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Oral Disease - Soft tissue > Viral and bacterial infections of mucosal tissue > Flashcards

Viral and bacterial infections of mucosal tissue Flashcards

1
Q

How many human herpes viruses are there?

A

8 (HHV 1-8)

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2
Q

What viruses have oral manifestations?

A 
Human Herpes Virus 
Coxsackie 
Human papillomavirus 
Human Immunodeficiency Virus (HIV)
Measles 
Mumps
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3
Q

List the human herpes viruses

A 
HHV1 - Herpes simplex 1 (HSV1) 
HHV2 - Herpes simplex 2 (HSV2)
HHV3 - Varicella Zoster virus (VZV) 
HHV4 - Epstein Barr Virus (EBV) 
HHV5 - Cytomelagovirus 
HHV6 and HHV7 
HHV8 - Kaposi's sarcoma-associated Herpes virus
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4
Q

Which herpes simplex virus has a predilection for the oral cavity, and which has a predilection for genitals?

A

HSV1 oral

HSV2 genital

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5
Q

Describe clinical features of intra-oral herpes

A
  • Dozens of small ulcers that may coalesce or appear punched out
  • Gingival lesions - gingivostomatitis
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6
Q

Describe the clinical features of primary herpetic stomatitis

A
  • Dome-shaped ulcers, around 2-3mm dia
  • Rupture may lead to sharply defined shallow ulcers with yellow/gray floor and red margins
  • Common on the hard palate and dorsal tongue
  • Gingival lesions
  • Halitosis and impeded function
  • Systemic symptoms
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7
Q

What is the management of primary herpetic stomatitis

A
  • OTC analgesics, CHX, fluid intake and soft diet for symptomatic relief
  • Aciclovir if immunocompromised
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8
Q

Where does herpes simplex remain latent?

A

In the trigeminal ganglion

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9
Q

What is another term for herpes labialis

A

Cold sore

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10
Q

What is recurrent herpes labialis?

A

Reactivation of latent HSV due to a trigger

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11
Q

What may trigger recurrent herpes labialis

A

common cold, UV, menstruation, local irritation, emotional upset

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12
Q

Describe clinical features of recurrent herpes labialis

A
  • Vesicles along the mucocutaneous junction of the lips +/- adjacent skin
  • Vesicles may enlarge, coalesce and weep exudate
  • Rupture of vesicles occurs after 2-3 days and it crusts over, or it may ulcerate
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13
Q

What may cause secondary infection of recureent herpes labialis

A

Staphylococcus or streptococcus

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14
Q

Management of herpes labialis

A
  • Symptomatic relief - OTC analgesics
  • Topical penciclovir, aciclovir or hydrocolloid film
  • Systemic aciclovir if immunocomp
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15
Q

What infections occur with HHV3 - Herpes varicella zoster virus

A
  • Primary infection = chickenpox (varicella)

- Reactivation = shingles (zoster)

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16
Q

Where does varicella zoster virus remain latent?

A

In the sensory nerve ganglia

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17
Q

Intraoral cinical features of chickenpox (varicella)

A

Vesicles which may rupture and form painful, round/ovoid ulcers with inflammatory halos
Common on the palate

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18
Q

Extraoral clinical features of chickenpox (varicella)

A

Centripetal (trunk, head, neck) itchy rash which goes through macular, papular, vesicular and pustular stages and may crust over
Systemic - fever, malaise, irritability, anorexia

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19
Q

Management of chickenpox

A
  • Analgesics
  • Antihistamines or calamine lotion for itching
  • Aciclovir systemically if pregnant, neonates or immunocompromised
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20
Q

When may complications of chickenpox arise

A
  • If primary infection in adulthood
  • Reactivation as shingles (main complication)
  • Pregnancy or non-immune
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21
Q

Define shingles

A

Painful, unilateral rash in a dermatome due to reactivation of latent VZV in the sensory nerve ganglion

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22
Q

Epidemiology of zoster

A
  • Middle aged and over
  • Underlying immunodeficiency
  • Children if there was maternal varicella during pregnancy
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23
Q

Intraoral features of shingles

A
  • Unilateral, severe pain or paraesthesia before, during or after (PHN)
  • Maxilla = rash over cheek and ulcers on palate
  • Mandible - rash lower face and lip, ulcer on tongue and soft tissues
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24
Q

What are extraoral features of shingles

A
  • Unilateral rash in the dermatome, may crust over and heal +/- scarring
  • Suppraration and scaring if lesions infected with bacteria
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25
Q

What is post-herpetic neuralgia

A

Complication of shingles, resulting in burning pain after the shingles disappears

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26
Q

When may Ramsay Hunt Syndrome occur?

A

If zoster involves the geniculate ganglion of the facial nerve

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27
Q

What are the signs of ramsay hunt syndrome

A

Facial paralysis, rash, tinnitus, nausea, vertigo

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28
Q

Management of shingles

A
  • OTC analgesics for ulcers
  • Systemic aciclovir for symptomatic relief and prevent PHN
  • Early treatment indicated to reduce risk of PHN
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29
Q

What treatment is indicated for post-herpetic neuralgia

A

Antidepressant and an anti-epileptic

30
Q

What intraoral lesions may arise due to EBV

A
  • Oral hairy leukoplakia
  • Hodgkin lymphoma
  • Burkitt lymphoma
  • Petechial haemorrhage at the junction of hard and of palate
31
Q

What does coxsackie virus lead to?

A
  • Herpangina

- Hand-foot and mouth disease

32
Q

Describe features of herpangina

A
  • Young children
  • Sudden onset of fever, sore throat, anorexia and dysphagia
  • Vesicles on the tonsils, soft palate and uvula which break down into ulcers
33
Q

Describe features of hand-foot and mouth disease

A
  • Children

- Shallow ulcers with vesicles orally, and ulcers on the hands and feet

34
Q

Describe oral manifestation of measles

A

Koplik spots on the oral mucosa - these are pin-point blue/white spots on an erythematous base
Found particularly on the BM

35
Q

Describe oral manifestations of cytomegalovirus

A
  • Common ulcer on the hard or soft palate, tongue or FOM

- May be mistaken for aphthous ulcer

36
Q

Describe oral manifestations of HPV

A
  • Oral warts
  • Verruca vulgaris
  • Focal epithelial hyperplasia
  • HPV related dysplasia
  • HPV related SCC
37
Q

Describe the clinical appearance of oral warts

A
  • singular or multiple raised masses resembling focal epithelial hyperplasia
  • or small cauliflower like projections
38
Q

Describe oral manifestations of hepatitis

A
  • Lichen planus
  • Xerostomia / Sjogrens
  • Sialdenitis
39
Q

What oral lesions occur with the treatment of hepatitis infections

A
  • Gingival bleeding or swelling
  • Periodontal changes
  • Oral pain
  • Lichen planus
  • Discolouration of the tongue
40
Q

What is HIV

A

Retrovirus that affects humans and eventually leads to acquired immunodeficiency syndrome

41
Q

What is the pathology of HIV

A

Destroys T helper cells, macrophages and dendritic cells - thus impairs cell mediated immunity, leaving progressive susceptibility to opportunistic infections and AIDS

42
Q

Why does CD4 count decline in HIV

A

Proptosis
Apoptosis
Direct viral killing
CD8 cytotoxic lymphocytes

43
Q

How is HIV transmitted

A
  • Sexual intercourse
  • Infected needles and syringes w drugs
  • Vertically mother to baby
  • Blood transfusions
  • Occupational exposure
44
Q

Describe the replication cycle of HIV

A
  • Binding, fusion and entry
  • Reverse transcriptase from viral RNA to DNA
  • Integration of DNA to host DNA
  • Transcription, translation and assembly then release of viral proteins
45
Q

What is the diagnostic feature of HIV

A

Reduced CD4 count

46
Q

What are the common oral manifestations of HIV

A 
Candida 
Hairy leukoplakia 
Periodontal changes 
Kaposi's sarcoma 
Non-hodgkin's lymphoma
47
Q

What are additional, less common oral manifestations of HIV

A
  • Ulcers
  • Salivary gland disease or xerostomia
  • Thrombocytopenia purpura
  • Manifestations of other viruses
48
Q

What is the clinical presentation of hairy leukoplakia

A

Corrugated or ‘hairy’ white lesion typically on the lateral border of the tongue

49
Q

What is the cause of oral hairy leukoplakia

A

EBV

50
Q

What periodontal changes occur with HIV

A
  • Linear gingival erythema

- Necrotising gingival conditions

51
Q

When to be suspicious for HIV with periodontal changes

A
  • Disproportionate to OH
  • Rapid bone loss
  • Advanced disease for age
52
Q

What is Kaposi’s sarcoma

A

HIV-associated vascular malignancy

53
Q

Presentation of Kaposi’s sarcoma

A

Red or purple macules, which progress to papules, nodules or plaques
Predilection for head, back, neck, trunk and MUCOUS MEMBRANES (bruises in the mouth)

54
Q

What is the theory behind pathology of Kaposis

A

Cancer of lymphatic endothelium, forming vascular channels that fill with blood cells (giving rise to the bruise like appearance)

55
Q

What are the clinical features of NHL

A

Rapidly enlarging mass with bone destruction and ulceration
Common on fauces, gingiva and palate
Systemic symptoms typical of cancer

56
Q

How is HIV diagnosed

A

Antibody test via blood test

57
Q

What are the drug classes for HIV

A
  • Entry inhibitors
  • Reverse transcriptase inhibitors (nuceloside and non-nucleosite)
  • Integrade inhibitors
  • Protease inhibitors
58
Q

What is HART?

A

Highly active anti-retroviral treatment

59
Q

What HIV treatment is recommended for all therapy naive HIV patients

A

2 nuceloside reverse transcriptase inhibitors
1 other HIV drug
Protease inhibitor
Non-nucleoside RT inhibitor

60
Q

What is PREP

A

Pre-exposure prophylaxis, used in high risk groups in advance to having diagnosis to prevent it

61
Q

What oral lesions are persistent even with HART

A
  • HPV related papilloma

- HIV related salivary gland disease

62
Q

List orofacial adverse effects of HART

A
  • Lipodystrophy
  • Hyperpigmentation
  • Oral ulceration
  • Xerostomia
  • Hypersensitivity reaction (SJS/TENS)
63
Q

What is lipodstrophy?

A

Changes in fat distribution which hollow out the face

64
Q

Which bacterial infections can cause oral ulceration?

A

Tuberculosis

Syphilis

65
Q

What types of TB can cause oral manifestations

A
  • Oral TB (however this is rare)

- Secondary infections from pulmonary TB

66
Q

Describe oral ulcerations in TB

A

Chronic, painless, undermined ulcer on the dorsal tongue, covered in a yellow slough

67
Q

What are the oral manifestations of primary syphilis

A

Shallow, painful ulcer with indurated base on the lips, tongue or other mucosal site

68
Q

What are the oral manifestations of secondary syphilis

A

2-3 months after initial infection

Flat ulcerations common on the tongue and forming snail track ulcers

69
Q

What are the oral manifestations of tertiary syphilis

A

Years after exposure

Necrotic granulomas called gummas which are destructive (Esp on the palate where they may perforate the nasal cavity)

70
Q

What other lesions may be associated with tertiary syphilis

A

White pigmented lesions - these are OPML

Oral Disease - Soft tissue (12 decks)

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