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oral pathology 1 - Su19 > final - viral infections > Flashcards

final - viral infections Flashcards

1
Q

_ virus of the human herpesvirus fam

2 forms: _ predominantly oral
and _ predominantly genital

initial contact with the virus produces _

A

DNA virus

HSV-1 - oral

HSV-2 - genital

initial contact = primary infection

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2
Q

HSV is _ - will be transported via nerves o sensory ganglia (latent stage)

virus may become reactivated as recurrent infection

A

HSV is neurotropic

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3
Q

_ aka Herpetic gingivostomatitis

spread thru _, usually early in childhood

Symptoms?

A

primary herpes

thru saliva

acute fever, cervical lympadenopathy, oral sores

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4
Q

primary herpes aka herpetic gingivostomatitis

oral lesions begin as _ that quickly rupture to form _ , then they often coalesce, resulting in larger ulcers having _ borders

A

begin as vesicles (fluid-filled elevation - .5cm (5mm) or less)

form shallow ulcers (complete loss of surface epithelium)

serpentine borders (of or like a serpent or snake)

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5
Q

_ Dx

exfoliative cytology or biopsy(rarely)

infected cells show multinucleations and ballooning degeneration of nuclei = viral cytopathic effect (Tzanck cells)

A

primary herpes

viral culture

sequential serum Ab titers

immunohistochemistry on sampled tissue

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6
Q

Primary herpes tx?

A

if identified in first 2-3 days, acyclovir

valacyclovir (Valtrex) is absorbed better and is eventaul metabolized into acyclovir

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7
Q

primary herpes symptomatic care

A

analgesics and antipyretics

topical anesthetics - need nutrients and H20

popsicles can be soothing or pediatric patients

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8
Q

Px of primary herpes

A

generally good

only one episode - last 10-14 days (without tx)

25% chance of at least 1 recurrent episode

care should be taken not to spread virus during active infection

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9
Q

recurrent herpes

2 forms

only _% of affected people will remember primary infection due to _

A

recurrent herpes labialis

recurrent intra oral herpes

due to subclinical or mild symptoms (childhood)

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10
Q

cold sore, fever blister

triggered by UV light or trauma

affect vermilion zone or perioral skin

A

recurrent herpes labialis

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11
Q

_ herpes

prodromal itching, tingling, burning, erythema

followed by cluster o vesicles

A

recurrent herpes labialis

vermilion zone/ perioal skin

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12
Q

recurrent herpes labialis

with no tx,

A

vesicles rupture, form a crust and heal in 7-10

avoid excess sun- wear sunscreen to help prevent lesion development

topical antiviral agents - stat sig decrease in healing time

best results - patient-initiated systemic valacyclovir - must be started first 2-3 days of onset

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13
Q

_ herpes seems to be relatively uncommon

usually few symptoms - irritated or rough feeling

cluster of shallow ulcers

confined to what type of muscosa

heal in one week with no tx

A

recurrent intraoral herpes

confined to mucosa bound to periosteum
- hard palate and attached gingiva

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14
Q

_ herpes

any oral mucosal surface can be affected - large shallow ulcers with elevated, _ borders

most cases represent reactivated virus

A

herpes immunosuppressed

pt’s who are immunocompromised

scalloped borders

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15
Q

Tx for herpes immunosuppressed

A

IV acyclovir for acute cases

maintenance therapy with oral acyclovir may be necessary

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16
Q

providers can get _

one of the hazards with not wearing gloves

despite the host having Ab to herpesvirus, the infection can still be induced with a sufficient viral inoculum

A

Herpetic Whitlow

herpes lesions on fingers

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17
Q

Varicella (chickenpox)

represents primary infection with _

spread?

most cases occur during childhood
there is a vaccine now given to newborns

A

varicella-zoster virus

spread thru direct contact or air-borne droplets

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18
Q

Varicella - chickenpox

fever and malaise

_ lesions - intensely pruritic _

patient contagious _ days prior to xanthem until all lesions crusted

A

cutaneous lesions - itchy vesicles (fluid-filled elevation - .5cm (5mm) or less)

“dew drops on rose petals”

vesicles rupture and form hardened crust

contagious 2 days prior to xanthem (breakout)

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19
Q

oral lesions from Varicella - chickenpox

common/uncommon?

location?

A

fairly common

few 1-2mm shallow ulcers at any intraoral site

not as symptomatic as the cutaneous lesions

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20
Q

Varicella - chickenpox

Dx based on clinical signs

tx?

A

usually supportive care

acyclovir if detected within 1 day onset

good Px - complications are uncommon

recurrent disease (herpes zoster) may develop

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21
Q

reactivation of VZV - 10-20% of cases

increasing frequency with _

A

herpes Zoster - Shingles

increases frequency with age

22
Q

painful erythema and vesicles, usually on trunk

may occur in head and neck region

lesions stop at midline

A

herpe zoster

shingles - reactivation of VZV (chicken pox)

23
Q

_ tx

systemic acyclovir or valacyclovir (5x the dosage for HSV) - if early in the course of disease

good Px- lesions resolve in 2-3 weeks

_ can develop

A

herpes zoster - shingles

with multiple episodes - rule out immune problem

post-herpetic neuralgia can develop ~15%

24
Q

enterovirus infection caused by any strain of coxsackievirus A, B or echovirus

primary affects 1-4 years of age

A

herpangina

25
Q

acute onset of sore throat, fever and 1-4mm oral ulcers localized to posterior soft palate/tonsillar pillar region

A

herpangina (coxaskievirus A, B, or echovirus)

Dx - clinical findings and setting of a local epidemic

self limiting 7-10days

26
Q

Herpangina(coxsackievirus A, B, or echovirus) Dx and tx

A

dx - based on clinic findings - acute sorethroat, fever, small ulcers on sot palate/tonsillar pillar region

self limiting - 7-10 days

supportive care - analgesics, antipyretics, topical anesthetics

27
Q

enterovirus infection caused by coxsackievirus A16 (A5, 9, 10) as well as echovirus 10 or enterovirus 71

flu-like illness with sore throat and fever

A

hand. foot, and mouth diesease

oral and hand lesions are most commonly seeen

28
Q

hand, foot and mouth disease caused by _ virus

oral lesions consist of _

buccal mucosa, labial mucosa and tongue are most common intraoral sites

A

coxsackievirus A16 (A5, 9, 10) as well as echovirus 10 or enterovirus 71)

intraoral - shallow ulcers typically 2-7mm

skin - 1-3 erythematous macules that may develop a central vesicle

29
Q

intraoral - shallow ulcers typically 2-7mm

skin - 1-3 erythematous macules that may develop a central vesicle

A

hand, foot, mouth

Dx - based on characterisitc clinical manifestations

supportive care, 7-10days resolves, good px

Macule - area of color change – no elevation or depression of surface – any shape or color

vesicle - fluid-filled elevation less than 5mm

30
Q

HIV - human immunodeficiency virus can be found in most bodily fluids (tears, saliva, milk)

most frequent modes of transmission?

A

male to male sexual contact

heterosexual contact

injection drug use

31
Q

HIV attacked _ cells

considered AIDS when the number of these cells is <200 cells/ul of blood

A

CD4 T helper cells

profound immunosuppresion in HIV+ pt leads to opportunistic infections, neoplasms, systemic features (GI, pulmonary, dermatologic, neurologic, oral mucosa

32
Q

_ therapy introduced in 1996 for HIV patients

dramatic reduction in mortality rates
-HIV now considered chronically manageable

clinical manifestations much less common **

A

Combination Antiretroviral therapy

cART

oral manifestations present like candidiasis

33
Q

Head and Neck manifestations of HIV

often reflect _ state

maybe _ sign of HIV infection

some predict progression to AIDS

some meet criteria for Dx of AIDS

may cause pain/discomfort, cosmetic problems

A

reflect immunocompromised state

maybe first sign

34
Q

generalized non-tender lymphadenopathy

cervical nodes are frequently affected, including posterior cervical nodes

other causes, infections, lymphoma, metastatic carcinoma may have to be ruled out first

A

persistent lymphadenopathy

35
Q

_ is most common oral fungal infection in HIV patient

A

Candidiasis most common

deep fungal infections - seen less frequently

36
Q

HIV patient, opportunitistic infection of _ - non-healing ulceration or granular lesion

pulmonary infection predominates, but dissemination to oral mucosa may occur - thru hematogenous spread or direct implantation

A

histoplasmosis

37
Q

HIV opportunistic

unusual pattern of gingivitis - lack of response to OHI

red. linear band at the marginal gingiva

spontaneous bleeding possible

A

linear gingival erythema

abnormal response to subg bacteria

38
Q

HIV opportunistic

similar to that seen in immuno-competent

may be seen in a setting of relativelt few apparent local factors

responds to standard therapy - but prophylactic CHX used 2x daily for maintenance

A

NUG

necrotizing ulcerative gingivitis

39
Q

HIV opportunitistic

pain and spontaneous gingival bleeding

interproximal necrosis and cratering

edema and intense erythema

extremely rapid bone less that occurs concurrently with soft tissue destruction - no pocketing**

A

NUP

necrotizing ulcerative periodontitis - HIV-related periodontitis

40
Q

HIV opportunistic

extensive painful tissue destruction that not only affects gingiva, and supporting alveolar bone - also adjacent soft tissue and deeper osseous structures

A

necrotizing stomatitis

much more severe presentation of NUG- adjacent soft tissue and deeper osseous bone destroyed

41
Q

tx and px for necrotizing stomatitis - HIV opportunistic

A

extensive debridement
topical antiseptics
systemic Antibiotics

Px - guarded

42
Q

HIV opportunistic

skin infection caused by poxvirus, little nodule with imbilicated central plug

facial skin is often affected

many more lesions develop compared to immunocompetent patient, and lesions tend to stay and not regress

A

molluscum contagiosum

43
Q

HIV opportunistic

usually represents reactivation of virus
MAY AFFECT ANY ORAL MUCOSAL SURFACE

typically present as persistent painful diffuse shallow ulcerations - must be tx’d with acyclovir

A

herpes simplex infection

Immunocompetent patient clinical presentaation
Recurrent herpes labialis on lip, hard palatal or attached gingiva

Immunocomproised - looks look primary infection but not
44
Q

HIV opportunistic

generally more of a problem from a cutaneous standpoint

unilateral distribution of vesicles and ulcers

A

herpes zoster infection

45
Q

non-removable white plaques of the lateral tongue - vertical parallel lines

most pt’s are HIV-infected (other immunocomprised states, rare in healthy patients)

caused by Epstein-Barr Virus - EBV. often superimposed candidiasis

A

oral hairy leukoplakia

plaque – slightly elevated lesion – any surface area

*used as progression indicator from HIV to AIDS

46
Q

biopsy reveals parakeratosis with “balloon cells” of upper spinous laters of epi

ID of EBV in epithelial cell nuclei

no tx indicated

A

oral hairy leukoplakia

non-removeable white plwaue lateral tongue - vertical lines

47
Q

HIV opportunistic

seen with increased frequency intraorally in HIV+

exophytic lesions, solitary or more commonly multiple
may resemble squamous papilloma, condyloma, or focial epithelial hyperplasia

A

human papillomavirus

exophytic - dome-shaped or nodular mass with a smooth surface and fluctuant to firm in palpation

48
Q

HIV opportunistic

aphthous-like ulcerations

probable immune-mediated etiology
painful. persistent - one or multiple

may need to rule out infectious etiology by means of culture, exfoliative cytology, biopsy

most respond to _

A

topical corticosteriods

49
Q

multifocal malignancy of vascular endothelial cell origin

etiology linked to humanherpes virus 8 - HHV-8

A

AIDS-related Kaposi Sarcoma

only 1/2 of patients will have oral involvment - palate or gingiva

22% at initial site

bloood caused color change

patients usually die to infectious causes, rather than KS

tx’d only if cosmetic or fxnal concern

surgical excision, local radiation therapy or intralesional vinblastine injections

50
Q

not as common as Kaposi carcoma

clinically may resemble KS, but often extra-nodal (CNS or GI)

very poor px - 3-4month survival

A

AIDS-related lymphoma

oral pathology 1 - Su19 (10 decks)

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