L8: viral infections pt 2 Flashcards
what kind of cells does EBV affect
immortalises b cells and remains in host for life (latent)
ebv is hhv what
hhv 4
how does ebv spread?
via bodily fluids (saliva, blood, semen)
what is known as the kissing disease?
infectious mononuleosis, which is brought about by ebv (hhv4)
what are the symptoms of infectious mononucleosis?
person infected with ebv wil have infectious mononucleosis
- lymphadenopathy, hepatosplenomegaly, thrombocytopenia, aplstic anemia
- pharyngitis, rhinitis, cough, rash
- fatigue, malaise
symptoms of infectious mononucleosis is more pronounced in who
older px
associated conditions with ebv infection:
- OHL
- lymphoproliferative disroders eg burkitts lymphoma
- nasopharyngeal carcinoma
- salivary lymphoepithelial carcinoma
- sarcoma
what is an eg of lymphoproliferative disorder?
burkitts lymphoma
oral presentation of ebv
- necrotizing ulcerative gingivitis (NUG)
- mucosal petechiae
how to dx ebv?
- full blood cell count - if got lymphocytosis (increase in absolute lymphocyte count)
- clinically
- serology (paul bunnell test to detect heterophil antibodies)
- serology (indirect immunofluorescent test for ebv specific AB - done if the PB test is negative)
- ELISA and recombinant DNA derived Ag test
what is the paul bunnell test used to detect and what infection does it detect?
detects heterophil antibodies which are Ig that agglutinate sheep erythrocytes
used as a rapid test for ebv
tx for ebv
supportive care via:
- antipyretics
- non aspirin nsaid
- not rec to use AB in cases with tonsilitis
- not rec to use corticosteroid unless there is life threatening symptoms like airway obstruction (due to enlarged tonsils and adenoids)
- antiviral agents (but only temporary resolution of OHL)
primary cmv infection is mostly in what type of ppl
infancy – through placenta, breastfeeding
adolescence - sexual activity
recurrent cmv infection is mostly in what types of ppl
immunocompromised
cmv lies latent in what
endothelial cells mainly, also got lymphocytes, macrophages and salivary glands
cmv spreads via what
body fluids like saliva and blood
which virus is present in 40% of 30 year olds, and 80-100% of 60 year olds?
cmv
tx of cmv
- most resolve spontaneously
- symptomatic relief can be provided by NSAIDs
- immunocompromised px: give anti virals like ganciclovir and valganciclovir
- in immunocompromised, can also give cART (combination antiretroviral therapy) to improve immune status
histopatho findings of cmv
owl eye cells (swollen infected cells)
aka reed sternberg cells
in what type of infection do we see owl eye cells
cmv
what types of cells do hhv 6, 7, 8 target?
6 and 7 target t lymphocytes
8 targets b lymphocytes and endothelial cells
which virus is a common cause of childhood acute febrile illness?
hhv 6
what are the types of enteroviruses?
- coxsackie virus (type A and B)
- echo virus
characteristics of enteroviruses:
- is it widespread and contagious?
- what kind of outbreak does it cause?
- what kind of diseases caused?
- widespread and highly contagious
- cause epidemic outbreaks
- wide spectrum of diseases but mostly self limiting
where are the lesions of hfmd?
- hand and foot: around fingers toes and heel margins
- oral lesions in labial and buccal mucosa, vestibules, tongue, palate
which lesions are painless and which are painful in hfmd?
those on hands and feet are painless, those in oral cavity are mild to moderate pain
what are the descriptions of lesions of hfmd on the skin and the oral lesions?
skin is firm raised NODULES, painless
oral lesions are multiple small ULCERS, mild to moderate pain
how to dx hfmd?
clinical presentation: will have prodromal flu like symptoms before lesions develop
- immunofluorescence or culture
mx of hfmd?
supportive and palliative ** (these are KEYWORDS)
- give lots of fluids, can give anesthetics and analgesics
- monitor for systemic complications/ systemic disease
how long does hfmd last
usual course is 7-10 days
hfmd caused by what kind of virus
enterovirus - coxsackie A16
how does hfmd spred?
via faecal oral route
herpangina caused by what virus?
enterovirus – coxsackie A1-6, A8, A10, A22
what are some systemic symptoms of herpangina?
sore throat, dysphagia, fever, malaise, headahce
description of herpangina lesions
multiple small 2-3mm ulcers
red macules -> fragile vesicles then rapidly ulcerate
how long do herpangina lesions take to heal?
7-10 days
location of herpangina lesions
posterior oral cavity/ oropharynx
if we see some lesions elsewhere, it is unlikely herpangina
how to dx herpangina?
- clinical presentation
- viral culture, immunofluoresnce
mx of herpangina?
- supportive and palliative for symptomatic cases
- can give anesthetics and analgesics
histo patho findings of herpangina
- _____ and _______ oedema that form intraepithelial ______
- vesicle enlarges and ruptures through ________ layer to form _______ vesicle
- epithelial ____ and ______
- inclusion bodies and multinucleated epithelial cells _______
- intracellular and intercellular oedema that form intraepithelial vesicle
- vesicle enlarges and ruptures through epithelial basal cell layer to form subepithelial vesicle
- epithelial necrosis and ulceration
- inclusion bodies and multinucleated epithelial cells absent
histopatho findings of herpangina
- intracellular and intercellular _____ that form ______
- vesicle enlarges and _____ through epithelial basal cell layer to form _____
- _______ _____ and ulceration
- ________ bodies and _______ epithelial cells absent
- intracellular and intercellular oedema that form intraepithelial vesicle
- vesicle enlarges and ruptures through epithelial basal cell layer to form subepithelial vesicle
- epithelial necrosis and ulceration
- inclusion bodies and multinucleated epithelial cells absent
ddx of herpangina?
hfmd (similar clinical findings)
to differentiate, hfmd usually has more lesions and involve anterior oral cavity more, whereas herpangina is posterior oral cavity
what type of virus got more than 100 strains identified but we only need to focus on a few?
hpv
need to focus on
hpv 6 and 11 (benign )
hpv 13, 32 (focal epithelial hyperplasia)
and 16, 18, 31, 33 and 35 (squamous cell carcinoma)
are the hpv oral lesions contagious?
mildly contagious, require direct mucosal contact
hpv lies latent in what cells
epithelial cells
hpv infect what type of cells? how?
infect keratinocytes via
- viral DNA incorporation into host DNA
- E6&7 genes induce transformation of cell
what HPV associated with focal epithelail hyperplasia?
hpv 13, 32
what HPV associated with SCC?
16, 18, 31, 33 and 35
what HPV associated with proliferative verrucous leukoplakia (benign)?
6, 11
verruca vulgaris is which hpv?
2,4
mx of hpv?
- biopsy to identify virus is recommended before removal
- removal of hpv lesions can be done by:
conservative surgical excision,
co2 laser (which vaporises lesion)
cryotherapy (liquid nitrogen)
electrosurgery
chemical tx
but there will be high rate of recurrence of lesions
what are the chemical tx avail for hpv lesions? -
- podophyllotoxin 0.5% gel
- interferon alpha (INF-a) * rmb this one, is an intra lesional injection
- imiquimod cream/ soln
histopatho findings of HPV
- proliferation of _____ arranged in ____ like projections, with ________ CT cores
- ______ (viral altered epithelial cells) present in spinous cell layer
- proliferation of keratinised squamous epithelium arranged in finger like projections, with fibrovascular CT cores
- koilocytes (viral altered epithelial cells) present in spinous cell layer
histopatho findings of HPV
- proliferation of ______ squamous epithelium arranged in finger like projections, with __________
- koilocytes (_______ cells) present in ______ ___ layer
- proliferation of keratinised squamous epithelium arranged in finger like projections, with fibrovascular CT cores
- koilocytes (viral altered epithelial cells) present in spinous cell layer
