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Oral Pathology Exam 5 > Infective Stomatitis - Viral > Flashcards

Infective Stomatitis - Viral Flashcards

1
Q

Human papilloma viruses (HPV) are what type of viruses?

A

DNA

- over 100 types

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2
Q

Describe the presentation of a Papilloma

A

Virus-induced benign proliferation of stratified squamous epithelium.

  • White/red/normal color “cauliflower” shaped exophytic nodule, sessile or pedunculated.
  • Usually small, but can be as large as 3 cm
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3
Q

Papilloma is usually what HPV subtypes?

A

6 & 11

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4
Q

What age group does a Papilloma usually target

A

Age 30 to 50 years

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5
Q

What location is Papilloma commonly found

A

Tongue, lips,&raquo_space; soft palate

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6
Q

Verruca vulgaris is usually what HPV subtypes

A

*2, 4, 6, 40

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7
Q

Describe the presentation of Verruca vulgaris

A

“common wart”
Pink/white nodule with rough, pebbly surface
Usually less than 5mm

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8
Q

What age group does Verruca vulgaris usually target

A

Children

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9
Q

What location is Verruca vulgaris commonly found

A

Usually on skin of hands

- Oral mucosa: vermillion border, labial mucosa, anterior tongue

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10
Q

Histologic features of verruca vulgaris

A

Well defined papillary growth with KOILOCYTES (enlarged cells with cytoplasmic clearing)
- Large keratohyaline granules

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11
Q

How does Verruca vulgaris spread?

A

Contagious

Can spread to other parts of skin or mucosa by autoinoculation

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12
Q

Treatment of Verruca vulgaris

A

Liquid nitrogen

cryotherapy/surgical excision/salicylic acid

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13
Q

Condyloma acuminatum is usually what HPV subtypes

A

2, *6, *11, 53, 54, 16, 18

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14
Q

What age does Condyloma acuminatum usually target

A

Teenagers and young adults

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15
Q

What location is Condyloma acuminatum commonly found?

A

Affects oral mucosa, larynx, genitalia

Oral mucosa: labial mucosa, soft palate, lingual frenum

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16
Q

How is Condyloma acuminatum spread?

A

Transmitted through sexual transmission or self-inoculation

- Incubation of 1 to 3 months from time of sexual contact

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17
Q

How does Condyloma acuminatum present?

A

Pink to white exophytic mass with short, blunted surface projections.

  • 1 to 1.5 cm, can be as large as 3 cm.
  • Often occurs in clusters and not quite as exophytic and papillary as papillomas or vurruca
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18
Q

Focal epithelial hyperplasia is usually what HPV subtypes?

A

13 and 32

- Also known as Heck’s disease

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19
Q

How does focal epithelial hyperplasia present?

A

Multiple soft, flattened papules clustered together

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20
Q

What age group is Focal epithelial hyperplasia most common?

A

In children often malnourished and in poor living conditions

- 1st described in Native Americans and Eskimos

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21
Q

Describe the location where Focal epithelial hyperplasia is most commonly found

A

Labial, buccal and lingual mucosa

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22
Q

Histologic features of Focal epithelial hyperplasia

A

Koilocytes and mitosoid cells

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23
Q

How is HPV identified?

A

Biopsy & Histologic examination

- HPV identified by DNA in situ hybridization, immunohistochemical analysis and PCR

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24
Q

Describe the interaction between HPV and cancer

A

Only some types, especially *16, *18, 6, 11, 30s, 50s

  • causes cervical cancer and most oropharyngeal cancer
  • 25 years ago, 20-25% of throat cancer was HPV, today it’s 75%
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25
Q

What type of virus is Human Herpes viruses

A

DNA viruses

26
Q

In general, describe the interaction and life cycle of HHV in humans

A

Humans are natural reservoirs for the virus
- All HHVs can reside throughout the life of an infected host and are characterized by dormancy or latency where they reside within the host with the potential to be reactivated and produce recurrent patterns of disease

27
Q

Describe general features of Acute herpetic gingivostomatitis

A
  • more than 90% are the result of HSV-1
  • Oral disease caused by initial infection of HSV
  • Very acute in onset
28
Q

What age group does Acute herpetic gingivostomatitis target

A

Usually in children 6 months to 5 years old, but can occur in adults

29
Q

Symtpoms and signs of Acute herpetic gingivostomatitis

A
  • Fever**, lymphadenopathy, nausea, irritability
  • Painful, erythematous gingiva and tiny (1-3 mm) coalescing vesicles progress to widespread, multiple sharply marinated ulcers of oral mucosa and skin around mouth & lips
30
Q

In adults, how might acute herpetic gingivostomatitis present?

A

May present as pharyngotonsillitis

31
Q

General features of Recurrent herpes simplex infection

A

Occurs in 15-45% of the U.S. population

- Virus is neurotrophic and persists in a latent state in the trigeminal ganglion

32
Q

What stimuli trigger viral replication and lead to recurrent clinical lesions of HSV

A 
Old age
UV light
Emotional stress
pregnancy
allergy
trauma
illness
dental therapy
33
Q

Symptoms of Recurrent herpes simplex lesions

A

Prodromal symptoms of pain, burning, or tingling

- HERPES labialis –> “cold sore” or “fever blister”

34
Q

Where is Herpes labialis commonly found?

A

Junction of vermillion and skin, NOT on mucosa (aphthae)

Intraoral: limited to keratinized mucosa that is bound to bone –> hard palate and gingiva

35
Q

How does herpes labialis or recurrent herpes present?

A

Tiny vesicles or ulcers that coalesce

36
Q

How is HSV (acute or recurrent) diagnosed?

A

Usually based on clinical findings

  • Cytologic smear and/or tissue biopsy
  • Serologic tests for HSV antibodies are positive 4-8 days after initial exposure
37
Q

***At any time, 5-30% of your patients will asymptomatically excrete and will have HSV DNA in their saliva

A

Yep. Learn that statement. It was in bold

38
Q

In general, how are acute or recurrent herpes lesions treated?

A

Topical and systemic antiviral medications

  • effective when administered early prodrome period in primary or recurrent infection
    1. Acyclovir (Zovirax)
  • 800 mg tablet every 4 hours orally for 7-10 days
  • 5% ointment applied to affected areas topically with a finger cot q4h
  • Or pencicylovir topical
    2. Famciclovir (Famvir)
  • single 1500 mg dose or single-day (750 mg 2x for one day) dose
    3. Valacyclovir (Valtrex)
  • 2g (four 500 mg tablets) q12h for one day
39
Q

Varicella-Zoster virus (VZV/HHV-3) affects what age group?

A

Usually children 5-9 years of age

  • Highly contagious
  • 10-21 day incubation
40
Q

Clinical presentation of VZV or chickenpox

A

Headache, fever

- Erythema –> vesicle –> pustule –> hardened crust on skin and mucous membranes

41
Q

Locations that VZV is normally found

A

Skin: extremities, face, trunk

Perioral & oral lesions: vermillion border of lips, palate and buccal mucosa

42
Q

Tx of VZV

A

Symptomatic
Recovery in 2 to 3 weeks
VZV vaccine

43
Q

Describe Herpes Zoster

A

Shingles –> reactivation of VZV

  • VZV may lie dormant in sensory neural ganglia after initial chickenpox infection
  • Herpes zoster occurs if the virus becomes reactivated
44
Q

Herpes Zoster is usually found in what age group?

45
Q

Predisposing factors and clinical presentation of Herpes Zoster?

A

PD- Immunosuppression, treatment with cytotoxic drugs, radiation, malignancy, old age, alcohol abuse, dental treatment

Presentation: can be a single occurrence or multiple

  • Prodromal symptoms: intense pain, fever malaise, headache
  • Unilateral painful eruption of vesicles along the distribution of a sensory nerve classically stops at the midline
46
Q

Where do Herpes Zoster oral lesions present?

A

Occur if trigeminal nerve is involved and lesions may be present on the the movable or bound mucosa

47
Q

Describe both postherpetic neuralgia and Ramsay Hunt Syndrome

A

Postherpetic neuralgia: chronic infection, may take months to resolve

Ramsay Hunt Syndrome: Infection of external auditory canal with involvement of the ipsilateral facial and auditory nerves producing facial paralysis, hearing deficits and vertigo

48
Q

Eptsein-Barr virus is also known as:

A

Infectious mononucleosis or “kissing disease”

49
Q

How is Epstein-Barr virus transmitted?

A

Through close contact or saliva

50
Q

What age group is HHV-4 or Epstein Barr virus most commonly found in?

A

Late adolescents/ young adults in developed countries

51
Q

Symptoms of Epstein-Barr virus

A

Sore throat, fever, lymphadenopathy, tonsillitis, fatigue, enlarged spleen.
- Petechiae on hard/soft palate as prodrome

52
Q

Treatment of Epstein-Barr virus

A

Self-limiting in 4 to 6 weeks, treatment is symptomatic

53
Q

Describe Hairy Leukoplakia

A

Corrugated white lesion, usually on lateral border of tongue

  • Cannot be wiped off!
  • Often associated with candidal infection
  • EBV can be identified by in situ hybridization, pCR, immunohistochemistry and is the cause
  • Most commonly occurs in HIV+ patients, but can occur in others
54
Q

What other diseases may be associated with EBV

A

Neoplasms, Burkitt’s lymphoma and other lymphomas, Nasopharyngeal carcinoma

55
Q

What patients is Cytomegalovirus most commonly found

A

Usually affects newborns and immunosuppressed adults

- Common in AIDS patients

56
Q

How is CMG trasmitted?

A

through exchange of bodily fluids

57
Q

Oral lesions of CMG

A

Chronic ulceration, affects endothelial cells and blood flow
- Can reside latently in salivary gland cells
- Infected cells show “owl eye” appearance
Systemic antiviral treatment is necessary in immunosupppressed individuals.

58
Q

HHV-8 presentation

A

Causative virus in Kaposi’s sarcoma

  • Reddish-purple flat or raised lesions
  • Most cases are associated with AIDS
59
Q

Oral presentation of HHV-8

A

most commonly on palate, gingiva and tongue

60
Q

What diseases are associated with Coxsackie A viruses?

A

Herpangina
Hand-foot-and-mouth disease
Acute lymphonodular pharyngitis

61
Q

Name the Paramyxoviruses

A

Measles (Rubeola)

Mumps

62
Q

What is the hallmark of measles

A

Koplik’s spots - may be an early intraoral manifestation

- small, red patches with white, necrotic centers

Oral Pathology Exam 5 (5 decks)

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