Orofacialinfections- Viral infections Flashcards
What are the different types of Herpes infection and how do they affect the oral and maxillofacial manifestations?
Herpes simplex virus 1 -HHV1–herpes labialis& oral ulceration
Herpes simplex virus 2 -HHV2-oral ulceration
Varicella zoster virus -HHV3-Primary infection causes chicken pox. Reactivation causes shingles
Epstein Barr virus -HHV4-infectious mononucleosis, hairy leukoplakia, Burkitt’slymphoma, nasopharayngealcarcinoma
Cytomegalovirus-HHV5–oral ulceration, retinitis
Kaposi’s sarcoma-associated herpesvirus-HHV8 –Kaposi’s sarcoma
NB: HHV6 and 7 are not relevant to the dental surgeon’s clinical practice.
What is this and how does it present?
Primary herpetic gingivostomatitis
- Acute gingivitis
- Oral ulceration
- Submandibular lymphadenopathy
- malaise
- Fever
- Supportive Rx: Fluids
What does the primary herpetic gingistomatisis oral ulcerations look like?
Vesicles which bust to form pin point ulcers which become ragged ulcers
How do you confirm something is a virus?
Take a swab and send for culture, see what grows.
How do you treat intraoral herpes ulceration?
Systemic medication
–Aciclovir 200-400mg 5 times a day for 5-7 days or
–Valaciclovir 1g twice daily for 3-5.
For immunocomprimised patients give a course of acyclovir.
How do you treat herpes labialis?
- *Topical treatmen**t: aciclovir 5% and penciclovir1% cream
- *Systemic treatment**: Aciclovir200-400mg 5 times a day for 5-7 days or Valaciclovir1g twice daily for 3-5 days.
What is the diagnosis of sudden onset recurrent ulceration, commonly on the lip? it can have target lesions on the shins or hands. what is the management?
Herpes induced Erythema multiform.
Prophylactic daily valaciclovir
What is the life cycle of chicken pox? (Varicella zoster)?
Primary infection with varicella zoster virus
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VZV remains latent within nerve cell bodies
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Herpes zoster (shingles) involving extra or intraoral sensory distribution.
How does oral herpes zoster present?
Nonspecific s & s : headache, fever, and malaise
•Oral manifestations: small vesicles or simply well defined ragged ulceration confined to a sensory nerve distribution
•Burning pain and allodynia.
•Diagnosis: clinical +/-laboratory based confirmation of infection .
How do you manage herpes zoster?
Antivirals: Systemic acyclovir for 10 days. Aciclovir 800mg 5 times /day . Note: dose compared to treatment for HSV infection.
•Analgesia
what are the complications of herpes zoster?
Postherpeticneuralgia (PHN)
•Ramsay-hunt syndrome
•Other neurological complications eg. meningitis.
what is ramsey hunt syndrome?
Ramsay Hunt syndrome results in paralysis of the facial muscles on the same side of the face as the infection. So, the virus infects the facial nerve that normally innervates controls the muscles of the face. Ramsay Hunt syndrome is typically associated with a red rash and blisters (inflamed vesicles or tiny water-filled sacks in the skin) in or around the ear and eardrum and sometimes on the roof of the mouth or tongue.
what is infectious mononucleosis?
Primary infection to the virus is often a subclinical infection
–Symptomatic infection causes infectious mononucleosis.
–The virus (usually acquired from infected saliva) replicates in the cells of the mucosa and salivary glands and spreads to B lymphocytes and the bloodstream.
•Presentation is non specific with headache, fever, malaise, myalgia, lymphadenopathy and fatigue.
•No specific oral manifestations.
What virus is hairy leukoplakia associated with? how does it present
Epstein Barr virus.
Most often seen in immunocomprimised patients.
White lesion on the lateral border of the tongue which cannot be wiped away.
what is this histiological slide of?
hariy leukoplakia
