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Oral Medicine > Viral Infections > Flashcards

Viral Infections Flashcards

1
Q

What is the primary occurrence of HSV1?

A

Primary herpetic gingivostomatitis

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2
Q

How is HSV1 spread & what is the incubation period?

A

Via saliva

4-7 day incubation period

Most common in young children

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3
Q

Clinical presentation of primary herpetic gingivostomatitis?

A

2-3mm vesicles on keratinised tissue which rupture => painful ulcers which heal in 7-10 days

Diffuse gingivitis

Lip erosions

Cervical lymphadenopathy

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4
Q

Prodromal symptoms of primary herpetic gingivostomatitis?

A

Malaise, irritability & fever

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5
Q

How to diagnose primary herpetic gingivostomatitis?

A

Usually clinical observations alone

Can be confirmed through viral culture, electron microscopy & PCR

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6
Q

How to manage primary herpetic gingivostomatitis?

A

Reassure pt (resolution in 2-3 weeks)

Encourage rest & fluid intake (dehydration risk)

Prevention of spread (limit close contact to reduce spread)

Antiseptic mouthwash (e.g. CHX) to prevent secondary bacterial infection

Simple analgesics/antipyretics (e.g. paracetamol)

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7
Q

How to to manage severe cases of primary herpetic gingivostomatitis?

A

Aciclovir suspension or tablets

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8
Q

Where does HSV1 virus remain?

A

Latent/dormant in the dorsal root of trigeminal ganglion or localised neural tissue

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9
Q

How can HSV1 recur?

A

Herpes labialis (cold sore)
Intra-oral reactivation
Herpetic whitlow
Erythema multiforme

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10
Q

What can trigger HSV1 reactivation?

A

Sunlight (UV radiation)

Trauma (e.g. post-op onset)

Menstruation

Immunosuppression (e.g. HIV, transplants or chemotherapy)

Infection (e.g. pneumonia)

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11
Q

Prevention/management of HSV1 recurrence?

A

Prevention = Suncreen & PPE (hand/eye protection)

Topical acyclovir or peniciclovir => reduced severity & duration of attack

Systemic acyclovir prophylaxis (severe)

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12
Q

Clinical features of intra-oral reactivation of HSV1?

A

Occurs on keratinised tissue - often on hard palate (near greater palatine foramen) or attached gingiva

Prodromal tingling followed by painful localised collection of vesicles which ulcerate

Usually follows dental tx

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13
Q

Clinical features of herpetic whitlow?

A

Oedema

Intense pain

Erythema

Followed by crusting vesicular lesion on digits

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14
Q

Occupation risk associated with herpetic whitlow?

A

HSV acquired from pt saliva => affects skin of digits

Highly infective

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15
Q

Aetiology of erythema multiforme?

A

Infections - HSV (70%), hepatitis, mycoplasma, bacterial, fungal or parasites

Medication - NSAIDs, anti-fungals or barbiturates

Systemic - SLE, malignancy or pregnancy

Idiopathic (50%)

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16
Q

Clinical features of erythema multiforme?

A

Oral lesions:
- Bullae or erythematous blister break to form irregular ulcers that bleed & crust over
- Lip crusting common

Skin lesions:
- ‘Target/iris lesion’ of macules & papules, pale area surrounding by oedema & bands of erythema
- Often affects extremities (palms & soles)

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17
Q

Dental tx for patients with active herpetic lesions?

A

Postpone elective dental treatment due to infectious nature

Complete emergency treatment only (avoid aerosols)

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18
Q

How to treat recurrent herpes lesions?

A

Topical use (5%) QDS - used early on
Systemic use - prophylaxis or tx

19
Q

What is caused by the primary infection of HH3/VZV?

A

Chicken pox

20
Q

Clinical features of primary HH3/VZV infection?

A

Initial site = upper respiratory tract (14 day incubation period)

2-3 weeks after initial infection: Itchy, maculopapular rash on back, chest & face

Oral presentation:
- Vesicles/ulceration
- Most common on hard palate/fauces/uvula

21
Q

How can VZV/HHV3 recur?

A

Shingles
Post herpetic (Trigeminal) neuralgia
Ophthalmic shingles
Ramsay-Hunt Syndrome

22
Q

Where does HHV3/VZV remain latent?

A

In dorsal root or cranial ganglia

23
Q

What can trigger VZV/HHV3?

A

Immunosuppression (e.g. AIDS, Hodgkin’s lymphoma, transplant, age)

24
Q

Clinical presentation of shingles?

A

On trunk - erythematous painful lesion

Systemic illness - malaise, pyrexia & lymphadenopathy

25
Q

What is post herpetic neuralgia?

A

Burning continuous pain & allodynia

Occurs in ‘zone of eruption’

26
Q

What is ophthalmic shingles?

A

Risk of corneal scarring & vision loss - urgent ophthamology referral

27
Q

What is Ramsay-Hunt syndrome?

A

VZV infection affecting geniculate ganglion

Lower motor neuron facial nerve palsy

Vesicular rash present on EAM & palate

Dizziness, loss of taste

28
Q

Management of VZV recurrence?

A

Pain relief (opioids may be required)
Antiviral treatment

29
Q

What disease does EBV/HHV4 cause?

A

Infectious mononucleosis/glandular fever (‘Kissing disease’)

30
Q

Clinical presentation of infectious mononucleosis/glandular fever (‘Kissing disease’)?

A

Lymphadenopathy - generalised & tender

Sore throat

Faucal oedema & creamy tonsillar exudate

Oral (30%) - palatal petechiae (purple spot rash) & gingival bleeding

General - fever, malaise/lassitude & anorexias

31
Q

How to manage infectious mononucleosis/glandular fever (‘Kissing disease’)?

A

Symptomatic management - no specific tx

Bed rest, fluid intake, analgesics

Antiseptic m/ws

32
Q

Where is EBV infection also complicated in?

A

Oral hairy leukoplakia
Non-Hodgkin’s & Burkitt’s lymphoma
Nasopharyngeal carcinoma

33
Q

Prevalence of oral hairy leukoplakia?

A

Immunocompromised or use of potent oral corticosteroids

34
Q

Clinical presentation of oral hairy leukoplakia?

A

Asymptomatic, white lesion with flat/plaque-like papillary villous on lateral border of tongue

35
Q

What does HHV8 cause?

A

Kaposi’s sarcoma

36
Q

Clinical presentation of Kaposi’s sarcoma?

A

More common in males

Affects palate & gingival tissues - reddy-blue or purple macules/modules which may ulcerate

Oral KS = pathognonomic of AIDS

Promotes angiogenesis

37
Q

Clinical presentation of HPV?

A

HPV-related lesions on hands & fingers (Butcher’s warts), genital mucosa (condyloma) & skin - may be transferred to oral cavity

38
Q

What does Coxsackie virus cause?

A

Hand, foot & mouth disease

39
Q

Clinical features of hand, foot & mouth disease?

A

Prodrome - mild systemic upset

Triad of manifestations = erythematous macular & vesicular eruptions on hands, feet & oropharyngeal mucosa

Skin lesions (hand/feet) transient * last 1-3 days

Ora lesions: affect pharynx, soft palate, buccal mucosa & tongue
- Multiple shallow & painless oral vesicles/ulcers
- No lymphadenopathy
- No gingival involvement

40
Q

How to manage hand, foot & mouth disease?

A

Supportive (e.g. fluids & antiseptic m/w)

Differentiate from primary herpetic gingivostomatitis (serology needed)

41
Q

2 diseases caused by paramyxovirus?

A

Measles
Mumps

42
Q

Clinical features of measles?

A

Koplik’s spots (formed 1-2 days prior to rash onset)
- Irregular, patchy erythema with tiny central white specks
- Affect buccal & labial mucosa

Fever, rhinitis, cough & conjunctivitis

Spreading maculopapular rash (starting at forehead & ears)

43
Q

Clinical features of mumps?

A

Painful swelling of major salivary gland

General - headache, joint pain, dry mouth, trismus, pyrexia & anorexia

44
Q

Oral lesions associated with HIV?

A

Candidiasis (pseudomembranous, erythematous or hyperplastic)

Oral hairy leukoplakia (caused by EBV - opportunistic pathogen)

Kaposi’s sarcoma (tumour of endothelial cells caused by HHV8 - opportunistic pathogen)

Non-Hodgkin’s lymphoma

Periodontal disease (necrotising ulcerative gingivitis or periodontitis)

Oral ulcers

Oral Medicine (9 decks)

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