viral infections Flashcards

1
Q

which type of herpes is mainly found in the oral cavity? which type is associated with genital infections?

A

HSV-1 = predominantly oral

HSV-2 = predominantly genital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Initial contact with the herpes virus produces what?

A

a primary infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

HSV is __________, meaning it will be transported via nerves to sensory ganglia (latent stage)

A

neurotropic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how is primary herpes usually spread?

A

Spread through saliva, usually early in childhood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name the symptoms/signs of primary HSV:

A

Acute fever, cervical lymphadenopathy, oral sores

Oral lesions begin as vesicles that quickly rupture to form shallow ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what happens to the multiple small ulcers of primary HSV infections?

A

Small ulcers COALESCE

  • resulting in larger ulcers having SERPENTINE borders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the viral cytopathic effect (Tzanck Cells)? what condition is it associated with?

A
  • caused by PRIMARY herpes

- infected cells show multinucleation and ballooning degeneration of nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how can primary herpes be diagnosed?

A
  • Exfoliative cytology or biopsy
  • Viral culture
  • Sequential serum antibody titers
  • Immunohistochemistry on sampled tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the treatment for primary herpes if identified within 2-3 days of outbreak?

A

If identified within the first 2-3 days:

  • acyclovir or one of its analogues may be helpful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the difference between acyclovir and valacyclovir?

A

Valacyclovir (Valtrex) is absorbed better than acyclovir

  • it is is eventually metabolized to acyclovir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what can be used to treat the SYMPTOMS of primary herpes infections?

A
  • analgesics, antipyretics
  • Topical anesthetics so patient can eat and drink
  • popsicles can be good for children to soothe pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the prognosis for primary herpes? how long does the infection last?

A

Prognosis is generally good

Only one episode – lasts 10 to 14 days, even without treatment

Approximately 25% chance of developing at least one episode of recurrent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

name the 2 forms of recurrent herpes (recurrent HSV):

A

Recurrent Herpes Labialis

Recurrent Intraoral Herpes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: most patients with recurrent herpes can remember their initial exposure (primary infection)

A

FALSE

only 12% of affected individuals will remember primary infection (subclinical or mild symptoms)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what triggers Recurrent Herpes Labialis? what areas does it affect?

A

Triggered by UV light exposure or trauma

Affect vermilion zone or perioral skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the symptoms of recurrent herpes labialis?

A

Prodromal itching, tingling, burning, erythema

followed by cluster of vesicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

if recurrent herpes labialis is not treated, what occurs?

A
  • vesicles rupture, form a crust

- lesions heal in 7-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name the treatment options for recurrent herpes labialis:

A

Avoid excess sun exposure

Sunblocks may be helpful to prevent lesion development

Topical antiviral agents - statistically significant decrease in healing time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what treatment seems to be most effective in treating recurrent herpes labialis?

A

Patient-initiated systemic valacyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Recurrent Intraoral Herpes infections are found in what areas of the mouth?

A

mucosa bound to periosteum

hard palate and attached gingiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F: symptoms of Recurrent INTRAORAL herpes are milder than those of herpes labialis

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what condition can lead to recurrent herpes in any area of the mouth?

A

Immunosuppressed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

clinical signs of recurrent HSV in an immunocompromised patient:

A

Large shallow ulcers with elevated, scalloped borders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what viral condition can be caused by not wearing gloves while performing dental procedures?

A

Herpetic Whitlow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chickenpox represents a primary infection with what virus?

A

varicella-zoster virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how is varicella-zoster spread?

A

Spread through direct contact or air-borne droplets

Most cases occur during childhood; in the US, a vaccine is now routinely given to newborns, which has decreased infection rates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the clinical signs/symptoms of chickenpox (primary VZ infection)?

A

Cutaneous lesions – intensely pruritic vesicles
- “Dew drops on rose petals”

Vesicles rupture and form hardened crust

Fever and malaise are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

describe the oral lesions of the varicella-zoster virus:

A

A few 1-2 mm shallow oral ulcers may develop at any intraoral site

Generally not as symptomatic as the cutaneous lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

how is a varicella-zoster infection diagnosed? what treatments are available?

A

Diagnosis is generally based on clinical signs

Treatment is usually supportive; acyclovir (or one of its analogues) if detected within 1 day of onset

Good prognosis; complications are uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what disease may occur due to a recurrent infection of varicella-zoster?

what % of primary infected patients will have this reoccurrence?

A

herpes zoster

  • occurs in 10-20% of the population
31
Q

characteristics of herpes zoster (shingles)

A

Increasing frequency with aging

Painful erythema and vesicles, usually on trunk

May occur in head and neck region

Lesions stop at midline

32
Q

what is the treatment for a VZV infection?

A

Systemic acyclovir or valacyclovir (5x the dosage for HSV) if early in the course of disease

Good prognosis; lesions resolve in 2-3 weeks

33
Q

what severe condition can develop in patients with a shingles outbreak?

A

Post-herpetic neuralgia

effects about 15% of those infected

34
Q

what is Herpangina caused by?

A

Enterovirus infection caused by any one of several strains of coxsackievirus A or B, or echovirus

35
Q

Herpangina primarily effects what group?

A

Primarily affects children 1-4 years of age

36
Q

signs/symptoms of Herpangina:

A

localized to posterior soft palate/tonsillar pillar region

Acute onset of sore throat, fever and 2-4mm oral ulcers

37
Q

how long do most herpangina infections last?

A

usually resolving within 7-10 days

38
Q

Hand, Foot and Mouth Disease is caused by what virus?

A

Enterovirus infection usually caused by:
A) coxsackievirus A16

B) coxsackievirus A5, 9 and 10, as well as echovirus 10 or enterovirus 71 can also cause it

39
Q

what are the clinical signs of hand, foot and mouth disease?

A

Flu-like illness w/ sore throat and fever

Oral and hand lesions are most commonly seen

40
Q

what types of lesions develop during hand, foot and mouth disease?

A

Oral lesions consist of shallow ulcers typically 2-7 mm in diameter

Buccal mucosa, labial mucosa and tongue are most common intraoral sites

Skin lesions consist of 1-3 mm erythematous macules that may develop a central vesicle

41
Q

immunosuppression in HIV patients can lead to what complications?

A
opportunistic infection(s)
neoplasms
systemic features (gastrointestinal, pulmonary, dermatologic, neurologic, oral mucosal)
42
Q

HIV+ patient with CD4 count of ______ are considered to have AIDS

A

less than 200

43
Q

what treatment is used to combat the HIV virus?

A

Highly Active Antiretroviral Therapy (HAART)

44
Q

T/F: HAART therapy has made clinical manifestations of HIV much less common

A

True

45
Q

why are Head & Neck Manifestations of HIV important?

A

Often reflect immunocompromised state

May be FIRST SIGN of HIV infection

Some Predict PROGRESSION to AIDS

Some meet criteria for DIAGNOSIS of AIDS

46
Q

what is Persistent Lymphadenopathy?

A
  • found in HIV patients
  • Generalized non-tender lymphadenopathy
  • Cervical lymph nodes are frequently affected, including posterior cervical nodes
47
Q

besides HIV, what other conditions can cause persistent lymphadenopathy?

A

other infections; lymphoma; metastatic carcinoma

48
Q

what oral fungal infections affect those with HIV?

A

Candidiasis is most common

Histoplasmosis noted less frequently

49
Q

what are the oral presentations of histoplasmosis infections?

A

Present as non-healing ulceration or granular lesion

  • Pulmonary infection predominates, but dissemination to oral mucosa may occur
50
Q

what 4 bacteria-related conditions are associated with HIV?

A

1) Linear gingival erythema??
2) HIV-related periodontitis
3) Necrotizing ulcerative gingivitis
4) Necrotizing stomatitis

51
Q

what are the characteristics of Linear Gingival Erythema?

A

Unusual pattern of gingivitis

Red, linear band at the marginal gingiva

Spontaneous bleeding may be noted

Lack of response to improved oral hygiene

52
Q

T/F: the presentation of Necrotizing Ulcerative Gingivitis in patients with HIV is similar to that of normal patients

A

true

53
Q

HIV-Related Periodontitis is also known as what?

A

aka – Necrotizing Ulcerative Periodontitis

54
Q

clinical signs/symptoms of HIV-related periodontitis:

A

Pain and spontaneous gingival bleeding

Interproximal necrosis and cratering

Edema and intense erythema

Extremely rapid bone loss that occurs concurrently with soft tissue destruction

55
Q

T/F: there is usually no pocket formation during HIV-related periodontitis

A

true

56
Q

T/F: NUG has a much more severe presentation than Necrotizing Stomatitis

A

False

Necrotizing Stomatitis is way worse

57
Q

characteristics of Necrotizing Stomatitis

A

Extensive painful tissue destruction

- not only affects gingiva and supporting alveolar bone, but also adjacent soft tissue and deeper osseous structures

58
Q

what is the treatment for Necrotizing Stomatitis? what is the prognosis?

A

Management includes extensive debridement, topical antiseptics, and systemic antibiotics

Prognosis is guarded

59
Q

what are the 5 HIV-related viral infections?

A

1) Molluscum Contagiosum
2) Herpes simplex
3) Varicella-zoster
4) Epstein-Barr virus
5) Human papillomavirus

60
Q

what is Molluscum Contagiosum? what are the clinical signs?

A

Skin infection caused by poxvirus

Facial skin is often affected

61
Q

how does a Molluscum Contagiosum infection differ in a patient with HIV?

A

Many more lesions develop compared to non-immunocompromised patient

Lesions tend not to regress, unlike their normal course in immune competent person

62
Q

T/F: Herpes simplex infections in a patient with HIV will present on attached mucosa only

A

FALSE- any oral mucosal surface

63
Q

cutaneous dissemination of what viral infection can occur in patients with HIV?

A

Herpes Zoster Infection

64
Q

Oral Hairy Leukoplakia is caused by what virus? what groups are likely to acquire it?

A
  • Most pts are HIV-infected or immunocompromised

- Caused by Epstein-Barr virus (EBV); often superimposed candidiasis

65
Q

what are the clinical characteristics of oral hairy leukoplakia?

A

Non-removable white plaques of the lateral tongue

vertical parallel lines running along sides of tongue

66
Q

how is oral hairy leukoplakia diagnosed?

A

biopsy reveals parakeratosis with “balloon cells” of upper spinous layers of epithelium

  • identification of EBV in epithelial cell nuclei
67
Q

characteristics of HPV oral lesions in HIV-compromised patients include what?

A

Exophytic lesions, solitary or (more commonly) multiple

may resemble routine squamous papilloma, condyloma or focal epithelial hyperplasia

68
Q

what is the etiology/characteristics/treatment for Aphthous-Like Ulcerations?

A

Probable immune-mediated etiology

Painful, persistent – may be solitary or multiple

Most respond to topical corticosteroids

69
Q

Aphthous-Like ulcerations can often be confused with what other causes?

A

infections

May need to rule out infectious etiology by means of culture, exfoliative cytology or biopsy

70
Q

what is AIDS-Related Kaposi Sarcoma? what virus is it associated/linked with?

A

Multifocal malignancy of vascular endothelial cell origin

Etiology seems linked to HHV-8

71
Q

where are oral lesions of Kaposi’s sarcoma usually found?

A

palate or gingiva

72
Q

what are the treatments available for Kaposi Sarcomas?

A

Surgical excision, local radiation therapy or intralesional vinblastine injections

Typically treated only if a cosmetic or functional problem

73
Q

T/F: AIDS-Related Lymphomas are not as common as Kaposi Sarcomas

A

True

74
Q

characteristics of AIDS-related lymphomas:

A

Often extra-nodal (CNS or GI tract)

Clinically may resemble KS

Very poor prognosis in most cases, with median survival of 3-4 months