Viral Infections Flashcards
1
Q
Clinical Features
- Prodromal symptoms 12-24h before
- Abrupt onset
- Pinhead vesicles rapidly collapse → Multiple small erythematous lesions → Enlarge → Develop central ulceration covered by yellow fibrin
- Enlarged, painful, erythematous gingiva
- Resolves in 5-7 days (Mild) to 2 weeks (Severe)
A
Primary Herpetic Gingivostomatitis
2
Q
HSV remains latent in the?
A
Trigeminal ganglion
3
Q
Clinical Features
- Prodromal signs: Pain, burning, itching 6-24 hours before
- Multiple small, erythematous papules develop → Form a cluster of fluid-filled vesicles -> Rupture and crust within 2 days
- Heals within 7-10 days
A
Herpes Labialis
4
Q
Clinical Features
- 1-3mm vesicles rapidly collapse to form a cluster of erythematous macules with central yellowish ulceration
- 7-10 days to heal
A
Recurrent HSV (Immunocompetent)
5
Q
Investigation for HSV
A
- Viral isolation from tissue culture inoculated with fluid of intact vesicles
- Cytological smear
- Perilesional tissue biopsy
6
Q
Management of HSV in healthy patients
A
Supportive care and symptomatic management
- Warm salt water sinse
- Lidocaine 2% topical
- Oral analgesics (NSAIDs, opioids)
- Adequate nutrition and fluids replacement
7
Q
Management of HSV in immunocompromised patients
A
Systemic therapy
- Acyclovir 200mg 5times a day over 7-10 days
- Valacyclovir 1000mg/8hr over 7 days
8
Q
VZV is latent in the?
A
Sensory nerve ganglia
9
Q
What is Varicella?
A
Benign self-limiting illness in immunocompetent children
10
Q
Risk factors of Herpes Zoster (Shingles)
A
1 HIV infection, Radiation, Immunosuppressive agents
- Malignancies
- Old age
- Stress and alcohol
11
Q
Complications of Herpes Zoster
A
- Ramsay Hunt Syndrome
- Post herpetic neuralgia
12
Q
Clinical Features
- Systemic signs: Fever, malaise, pharyngitis, rhinitis
- Dermatologic findings
- Initial pruritic rash (exanthema)
- Erythema → Vesicle → Pustule → Crusting - Oral Findings
- Small aphthae-like ulcers on palate and buccal mucosa
- Painless lesions
- Vesicles rupture → 1-3mm ulcers x30
- Last for 5-10 days
A
Varicella (HHV-3)
13
Q
Clinical Features
- Prodromal signs: Tingling, burning, itching, flu-like symptoms
- Acute
- Clusters of fluid-filled vesicles on erythematous base → Ulcers
- Crusting occurs - Chronic
- Persistent pain longer than 3 months - Extends to midline and occur in conjunction with involvement of overlying skin
- Ocular involvement
A
Herpes Zoster (Shingles)
14
Q
Investigation for VZV
A
- Cytological smears
- Histology of tissue
- Viral culture, immunofluorescence stains for VZV antibodies
15
Q
Management of Varicella in healthy patients
A
Supportive care
16
Q
Management of Varicella in immunocompromised patients
A
Purified VZV Ig
17
Q
Prevention of VZV
A
- VZV vaccine (live attenuated virus)
- Recommended in those >60 years old
18
Q
Management of Herpes Zoster
A
- Supportive care and symptomatic relief: Anti-pyretics and anti-pruritics
- Early use of anti-viral medications
- Acyclovir 800mg 5 times a day, over 7-10 days
- Valacyclovir 1000mg/ 8 hours over 7 days
19
Q
Management of post-herpetic neuralgia
A
- Systemic steroids
- Early use of systemic antivirals
- Anti-depressants and anti-convulsants: Neurontin
- Symptomatic relief with Lidoderm patches
20
Q
Clinical Findings
- Children: Asymptomatic
- Young adults: Fever. lymphadenopathy, pharyngitis and tonsillitis
- Adults >40 years old: Fever and pharyngitis
A
Epstein Barr Virus infection (HHV-4)
21
Q
Conditions associated with Epstein Barr Virus
A
- Infectious mononucleosis
- Oral hairy leukoplakia
- Burkitt lymphoma
- Nasopharyngeal Carcinoma
22
Q
Management of EBV
A
- Infectious mononucleosis resolves within 4-6 weeks
- NSAIDs can be used to minimize most common symptoms
23
Q
CMV is latent in?
A
Salivary glands, macrophages, lymphocytes and endothelial cells
24
Q
Clinical Findings
- Neonates
- Ill within few days
- Hepatosplenomegaly
- Tooth defects - Immunocompromised adults
- Fever, malaise, myalgia, abnormal liver function tests, atypical peripheral leukocytes
- 1/3 has pharyngitis, lymphadenopathy
A
Cytomegalovirus (HHV-5)
25
Management of CMV infection
Resolve spontaneously in healthy patients
Therapy required in immunocompromised patients: Ganciclovir/Valganciclovir
26
Investigations for Viruses
1. Cytological smears
2. Histology of tissue
3. Others: Viral culture, PCR, Serology testing
27
Location of Primary Herpetic Gingivostomatitis
Non-keratinised and keratinised gingiva
28
Location of Recurrent HSV (Immunocompromised)
Non-keratinised mucosa
28
Location of Recurrent HSV (immunocompetent)
Keratinised mucosa bound to bone (Attached gingiva and hard palate)
29
HFMD is caused by?
Coxsackie A16, enterovirus 17
29
Clinical Features
1. Flu-like symptoms
2. **Macules** → 1-5mm **vesicles** → Oral ulcers
3. Heal within 1 week
Oral lesions of HFMD
30
HFMD occurs in the?
Labial and buccal mucosa, tongue
31
Herpangina is caused by?
Coxsackie A1-6, A8, A10, A22
31
Location of Recurrent VZV infection (Herpes Zoster/Shingles)
Non-keratinised and keratinised mucosa
32
Clinical Features
1. Systemic symptoms: Sore-throat, dysphagia, fever, malaise
2. Red **macules** → Fragile **vesicles** → Multiple small 2-3mm **ulcers**
3. Lesions heal in 7-10 days
Herpangina
33
Location of Herpangina
Soft palate or oropharynx
33
Management of Herpangina
1. Self-limiting
2. Supportive: Fluid intake and adequate nutrition, topical anesthetics, analgesics, anti-pyretic
34
Management of HFMD
1. Self-limiting
2. Supportive: Fluid intake and adequate nutrition, topical anesthetics, analgesics, anti-pyretic
35
Oral manifestations of HIV
1. Candidiasis
2. Oral hairy leukoplakia
3. Karposi sarcoma
4. ANUG
36
Human Papilloma Virus is latent in?
Epithelial cells
37
Clinical Features
1. White papule/nodule
2. Papillary projections
3. Painless, pedunculated/sessile
4. Keratin horn
5. Children
Verruca Vulgaris (HPV 2,4)
38
Clinical Features
1. Well-demarcated, exophytic mass
2. Short, blunted surface projections
3. Painless, sessile, pink
4. Teenagers and young adults
Condyloma Acuminatum (HPV 6,11)
38
Clinical Features
1. Solitary, exophytic nodule
2. Finger-like projections
'Cauliflower' appearance
3. Painless, pedunculated, soft
4. White/red/normal in colour
5. Adults
Squamous papilloma (HPV 6,11)
39
Management of Squamous Papilloma
Conservative surgical excision including base of lesion
39
Management of Verucca Vulgaris
Excised surgically or laser, cryotherapy or electrosurgery
41
Histopathological Features of HPV
Proliferation of keratinised squamous epithelium arranged in finger-like projections with fibrovascular CT cores
2. Koliocytes (Viral-altered epithelial cells) in spinous cell layer
42
Differential Diagnosis of HPV lesions
1. CA larger lesions than SP
2. CA has more blunt and broad cores
