Viral Infections Flashcards
What is primary hermetic gingivostomatitis?
Common in children
HSV-1 infection resulting in grey blisters which rapidly break down into small ulcers with elevated margins (throughout the mouth)
May also present with crusted blisters on peri oral skin
Child usually presents with prodromal illness - fever, malaise, bilateral lymphadenopathy and generalised gingival inflammation
What is the prodrome period of primary herpetic stomatitis?
2-4 days
What is the transmission of HSV-1
Direct contact
What is the treatment for primary herpetic stomatitis?
Condition is self limiting and resolves within 10-14 days so no active treatment is required.
Symptomatic relief, rest and maintaining fluids
What are serious compilations of herpes simplex virus?
Erythema multiforme
Encephalitis
What are some questions to ask the parents when child presents with primary gingivostomatitis?
When did you notice gums were inflamed?
Has child been unwell/ fever?
Have you ever had cold sores?
Has child has this before?
Can the child swallow?
Have they been eating/ drinking?
Extra oral manifestations?
MH - co existing conditions which may suggest differential diagnosis eg chrons or which may make child immunocompromised
What is the symptomatic relief for primary gingivostomatitis?
Paracetamol/ ibuprofen to manage pain and fever
Soft diet
Keep child hydrated
Benzydamine hydrochloride (difflam)
CHX to reduce risk of secondary bacterial infection
What is the antiviral treatment for primary gingivostomatitis?
Oral acyclovir within 5 days of prodromal period/ when new lesions are still forming
When should you refer a child with primary herpetic gingivostomatitis?
When difficulty swallowing
Dehydrated
Immunocompromised
Uncertain diagnosis
Erythema multiforme
If does not resolve within 14 days
What is herpes labialis?
Cold sores
After primary infection of HSV1, HSV remains in trigeminal ganglion and low levels of virus are present.
Recurrent HSV can also affect the hard palate
What triggers herpes labialis?
Exposure of the lip to intense sunlight, depressed immunity etc
What is herpes zoster?
HHV-3
Causative agent for chicken pox and shingles
What is shingles?
Affects one or more dermatomes of the trigmeinal nerve - causing grey vesicles intraorally (restricted to the innervation of the dermatome) and painful/ itchy rash extra orally.
What is the treatment of shingles?
High dose systemic aciclovir
What is Coxsackie virus
Causes hand foot and mouth disease and herpangina
Manifests as vesicular eruptions
What is Epstein Barr virus? And its manifestation
HHV-4
Causes hairy leukoplakia - associated with the progression of HIV to AIDS as CD4-T cell count falls. Proliferation of epstein Barr virus in the lateral tongue epithelium causes warty ridged/ smooth white plaques on tongue
What Intra oral manifestations does human papillomavirus have?
Focal proliferation lesions referred to as squamous papillomas (warts) - may be senile or finger-like projections
Is an important cause of oropharyngeal cancer (found in 70% of tonsillar cancer) - HPV positive tumours have better prognosis (better response to chemo and radiotherapy)
What are some oral manifestations of HIV?
Kaposi sarcoma - initial lesions are flat brown spots which show haemosiderin deposition and vascular proliferation. Progression into raised plaques, then nodular purple lesions on palate and retromolar gingivae.
Hairy leukoplakia
Erythematous candidiasis - white speckles on erythematous background, frequently affecting tongue and palate. Treatment can be difficult due to resistant fungal strains in some patients.
Hyperplastic and pseudomembranous candidiasis
Gingivitis- which may resemble NG
Perio
