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4th yr- CMS- Infections > Viral infections of the orofacial tissues > Flashcards

Viral infections of the orofacial tissues Flashcards

1
Q

Give some key features of a virus

A
  1. They are obligate parasites
  2. They require host cells for replication and survival
  3. Most are fragile
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2
Q

How do viruses bind to epithelial cells

A

Via the protein antigens displayed in their envelope

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3
Q

How do viruses replicate

A
  1. New virus particles are assembled inside the host cells

2. Large number of viral particles are produced in side the cell

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4
Q

How do new virus particles leave the host cells

A

Due to large number of viral particles inside the cell host lysis occurs resulting in viral particles circulating the host

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5
Q

What can viruses lead to after cell death

A

Vesicle. pustule and crusted lesion formation eg cold sores

A local systemic inflammatory response can also be set up

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6
Q

How can we detect viral infections in the lab

A
  1. Swabs of fluid collection will be needed first
  2. Any organisms present will be cultured
  3. once enough particles/ organisms are grown then microscopy can be undertaken to identify them
  4. Can use PCR techniques to identify viral DNA or RNA
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7
Q

How do we identify viruses

A

By looking at their viral antigens

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8
Q

What technique do we use to identify viral DNA or RNA

A

PCR

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9
Q

What are the problems with anti viral therapy

A

Most drugs drugs are toxic to viruses and the host cells as viruses use host DNA to manufacture more of themselves so you will be attack host materials

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10
Q

Give examples of antiviral therapy

A
  1. aciclovir topical and oral
  2. penciclovir topically
  3. Valaciclovir
  4. Famciclovir
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11
Q

Is the human herpes virus (HHV) a DNA or RNA virus

A

DNA viruses

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12
Q

Describe the human herpes virus in its primary infection

A

May be asymptomatic which leads to latency with or without viral shedding
This can cad to reactivation but not in all patients

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13
Q

Describe how herpes simplex virus 1 (HSV1) presents clinically

A

Predominantly oral lesions - ‘primary gingivostomatitis”

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14
Q

Describe how herpes simplex virus 2 (HSV2) presents clinically

A

Predominantly genital lesions - primary genital herpes

genital herpes lesions are similar to the oral ones in appearance -

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15
Q

Name the human herpes virus types that are only naturally found in humans

A

HSV 1

HSV 2

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16
Q

How does HSV1 and HSV2 spread

A

Spread via direct contact

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17
Q

What happens to cells during primary HSV infection

A
  1. Direct contact with infected secretions leads to deep epithelial cells becoming infected
  2. Infected cells undergo lysis
  3. Inflammation occurs leading to oedema
  4. Thin walled vesicles form and these are full of virus particles
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18
Q

Describe the vesicles formed during primary HSV infection

A

They are fragile, rupture easily then crusting as healing follows

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19
Q

Talk through the signs and symptoms of Primary herpetic gingivostomatitis

A
  1. Pyrexia, sore throat, fractious infants
  2. Ulcers due to oral vesicles rapidly bursting
  3. Gingival inflammation which can make eating and speaking difficult
  4. Small children may drool, have bad breath
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20
Q

How can we manage Primary herpetic gingivostomatitis

A
  1. Reassurance and explanation
  2. Symptomatic relief including good oral hygiene
  3. Keep hydrated
  4. Take paracetamol for pyrexia
  5. SLS free toothpastes and mouthwashes
  6. Bland soft diet
  7. 0.15% benzine hydrochloride mouthwash or spray
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21
Q

HSVs are N_________

A

neurotropic

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22
Q

What do we mean by HSVs are neurotropic

A

Means that once infection has occurred, they forever live on in the sensory neurones

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23
Q

What can trigger reactivation of latent infection

A
  1. UV light exposure
  2. Wind
  3. Stress
  4. Steroids
  5. Menstruation
  6. Fever
  7. surgery
  8. Other illness
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24
Q

How can we manage cold sores

A
  1. Don’t share towels/ bedding when you have active lesion
  2. Topical acyclovir 5% applied every 4hours
  3. Topical penciclovir 1% cream applied every 2 hours
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25
Q

What are cold sores also called

A

Herpes Labialis

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26
Q

How do we manage recurrent intraoral herpes lesions

A
  1. Explanation
  2. Chlorhexidene mouthwash or spray
  3. DO NOT use topical antivirals inside the mouth
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27
Q

Give examples of viral infections

A
  1. human herpes virus

2. Varicella zoster virus

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28
Q

How is the Varicella zoster virus spread

A

By droplets from the nasopharyngeal secretions or vesicle fluid

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29
Q

What is primary infection with Varicella called

A

Chicken pox

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30
Q

What is chicken pox

A

An upper respiratory tract induction with Varicella zoster virus

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31
Q

How Is chicken pox spread

A

By droplet inhaltion

32
Q

Describe the clinical presentation of chicken pox

A
  1. Maculopapular cutaneous rash affecting the scalp, face, trunk, (limbs) develops in crops
  2. Generally feeling unwell
33
Q

What can reactivation of Varicella zoster virus lead to

34
Q

Varicella zoster virus is N_______

A

Neurotropic

35
Q

What can lead to reactivation of Varicella zoster virus

A
  1. malignant,
  2. other concomitant illnesses,
    3, stress,
  3. surgery,
  4. local or general trauma
36
Q

How does shingles present

A

Presents with a mild systemic illness but the rash can be extremely painful and the complications potentially very serious

37
Q

What is common with shingles

A

Secondary bacterial infections with staph aureus

38
Q

List some different forms of shingles

A
  1. Oral shingles (rare)
  2. Ocular shingles (urgent)
  3. Motor zoster
  4. Post-herpetic neuralgia
  5. Disseminated zoster
39
Q

Who is offered shingles vaccine

A

Offered to all over 70s

40
Q

What is HHV 4 called

A

Epstein Barr virus

41
Q

Is there a vaccine for HHV 4

42
Q

What is Epstein Barr virus caused by

A

infectious mononucleosis aka glandular fever or “mono”

43
Q

How is infectious mononucleosis (mono) spread

A

Via infected saliva

44
Q

What are the signs and symptoms of Epstein Barr virus

A
  1. Sore throat
  2. dysphagia, anorexia, malaise, fatigue and headache
  3. Generalised lymphadenopathy
  4. Splenomegaly or hepatomegaly
  5. Tonsillar swelling
  6. Facial pain
45
Q

What is human herpres virus 5 (HHV5) called

A

Cytomegalovirus

46
Q

How does cytomegalovirus present

A

Presents with a glandular five like syndrome and may be reactivated in immunocompromised states

47
Q

What are some less prominent features of cytomegalovirus

A
  1. lymphadenopathy

2. Gross tonsillar involvement

48
Q

What is human herpres virus 8 (HHV8) called

49
Q

in whim is Kaposi more common in

A

HIV or AID patients

50
Q

How do Kaposi’s sarcomas present

A

Red, blue or violaceous macule or raised areas that may ulcerate

51
Q

Is the human papilloma virus an RNA or DNA virus

52
Q

How does HPV spread

A

Via direct contact

53
Q

HPV is e______

A

epitheliotropic

54
Q

What does epitheliotropic mean

A

HPV can cause overgrowth of epithelium

55
Q

How does HPV spread

A

Oral lesions

56
Q

What can persistant infection with high risk HPV cause

A

Cancer of the cerivcal, vulva, vagina, anus, penis and oropharyngeal

57
Q

What is oropharyngeal cancer

A

SCC of the tonsils, base of the tongue, pharynx or soft palate

58
Q

What are the 2 broad risk factors of oropharyngeal cancer

A

HPV infection

Alcohol and tobacco use

59
Q

When were HPV vaccines introduced

60
Q

What does low risk HPV infection present as

A

Oral squamous cell papillomas

61
Q

What are ORAL squamous cell papillomas

A

exophytic warts of the oral cavity

62
Q

Is measles caused by DNA or RNA

A

RNA paramyxovirus

63
Q

How is measles spread

A

By droplets

64
Q

What is the clinical presentation of measles

A
  1. Prodromal phase lasts 10-14 dats :
    - Fever, runny nose, conjunctivitis and cough
    - Koplick’s spots
  2. Rash phase:
    - begins on forehead and spreads to limbs and trunks
  3. Early complications days 18-30
65
Q

What are Koplick’s spots

A

irregular patches of erythema with a central minute bluish-white speck “grains of salt” is pathognomonic

66
Q

What happens in the early complications phase of measles

A
  1. Transient immune suppression and increased risk of opportunistic infections
  2. Such as oral HSV, candidosis, bacterial infections, eye infections and pneumonia
67
Q

Is mumps an RNA or DNA virus

A

Paramyxovirus, RNA virus

68
Q

What are the clinical features of mumps

A
  1. Fever, malaise
  2. Meningitis, orchitis, oophoritis pancreatitis
  3. Sialadenitis of parotid
  4. Causes oral dryness
69
Q

What is hand, foot and mouth disease caused by

A

Caused by a variety of enteroviruses (RNA viruses) including Coxsackie A & B

70
Q

What is the short prodrome effects of hand, foot and mouth disease

A
  1. Fever
  2. Malaise
  3. Lymphadenopathy
    sore throat
  4. Oral lesions are mostly anterior intra-orally
  5. Hands and feet get vesicular exanthem
71
Q

Which family does human immunodeficiency virus fall under

A

Lentivirus subfamily of retroviruses (RNA)

72
Q

Describe the primary infection of HIV

A
  1. May be asymptomatic or non specific viral illness

2. Takes 4-6 weeks for the ‘seroconversion’ process to complete

73
Q

Describe the Post-Seroconversion phase of HIV

A

May last for years especially with modern day treatments keeping viral loads near/at undetectable levels

74
Q

What is AIDs defined as

A

Defined as a CD4+ (T-cells) of less than 200 plus have an “AIDS defining illness” (see later)

75
Q

What are the oral signs and symptoms of HIV

A
  1. cervical lymphadenopathy
  2. Oral candidoses
  3. OHL
  4. Oral papilloma
  5. Kaposi’s sarcoma
  6. Linear gingivitis
  7. Advanced periodontal destruction e.g. ANUP
  8. Sialadenitis
  9. Xerostomia
76
Q

How do we manage HIV

A

Effective retroviral drugs suppress viral load

4th yr- CMS- Infections (4 decks)

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