VIral Infections

Question 1

The types of Herpes virus disease ( MFP470 )

Answer 1

• Primary Herpetic Gingivostomatitis
• Epstein-barr virus (HH4)
• Recurrent herpes
• Herpes Zoster (HH3)
• Cytomegalovirus (HHV 5)
• Kaposi Sarcoma (HHV 8)

Question 2

HSV 1 vs 2

Answer 2

They are generally the same however
1 is above diaphragm and 2 is a genital virus

Question 3

Pathogenesis of Primary HSV1

Answer 3

Oral infection-DIrect contact
Move to trigeminal ganglion via sensory nerves
remains latent
uses the axons of the sensory nerves to travel back and forth to peripheral skin/mucosa

Question 4

HSV1 most common condition

Answer 4

Primary Herpetic Gingivostomatitis

Question 5

Adult varient of HSV1

Answer 5

Pharyngotonsillitis in adults

Question 6

symptoms Primary herpetic GIngivostomatitis

Answer 6

Fever,malaise, painful mouth

Question 7

Oral symptoms of PHG

Answer 7

small vesicles, ulcerations and enlarged painful gingiva

Question 8

how does secondary HSV 1 manifest

Answer 8

Re-activation resulting in - Herpes labialis

Question 9

Triggers for herpes labialis

Answer 9

UV, trauma, Immune deficiency

Question 10

Prodromal signs of Herpes Labialis

Answer 10

Itching,tingling and erythema

Question 11

Recurrent herpes simplex virus clinical features

Answer 11

Small cluster of vesicles on vermillion and peri-oral skin

it may present intra-orally on the posterior palate over the greater palatine foramina and occasionally on the gingiva. These vesicles ruptre and ulcerate within 10days

N.B Generally no fever or lymphadenopathy ( unless secondary infection ) - Herpetic whitlow ( hands and fingers )

Question 12

Herpes labialis vs recurrent aphthous ulceration

Answer 12

Recurrent aphthous ulceration usually forms on non-keratinzed mucosa — no vesicle phase.

Question 13

Treatment of recurrent herpes simplex virus

Answer 13

Penciclovir

Question 14

Management of Herpes labialis

Answer 14

Explain to patient the virus stays with them
- infection occurs dur to triggers such as trauma, immune deficiency Excessive UV light exposure

-DIfficulty to treat as resistant to anti-virals may occur
- When patient experiences tingling itching feeling with no ulcer - put patient on penciclovir ( prodromal stage)

With immune compromised patients – systemic medication

Question 15

Varicella zoster virus pathogenesis

Answer 15

It enters the host via ( air droplets ) the respiratory tract and conjunctiva and replicates at site of entry

or via direct contact with lesions
Primary infection in children presents as chicken pox ( varicella ) — recurrence presents as zoster ( shingles )

Question 16

Clinical features herpes varicella

Answer 16

Pruritic rash
vesicle pustul crust formation

Question 17

Herpes zoster ( secondary infection ) pathogenesis

Answer 17

Latent in dorsal root ganglia

Question 18

Herpes zoster clinical features

Answer 18

Unilateral vesicles that ulcerate
ramsey hunt syndrome
postherpetic neuralgia

Question 19

Herpangina ( hand foot and mouth disease ) path

Answer 19

Cocksakie A virus
RNA virus of picornavirus family
self limited symptomatic relief

Question 20

Clinical features of herpangina

Answer 20

Malaise, fever and sore throat
offten diffuse erythema on soft palate fauces and tonsillar areas
bilateral

Question 21

PHG vs herpangina

Answer 21

PHG is a gingivostomatitis
herpangina is an oropharyngitis
systemic features differentiate it from recurrent aphthous ulceration

Question 22

Human Papillomavirus varients

Answer 22

over 100
with high risk and low risk types

Question 23

Brief description of squamous cell papilloma

Answer 23

Benign exophytic papillary growth
Mostly subtype 6 and 11
soft, pedunculated cauliflower-like and painless lesion
simple excision
50-60 years

Question 24

Diff for squamous papilloma

Answer 24

Traumatic fibroma ( smooth surface and occurs in areas of chronic injury ) and fibro-epithelial polyp

Question 25

Brief description of verruca Vulgaris

Answer 25

Wart!
type 2 ,4 ,6 ,40
VV of oral cavity results from auto-inoculation from warts on the hands of children.
as with other HPV- viral DNA incoporates into human DNA

Generally in keratinized mucosa

slow growing, painless, exophytic pink to white lesions which consists of sharp, finger like processses

Question 26

Brief description of condyloma acuminatum

Answer 26

HPV 2 ,6 ,11 ,53 ,54
Sexually transmitted HPV, usually in genital areas.
multiple cauliflower like lesions
Infection of the oral ketinocytes

Generally in non-keratinzed tissue

Question 27

Multifocal Epithelial hyperplasia description

Answer 27

Type 13 32
hecks disease
appears similar to squamous papilloma
multiple elevated lesions on mucosal surfaces

Question 28

What is Hecks disease?

Answer 28

Is a HPV associated disorder with HPV type 13 and 32. Many genetic factors area at play

Question 29

Oropharyngeal Cancer Path

Answer 29

Associated with HPV 16 and 18

This includes carcinomas developing from the soft palate, base of tongue and palatine tonsil area and posterior pharyngeal wall

Patients
who smoke tobacca
have poor lifestyle choices
and partake in excessive alcohol use

Question 30

Oral hairy leukoplakia associated virus

Answer 30

Epstein-Barr virus

Question 31

OHL pathogenesis

Answer 31

Associated with immune deficiency
reduced number of CD4+ T-lymphocytes and associated with immune dysfunction
A good indicator of HIV

Question 32

OHL clinical features

Answer 32

Hyperplastic lesion which characteristic asymptomatic white vertical corrugations on lateral margin of the tongue

Question 33

DDX of OHL

Answer 33

leukoplakia
Friction keratosis
lichen Planus
chronic hyperplastic candidiasis