Viral Infections Flashcards
Herpes Group Viruses
HSV 1 and 2
Varicella-Zoster virus
Epstein-Barr virus
Cytomegalovirus
HHV1
Primary herpetic gingivostomatitis may become latent and recur as a cold sore
HHV 2
Genital herpes and occassionally causes oral disease that is similar to HHV 1
HHV 3
Varicella zoster virus
primary infection chickenpox
secondary reactivation herpes zoster
HHV 4
Epstein Barr virus causes infection mononucleosis
Oral hairy leukoplakia
HHV 5
Cytomegalovirus
Primary infection of salivary glands and other tissues
HHV 6
Roseola Infantum
Febrile illness that affects young people
Chronically persists in salivary glands
HHV 7
Saliva of healthy adults
Roseola Infantum
HHV 8
Kaposi sarcoma
HSV Transmission
- Direct contact with infective lesion
- Contact with infected saliva from individual shedding of the virus
- Transfer via inanimate objects
HSV
sudden onset, incubation period 2-20 days
duration, 10-14 days
number - 5% clinically severe
frequency, once only infection
HSV Oral Clinical features
cervical lymph adenopathy
pyrexia
rarely macular skin rashes
HSV diagnoses
virus PCR swab
clinical diagnoses
antibody status in acute and convalescent sera
immunofluorescence
HSV management
maintain fluid intake
analgesic therapy
systemic acyclovir
mouthwash therapy
Recurrent HSV CF
Initial prodrome
clusters of tiny blisters, which ulcerate
crusting and healing
Herpes Labialis HPC
Spontaneous onset, trauma
7-10 days
single or multiple
junction vermilion border lip
Herpes Labialis management
preventive measures
warn pts of infectivity of the lesion
topical acyclovir cream in prodromal phase
Herpes Labialis dental implications
transmission to dentist
transmission to dental equipment
cross infection control of paramount importance
Varicella zoster virus
highly contagious - direct contact/coughing
initial infection
dormant in dorsal root, cranial nerve or autonomic ganglion
recurrent infection - herpes zoster
Herpes zoster CF
Unilateral painful vesicular eruption localised to a single dermatome
Herpes Zoster HPC
Reactivation associated with impaired host immunity
pain precedes eruption by 2-4 days
commonest CNS viral infection
40+ age group
Herpes Zoster management
high dose systemic acyclovir for 7-10 days
800mg x 5 days
Herpes Zoster dental significance
Infectivity of lesions
pain may mimic toothache
post herpetic neuralgia
Varicella zoster pathology
degeneration of epithelial cells leads to vesicle formation and ulcer formation
chronic inflammatory cell infiltrate in the connective tissue
Epstein Barr virus
associated with glandular fever
associated with hairy leukoplakia
EBV related to oral ulceration: mimics SCC in immunocompromised
associated with mumps-like disease
Cytomegalovirus
associated with oral ulceration in immunocompromised host
can affect salivary glands in infants and immunocompromised
Acyclovir
viruses are obligate intracellular parasites requiring host cell metabolic processes for replication
antiviral drugs should affect virus but not host cells
Acyclovir MOA
Analogue of purine nucleotide
Viral enzymes phosphorylate drug to Acyclo-AMP
Cellular enzymes phosphorylate Acyclo-AMP to Acylclo-GTP
Acyclo-GTP inhibits viral DNA synthesis
Acyclovir uses
Herpes labialis
Primary herpetic gingivostomatitis
Herpes Zoster Infection
Acyclovir pharmacokinetics
oral absorption moderate
1/2 2.5hrs
crosses blood brain barrier
eliminated by the kidney
Acyclovir and Primary Gingivostomatitis
systemic therapy 200mg 5x day
begin tx at onset of infection
children over 2yrs - full adult dose
Acyclovir and herpes labialis
topical 5% cream in prodromal phase
aborts lesion in prodromal phase in 40% cases
reduces duration of lesion which develop
Paramyxovirus
Measles virus
Mumps virus
Measles transmission
primarily airbone
high contagious
effective vaccination programme
Measles clinical picture
respiratory symptoms
inflamed eyes
pyrexia
rash
koplik spots
self limiting
potentially serious life threatening complications e.g., encephalitis, pneumonia and blindness
Mumps transmission
airborne
inanimate objects
highly contagious
effective vaccination programme
Mumps clinical picture
enlarged salivary glands
flu like symptoms
usually self limiting
potentially serious complications
Mumps diagnosis and tx
clinical
pcr
acute and convalescing serum
supportive therapies
notify public health agency
hand, foot and mouth disease
symptoms –> general malaise, fever, flat red rash on hands, feet and around mouth
diagnosis –> clinical
HPV: squamous papilloma
benign mucosal mass
pedunculated
finger like projections
HPV 6 and 11
excisional biopsy
