Viral infections Flashcards

1
Q

List the three ways herpes viruses contribute to disease

A
  • Direct destruction of cells and tissues
  • Induction of immune responses
  • Facilitating neoplastic transformation
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2
Q

List the 3 subtypes of herpes viruses

A
  • Α: short reproductive cycle and irreversible destruction of cells
  • Β: long reproductive cycle and slow infection process
  • 𝛄: establish infection in B or T lymphocytes; associated with malignant disease
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3
Q

Briefly describe HSV-1 and HSV2 - 2 infections in terms of transmission

A
  • HSV-1: transmitted via close contact with infected fluids (usually saliva)
  • Gives rise to disease of the mouth and surrounding skin
  • HSV-2 is transmitted by genital-to-genital contact with infected fluids or lesions
  • Predominately gives rise to genital disease
  • HSV-1 can cause genital disease and HSV-2 can give rise to oral illness as a consequence of acquisition via orogenital contact
  • Both HSV-1 and HSV-2 lead to an initial primary infection with later episodes of less severe secondary infection in some, but not all patients
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4
Q

Describe primary HSV in terms of incubation, clinical features (5) and resolution

A

Incubation
• Arises within 1-2 weeks of acquisition of the virus

Clinical features:
• Malaise, pyrexia and lethargy
• Widespread ulceration of the oral mucosa and gingiva
• Ulcers are superficial, initially small and spherical but may coalesce to give rise to large-sized, irregular ulcers
• Can arise on any oral mucosal surface-typically all sites of the mouth affected
• Gingiva swollen, erythematous and ulcerated

Resolution:
• Resolution within 7-10 days in immunocompetent patients
• Primary HSV-2 infection of the mouth can give rise to a similar clinical pattern to that of HSV-1

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5
Q

Describe recurrent Herpes simplex infection in terms of:

  • clinical features (4)
  • triggers (5)
  • resting state
A

Clinical features:
• Affects vermillion border of the lip
• Can arise on perioral and perinasal skin
• Prodromal -> paraesthesia -> erythema -> vesiculation -> pustule formation -> superficial ulceration -> spontaneous healing
• Clinical course of 5-7 days

Triggers:
• Illness (e.g. flu)
• Sunlight or UV light
• Menstrual cycle 
• Pregnancy
• Immunosuppression

Resting state:
• HSV between infections will lie dormant in the trigeminal ganglion

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6
Q

Describe Herpes simplex infections in terms of:

  • diagnosis
  • management
A

Diagnosis:
Primary HSV-1 infection
• Based on clinical features
• Confirmatory investigations: identification of HSV-1 DNA by PCR (polymerase chain reaction)
• In the case of adults full blood test to rule out causes of immunosuppression

Recurrent herpes labialis
• Clinically characteristic, therefore usually no investigation warranted
• Identification of HSV DNA via PCR if any confusion

Management:
Primary HSV-1infection
• Symptomatic relief
• Topical anti-inflammatories
• Topical anaesthetics
• Drink fluids
• Acyclovir if detected early enough

Recurrent herpes labialis
• Topical over the counter medications if needed

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7
Q

Describe herpetic whitlow

A
  • Infection of the fingers when the virus is inoculated into the fingers through a break in the skin
  • HSV-1 or HSV-2 may be a cause
  • Occupational hazard, including within the dental profession before the widespread use of gloves
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8
Q

List the two forms of Varicella Zoster Virus

A
  • HHV-3
  • Primary infection: chickenpox
  • Secondary Infection: shingles
  • Transmission via droplets or close contact with lesions
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9
Q

Describe chicken pox in terms of

  • Appearance
  • Symptoms (3)
  • oral lesions
  • diagnosis and management
A

Appearance:
• Macular-popular cutaneous rash, vesicles, pustules and scab after 3-4 days

Symptoms:
• Fever and malaise
• Headache
• Incubation of 7-14 days

Oral lesions:
• Short lasting small white-opaque vesicles, usually on palate and buccal mucosa
• Precede cutaneous involvement
• May go unnoticed

Diagnosis:
• Confirmatory viral or serological investigations are rarely warranted

Management:
• Symptomatic relief

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10
Q

Describe herpes zoster (shingles) in terms of:

  • distribution (2)
  • how oral lesions appear
  • diagnosis
  • management
A

• Caused by reactivation of the varicella zoster virus in the ganglion of the cranial nerve

Affects dermatomes:
• Thoracic via reactivation of spinal ganglia. Painful eruptions of vesicles with ulceration and erythema
• Trigeminal nerve; ophthalmic, maxillary or mandibular divisions of one side

Oral lesions:
• vesicles, small superficial ulcers which coalesce to form larger, irregular ulcers
• Site depends on the affected branch
• Unilateral

Diagnosis
• Based on clinical manifestations
• FBC-evidence of unknown neutropenia, leukaemia, or other significant disease

Management
• Antiviral therapy is warranted
• Topical antivirals are of no benefit
• Cases of ophthalmic shingles should be referred for a specialist ophthalmology opinion

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11
Q

Describe the Epstein-Barr Virus in terms of the type of virus it is, transmission and manifestations (3)

A
  • 𝛄 herpes virus
  • Transmission is via the salivary route

Gives rise to a variety of different clinical illnesses
• Infectious mononucleosis
• Oral Hairy leukoplakia
• Malignancies of the head and neck

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12
Q

Describe infectious mononucleosis in terms of

  • Onset
  • clinical features (5)
  • diagnosis
  • management
A

Onset
• Arises approx. 5 weeks following viral acquisition
• Typically occurs in young adults

Clinical features
• Pharyngitis
• Pyrexia (fever)
• Cervical 
• Nausea and abdominal pain
• Pink maculopapular rash

Diagnosis
• Identification of atypical lymphocytosis in full blood count
• Identification of anti-EBV antibodies in serum

Management
• Symptomatic management

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13
Q

Describe oral hairy leukoplakia in terms of

  • clinical features (3)
  • diagnosis
  • management
A

Clinical features
• Adherent, homogenous, hair-like white patches
• Lateral aspects of tongue
• Dorsal or ventral surfaces

Diagnosis
• Histopathological examination would show hyperkeratosis, acanthosis, lack of inflammatory infiltrate
• Immunohistochemistry

Management
• Does not warrant treatment

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14
Q

Describe cytomegalovirus in terms of transmission and manifestations

A
  • HHV-5, β herpesvirus
  • Transmission via body fluids
  • Rarely gives rise to oral disease
  • In immunocompromised patients, CMV can cause superficial oral mucosal ulceration with a stellate appearance
  • Occurs primarily on the tongue
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15
Q

Describe Kaposi’s sarcoma in terms of its:

- clinical appearance

A
  • HHV-8–neoplastic disease
  • Was the most common neoplastic disease of AIDS

Clinical appearance
• Red, blue or purple macule, papule or nodule
• Typically arises at the hard-soft palate junction although can develop at other sites e.g. the maxillary gingiva
• As the disease progresses, the affected site becomes ulcerated and necrotic
• Can lead to tooth mobility and tooth loss

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16
Q

Describe Kaposi’s sarcoma in terms of its:

- management

A

Diagnosis:
• Biopsy-histological and immunohistochemical examination
• Radiological investigation for staging

Management:
• Radiotherapy
• Chemotherapy

17
Q

Describe coxsackie viruses in terms of

  • genetic material
  • the most common type of coxsackie virus
  • virus replication and transmission
A

Genetic material
• RNA virus

Common type of coxsackie virus
• Most common type is A and then type B

Virus replication and transmission
• Virus replicates first in the mouth and then extensively in the lower gastrointestinal tract
• Transmission is via fecal-oral route, but some shedding also occurs in the upper respiratory tract

18
Q

Describe Hand-Foot-and-Mouth Disease in terms of:

  • Incubation and transmission
  • Clinical appearance
  • Symptoms (4)
  • Diagnosis
  • Treatment
A

Incubation and transmission
· Incubation period of 3-7 days
• Affects infants and children between 3 and 10
• Most common coxsackie A16
• Fecal-oral or via inhalation of respiratory droplets
• Transmission via direct interaction with cutaneous lesions

Clinical appearance
• Vesicles and oral ulcers: buccal mucosa, labial mucosa, tongue, but any site can be affected
• Vesicles on hands and soles of feet

Symptoms
• Fever
• Reduced appetite
• Sore throat
• Malaise

Diagnosis
• Clinical diagnosis

Treatment
• Mainly supportive via hydration, topical/systemic analgesics and antipyretics

19
Q

Describe herpangina in terms of what type of coxsackie virus it is, transmission, clinical appearance, diagnosis and treatment

A

Coxsackie virus type
• Type A coxsackie group infection
• Occurs most commonly in children

Transmission
• Via saliva or fecal-oral route

Clinical appearance
• 24-48 h diffuse erythema and vesiculation of posterior region of oral mucosa and oropharynx
• Soft palate, tonsillar pillars
• Vesicles rupture to give rise to shallow and painful ulcers

Diagnosis
• Based on clinical picture

Treatment
• Adequate hydration, appropriate analgesia and antipyretics

20
Q

List the 4 types of human papillomavirus

A
  • Dermatotropic vs Mucosotropic

* Oncogenic vs Non-oncogenic

21
Q

List and describe the 3 types of non-oncogenic HPV diseases

A

Squamous Papilloma
• Most common oral HPV lesion
• HPV 6 and 11
• Small, finger like projections giving rise to a rough or cauliflower-like surface
• Treatment: excisional biopsy via scalpel or laser surgery

Condyloma acuminata
• Warts
• Possibly acquired sexually 
• Gives rise to similar lesions to SP
• HPV types 2, 6, 11

Verruca Vulgaris
• HPV 2, 4, 7 (sometimes also 1 and 57)
• Clinically indistinguishable from SP and condyloma acuminata
• May arise on the oral mucosa

22
Q

Describe multifocal epithelial hyperplasia (heck disease) in terms of:

  • the type of HPV it is
  • clinical appearance
  • Diagnosis
  • treatment
A

Classification
• Non - oncogenic

Clinical appearance
• Multiple soft, flat or rounded elevated nodules
• Develop early childhood
• Persist for several years and regress spontaneously

Diagnosis
• Clinical picture and review of genetic background
• Histopathology and Immunohistochemistry

Treatment
• No specific
• Removal of unsightly lesions and those that interfere with function

23
Q

Describe oncogenic HPV disease

A
  • Recognised as a cause of some squamous cell carcinoma
  • Tongue, tonsillar area and upper pharynx
  • Males under 50 years of age with no tobacco or alcohol use
  • Better survival rate than oral SCC related to tobacco and alcohol
  • HPV type 16-implicated in cervical cancers of females and anogenital cancers of males
24
Q

Describe measles and describe koplik spots

A
  • Viral infection preventable by vaccine (MMR-measles, mumps, rubella)
  • Prodromal phase: upper respiratory tract infection, tonsillopharyngitis and Koplik spots
  • Koplik spots: small, white lesions with erythematous bases on the buccal mucosa and inner aspect of the lower lip
25
Q

List three viral sources of viral infections of salivary glands

A
  • Mumps
  • Hepatitis C Virus (HCV)
  • HIV salivary gland disease
26
Q

Describe three sources of viral infections of salivary glands

A

Mumps
• Uncommon due to availability of vaccine
• May affect one or both parotid glands, submandibular and rarely sublingual glands

Hepatitis C Virus (HCV)
• Painful or painless swelling of one or both parotid glands
• Xerostomia

HIV salivary gland disease
• Salivary gland manifestations in up to 10% of individuals with untreated HIV

27
Q

Briefly describe HIV in terms of:

  • genetic material
  • the way it affects individuals
  • concerning oral presentations
A

Genetic material
• HIV comprises two main RNA viruses: HIV-1 and HIV-2

The way it affects individuals
• Clinical disease is a result of loss of CD4+ T lymphocytes and failure of cell-mediated immunity

Concerning oral lesions
• Increases the risk of opportunistic infection; viruses, mycobacteria and fungi
• Oral disorders have fallen due to availability of antiretroviral therapy
• Look out for: Pseudomembranous candidiasis, hairy leukoplakia and Kaposi’s sarcoma