Mouth Ulcerations Flashcards
What 2 viruses most commonly causes mouth ulcers/lesions & what are the four associated conditions (2 conditions per virus)
Herpes simplex virus 1
- primary gingivostomatitis
- herpes labialis (‘cold sore’)
Coxsackie virus (enterovirus)
- Herpangina
- hand foot & mouth disease
How is HSV1 acquired
Through close contact, oral secretions, usually in childhood
How does primary HSV1 infection present
Gingivostomatosis
- infection produces a severe inflammatory reaction
- vesicles & painful ulcers form, mouth & gum are inflamed
Where does the latent HSV1 virus stay
Trigeminal nerve ganglion
What can cause the reactivation of HSV1 infection
stress, trauma, febril illnesses and UV radiation
What is the recurrent form of HSV1 disease known as
herpes labialis (‘cold sore’)
What is Herpetic Whitlow
HSV infection of the finger, can be misdiagnosed as bacterial infection
What is the most concerning complication HSV1
Herpes simplex encephalitis
How does herpes simplex encephalitis present
fever, headache, seizures, focal neurological signs, and impaired consciousness
HSV1 diagnosis
Usually clinical
If wanting to confirm or uncertain - PCR swab
HSV1 infection treatment
Antiviral medications e.g. acyclovir help to reduce the severity and frequency of symptoms, but cannot cure the infection
Herpangina presentation
Yellow/greyish papulovesicles/ ulcers on soft palate
With high fever
Herpangina causative microorganism
Coxsackie virus (enterovirus)
What age would you expect someone with Herpangina to be
Younger (similar age range to herpetic primary gingivostomatitis)
Herpangina diagnosis & treatment
Usually clinical or PCR
Supportive treatment - self limiting
What microorganism causes hand, foot & mouth disease
Coxsackie virus (enterovirus)
Hand, foot & mouth presentation
Maculopapular rash of hands & feet
Oral enanthem (red oral ‘spots’)
Family outbreak common
Hand, foot & mouth diagnosis
Clinically or PCR
Hand, foot & mouth disease treatment
Supportive - self limiting
How can primary sphyilis present orally
Painless, indurated ulcer at site of entry of the bacterium treponema pallidum (e.g. due to unprotected sex)
Describe an aphthous ulcer
- Recurrent round or oval sore or ulcer inside the mouth
- On an area where the skin is not tightly bound to the underlying bone
- E.g. on the inside of the lips and cheeks or underneath the tongue
Aphthous ulcer (aphthae) aetiology
NOT viral, not fully understood,
Thought to be due to immune dysfunction & triggered by external factors e.g. emotional stress, certain foods
Aphthous ulcer (aphthae) presentation
Recurring, painful ulcers of the mouth
Ulcers are round/ovoid with inflammatory halo
Ulcers are confined to the mouth
Absence of systemic disease
Aphthous ulcer (aphthae) diagnosis & treatment
Clinically diagnosis & self limiting
What systemic diseases are associated with recurrent ulcers
- Behçet’s disease
- Reactive arthritis (reiter’s disease)
- Autoimmune e.g. coeliac, IBD
- Drug reactions e.g. NSAIDs, beta-blockers, sulphonamides
- Skin disease e.g. lichen planus, pemphigus vulgaris etc
Behçet’s disease clinical presentation
- Ulcers - Painful sores in the mouth, genitals etc
- Ophthalmology - Uveitis
- MSK - Arthritis, causing swelling, redness, and tenderness
- Dermatology - Skin rashes and lesions
- GI - Abdominal pain, nausea, diarrhea, and bloating
- Other e.g. stroke…
Behçet’s disease tends to affect ______ ethnic origin
Middle East & Asian
