final - viral infections Flashcards by Luke Lloyd

_ virus of the human herpesvirus fam

2 forms: _ predominantly oral
and _ predominantly genital

initial contact with the virus produces _

DNA virus

HSV-1 - oral

HSV-2 - genital

initial contact = primary infection

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

virus may become reactivated as recurrent infection

HSV is neurotropic

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_ aka Herpetic gingivostomatitis

spread thru _, usually early in childhood

Symptoms?

primary herpes

thru saliva

acute fever, cervical lympadenopathy, oral sores

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primary herpes aka herpetic gingivostomatitis

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

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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_ Dx

exfoliative cytology or biopsy(rarely)

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

primary herpes

viral culture

sequential serum Ab titers

immunohistochemistry on sampled tissue

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Primary herpes tx?

if identified in first 2-3 days, acyclovir

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

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primary herpes symptomatic care

analgesics and antipyretics

topical anesthetics - need nutrients and H20

popsicles can be soothing or pediatric patients

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Px of primary herpes

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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recurrent herpes

2 forms

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

recurrent herpes labialis

recurrent intra oral herpes

due to subclinical or mild symptoms (childhood)

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cold sore, fever blister

triggered by UV light or trauma

affect vermilion zone or perioral skin

recurrent herpes labialis

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_ herpes

prodromal itching, tingling, burning, erythema

followed by cluster o vesicles

recurrent herpes labialis

vermilion zone/ perioal skin

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recurrent herpes labialis

with no tx,

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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_ 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

recurrent intraoral herpes

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

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_ herpes

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

most cases represent reactivated virus

herpes immunosuppressed

pt’s who are immunocompromised

scalloped borders

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Tx for herpes immunosuppressed

IV acyclovir for acute cases

maintenance therapy with oral acyclovir may be necessary

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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

Herpetic Whitlow

herpes lesions on fingers

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Varicella (chickenpox)

represents primary infection with _

spread?

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

varicella-zoster virus

spread thru direct contact or air-borne droplets

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Varicella - chickenpox

fever and malaise

_ lesions - intensely pruritic _

patient contagious _ days prior to xanthem until all lesions crusted

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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oral lesions from Varicella - chickenpox

common/uncommon?

location?

fairly common

few 1-2mm shallow ulcers at any intraoral site

not as symptomatic as the cutaneous lesions

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Varicella - chickenpox

Dx based on clinical signs

tx?

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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reactivation of VZV - 10-20% of cases

increasing frequency with _

herpes Zoster - Shingles

increases frequency with age

painful erythema and vesicles, usually on trunk

may occur in head and neck region

lesions stop at midline

herpe zoster

shingles - reactivation of VZV (chicken pox)

_ 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

herpes zoster - shingles

with multiple episodes - rule out immune problem

post-herpetic neuralgia can develop ~15%

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

primary affects 1-4 years of age

herpangina

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

herpangina (coxaskievirus A, B, or echovirus) Dx - clinical findings and setting of a local epidemic self limiting 7-10days

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

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

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

hand. foot, and mouth diesease oral and hand lesions are most commonly seeen

hand, foot and mouth disease caused by _ virus oral lesions consist of _ buccal mucosa, labial mucosa and tongue are most common intraoral sites

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

intraoral - shallow ulcers typically 2-7mm skin - 1-3 erythematous macules that may develop a central vesicle

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

HIV - human immunodeficiency virus can be found in most bodily fluids (tears, saliva, milk) most frequent modes of transmission?

male to male sexual contact heterosexual contact injection drug use

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

CD4 T helper cells profound immunosuppresion in HIV+ pt leads to opportunistic infections, neoplasms, systemic features (GI, pulmonary, dermatologic, neurologic, oral mucosa

_ therapy introduced in 1996 for HIV patients dramatic reduction in mortality rates -HIV now considered chronically manageable clinical manifestations much less common **

Combination Antiretroviral therapy cART oral manifestations present like candidiasis

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

reflect immunocompromised state maybe first sign

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

persistent lymphadenopathy

_ is most common oral fungal infection in HIV patient

Candidiasis most common deep fungal infections - seen less frequently

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

histoplasmosis

HIV opportunistic unusual pattern of gingivitis - lack of response to OHI red. linear band at the marginal gingiva spontaneous bleeding possible

linear gingival erythema abnormal response to subg bacteria

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

NUG necrotizing ulcerative gingivitis

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**

NUP necrotizing ulcerative periodontitis - HIV-related periodontitis

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

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

tx and px for necrotizing stomatitis - HIV opportunistic

extensive debridement topical antiseptics systemic Antibiotics Px - guarded

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

molluscum contagiosum

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

herpes simplex infection Immunocompetent patient clinical presentaation Recurrent herpes labialis on lip, hard palatal or attached gingiva Immunocomproised - looks look primary infection but not

HIV opportunistic generally more of a problem from a cutaneous standpoint unilateral distribution of vesicles and ulcers

herpes zoster infection

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

oral hairy leukoplakia plaque – slightly elevated lesion – any surface area *used as progression indicator from HIV to AIDS

biopsy reveals parakeratosis with "balloon cells" of upper spinous laters of epi ID of EBV in epithelial cell nuclei no tx indicated

oral hairy leukoplakia non-removeable white plwaue lateral tongue - vertical lines

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

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

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 _

topical corticosteriods

multifocal malignancy of vascular endothelial cell origin etiology linked to humanherpes virus 8 - HHV-8

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

not as common as Kaposi carcoma clinically may resemble KS, but often extra-nodal (CNS or GI) very poor px - 3-4month survival

AIDS-related lymphoma