Oral Viral Infection Flashcards
What are the clinical features of herpes simplex virus types 1 & 2?
Gingivo stomatitis - canker sores
Herpes labialis - cold sores
Keratoconjunctivitis - eye infection of cornea and conjunctiva
Herpetic whitlow - infection of the fingernail
Bell’s palsy
Genital herpes
How would a lab diagnosis of HSV 1 & 2 be made?
Most diagnoses can be made based on history and clinical appearance
BUT
LAB
Vesicle/ ulcer fluid - swab & molecular sample media for PCR
What HSV are most likely to infect oral and genital lesions respectively (for secondary infections) and why?
HSV1 - more prone to oral infections because it is better at replicating in the TRIGEMINAL GANGLIA
HSV2 - more prone to genital infections because better at replicating in the SACRAL GANGLIA which innervates the genitals.
NOTE - either can infect either site for the primary infection.
Briefly explain pathogenesis of herpes simplex virus.
- ACUTE INFECTION - virus enters through mucosa or damaged epithelium
- LATENCY - retrograde transport - virus hides out in nucleus of neurons while infection is cleared out by immune system. Then virus is shuttled from axon termini to cell body - can feel tingling before virus starts replicating again
- RE-ACTIVATION - anterograde transport - virus infects epithelial cells again and virus replicates again causing visible lesions.
In re-activation of HSV, why can a person feel tingling before recurrent lesions appear?
The virus re-activates in the neuron, so a person can sometimes feel this before the visible lesions appear.
Good because they can treat and sometimes prevent lesions from appearing if this happens.
What is the route of transmission for HSV?
Direct contact by close person:person contact
What does Epstein-Barr virus cause?
Glandular fever
What does varicella zosters virus cause?
Chicken pox and shingles
What is the incubation period for varicella zoster infection?
10-21 days
What are the complications for VZV caused chickenpox?
Secondary bacterial infections
Pneumonia
Congenital/ perinatal/ neonatal - affects the baby depending on time and severity of infection for the mother
Signs and symptoms of shingles (caused by zoster)?
Vesicles appear representing nerve where virus has been dormant - does not cross the midline- only on one side of the body
The affected area may be INTENSELY PAINFUL.
What are complications of shingles (caused by zoster)?
Post herpetic neuralgia
Secondary bacterial infections
Ophthalmic zoster
What is the route of transmission of varicella zoster?
Direct contact - droplet or airborne spread.
Why is it important to diagnose and treat shingles early?
Reduces severity and duration of pain and complications
Pain may mimic toothache
What virus causes hand foot and mouth disease?
Coxsackie A virus
Part of enterovirus family
What are the clinical features of hand foot and mouth disease?
Fever, runny nose, sneezing, cough
Maculopapular skin rash, mouth blisters and body and muscle aches
How is hand foot and mouth disease transmitted?
Nose and throat secretions, fluid from blisters or scabs
Faeces (faeco-oral transmission)
What is the treatment for hand foot and mouth disease?
No specific medical treatment - symptomatic relief and prevent dehydration
Fluid intake, bed rest, analgesics
How is measles spread?
RNA virus spread through airborne transmission or direct contact with infected respiratory secretions
Signs and symptoms of measles
High fever
Cough
Runny nose
Conjunctivitis
Kopliks spots - small grey-white spots in mouth
3-5 days later - rash begins on face and spreads downwards
What’s the incubation period for mumps?
12-24 days
What are the symptoms of mumps?
Headache and fever
Swelling of parotid gland (uni or bilateral)
Signs and symptoms of monkeypox
Blistering rash or skin lesions on face and genital area
Fever
Sore throat
Headache
Muscle aches
Back pain
Low energy
Swollen lymph nodes
What other conditions can monkeypox be confused with?
Symptoms may be confused with herpes simplex, chickenpox or syphilis.
What is acyclovir’s mechanism of action?
Blocks DNA polymerisation by tricking replicating herpes virus into incorporating defective acyclovir molecule into growing DNS chain and blocks further viral DNA synthesis.
What is acyclovir used to treat?
Re-activation of herpes simplex
Shingles and chickenpox- by zoster
What is prescription of aciclovir cream (for topical herpes labialis lesions)?
Aciclovir cream 5%
2g
Apply to lesion every 4 hours (5x per day) for 5 days
Same for adults and children
For immunocompromised patients and patients with severe infections but non-immunocompromised, what would be prescribed for adults with HSV infections e.g. PHGS?
25 200mg tablets - 1 tablet 5x daily, for 5 days
What is prescription of aciclovir tablets for immunocompromised or severe infections in CHILDREN with HSV infections e.g. PHGS??
Aciclovir tablets (200mg)
OR
Oral suspension (200mg/5ml)
6m-1y - 100mg 5x per day
2-17y - 200mg 5x per day - same for adults
What is initial treatment for herpes simplex infections (e.g. PHGS)?
Symptomatic relief
- Plenty fluids - avoid dehydration
- Nutritious diet - soft diet may be beneficial for pain
- Bed rest
- OTC analgesics
- CHX mouthwash if regular OH not possible due to pain
What is prescription for CHX mouthwash (local measure)?
CHX mouthwash 0.2%
300ml, rinse mouth for 1 minute with 10ml 2x per day
(15 days/ 2 weeks)
What is prescription for hydrogen peroxide mouthwash (local measure)?
hydrogen peroxide mouthwash 6%
rinse mouth for 2 minutes with 15ml diluted in half a tumbler of warm water 3x per day
What is primary herpetic gingivostomatitis (PHGS)?
Manifestation of HSV1 - painful oral lesions and fever.
Self-limiting infection that typically resolved within 10-14 days
Most commonly affects children between 6 months to 5 years but can affect any age.
What are the signs/ symptoms of primary herpetic gingivostomatitis?
Fever
Malaise
Cervical lymphadenopathy
Multiple small ulcers that coalesce - keratinised and non-keratinised mucosa
Generalised inflammation of the gingivae
What are 8 things you would ask a parent regarding their child with PHGS?
- How long has ulceration been present
- Has child had any associated fever/ lymphadenopathy?
- Has child been able to eat/ drink?
- Have you (parents) ever had cold sores?
- Has this presentation ever happened before?
- When has child last passed urine?
- Are lesions present anywhere else on the body?
- Have you noticed any triggers? E.g. Has child had any new antibiotics in last few days?
What are risk factors that may trigger herpes reaction (recurrent herpetic gingivostomatitis?)
Stress
systemic illness
Immunosuppressed
Menstruation - biggest one for women
What are the symptoms of RECURRENT herpetic gingivostomatitis?
Pain on brushing
Vesicles
Depends on site - can cause difficulty swallowing
Can be stingy - burning sensation
Describe the viral replication of herpes simplex virus?
Binding
Entry
Release and nuclear transport
Nuclear entry
Gene expression
DNA replication
Packaging
Egress - leaving
What is the prescription for treatment of shingles?
Acyclovir 800mg, send 35 tablets, 1 tablet 7x/ day
Refer to specialist or GMP
What is kaposi sarcoma and what causes ot?
Neoplsm affecting any part of the GI tract (mouth to anus).
Presents as brownish-red/ purple patches/ nodules in the mouth
Caused by HHV-8
