Stephens Columns Flashcards
Virus with multiple forms of which humans are the only natural reservoir, having 8 total types, all of which cause a primary infection, then remain latent in specific cell types for the life of the individual (Neville 240)
Herpes/Herpetoviridae (HHV)
HHV that has 2 simplexes which are DNA viruses (Neville 240)
HSV-1/HHV-1
This HHV simplex is a DNA virus and is spread predominantly through infected saliva or active perioral lesions. The virus commonly seen in the oral, facial, and ocular areas. Pharynx, intraoral sites, lips, eyes, and skin above the waist are most common sites (Neville 241)
HSV-1/HHV-1
This HSV simplex is a DNA virus and is spread predominantly through sexual contact, involving the genitalia and skin below the waist (Neville 241)
HSV-2/HHV-2
What is the initial exposure of an individual without antibodies to HHV-1 called (Neville 241)
primary infection (also called acute herpetic gingivostomatitis [Neville 242])
What is the common age of onset, the symptomology and the morbidity of an HSV-1/HHV-1 primary infection (Neville 241)
-young age (6mo-5yrs, peaks at 2-3 yrs old[Neville 242]) -Asymptomatic -No significant morbidity
Most frequent site of latency for HSV-1/HHV-1 after primary infection (Neville 241)
trigeminal ganglion
By what means does the HSV-1/HHV-1 virus use to travel from its site of latency to the peripheral skin or mucosa (Neville 241)
via axons of the sensory nerves
Term for the reactivation of HSV-1/HHV-1 infection (Neville 241)
secondary/recurrent/recrudescent HSV-1
Many pts with Secondary/recurrent/recrudescent HSV-1 present the infection how (Neville 241)
asymptomatic viral shedding in the saliva
2 instances when can HSV-1/HHV-1 spread to an uninfected person (Neville 241)
during asymptomatic viral shedding From the symptomatic active lesions
Only stimulant that has been demonstrated unequivocally to induce HSV-1/HHV-1 recurrent lesions (Neville 241)
Ultraviolet light
Almost all HSV primary infections occur from what (Neville 241)
contact with an infected person who is releasing the virus
Usual incubation period after HSV infection (Neville 241)
3-9 days
What is the difference in the presentation of primary infection of those presenting early in life (childhood) versus those presenting later in life (adulthood) (Neville 241)
HSV-1 childhood primary exhibit gingivostomatitis HSV-1 adult primary exhibit pharyngotonsillitis
What decreases the chance of an HSV-2 infection besides not being promiscuous (Neville 241)
having antibodies to HSV-1
HSV-2 initial infections normally occur in what age range (Neville 241)
15-35
HSV infections have been associated with an increase in the risk of presenting what non-infectious process (Nevill 241)
Erythema multiforme
Most common pattern of symptomatic primary HSV infection, 90% by HSV-1 infection. Presentation is abrupt with: Anterior cervical; lymphadenopathy; Chills; Fever (103-105°F); Nausea; Anorexia; Irritability; Sore mouth lesions (Neville 242)
acute herpetic gingivostomatitis (primary herpes)
What will be the manifestation of the sore mouth lesions of acute Herpetic Gingivostomatitis (primary herpes) (Neville 242)
-multiple ulcerations on both free and attached mucosa -Gingiva enlarged, painful, extremely erythematous Punched out lesions along the midfacial free gingival margin can involve labial mucosa and extend perioral
How long will it take for a mild case of acute herpectic gingivostomatis (primary herpes) to resolve (Neville 242)
5-7 days
How will acute herpectic gingivostomatitis (primary herpes) present in an adult (Neville 242)
sore throat; Fever Malaise; Headache; Numerous ulcerations on tonsils and posterior pharynx
Significant cause of pharyngotonsillitis in young adults from higher socioeconomic groups (Neville 243)
HSV, mostly HSV-1, but HSV-2 increasing
This is a recurrence of the HSV infection at the site of primary inoculation or in adjacent areas of surface epithelium supplied by the involved ganglion (Neville 243)
recurrentl herpex simplex infections/secondary herpes/recrudescent herpes
Most common site of recurrence for HSV-1 (Neville 243)
vermillion border and adjacent skin of lips
Clinical name of recurrence of HSV-1 on the vermillion border and adjacent skin of lips (Neville 243)
herpes labialis
Lay term for recurrence of HSV-1 on the vermillion border and adjacent skin of lips (Neville 243)
-cold sore -fever blister
What develops 6-24 hrs prior to herpes labialis (HSV-1 recurrent infection) presenting (Neville 243)
prodromal signs/symptoms: Pain; Burning; Itching; Tingling; Localized warmth; Erythema of involved epithelium
How does Herpes Labialis (HSV-1 recurrent infection) present after the prodrome (Neville 243)
multiple small, erythematous papules develop and form clusters of fluid filled vesicles that rupture and crust within 2 days
How long does it take for healing to occur from Herpes labialis (HSV-1 recurrent infection) (Neville 243)
7-10 days
When are symptoms most severe for Herpes labialis (HSV-1 recurrent infection) (Neville 243)
first 8 hrs
When is the viral replication of Herpes labialis (HSV- 1 recurrent infection) most active (Neville 243)
first 48 hrs
What is the normal recurrenc of Herpes labialis (HSV-1 recurrent infection) (Neville 243)
2 recurrences annually
What is the only mucosa that HSV-1 will recur on: bound down or non-bound down (Neville 244)
keratinized mucosa that is bound down (attached gingival and hard palate)
HSV-1 infection of the thumbs or fingers that can result in paresthesia or permanent scarring (Neville 244)
herpetic whitlow/herpetic paronychia
Which HSV is a risk for newborns, HSV-1 or HSV-2 (Neville 245)
HSV-2 spread through birth canal of infected mother. Baby is safe from HSV-1 as it is spread through saliva and maternal HSV-1 antibodies in the baby protect it for its first 6 months of life outside the womb
List the 8 Herpes viruses and their names or what they cause if it is known (Neville 241)
-HSV-1 oral herpes -HSV-2 genital herpes -HHV-3 Varicella-Zoster virus (VZV) (Chickenpox/shingles) -HHV-4 Epstein-Barr virus (EBV) (mononucleosis) -HHV-5 Cytomegalovirus (CMV) -HHV-6 have roseola pattern on skin -HHV-7 have roseola pattern on skin -HHV-8 Kaposi Sarcoma herpesvirus
Herpex virus has main effects on what cell type (Neville 245)
epithelial cells
antiviral capsule prescription for treatment of herpes during the first 3 symptomatic days (Neville 245, Siversky regimen list )
-Rx Acyclovir 200 mg capsules -Disp: 38 capsules -Sig: Take three (3) stat, then one (1) capsule 5 times a day for 7 days
3 different means to deliver Acyclovir for the treatment of Herpes to accelerate clinical resolution of symptoms (Neville 245, Siversky regimen list)
1) Acyclovir 5% cream 2) Acyclovir 200 mg capsules 3) Acyclovir 5% ointment w/ Dyclonine HCl 1% or Lidocaine 1% compounded
Prescription for Acyclovir 5% cream (Siversky regimen list)
-Rx Acyclovir 5% Cream -Disp: 3 or 15 mg tube -Sig: Apply to affected area six (6) times a day
Prescription for Acyclovir 5% ointment with Dyclonine HCl 1% or Lidocaine 1% Compound (Siversky regimen list)
-Rx Acyclovir 5% ointment with Dyclonine HCl 1% or Lidocaine 1% -Sig:Apply to affected area q2h (start applying prodromal stage)
This is a non-prescription ointment that comes in a 2g tube and is applied to the affected area 5 times a day (Siversky regimen list)
Docosonal (Abreva)
2 antivirals in the family of acyclovir, but who show improved bioavailability and more convenient oral dosing schedules than acyclovir (Neville 247)
Valacyclovir Famciclovir
Prescription for antiviral Famciclovir (Siversky regimen list)
-Rx Famciclovir 125 mg tabs -Disp: 10 tabs -Sig: Take one tab bid for five days
Prescription for antiviral Valacyclovir (Siversky regimen list)
-Rx Valacyclovir 500 mg tables -Disp: 8 tabs -Sig:Take 4 tabs in prodrome and 4 tabs 12 hours later
Why is Penciclovir a better antiviral cream than acyclovir (Neville 247)
Penciclovir’s base allows increased absorption through the vermillion border while acyclovir cream’s base prevents significant absorption
Prescription for Penciclovir cream (Siversky regimen list)
-Rx Penciclovir 1% Cream -Disp: 2 gm tube -Sig: Apply a thin amount to affecte area q2h during waking hours for a period of 4 days (treatment should begin as early as possible, ie. during prodrome or when lesions appear)
Is there a vaccine against HSV-1 or HSV-2 (Neville 248)
No
Holistic treatments for herpes outbreak (Siversky)
-Citrus -Bioflavonoids -Ascorbic Acid 400mg
Prescription for Herpes treatment with Acyclovir (Siversky list too know from Brady Wilde)
-Acyclovir 5% cream -Disp: 3 to 15 gm tube -Sig: Apply to affected area 6 times a day
Prescription for Herpes treatment with Penciclovir (Siversky list too know from Brady Wilde)
-Penciclovir 1% cream -Disp: 2 gm tube -Sig: apply a thin amount to affected area q2h during waking hours for a period of 4 days
When should Penciclovir treatment be initiated (Siversky list too know from Brady Wilde)
begin as early as possible (i.e during prodrome or whne lesions appear)
Prescription for Herpes treatment with Valacyclovir (Siversky list too know from Brady)
-Valacyclovir 500mg tablets -Disp: 8 tabls -Sig: take four tablets in prodrome and four tablets 12 hours later
Can be caused during a candidiasis infections, and is characterized by erythema, fissuring and scling at the angles of the mouth (Neville 216)
Angular Cheilitis
Often occurs alone, typically in older person with reduced VDO and accentuated folds at the corners of the mouth where saliva will tend to pool, causing moisture that favors a yeast infection (Neville 216)
Angular Cheilitis
Most common presentation of bacterial or fungal infections of lips (Neville 304)
Angular Cheilitis
Other causes of angular cheilitis (Neville 304)
-contact dermatitis (secondary to chronic lip licking) -Allergic contact mucocitis -Atopic exzema -Iron deficiency anemia
2 things used to treat angular cheilitis (Siversky)
antifungal and steroids
Prescription for angular cheilitis (Siversky)
-Triamcinolone 0.1% and Nystatin 100,000 units/gram cream (Mycolog II) -Disp: 15 gm tube -Sig: Apply t.i.d. until healing occurs
Why give steroid for angular cheilitis (Siversky)
stop redness
What can be given if angular cheilitis if caused by vitamin deficiency (Siversky)
Vit B supplement
How does an aphthous ulcer present different than recurrent herpes infection (Siversky)
-size, Number, Location -Aphthous is single, large lesion on non-bound tissue