1. Direct contact with infective lesion 2. Contact with infected saliva from individual shedding of the virus 3. Transfer via inanimate objects

Viral Infections Flashcards by Josh Kennedy

Herpes Group Viruses

HSV 1 and 2
Varicella-Zoster virus
Epstein-Barr virus
Cytomegalovirus

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HHV1

Primary herpetic gingivostomatitis may become latent and recur as a cold sore

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HHV 2

Genital herpes and occassionally causes oral disease that is similar to HHV 1

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HHV 3

Varicella zoster virus
primary infection chickenpox
secondary reactivation herpes zoster

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HHV 4

Epstein Barr virus causes infection mononucleosis
Oral hairy leukoplakia

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HHV 5

Cytomegalovirus
Primary infection of salivary glands and other tissues

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HHV 6

Roseola Infantum
Febrile illness that affects young people
Chronically persists in salivary glands

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HHV 7

Saliva of healthy adults
Roseola Infantum

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HHV 8

Kaposi sarcoma

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HSV Transmission

Direct contact with infective lesion
Contact with infected saliva from individual shedding of the virus
Transfer via inanimate objects

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HSV

sudden onset, incubation period 2-20 days
duration, 10-14 days
number - 5% clinically severe
frequency, once only infection

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HSV Oral Clinical features

cervical lymph adenopathy
pyrexia
rarely macular skin rashes

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HSV diagnoses

virus PCR swab
clinical diagnoses
antibody status in acute and convalescent sera
immunofluorescence

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HSV management

maintain fluid intake
analgesic therapy
systemic acyclovir
mouthwash therapy

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Recurrent HSV CF

Initial prodrome
clusters of tiny blisters, which ulcerate
crusting and healing

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Herpes Labialis HPC

Spontaneous onset, trauma
7-10 days
single or multiple
junction vermilion border lip

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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