, ___-____% of your patients will asymptomatically EXCRETE and will have HSV DNA in their saliva
5-30%…wear that PPE yo
At what point in the infection cycle are topical and systemic antiviral medications effective?
EARLY PRODROME period (pain, burning, tingling w/o seeing a lesion)
What are the three systemic AntiViral meds we discussed? Which one has a topical option?
1.AcycloVir (Zo-Vir-Ax)…has a TOPICAL option 2.Fam-cic-lo-vir (FamVir) 3.VAL-A-cyclovir (VAL-trex)
What is the primary infection of vericella-zoster? What age range does this typically occur? How long is the incubation period?
ChickenPox…ages 5-9…10-21 day incubation
What is the 4 stage progression of a VZV (chickenpox) lesion?
erythema –> vesicle —> pustule —->hardened crust on skin and mucus membranes
What are the three most common oral locations of VZV/ChickenPox lesions?
1.Vermillion border of the lips 2.Palate 3.Buccal Mucosa
How long does it take to recover from ChickenPox? Is there a vaccine available?
2-3 weeks…yes there is a VZV vaccine
VZV may lie dormant in _______ neural ganglia after initial chickenpox infection…whats the nickname for this again?
SENSORY…shingles
These are a few predisposing factors for a shingles outbreak…What are 2 more?? treatment with cytotoxic drugs, radiation, malignancy, old age, alcohol abuse…
Immunosuppression….dental treatment
intense pain, fever malaise, headache are considered symptoms of which phase of a shingles outbreak?
Prodromal symptoms
In a shingles outbreak A HALLMARK sign is ______ painful eruption of vesicles along the distribution of a sensory nerve classically stops WHERE???
UNILATERAL at the MIDLINE
Did you know?? In a shingles outbreak, ORAL lesions occur if the _________ nerve is involved and lesions may be present on the movable or bound _______
trigeminal…mucosa
Which form of CHRONIC vericella zoster (shingles) (chronic infection) may take MONTHS to resolve
Postherpetic Neuralgia (DAMN)
Random boards-type association: What is the name of the syndrom described by infection of external AUDITORY canal with involvement of the ipsilateral facial and auditory nerves producing FACIAL paralysis, hearing deficits and vertigo?? and which virus is it associated with?
Ramsay Hunt Syndrome…Vericella Zoster
Which virus is associated with infectious mononucleosis again? (nickname and #)
Epstein Barr Virus…HHV-4
Which virus is associated with these facts? Transmitted through close contact or saliva…Late adolescents/ young adults in developed countries Sore throat, fever, lymphadenopathy, tonsillitis, fatigue, enlarged spleen
Epstein Barr-HHV 4
What is an ORAL sign of the PRODROME of Epstein Barr (HHV 4)?
Petechiae on the palate
In an Epstein Barr (HHV 4) infection Serum analysis shows presence of ________ antibody and elevated _________ count
heterophil…WBC
How long does Epstein Barr (HHV 4) typically take to clear up?
4-6 weeks
Interesting…an Epstein Barr (HHV 4) can cause this corrugated white lesion, usually on lateral border of tongue that cannot be wiped off…
Hairy LeukoPlakia
Hairy leukoplakia is typically attributed to a candidal infection, but it can also be which virus?
Epstein Barr (HHV 4)
What are two possible NEOPLASMS that can arise from an EBV (HHV 4) infection??
1.Burkitt’s lymphoma (B cells have receptors for EBV) and 2. NasoPharyngeal Carcinoma
Which herpes virus can also produce MONO like symptoms but is NOT Epstein Barr?
CytoMegaloVirus (HHV 5)
What % of CMV (HHV 5) infections are ASYMPTOMATIC?
90%
Hold the phone, 90% of CMV (HHV 5) infections might be asymptomatic, BUT some can lead to SERIOUS complications leading to organ failure, ________, and severe mental and motor retardation
blindness
Oral manifestations of CMV (HHV 5) chronic ________, affects _______ cells and blood flow
ulceration….endothelial
CMV (HHV 5) can reside latently in ________ cells
salivary gland
CMV (HHV 5) infected cells show “_____” appearance
“owl eye”
For CMV (HHV 5) infections systemic antiviral treatment is necessary in __________ individuals
immunocompromised
What is the causitive virus in KAPOSI’s sarcoma?
HHV 8
HHV-8 can cause WHAT 2 COLORS? with flat or raised lesions…
reddish-purple
Where are the three most likely oral locations for HHV-8?
1.palate 2.gingiva 3.tongue
Interesting…Before the advent of AIDS, HHV-8 infection was rare and usually seen in men over the age of ____…Now, MOST cases are associated with AIDS
60
Which virus is associated with Herpangina?
Coxsackie A
Which virus is associated with Hand-Foot-and-Mouth disease?
Coxsackie A
Which virus is associated with Acute Lymphonodular pharyngitis?
Coxsackie A
Coxscakie A virus is associated with what 3 conditions?
Herpangina, Hand-foot-and-mouth disease, and Acute lymphonodular pharyngitis
Coxsackie A virus usually affects children under age __, often in epidemics
5
How is Coxsackie A transmitted?
Fecal-Oral
What are the 2 general, painful manifestations of Coxsackie A in the mouth? WHERE do these occur?
vesicles on the SOFT PALATE and ulcers
Hmmm vague but, which virus: Vesicles on soft palate with erythematous pharyngitis in herpangina?
Coxsackie A
Hmmm more random facts…Coxsackie A shows hyperplastic _______ tissue on the _______ and tonsils in acute lymphonodular pharyngitis
lymphoid….soft palate
Coxsackie A- What type of lesion is occurring on skin of feet, toes, hands, and fingers in hand-foot-and-mouth disease?
PAPULES
When does a Coxsackie A viral infection usually resolve?
7-10 days
Which virus causes MEASLES (rubeloa) and MUMPS?
Para-Myx-O-Virus
What is the HALLMARK sign of MEASLES?
Koplik Spots (Small, red patches with white, necrotic centers)
Koplik spots in MEASLES (paramyxovirus) are described as Small, ____ patches with white, necrotic centers..
RED
Is there a vaccine for ParaMyxOvirus?
YEP, MMR
