Microbiology of Oral Ulcers

Question 1

What viruses can cause oral ulceration?

Answer 1

Herpes Simplex Virus
Coxsackie Virus
Treponema pallidum

Question 2

Which type of Herpes simplex virus is responsible for oral ulcers?

Answer 2

Type 1 - aquired in childhood

Question 3

How is HSV 1 spread?

Answer 3

saliva contact

Question 4

What can HSV1 cause?

Answer 4

primary gingostomatitis

Question 5

What populations commonly present with primary gingostomatitis?

Answer 5

preschool children - primary infection

Question 6

What is the presentation of primary gingostomatitis?

Answer 6

lip, buccal mucosa and hard palate inflammation
systemic upset
local lymphadenopathy
1-2mm vesicles

Question 7

What is the treatment of HSV 1 primary gingostomatitis?

Answer 7

aciclovir

Question 8

What happens after the primary infection of HSV 1?

Answer 8

becomes latent in the trigeminal ganglion

Question 9

What does HSV 1 affect when it reactivates?

Answer 9

mucosal surfaces - normally same place as last time

Question 10

What does herpes simplex virus type 2 cause?

Answer 10

genital herpes or less commonly cold sores

Question 11

What is the presentation of HSV 2 cold sores?

Answer 11

oral herpetic lesions - if intra oral it wont normally be HSV

Question 12

How is HSV diagnosed?

Answer 12

swab the lesion then do PCR of viral DNA

Question 13

What is a complication of HSV?

Answer 13

herpes simplex encephalitis

Question 14

What type of virus is the coxsackie virus?

Answer 14

enterovirus - feacal oral spread

Question 15

What diseases does the coxsackie virus cause?

Answer 15

Hand, foot and mouth disease

Herpangia

Question 16

What is the presentation of Herpangia?

Answer 16

vesicles/ulcers on the soft palate - stops the child from eating

Question 17

What population is affected by Herpangia?

Answer 17

primary school age

Question 18

How is Herpangia diagnosed?

Answer 18

PCR swab or just clinical

Question 19

What is the presentation of hand, foot and mouth disease?

Answer 19

blisters on hands and in mouths

Question 20

How does hand, foot and mouth disease get spread?

Answer 20

feacal oral spread - saliva sharing in young children

Question 21

How is hand, foot and mouth disease diagnosed?

Answer 21

viral PCR or just clincial

Question 22

What disease does Treponema pallidum cause?

Answer 22

Primary syphilis

Question 23

What is the presentation of primary syphilis?

Answer 23

painless ulcer at the site of entry of the bacterium
boggy/thick ulcers and swollen lips
most common site is genital but some oral

Question 24

What is the treatment of primary syphilis?

Answer 24

penicillin

Question 25

What are the posible complications of primary syphilis?

Answer 25

secondary and tertiary syphilis

Question 26

What are apthous ulcers?

Answer 26

recurring, self limiting ulcers lasting under 3 weeks

painful ulers in the mouth that have inflammatory halos

Question 27

When do apthous ulcers occur?

Answer 27

begin in childhood and become less severe in the 3rd decade

Question 28

What systemic diseases are associated with ulcers?

Answer 28

Bechets disease - oral, genital, uveitis, middle east and Asia
Gluten sensitive enteropathy or IBD - diarrhoea and weight loss
Reiters disease - arthritis
Skin diseases - lichen planus, pemphigus, pemphigoid