Orofacial viral infections

Question 1

What viruses can cause pharyngitis?

Answer 1

Adenovirus
Epstein Barr virus
Cytomegalovirus

Question 2

What virus causes gingivostomatitis?

Answer 2

Herpes simplex 1

Question 3

What virus causes parotitis?

Answer 3

Mumps virus

Question 4

How is viral infections diagnosed?

Answer 4

Viral nuclei acid detection
Nucleic acid amplification
Serology
Interpreting significant viral antibodies

Question 5

What are the 3 sub types of human herpes virus?

Answer 5

Alpha

• herpes simplex 1 and II
• varicella zoster

Beta

• cytomegalovirus
• HHV6 and HHV7

Gamma

• Epstein Barr virus
• HHV8 (Kaposi’s sarcoma associated virus)

Question 6

What is the most common viral salivary gland infection?

Answer 6

Paramyxovirus (mumps)

• unilateral presentation with 2-3week incubation period
• 2nd attacks possible and common in childhood

Tx:

• vaccinations
• supportive fluids and pain relief

Question 7

Wha viruses are associated with H&N malignancies?

Answer 7

HPV 16 and 18
EBV
HHV8 - kaposi’s sarcoma

Question 8

Describe the aetiology, symptoms and treatment for measles?

Answer 8

Aetiology:

• RNA paramyxovirus
• highly contagious with droplet spread
• incubation 12day period

Symptoms:

• fever, malaise, conjunctivitis
• dry cough
• koplik spots found on buccal mucosa Before main rash develops
• red oropharynx

Treatment

• vaccination
• bed rest, fluids, analgesia

Question 9

What are the orofacial manifestation associated with HIV and AIDS?

Answer 9

Hairy leukoplakia
Kaposi’s sarcoma
Non Hodgkin’s lymphoma 
HSV
HPV
VZV

Question 10

Describe HHV8?

Answer 10

Virus causing Kaposi’s sarcoma - commonly in aids patients as well as primary effusion lymphoma.

Presentation
- purple or bluish macules or swellings affecting skin and oral mucosa mostly hard palate

Treatment
- ART drugs

Question 11

What is the clinical presentation of PHG?

Answer 11

• pyrexia. Sore mouth and throat
• widespread vesicles which coalesce following painful ulcers
• self limiting

Question 12

What is the management of PHG?

Answer 12

Supportive

• bed rest, fluids, anti-pyretics
• CHX MW/swab use

Severe/immunocompromised:
- Aciclovir 200mg 5x daily for 5 days

Question 13

Wha virus causes PHG?

Answer 13

Herpes simplex virus 1

Question 14

What causes herpes labialis?

Answer 14

Reactivation of Herpes simplex virus 1

- presents extra orally secondary to PHG as it lies latent in trigeminal ganglion

Question 15

What antiviral therapy can be used for herpes labialis?

Answer 15

Aciclovir cream 5% 2g tube 5x daily for 5-10 days or once lesions have healed.

Question 16

What can cause activation of herpes labialis?

Answer 16

Immunosuppression
UV light
Stress
Weather changed

Question 17

What virus causes chicken pox and shingles?

Answer 17

Varicella zoster virus:

Varicella Chickenpox:
- primary infection affecting facial skin and oral mucosa vesicles

Zoster Shingles:
- remains latent in sensory ganglion and reactivates as shingles

Question 18

What pattern of lesions occurs in shingles?

Answer 18

• distribution of lesions are strictly unilateral and doesn’t cross midline but can affect trunk coupled with face but follows dermatome.

Question 19

What conditions can shingles cause?

Answer 19

Post herpetic neuralgia
Corneal scarring
Ramsay hunt syndrome - facial nerve affected causing facial paralysis and hearing loss
Peripheral motor neuropathy

Question 20

What antiviral therapy is used for shingles?

Answer 20

Aciclovir 800mg 5x daily for 7 days within 72hrs of onset of rash

Question 21

What is the aetiology, presentation. And treatment of herpangina?

Answer 21

Aetiology

• mouth infection caused by coxsackie virus A
• most common in young children

Presentation

• pinhead vesicles in tonsils, uvula, soft palate, tongue and oropharynx which rupture to form large ulcers with erythematous rim
• no cutaneous lesions or gingivitis
• lesions are all at the back of mouth
• healing within 5-7days

Treatment:
- leave to heal - self limiting
Pain relief
Increase fluid intake and bed rest

Question 22

What is the aetiology, presentation and treatment for hand foot and mouth?

Answer 22

Aetiology

• caused by coxsackie virus A16
• 1 week incubation primarily in young children

Presentation

• maculopapular vesicular rash on soles of feet, oral mucosa and hands
• vesicles have erythematous halos where ulcers are shallow, painful and self limiting

Treatment:

• self limiting recover 5-7days
• increase fluid, rest and soft diet
• pain relief, anti inflammatory and anti-pyretics.

Question 23

What condition is commonly caused by HPV16 and 11?

Answer 23

Oral mucosa squamous cell papilloma
It is exophytic cauliflower like appearance white or pink in colour
= most common on gingivae or palate

Question 24

What conditions do Epstein Barr virus cause?

Answer 24

Mononucleosis/glandular fever
Oral hairy leukoplakia
Non Hodgkin’s 
Burkitt’s lymphoma 
Nasopharyngeal carcinomas

Question 25

What blood test is used for diagnosing EBV?

Answer 25

Paul bunnel/monospot test

Question 26

A patient presents with a painless pale lesion on his buccal mucosa which has frond like projections. What is the likely aetiology?

Answer 26

Human papilloma virus

Question 27

What is the correct aciclovir regime for an 18 month old child with severe case of PHG?

Answer 27

100mg oral suspension 5x daily for 5 days