General oto oral infectious disease Flashcards
What is the natural history of primary herpetic
gingivostomatitis?
Mean duration of: ● Fever: 4.4 ± 2.4 days ● Oral lesions: 12 ± 3.4 days ● Extraoral lesions: 12 ± 3.9 days ● Dysphagia to food: 9.1 ± 3 days ● Dysphagia to liquid: 7.1 ± 2.5 days ● Viral shedding: 7.1 ± 2.5 days
What is the most common presentation of a
primary HSV infection in the pediatric population?
Herpetic gingivostomatitis
General prodromal symptoms associated with
primary herpetic gingivostomatitis include what?
General malaise, fever, anorexia, irritability, and headache
What are primary and secondary clinical findings associated with primary herpetic gingivostomati-
tis?
● Primary: Painful pinhead vesicles that rupture to form
ulcerative lesions, which are irregular and covered by a
yellow gray membrane
● Secondary: Submandibular lymphadenitis, halitosis, and
dehydration from refusal to take in adequate oral
hydration
What tests can be used to definitively diagnose an
HSV-1 viral infection?
PCR, viral culture, serology, immunofluorescence.
Note: Tzanck smear is not helpful for delineating HSV-1
from HSV-2.
What are potential complications of herpetic
gingivostomatitis?
Dehydration, herpetic whitlow, herpetic keratitis, secondary
bacterial infection, esophagitis, epiglottitis, pneumonitis,
encephalitis, eczema herpeticum
What are the three most common antiviral agents
used to treat herpetic gingivostomatitis, and what
is their mechanism of action?
Acyclovir, valacyclovir, famciclovir. Metabolized by viral
enzymes to form metabolites that interfere with DNA
synthesis and cause cell death. It works best if initiated
within 72 hours.
What benefit does valacylcovir offer compared
with acyclovir for the treatment of herpetic
gingivostomatitis?
The dosing is twice a day compared with three to five times
per day; however, it is more expensive.
What is the generally accepted window of
opportunity for prescribing oral acyclovir for effective treatment of primary herpetic gingivos-
tomatitis?
Three days. This therapy has been shown to decrease the
duration of the lesions (intraoral and extraoral), fever,
dysphagia/odynophagia, and viral shedding.
Recurrent oral HSV-1 infections can be associated
with what important complications?
● Disfiguring lesions
● Erythema multiforme
● Aseptic meningitis
● Eczema herpeticum
What noncontagious acute gingivitis is caused by an
overgrowth of common bacterial species, including
Prevotella intermedia, α-hemolytic streptococci, Ac-
tinomyces, or spirochetes, among others?
Acute necrotizing ulcerative gingivitis (trench mouth)
In a patient with acute necrotizing gingivostoma-
titis, if the disease progresses beyond the gingiva
to include other mucosal surfaces, what is this
condition called?
Noma (cancrum oris)
What are common risk factors for development of
acute necrotizing ulcerative gingivitis?
Stress, immune incompetence (i.e., HIV infection), poor
nutrition, poor oral hygiene, alcohol or tobacco use. This is
not a contagious disease.
What are common examination findings seen in acute
necrotizing ulcerative gingivitis (“trench mouth”)?
Lymphadenopathy, halitosis, mucosal edema/ulceration/
inflammation, with or without a pseudomembrane
What is the treatment for acute necrotizing
ulcerative gingivitis?
● Analgesia (NSAID, narcotics, viscous lidocaine, etc.)
● Antibacterial (clindamycin, penicillin, or erythromycin)
● Oral hygiene (chlorhexidine 0.12% mouth rinse, brushing,
flossing, etc.)
● Dental consultation for debridement and definitive
periodontal therapy
● Management of underlying immunocompromised status
is important if present
What is the most common oral manifestation of
HIV infection?
Oral candidiasis
What are the common forms of oral candidiasis?
● Pseudomembranous candidiasis (thrush)
● Erythematous (atrophic) candidiasis
● Angular cheilitis (perlèche)
● Hyperplastic candidiasis
What in-office diagnostic test can you perform to
confirm the diagnosis of oral candidiasis?
Scraping of erosive lesion followed by potassium hydroxide
(KOH) preparation and looking for budding yeast with or
without pseudohyphae
Review the initial treatment options for oral candidiasis.
Topical antifungal lozenges or solutions for 7–14 days:
Clotrimazole troches, nystatin suspension, or nystatin
pastilles
What can you offer as treatment for moderate to
severe oral candidiasis or for patients who do not
respond to topical therapy for oral candidiasis?
Oral fluconazole for 7 to 14 days
When is daily suppressive management with
antifungals indicated for oral candidiasis?
Suppressive management Is usually unnecessary (even for
HIV-positive patients). Treating active infections and managing the underlying immunocompromised status are recommended. When indicated (usually assisted by Infectious Disease Physicians), management usually includes fluconazole, three times a week.
