Oral Viral Infections

Question 1

what is a cellular feature of viruses making them different from bacteria and fungi

Answer 1

no intracellular organelles

Question 2

discuss a viral swab

Answer 2

flocked swab unlike a bacterial or fungal swab
placed in molecular sample solution (MSS) which extracts viral DNA/ RNA
after immersion swab is removed from solution

Question 3

what are viruses made up of

Answer 3

glycoproteins
proteins
phospholipids
nucleic acids

Question 4

example of DNA and RNA virus

Answer 4

DNA - human herpes
RNA - hep C

Question 5

what are the 8 stages of herpes simplex replication

Answer 5

1. binding
2. entry
3. nuclear transport
4. nuclear entry
5. gene expression
6. DNA replication
7. packaging
8. release

Question 6

specimen for serology

Answer 6

EDTA blood

Question 7

4 types of human herpes virus

Answer 7

HSV1
HSV2
varicella zoster
epstein barr
cytomegalovirus

Question 8

primary herpetic gingivostomatitis

Answer 8

manifestation of HSV1 primary infection most commonly seen in children
hard palate and dorsum of tongue are most commonly affected

Question 9

herpes labialis

Answer 9

cold sores
manifestation of reactivation of HSV1

Question 10

herpetic whitlow

Answer 10

caused by herpes simplex viruses
painful infection of fingers caused by touching herpetic lesion of someone else - virus penetrates via break in skin near nail or other broken skin

Question 11

Epstein Barr virus

Answer 11

Type of Human Herpes virus
spreads via saliva and other bodily fluids
causes glandular fever

Question 12

post herpetic neuralgia

Answer 12

pain that continues after shingles rash has gone
(shingles = reactivation of varicella zoster)

Question 13

what patient demographic is zoster (shingles) typically seen in

Answer 13

elderly or immunocompromised

Question 14

chickenpox

Answer 14

primary infection of varicella zoster virus

Question 15

discuss the pathogenesis of HSV

Answer 15

1 - primary infection - infects epithelial cells in mucosa or skin, replicates in epithelium then is taken up by sensory neurons and transported to sensory ganglia
2 - latency - latent infection established in ganglia
3 - reactivation - latent virus in ganglia reactivates and transported back to epithelium where lesions form

Question 16

why may prodromal tingling/ pain be felt prior to recurrent HSV lesions occuring

Answer 16

due to virus reactivating in neuron first prior to being transported back to epithelium

Question 17

clinical features of primary HSV infection

Answer 17

majority asymptomatic, if not - severe

in adults (less common) - pharyngitis
in children - gingivostomatitis
both often have systemic symptoms - fever, malaise, regional lymphadenopathy

Question 18

appearance of gingivostomatitis

Answer 18

erythmatous and painful with multiple vesicles/ ulcerations

Question 19

clinical features of recurrent HSV infection

Answer 19

cold sores. - usually on lips/ corners of mouth
can also develop sores on cornea (herpes keratitis)

Question 20

what may act as a trigger for reactivation of HSV

Answer 20

sunlight
fever
stress
immunosuppression

Question 21

lab diagnosis of HSV

Answer 21

rarely done
flocked swab, placed in molecular sample solution which extracts viral DNA/RNA - after immersion swab removed and sample sent to lab for PCR testing

Question 22

treatment of primary herpetic gingivostomatitis

Answer 22

general adive and symptomatic relief
- nutritious diet, plenty fluids, bed rest
- analgesics
- antimicrobial MW

if immunocompromised or severe infection aciclovir

Question 23

what antimicrobial MW could be prescribed for primary herpetic gingivostomatitis

Answer 23

CHX 0.2%, 1min, 10ml rinse 2 x daily

hydrogen peroxide 6%, 15ml diluted, 2 mins 3x daily

Question 24

aciclovir regimen for immunocompromised patients or severe HSV infection

Answer 24

200mg, 5x daily, 5 days

Question 25

treatment for herpes labialis

Answer 25

aciclovir cream 5%, apply to lesion every 4 hours for 5 days