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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

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2
Q

Initial contact with the herpes virus produces what?

A

a primary infection

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3
Q

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

A

neurotropic

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4
Q

how is primary herpes usually spread?

A

Spread through saliva, usually early in childhood

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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

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6
Q

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

A

Small ulcers COALESCE

  • resulting in larger ulcers having SERPENTINE borders
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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

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8
Q

how can primary herpes be diagnosed?

A
  • Exfoliative cytology or biopsy
  • Viral culture
  • Sequential serum antibody titers
  • Immunohistochemistry on sampled tissue
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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
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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
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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
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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

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13
Q

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

A

Recurrent Herpes Labialis

Recurrent Intraoral Herpes

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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)

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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

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16
Q

what are the symptoms of recurrent herpes labialis?

A

Prodromal itching, tingling, burning, erythema

followed by cluster of vesicles

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17
Q

if recurrent herpes labialis is not treated, what occurs?

A
  • vesicles rupture, form a crust

- lesions heal in 7-10 days

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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

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19
Q

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

A

Patient-initiated systemic valacyclovir

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20
Q

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

A

mucosa bound to periosteum

hard palate and attached gingiva

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21
Q

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

A

TRUE

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22
Q

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

A

Immunosuppressed patients

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23
Q

clinical signs of recurrent HSV in an immunocompromised patient:

A

Large shallow ulcers with elevated, scalloped borders

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24
Q

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

A

Herpetic Whitlow

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25
Chickenpox represents a primary infection with what virus?
varicella-zoster virus
26
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
27
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
28
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
29
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
30
what disease may occur due to a recurrent infection of varicella-zoster? what % of primary infected patients will have this reoccurrence?
herpes zoster - occurs in 10-20% of the population
31
characteristics of herpes zoster (shingles)
Increasing frequency with aging Painful erythema and vesicles, usually on trunk May occur in head and neck region Lesions stop at midline
32
what is the treatment for a VZV infection?
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
what severe condition can develop in patients with a shingles outbreak?
Post-herpetic neuralgia | effects about 15% of those infected
34
what is Herpangina caused by?
Enterovirus infection caused by any one of several strains of coxsackievirus A or B, or echovirus
35
Herpangina primarily effects what group?
Primarily affects children 1-4 years of age
36
signs/symptoms of Herpangina:
***localized to posterior soft palate/tonsillar pillar region*** Acute onset of sore throat, fever and 2-4mm oral ulcers
37
how long do most herpangina infections last?
usually resolving within 7-10 days
38
Hand, Foot and Mouth Disease is caused by what virus?
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
what are the clinical signs of hand, foot and mouth disease?
Flu-like illness w/ sore throat and fever Oral and hand lesions are most commonly seen
40
what types of lesions develop during hand, foot and mouth disease?
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
immunosuppression in HIV patients can lead to what complications?
``` opportunistic infection(s) neoplasms systemic features (gastrointestinal, pulmonary, dermatologic, neurologic, oral mucosal) ```
42
HIV+ patient with CD4 count of ______ are considered to have AIDS
less than 200
43
what treatment is used to combat the HIV virus?
Highly Active Antiretroviral Therapy (HAART)
44
T/F: HAART therapy has made clinical manifestations of HIV much less common
True
45
why are Head & Neck Manifestations of HIV important?
Often reflect immunocompromised state May be FIRST SIGN of HIV infection Some Predict PROGRESSION to AIDS Some meet criteria for DIAGNOSIS of AIDS
46
what is Persistent Lymphadenopathy?
- found in HIV patients - Generalized non-tender lymphadenopathy - Cervical lymph nodes are frequently affected, including posterior cervical nodes
47
besides HIV, what other conditions can cause persistent lymphadenopathy?
other infections; lymphoma; metastatic carcinoma
48
what oral fungal infections affect those with HIV?
Candidiasis is most common Histoplasmosis noted less frequently
49
what are the oral presentations of histoplasmosis infections?
Present as non-healing ulceration or granular lesion - Pulmonary infection predominates, but dissemination to oral mucosa may occur
50
what 4 bacteria-related conditions are associated with HIV?
1) Linear gingival erythema?? 2) HIV-related periodontitis 3) Necrotizing ulcerative gingivitis 4) Necrotizing stomatitis
51
what are the characteristics of Linear Gingival Erythema?
Unusual pattern of gingivitis Red, linear band at the marginal gingiva Spontaneous bleeding may be noted Lack of response to improved oral hygiene
52
T/F: the presentation of Necrotizing Ulcerative Gingivitis in patients with HIV is similar to that of normal patients
true
53
HIV-Related Periodontitis is also known as what?
aka – Necrotizing Ulcerative Periodontitis
54
clinical signs/symptoms of HIV-related periodontitis:
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
T/F: there is usually no pocket formation during HIV-related periodontitis
true
56
T/F: NUG has a much more severe presentation than Necrotizing Stomatitis
False Necrotizing Stomatitis is way worse
57
characteristics of Necrotizing Stomatitis
Extensive painful tissue destruction | - not only affects gingiva and supporting alveolar bone, but also adjacent soft tissue and deeper osseous structures
58
what is the treatment for Necrotizing Stomatitis? what is the prognosis?
Management includes extensive debridement, topical antiseptics, and systemic antibiotics Prognosis is guarded
59
what are the 5 HIV-related viral infections?
1) Molluscum Contagiosum 2) Herpes simplex 3) Varicella-zoster 4) Epstein-Barr virus 5) Human papillomavirus
60
what is Molluscum Contagiosum? what are the clinical signs?
Skin infection caused by poxvirus Facial skin is often affected
61
how does a Molluscum Contagiosum infection differ in a patient with HIV?
Many more lesions develop compared to non-immunocompromised patient Lesions tend not to regress, unlike their normal course in immune competent person
62
T/F: Herpes simplex infections in a patient with HIV will present on attached mucosa only
FALSE- any oral mucosal surface
63
cutaneous dissemination of what viral infection can occur in patients with HIV?
Herpes Zoster Infection
64
Oral Hairy Leukoplakia is caused by what virus? what groups are likely to acquire it?
- Most pts are HIV-infected or immunocompromised | - Caused by Epstein-Barr virus (EBV); often superimposed candidiasis
65
what are the clinical characteristics of oral hairy leukoplakia?
Non-removable white plaques of the lateral tongue vertical parallel lines running along sides of tongue
66
how is oral hairy leukoplakia diagnosed?
biopsy reveals parakeratosis with “balloon cells” of upper spinous layers of epithelium - identification of EBV in epithelial cell nuclei
67
characteristics of HPV oral lesions in HIV-compromised patients include what?
Exophytic lesions, solitary or (more commonly) multiple may resemble routine squamous papilloma, condyloma or focal epithelial hyperplasia
68
what is the etiology/characteristics/treatment for Aphthous-Like Ulcerations?
Probable immune-mediated etiology Painful, persistent – may be solitary or multiple Most respond to topical corticosteroids
69
Aphthous-Like ulcerations can often be confused with what other causes?
infections May need to rule out infectious etiology by means of culture, exfoliative cytology or biopsy
70
what is AIDS-Related Kaposi Sarcoma? what virus is it associated/linked with?
Multifocal malignancy of vascular endothelial cell origin Etiology seems linked to HHV-8
71
where are oral lesions of Kaposi's sarcoma usually found?
palate or gingiva
72
what are the treatments available for Kaposi Sarcomas?
Surgical excision, local radiation therapy or intralesional vinblastine injections Typically treated only if a cosmetic or functional problem
73
T/F: AIDS-Related Lymphomas are not as common as Kaposi Sarcomas
True
74
characteristics of AIDS-related lymphomas:
Often extra-nodal (CNS or GI tract) Clinically may resemble KS Very poor prognosis in most cases, with median survival of 3-4 months

oral pathology final (4 decks)

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