Viral Infections Flashcards by Gavin Fox

DNA virus in the herpesvirus family; HHV-1 (oral) and HHV-2 (genital)

herpes simplex virus

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children, sometimes adults; diffuse painful shallow ulcers; fever malaise; lymphadenopathy; one episode- 10 to 14 days; virus remains dormant in sensory or autonomic ganglia

primary herpetic gingivostomatitis

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punched out areas at gingival margins

primary herpetic gingivostomatitis

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primary herpetic gingivostomatitis

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primary herpetic gingivostomatitis

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reactivation of virus; asymptomatic shedding vs. symptomatic; can be stimulated by UV light, trauma, stress

recurrent herpes labialis

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recurrent herpes labialis

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perioral skin or vermilion; prodromal itching or tingling; cluster of vesicles; heal with crusting- 7 to 10 days

recurrent herpes labialis

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recurrent herpes labialis

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recurrence on thumbs or fingers; less common with universal use of gloves

herpetic whitlow

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herpetic whitlow

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relatively uncommon; usually few symptoms; cluster of shallow ulcer- intact vesicles rare; mucosa bound to periosteum (Hard palate and attached gingiva); heal within one week

recurrent intraoral herpes

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recurrent intraoral herpes

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reactivation of virus; any oral mucosal surface; large shallow ulcers; scalloped, elevated borders; antiviral meds indicated; may co-infect with CMV

Herpes in the Immunocompromised host

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hepes in the immunocompromised pt

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acantholysis and ulceration of the epithelium; epithelial cells at margin of ulcer show ballooning degeneration and multiple anglulated nuclei; Tzanck cells- Acantholytic epithelial cells; mixed inflammatory infiltrate

herpesvirus infection

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ballooning degeneration

herpesvirus infection

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Primary herpes treatment: antiviral meds if recongnized early (1st _ hrs)

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primary varicella-zoster infection; upon resolution, the virus will remain dormant in sensory nerve ganglia; reactivation- shingles

chicken pox

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fever, malaise, rhinitis; cutaneous lesions-pruritic vesicles (dew drops on rose petals); patients are contagious until all lesions crusted

varicella

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varicella

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varicella: few, diffuse, 1-2 mm oral ulcers; typically affect the _ and _

palate and buccal mucosa

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varicella treatment: typically symptomatic in children; antiviral meds are helpful if administered within the first _ hrs of the exantham

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reactivation of VZV; typically occurs in elderly; single recurrence only; associated with immunosuppression, trauma like dental treatment

Herpes zoster (shingles)

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prodrome pain, sometimes accompanied be fever, malaise, and headache, painful vesicles, which crust in 7-10 days; usually on trunk, sometimes head and neck; vesicles affect cutaneous zone of innervation to midline

herpes zoster

herpes zoster (shingles)

herpes zoster

post-herpetic neuralgia; Ramsey Hunt syndrome

herpes zoster

disease caused by exposure to EBV; typically spread through contact; following exposure, EBV remains in the host for life

infectious mononucleosis

children are typically symptomatic; classic presentation (Young adult): fatigue, malaise, tender cervical lymphadenopathy, fever; oral- tonsillar enlargement, palatal petechiae; patients may also develop NUG

infectious mononucleosis

cervical lymphadenopathy associated with

infectious mono

tonsillar enlargement associated with

infectious mono

palatal petechiae associated with

infectious mono

diagnosis of infectious mono: _ antibody test

paul-bunnell

treatement of infectious mono with _ can trigger a polyclonal B cell proliferation

corticosteroids

group of viruses including poliovirus, coxsackievirus and echovirus; at least 30 are known to cause sympomatic infections with rashes; transmission typically through fecal-oral route, saliva or respriratory droplets

enteroviruses

caused by infection with one of a number of coxsackieviruses most commonly coxsackievirus A; typically asymptomatic; sore throat, fever, headache

herpangina

1-2 mm ulcers on soft palate; healing occurs in 7-10 days

herpangina

caused by several strains of consackievirus, most commonly coxsackievirus A; sore throat, fever; cutaneous and oral lesions

hand, foot,and mouth disease

oral lesions- 1-2 mm ulcerations, diffusely distributed on oral mucosa; cutaneous lesions-erythematous macules with central vesicles

hand foot and mouth

herpangina or hand foot and mouth

hand foot and mouth

caused by coxsackievirus A10; rare condition with few reported cases

actue lymphonodular pharyngitis

sore throat, fever; yellow to dark pink nodules dispersed over the soft palate

acute lymphonodular pharyngitis

infection by a paramyxovirus; 1980s: increased incidence due to lack of vaccine or vaccine failure; droplet transmission

rubeola (measles)

fever, malaise, coryza, conjunctivitis and cough; classic maculopapular rash; much more serious in the immunocompromised

rubeola

Koplick's sports, may effect developing dentition; NUG

rubeola

Rubeola- _ giant cells

Warthin-Finkleday

MMR vaccination includes

measles, mumps, rubella

togavirus infection; significance lies in the capacity to infect the developing fetus; droplet transmission

rubella

typically symptomatic; symptoms are more likely in adolescents and adults; flu-like symptoms with characteristic exanthematous rash

rubella

rash begins on face and spreads to rest of the body; macules evolve to papules and flaky desquemation

rubella

oral lesions: Forchheimer's sign (small, dark red papules on soft and posterior hard palate); palatal petechiae

rubella

deafness, heart disease, cataracts; may include encephalopathy, mental retardation, diabetes mellitus; thyroid disorders

congenital rubella syndrome

paramyxovirus infection; typically an infection of the salivary glands with the parotid being the most common; droplet, saliva, urine transmission

mumps (endemic parotitis)

often asymptomatic (30%); flu-like prodrome; swelling and pain of the affected gland; epididymoorchitis

mumps

oral manifestations; redness and enlargement of the salivary duct orifices (Stensen's); sublingual swelling if sublingual glands are affected

mumps

RNA retrovirus first reported in 1981; previously near 100% fatal, but with recent treatment regimens, patients are controlling the disease for much longer periods; virus has been found in most bodily fluids

HIV

3 most frequent transmission methods of HIV

sexual contact, parenteral exposure to blood, maternal/fetal

cells with _ receptors (primarity the T helper lymphocyte) are the target cell of HIV; Viral DNA is permanently integrated into host DNA via \_

CD4; reverse transcription

Clinical course of HIV: acute, self limited response (similar to \_); _ to _ year asymptomatic stage; symptomatic stage(\_/AIDS)

infectious mono, 8 to 10; AIDS-related complex

endpoint of HIV; 5 yrs after infection-18% have it; 13 yrs after infection-65% have it, 20% have symptoms, and 15% have no symptoms

AIDS

Fever, weight loss, diarrhea, candidiasis, herpes zoster, hairy leukoplakia

ARC

increased infections in AIDS includes

CMV, herpes simplex, toxoplasmosis

pulmonary presenting sign in AIDS in 50% of pts

pneumocystis carinii pneumonia

oral manifestation of HIV: lymphadenopathy present for longer than 3 months; 2 or more extrainguinal sites; common sites: cervical, submandibular, axillary

persistant generalized lymphadenopathy

fungal infections associated with HIV:

candidiasis; histoplasmosis; cryptococcosis; aspergillosis

most common HIV associated deep fungal infection; oral lesions common; chronic, indurated ulcer with raised border; may be single or multiple

histoplasmosis

in HIV: reactivation of virus; may affect any mucosal site surface; painful, diffuse ulcers; treatment -Acyclovir, Valtrex

HSV

in HIV patient

HSV

more severe than in immunocompetent; treatment - IV acyclovir

VZV

oral hairy leukoplakia; presence strongly suggestive of HIV; indication of advanced disease

EBV

condyloma acuminatum; most common types 6 and 11; unusual morphology; often unusual types; usually multiple lesions

HPV

mulluscum contagiosum

HIV associated perio: linear band of erythema involving the free margin; may represent an unusual pattern of candidiasis; most resolve with improved hygiene

linear gingival erythema

HIV associated perio: blunted or "punched out" papillae; fetid odor; pain; spontaneous hemorrhage; necrotic debris

NUG

HIV associated perio: gingival ulceration; rapidly progressive loss of attachment; edema, pain, spontaneous hemorrhage

necrotizing ulcerative periodontitis

HIV associated perio: severe pain; extensive bone and soft tissue destruction

necrotizing stomatitis

HIV associated malignancy: usually in homosexual men; decreasing in frequency; palate, gingiva most common sites

Karposi's sarcoma

karposi's sarcoma

Karposi's sarcoma

HIV associated malignancy: not as common as KS; often extranodal; clinically may resemble KS; very poor prognosis

AIDS-related lymphoma

HIV associated malignancy: typical risk factors, presentation, and distribution; tend to occur at a younger age; development may be accelerated by HIV

squamous cell carcinoma

HIV miscellaneous lesion/condition

HIV associated salivary gland disease

HIV miscellaneous lesion/condition

aphthous ulceration

HIV miscellaneous lesion/condition

HIV associated melanosis