Viral Infections Flashcards
What is the primary occurrence of HSV1?
Primary herpetic gingivostomatitis
How is HSV1 spread & what is the incubation period?
Via saliva
4-7 day incubation period
Most common in young children
Clinical presentation of primary herpetic gingivostomatitis?
2-3mm vesicles on keratinised tissue which rupture => painful ulcers which heal in 7-10 days
Diffuse gingivitis
Lip erosions
Cervical lymphadenopathy
Prodromal symptoms of primary herpetic gingivostomatitis?
Malaise, irritability & fever
How to diagnose primary herpetic gingivostomatitis?
Usually clinical observations alone
Can be confirmed through viral culture, electron microscopy & PCR
How to manage primary herpetic gingivostomatitis?
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)
How to to manage severe cases of primary herpetic gingivostomatitis?
Aciclovir suspension or tablets
Where does HSV1 virus remain?
Latent/dormant in the dorsal root of trigeminal ganglion or localised neural tissue
How can HSV1 recur?
Herpes labialis (cold sore)
Intra-oral reactivation
Herpetic whitlow
Erythema multiforme
What can trigger HSV1 reactivation?
Sunlight (UV radiation)
Trauma (e.g. post-op onset)
Menstruation
Immunosuppression (e.g. HIV, transplants or chemotherapy)
Infection (e.g. pneumonia)
Prevention/management of HSV1 recurrence?
Prevention = Suncreen & PPE (hand/eye protection)
Topical acyclovir or peniciclovir => reduced severity & duration of attack
Systemic acyclovir prophylaxis (severe)
Clinical features of intra-oral reactivation of HSV1?
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
Clinical features of herpetic whitlow?
Oedema
Intense pain
Erythema
Followed by crusting vesicular lesion on digits
Occupation risk associated with herpetic whitlow?
HSV acquired from pt saliva => affects skin of digits
Highly infective
Aetiology of erythema multiforme?
Infections - HSV (70%), hepatitis, mycoplasma, bacterial, fungal or parasites
Medication - NSAIDs, anti-fungals or barbiturates
Systemic - SLE, malignancy or pregnancy
Idiopathic (50%)
Clinical features of erythema multiforme?
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)
Dental tx for patients with active herpetic lesions?
Postpone elective dental treatment due to infectious nature
Complete emergency treatment only (avoid aerosols)
How to treat recurrent herpes lesions?
Topical use (5%) QDS - used early on
Systemic use - prophylaxis or tx
What is caused by the primary infection of HH3/VZV?
Chicken pox
Clinical features of primary HH3/VZV infection?
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
How can VZV/HHV3 recur?
Shingles
Post herpetic (Trigeminal) neuralgia
Ophthalmic shingles
Ramsay-Hunt Syndrome
Where does HHV3/VZV remain latent?
In dorsal root or cranial ganglia
What can trigger VZV/HHV3?
Immunosuppression (e.g. AIDS, Hodgkin’s lymphoma, transplant, age)
Clinical presentation of shingles?
On trunk - erythematous painful lesion
Systemic illness - malaise, pyrexia & lymphadenopathy
What is post herpetic neuralgia?
Burning continuous pain & allodynia
Occurs in ‘zone of eruption’
What is ophthalmic shingles?
Risk of corneal scarring & vision loss - urgent ophthamology referral
What is Ramsay-Hunt syndrome?
VZV infection affecting geniculate ganglion
Lower motor neuron facial nerve palsy
Vesicular rash present on EAM & palate
Dizziness, loss of taste
Management of VZV recurrence?
Pain relief (opioids may be required)
Antiviral treatment
What disease does EBV/HHV4 cause?
Infectious mononucleosis/glandular fever (‘Kissing disease’)
Clinical presentation of infectious mononucleosis/glandular fever (‘Kissing disease’)?
Lymphadenopathy - generalised & tender
Sore throat
Faucal oedema & creamy tonsillar exudate
Oral (30%) - palatal petechiae (purple spot rash) & gingival bleeding
General - fever, malaise/lassitude & anorexias
How to manage infectious mononucleosis/glandular fever (‘Kissing disease’)?
Symptomatic management - no specific tx
Bed rest, fluid intake, analgesics
Antiseptic m/ws
Where is EBV infection also complicated in?
Oral hairy leukoplakia
Non-Hodgkin’s & Burkitt’s lymphoma
Nasopharyngeal carcinoma
Prevalence of oral hairy leukoplakia?
Immunocompromised or use of potent oral corticosteroids
Clinical presentation of oral hairy leukoplakia?
Asymptomatic, white lesion with flat/plaque-like papillary villous on lateral border of tongue
What does HHV8 cause?
Kaposi’s sarcoma
Clinical presentation of Kaposi’s sarcoma?
More common in males
Affects palate & gingival tissues - reddy-blue or purple macules/modules which may ulcerate
Oral KS = pathognonomic of AIDS
Promotes angiogenesis
Clinical presentation of HPV?
HPV-related lesions on hands & fingers (Butcher’s warts), genital mucosa (condyloma) & skin - may be transferred to oral cavity
What does Coxsackie virus cause?
Hand, foot & mouth disease
Clinical features of hand, foot & mouth disease?
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
How to manage hand, foot & mouth disease?
Supportive (e.g. fluids & antiseptic m/w)
Differentiate from primary herpetic gingivostomatitis (serology needed)
2 diseases caused by paramyxovirus?
Measles
Mumps
Clinical features of measles?
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)
Clinical features of mumps?
Painful swelling of major salivary gland
General - headache, joint pain, dry mouth, trismus, pyrexia & anorexia
Oral lesions associated with HIV?
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
