Oral Viral Infections Flashcards
Which viruses are part of human herpesviruses
Herpes simplex- causing primary herpetic stomatitis and herpes labialis
Varicella zooster- causing chickenpox and zoster (recurrence)
Epstein Barr - infectious mononucleosis
Cytomegalovirus
HHV8- causing Kaposi sarcoma
Other viruses causing oral conditions:
Coxsackie- hand foot mouth disease and herpengina
Human papilloma virus- causing squamous papilloma and warts
Measles virus- causing measles
HIV
What kind of virus is herpesviruses
Double stranded DNA
How HSV and VZV cause infection
By ballooning degeneration- cell will swell up (keratinocyes) and lose attachment and then rapture and release viral particles to the non infected cells
HPv causing infection by:
Causes cell hyperplasia within the full thickness of stratified squamous epithelium
Diagnosis of oral viral infections
Mainly clinical
But laboratory investigations can be- IgG or IgM, PCR, immunofluorescence, immunochemistry on affected tissue, viral isolation from lesion and cultivation
Herpesviruses:
- Primary herpetic stomatitis (HSV1) - incubation period 5-7 days, intraoral vesicles that are pin point, rapture easily so probably seeing ulcers rather than vesicles; vesicles can be on the lips and causing crusting due to exudate coagulation, generalized gingival inflammation; can involve other parts like eyes, fingers, perioral; symptoms: pain, dysphagia, dehydration, fever, lymphadenopathy…
- Recurrent infection-cold sores; unilaterally, 2-3 times a year, commonly on lips, peri oral, it is reinfection of latent virus sitting in nerual cells
- VZV-chickenpox- prodromes: fever, fatigue, pharyngitis. Small ulcers mainly on soft palate and fauces, intraoral lesions can precede skin lesions
- Recurrent VZV(shingles) : prodrome: pain and paraesthesia. Unilateral vesicular eruption following distribution of the sensory nerves ( divisions of trigeminal, geniculate ganglion of facial), intraoral vesicles rapture rapidly and cutaneous lesion without 3 weeks, pain may persist (post herpetic neuralgia)
Management of the above:
1. Symptomatic relief: hydration, rest, pain relief, antimicrobial mouthwash (chlorhexidine 0.2% )
2. Mild infection of the lips in healthy individuals: aciclovir cream 5% very 4 h, penciclovir cream 1% every 2 h
Shingles and severe infections and immunocompromised pt management:
1. Severe infection in healthy: 200mg aciclovir tablets or oral suspension,5 tomes daily, for 5 days; prophylaxis: aciclovir 400mg twice daily
2. Immunocompromised pt: 400 mg aciclovir tablets or oral suspension, 5times daily, for 5 days for both adults and children
3. Immunocompromised with severe infection: refer to specialist
4. Shingles: 800mg aciclovir tablets of oral suspension, 5times daily for 5 days within 72 h of onset of rash; not in children, refer to specialist
HSV 4- Epstein Barr - infections mononucleosis
Long incubation period:4-6 weeks
Prodromes: severe fatigue, malaise, anorexia
Main symptoms: fever, pharyngitis, generalised lymphadenopathy (cervical nodes)
Diagnostic features:
Paul- Brunnel test +
Raised anti-EBV antibodies
If above negative, consider CMV and toxoplasmosis
Oral signs: tonsillar exudate, palatal petechiae
If not treated can cause complications such as non Hodgkin lymphoma
Cytomegalovirus (HSV5)
Mostly subclinical
If symptomatic - can be similar to mononucleosis
Large, shallow ulcers in immunocompromised patients
Histopathology: non specific ulceration but CMV + inclusion bodies present at the ulcer floor
Coxsackie viruses
- Hand foot mouth disease: incubation period of 4-7 days, highly infectious. Small ulcers (rarely intact vesicles) causing little pain mainly on buccal, labial, lingual and palatal mucosa. Vesicles and ulcers present on hands and feet. No gingivitis, no lymphadenopathy, no systemic upset. Self limiting - 7 days
- Herpengina - prodromes: muscular pain, nausea, malaise. Small ulcers on palate, uvula, tonsils. Associated with fever, lymphadenopathy, oropharyngitis; self limiting in 8-10 days
Measels
Koplik’s spots: prodrome of measles (2-4 days before measles cutaneous rash)
Appear mostly on buccal mucosa/opposite molars
White spots against erythematous background
Human papilloma virus
- Warts (HPV 2,4)- white, pinkish raised but mainly sessile. Similar to squamous cell papilloma but more rounded and sessile. Often multiple. Mainly children affected, secondary to self inoculation
- Primary squamous papilloma (HPV 6,11) - common in 20+ years olds, exophitic, pedunculated, distinct branched structure, finger like processes, white or pinkish, up to 20 mm in diameter
- Condyloma acuminatum (hpv6,11,16)- venereal wart. Benign HIV infection manifestation; transmitted via oro-genital contact. Multiple white/pink nodules. Fuse forming sessile or pedunculated papillary lesions
Management of oral mucosal HPV related lesions
Diagnosis: clinical, biopsy
Treatment: reasurrance and monitoring
Cryotherapy
Surgical excision
Histopathology of HPV lesions:
HPV induces hyperplastic changes rather than ballooning degeneration
Fibro-vascular core covered by stratified squamous epithelium with:
1. Hyperplastic basal cell layer
2. Acanthosis
3. Hyperortho/parakeratosis
Koilocytes
What are vesicles
Fluid filled swellings, developing in the case on the oral mucosal, particularly on the gingiva, tongue and buccal mucosa
If the vesicles forms within the epithelium rather than in basements membrane, it will be fragile and rapture rapidly so may not be seen clinically as a vesicle but as an ulcer
Primary herpetic gingivostomatitis
Multiple small round vesicles of acute onset, which ulcerate, sometimes coalescing on a background of inflamed mucosa
They cause great discomfort
It is an acute infection with short incubation period ( 5days)
Virus is spread by direct contact with infected saliva or reactivation lesions
Cervical lymphodenopathy is a significant feature
It is caused by HSV 1
