viral infections Flashcards
which type of herpes is mainly found in the oral cavity? which type is associated with genital infections?
HSV-1 = predominantly oral
HSV-2 = predominantly genital
Initial contact with the herpes virus produces what?
a primary infection
HSV is __________, meaning it will be transported via nerves to sensory ganglia (latent stage)
neurotropic
how is primary herpes usually spread?
Spread through saliva, usually early in childhood
name the symptoms/signs of primary HSV:
Acute fever, cervical lymphadenopathy, oral sores
Oral lesions begin as vesicles that quickly rupture to form shallow ulcers
what happens to the multiple small ulcers of primary HSV infections?
Small ulcers COALESCE
- resulting in larger ulcers having SERPENTINE borders
what is the viral cytopathic effect (Tzanck Cells)? what condition is it associated with?
- caused by PRIMARY herpes
- infected cells show multinucleation and ballooning degeneration of nuclei
how can primary herpes be diagnosed?
- Exfoliative cytology or biopsy
- Viral culture
- Sequential serum antibody titers
- Immunohistochemistry on sampled tissue
what is the treatment for primary herpes if identified within 2-3 days of outbreak?
If identified within the first 2-3 days:
- acyclovir or one of its analogues may be helpful
what is the difference between acyclovir and valacyclovir?
Valacyclovir (Valtrex) is absorbed better than acyclovir
- it is is eventually metabolized to acyclovir
what can be used to treat the SYMPTOMS of primary herpes infections?
- analgesics, antipyretics
- Topical anesthetics so patient can eat and drink
- popsicles can be good for children to soothe pain
what is the prognosis for primary herpes? how long does the infection last?
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
name the 2 forms of recurrent herpes (recurrent HSV):
Recurrent Herpes Labialis
Recurrent Intraoral Herpes
T/F: most patients with recurrent herpes can remember their initial exposure (primary infection)
FALSE
only 12% of affected individuals will remember primary infection (subclinical or mild symptoms)
what triggers Recurrent Herpes Labialis? what areas does it affect?
Triggered by UV light exposure or trauma
Affect vermilion zone or perioral skin
what are the symptoms of recurrent herpes labialis?
Prodromal itching, tingling, burning, erythema
followed by cluster of vesicles
if recurrent herpes labialis is not treated, what occurs?
- vesicles rupture, form a crust
- lesions heal in 7-10 days
name the treatment options for recurrent herpes labialis:
Avoid excess sun exposure
Sunblocks may be helpful to prevent lesion development
Topical antiviral agents - statistically significant decrease in healing time
what treatment seems to be most effective in treating recurrent herpes labialis?
Patient-initiated systemic valacyclovir
Recurrent Intraoral Herpes infections are found in what areas of the mouth?
mucosa bound to periosteum
hard palate and attached gingiva
T/F: symptoms of Recurrent INTRAORAL herpes are milder than those of herpes labialis
TRUE
what condition can lead to recurrent herpes in any area of the mouth?
Immunosuppressed patients
clinical signs of recurrent HSV in an immunocompromised patient:
Large shallow ulcers with elevated, scalloped borders
what viral condition can be caused by not wearing gloves while performing dental procedures?
Herpetic Whitlow
Chickenpox represents a primary infection with what virus?
varicella-zoster virus
how is varicella-zoster spread?
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
what are the clinical signs/symptoms of chickenpox (primary VZ infection)?
Cutaneous lesions – intensely pruritic vesicles
- “Dew drops on rose petals”
Vesicles rupture and form hardened crust
Fever and malaise are present
describe the oral lesions of the varicella-zoster virus:
A few 1-2 mm shallow oral ulcers may develop at any intraoral site
Generally not as symptomatic as the cutaneous lesions
how is a varicella-zoster infection diagnosed? what treatments are available?
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