Oral Viral Infections

Question 1

Name the key stages of HSV replication

Answer 1

BERN GDPE
Binding
Entry
Release
Nuclear entry
Gene expression
DNA replication
Packaging
Egress

Question 2

Name the types of herpes virus and examples of each

Answer 2

HSV1+2
- Primary herpetic gingivostomatitis
- Herpes labialis
- Viral ulceration (recurrent herpetic ulcerated lesions, palate, one nerve branch)

EBV
- Hairy leukoplakia

Varicella Zoster
- Shingles

Question 3

List some facts about HSV epidemiology

Answer 3

Very common infection >90% population
Resides in saliva
Transmission direct person contact
Common in childhood

Question 4

Steps for virus

Answer 4

1. Acute infection
   - Initial
2. Latency
   - Lies dormant in trigeminal ganglion
3. Reactivation
   - Triggered by stimuli (stress,immunocompromised,infection) to reactivate
4. Physical presentation
   - Herpes labialis
   - Ulceration
   - Cold sores

Question 5

Shingles tx

Answer 5

Aciclovir 800mg oral 5x daily for 7 days
Refer all pts with herpes zoster to a specialist or their GMP

Question 6

List the clinical features/symptoms of Varicella Zoster (2)

Answer 6

Painful vesicles in dermatome
Affected area may be associated with paraesthesia

Question 7

List the complications of Varicella zoster (3)

Answer 7

Lies dormant
Post herpetic neuralgia (Aciclovir to reduce)
Secondary bacterial infections

Question 8

Route of transmission of varicella zoster

Answer 8

Direct contact
Droplet
Airborne

Question 9

Example of coxsackie virus

Answer 9

Hand foot and mouth disease
Herpangina

Question 10

Features of hand foot and mouth disease

Answer 10

Fever, runny nose, cough
Skin rash on hands and feet
Oral ulcerations
Lasts 7-10 days
no tx: relieve symptoms

Question 11

Features of Herpangina

Answer 11

Vesicles in tonsillar/pharyngeal region
Lasts 7-10 days

Question 12

Signs/symptoms of primary herpetic gingivostomatitis

Answer 12

• Fluid filled vesicles rupture to ulcers
• Severe gingivitis
• Fever
• Headache
• Malaise
• Cervical lympadenopathy

Question 13

Tx for primary herpetic gingivostomatitis

Answer 13

Bed rest
Soft diet + fluids
Painkillers
Aciclovir if immunocompromised 200mg
Self limiting 10-14 days reassure heals with no scarring

Question 14

Triggers for recurrent herpes (3)

Answer 14

• Sunlight
• Stress
• Immunocompromised

Question 15

List ulceration hx questions

Answer 15

Site + size
Onset
Characteristic if pain
Associated med problems
Frequency/number
Exacerbating dietary factors
MH