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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
What type of virus is Human Herpes viruses
DNA viruses
26
In general, describe the interaction and life cycle of HHV in humans
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
Describe general features of Acute herpetic gingivostomatitis
* more than 90% are the result of HSV-1 - Oral disease caused by initial infection of HSV - Very acute in onset
28
What age group does Acute herpetic gingivostomatitis target
Usually in children 6 months to 5 years old, but can occur in adults
29
Symtpoms and signs of Acute herpetic gingivostomatitis
- 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
In adults, how might acute herpetic gingivostomatitis present?
May present as pharyngotonsillitis
31
General features of Recurrent herpes simplex infection
Occurs in 15-45% of the U.S. population | - Virus is neurotrophic and persists in a latent state in the trigeminal ganglion
32
What stimuli trigger viral replication and lead to recurrent clinical lesions of HSV
``` Old age UV light Emotional stress pregnancy allergy trauma illness dental therapy ```
33
Symptoms of Recurrent herpes simplex lesions
Prodromal symptoms of pain, burning, or tingling | - HERPES labialis --> "cold sore" or "fever blister"
34
Where is Herpes labialis commonly found?
Junction of vermillion and skin, NOT on mucosa (aphthae) | Intraoral: limited to keratinized mucosa that is bound to bone --> hard palate and gingiva
35
How does herpes labialis or recurrent herpes present?
Tiny vesicles or ulcers that coalesce
36
How is HSV (acute or recurrent) diagnosed?
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
***At any time, 5-30% of your patients will asymptomatically excrete and will have HSV DNA in their saliva
Yep. Learn that statement. It was in bold
38
In general, how are acute or recurrent herpes lesions treated?
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
Varicella-Zoster virus (VZV/HHV-3) affects what age group?
Usually children 5-9 years of age - Highly contagious - 10-21 day incubation
40
Clinical presentation of VZV or chickenpox
Headache, fever | - Erythema --> vesicle --> pustule --> hardened crust on skin and mucous membranes
41
Locations that VZV is normally found
Skin: extremities, face, trunk | Perioral & oral lesions: vermillion border of lips, palate and buccal mucosa
42
Tx of VZV
Symptomatic Recovery in 2 to 3 weeks VZV vaccine
43
Describe Herpes Zoster
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
Herpes Zoster is usually found in what age group?
Adults
45
Predisposing factors and clinical presentation of Herpes Zoster?
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
Where do Herpes Zoster oral lesions present?
Occur if trigeminal nerve is involved and lesions may be present on the the movable or bound mucosa
47
Describe both postherpetic neuralgia and Ramsay Hunt Syndrome
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
Eptsein-Barr virus is also known as:
Infectious mononucleosis or "kissing disease"
49
How is Epstein-Barr virus transmitted?
Through close contact or saliva
50
What age group is HHV-4 or Epstein Barr virus most commonly found in?
Late adolescents/ young adults in developed countries
51
Symptoms of Epstein-Barr virus
Sore throat, fever, lymphadenopathy, tonsillitis, fatigue, enlarged spleen. - Petechiae on hard/soft palate as prodrome
52
Treatment of Epstein-Barr virus
Self-limiting in 4 to 6 weeks, treatment is symptomatic
53
Describe Hairy Leukoplakia
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
What other diseases may be associated with EBV
Neoplasms, Burkitt's lymphoma and other lymphomas, Nasopharyngeal carcinoma
55
What patients is Cytomegalovirus most commonly found
Usually affects newborns and immunosuppressed adults | - Common in AIDS patients
56
How is CMG trasmitted?
through exchange of bodily fluids
57
Oral lesions of CMG
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
HHV-8 presentation
Causative virus in Kaposi's sarcoma - Reddish-purple flat or raised lesions - Most cases are associated with AIDS
59
Oral presentation of HHV-8
most commonly on palate, gingiva and tongue
60
What diseases are associated with Coxsackie A viruses?
Herpangina Hand-foot-and-mouth disease Acute lymphonodular pharyngitis
61
Name the Paramyxoviruses
Measles (Rubeola) | Mumps
62
What is the hallmark of measles
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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