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osomop 4th > viral infections > Flashcards

viral infections Flashcards

1
Q

what are the 3 main virus groups that cause mucosal diseases

A
  1. human herpes virus
  2. paramyxovirus
  3. human papilloma virus
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2
Q

what are herpes group viruses?

A

DNA viruses, all characterised by latency

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3
Q

list the herpes group viruses

A

> herpes simplex 1 and 2

> varicella - zoster virus

> Epstein - Barr virus

> cytomegalovirus

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4
Q

describe HHV1?

A

causes primary herpetic gingivostomatitis may become latent and recur as a cold sore

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5
Q

describe HHV2?

A

also known as HSV-2, causes genital herpes and occasionally causes oral disease that is clinically similar to that of HHV-1 infection

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6
Q

describe HHV-3?

A

also known as varicella-zoster virus, causes the primary infection chickenpox and the secondary reactivation herpes zoster.

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7
Q

describe HHV-4?

A

Epstein-Barr virus causes infectious mononucleosis. Implicated in various diseases, such as oral hairy leukoplakia

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8
Q

describe HHV-5?

A

also known as cytomegalovirus (CMV), causes primary infection of the salivary glands & other tissue, it is believed to have a chronic form

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9
Q

describe HHV-6?

A

causes roseola infantum, a febrile illness that affects young children. Believed to chronically persist in salivary gland in some hosts

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10
Q

describe HHV-7?

A

has been isolated from the saliva of healthy adults and has been implicated as one cause of roseola infantum

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11
Q

describe HHV-8?

A

is associated with Kaposi sarcoma

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12
Q

how is the herpes simplex virus transferred?

A

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

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13
Q

what is the HPC of primary herpatic gingivo stomatitis?

A

> onset - sudden onset, incubation period = 2-20 days

> duration - 10-14 days

> number - only 5% clinically severe

> frequency - once only infection

> sites - any mucosal site

> systemic upset - varies with clinical severity

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14
Q

what is the oral clinical features of PHGS?

A

> Variable, usually ulcers

> Worse in atopics and immunocomp

> May be subclinical

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15
Q

what is the extra oral features of PHGS?

A

> Cervical lymph adenopathy

> Pyrexia

> Rarely macular skin rashes

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16
Q

how do you diagnose PHGS?

A

> Virus PCR swab
Clinical diagnosis

Antibody status in acute and convalescent sera

Immunofluorescence

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17
Q

what is the managment of PHGS?

A

> Maintain fluid intake: lollies

> Analgesic therapy

> Systemic acyclovir: severe cases

> Mouthwash therapy

> Limit spread to other body sites

> Limit spread to other individuals

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18
Q

what happens after the PHGS has cleared?

A

> the herpes simplex virus may become latent in th snesory ganglia
often the trigeminal ganglion

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19
Q

what are the clinical features of recurrent herpes simplex? (herpes labialis)

A

> Initial prodrome

> Clusters of tiny blisters, which ulcerate

> Crusting and healing

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20
Q

what is the HPC of herpes labialis?

A

> onset - spontaneous, trauma, menstration or sunlight

> Duration - 7-10days

> number - single or multiple

> sites - junction vermillion border lip

> systemic upset - uncommon

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21
Q

what is the management of herpes labialis?

A

> Preventive measures, e.g sunblocks

> Warn patients of infectivity of the lesion

> Topical acyclovir cream in prodromal phase

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22
Q

how does recurrent intraoral herpes simplex present?

A

> Unilateral linear distribution of ulcers, often in palate

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23
Q

what happens in patients with severe immune defects with herpes labialis?

A

atypical forms can be seen eg tongue

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24
Q

what dental implications does HSV cause?

A

> Transmission to dentist (herpetic whitlow or keratitis)

> Transmission to dental equipment and surgery surfaces

> Cross infection control of paramount importance

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25
Q

how is the varicella zoster virus transferred?

A

> Highly contagious

> direct contact, coughing, sneezing

26
Q

what is the initial infection of the varicella- zoster virus?

A
  • chickenpox
27
Q

Where does the varcicella zoster virus lie dormant?

A

> in the dorsal root, cranial nerve or autonomic ganglion

28
Q

what is the recurrent infection caused by the varicella zoster virus?

A

> herper zoster
better known as shingles

29
Q

what is the clinical appearance of herpes zoster (shingles)

A
  • unilateral
    -painful
    -vesicular eruption
  • localised to a single dermatome

> intraoral lesions with obvious unilateral appearance

30
Q

what is the HPC of herpes zoster ? (shingles)

A

> reactivation associated with impaired host immunity

> pain preceeds eruption by 2-4 days

> common most CNS viral infection

> usually 40+ age group

31
Q

what is the management for herpes zoster (shingles) ?

A

> high dose systemic acyclovir for 7-10 days
800mg x5/day

32
Q

what is the dental significance of herpes zoster (shingles) ?

A

> infectivity of lesions

> pain may mimic toothache

> post herpetic neuralgia

33
Q

what is the pathology behind the varicella zoster virus?

A

> Degeneration of epithelial cells leads to vesicle formation and ulcer formation

> Chronic inflammatory cell infiltrate in the connective tissues

34
Q

what is the Epstein Barr virus associated with?

A

> associated with glandular fever

> associated with hairy leukoplakia

> EBV related to oral ulceration - mimics SCC in immunocompromised

> associated with mumps like disease

35
Q

what is cytomegalovirus associated with ?

A

> oral ulceration in immunocompromised host

36
Q

what can cytomegalovirus affect?

A

> salivary glands in infants and immunocompromised

37
Q

what is the action of acyclovir (anti viral drug_

A
  • antiviral drugs should affect the virus but not host cells
  1. Analogue of purine nucleotide
  2. Viral enzymes phosphorylate drug to Acyclo-AMP
  3. Cellular enzymes phosphorylate Acyclo-AMP to Acyclo-GTP
  4. Acyclo-GTP inhibits viral DNA synthesis
38
Q

what is the uses of acyclovir?

A

> Herpes labialis
Primary herpetic gingivostomatitis
Herpes Zoster Infection

39
Q

what is the pharmacokinetics of acyclovir?

A
40
Q

what is the pharmacokinetics of acyclovir?

A
  • Oral absorption moderate
  • Half life 2.5 hours
  • Crosses blood brain barrier
  • Eliminated by the kidney
41
Q

what is the acyclovir treatment for primary gingivostomatis?

A

> only in severe cases

  • Systemic therapy 200mg five times a day
  • Begin treatment at onset of infection
  • Children over 2 years old – full adult dose
42
Q

what is the acyclovir treatment for herpes labialis?

A
  • Topical (5%) cream in prodromal phase
  • Aborts lesion in prodromal phase in 40% cases
  • Reduces duration of lesions which develop
43
Q

what is the paramyxovirus better known as?

A

> large family - measles virus and mumps virus

43
Q

what is the paramyxovirus better known as?

A

> large family - measles virus and mumps virus

44
Q

what is the transmission pathway for measles?

A

> Primarily air borne
Highly contagious
Effective vaccination programme

45
Q

what is the clinical features of measles ?

A

> Respiratory symptoms
- Cough, runny nose

> Inflamed eyes
Pyrexia
Rash
Koplik spots
- intra-oral may form before skin rash

> Usually self limiting
Potentially serious / life threatening complications eg encephalitis, pneumonia, blindness

46
Q

what is the transmission pathway of mumps?

A

> Airborne
Inanimate objects
Highly contagious
Effective vaccination programmes

47
Q

what is the clinical features of mumps?

A

> Enlarged salivary glands
- Usually parotids
- Bi or unilateral

> Flu like symptoms
- Joint pain, headache, pyrexia, general malaise

> Usually self limiting
Potentially serious complications
- Meningitis, orchitis, oophoritis, pancreatitis, deafness,

48
Q

how do you diagnose measles and mumps?

A

> Clinical – both mumps & measles have distinct clinical picture
PCR
Acute and convalescing serum

49
Q

what is the treatments for measles and mumps?

A

> Supportive therapies
- Fluids, bed rest, analgesia

> Notify Public Health Agency

50
Q

what is the symptoms of hand foot and mouth disease?

A
  • General malaise
  • fever
  • flat red rash on hands, feet & around mouth.
  • Rarely complications eg meningitis
51
Q

what causes HFM disease?

A
  • variety of viruses
52
Q

what age is HFM disease most common?

A

< 5 years

53
Q

what is the diagnosis and treatment of HFM disease?

A

> diagnosis - clinical

> treatment - supportive

54
Q

what type of virus is the human papilloma virus?

A
  • DNA virus
  • over 100 types discovered
55
Q

how is the human papilloma virus transferred?

A
  • skin to skin contact
  • infectivity not fully understood, there are links with tobacco and sun exposure
56
Q

what is the the clinical appearance of a squamous papilloma?

A
  • pedunculated
  • finger like projections
  • benign mucosal mass
57
Q

what HPVs cause a squamous papilloma?

A

6 and 11

58
Q

what is the treatment if the squamous papilloma?

A
  • excisional biopsy
59
Q

how does the HPV become malignant in a host?

A

> HPV can integrate into host’s genome
interfere with function of regulatory proteins eg p53, p16, and pRb
loss of control over cell proliferation
Most types are considered “low-risk” for development of malignancy, but about 13 types are considered “high-risk”.

osomop 4th (18 decks)

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