7 (entire slide deck 6)

fluid filled blister, < 5 mm diameter (blister)

vesicle

luid filled blister, > 5 mm diameter (large blister)

bulla

fluid filled blister containing purulent material (pus

pustule

loss of or thinning of surface epithelium

erosion

loss of surface epithelium

ulcer

these types of conditions are characterized as slow onset (months, years) and are persistant

hereditary, autoimmune

these types of conditions are characterized as rapid onset (hours, days), and are recurrent

infections, idiopathic (no known obvious cause)

hereditary conditions

epidermolysis bullosa (wont cover in this course but can be on boards)

autoimmune conditions

lichen planus

pephigus

pemphigoid

lupus

infections

viral

mytotic (fungal)

idiopathic

aphthous stomatitis

erythma multiforme

herpes is _____

forever - cannot get rid of it

herpes is a ____ ___ DNA virus

double stranded

how many different types of herpes are there

8

All 8 types of herpes – cause primary infection – remain _____ in specific cell types

latent

HHV-1 and HHV-2 is known as

Herpes simplex virus (only these 2 )

HHV-3 is also known as

varicella zoster virus

HHV-4 is also known as

epstein-barr virus

• mononucleosis and hairy leukoplakia

HHV-5 is also known as

cytomegalovirus

HHV 6 and HHV7 are known as

just known as HHV6 and HHV7

HHV 8 is known as

Kaposi’s Sarcoma-associated Herpes virus

HHV! and HHV2 are similar in structure and disease mechanism but differ in ______, anatomic site predilection and epidemiology

antigenicity

How is HSV-1 predominantly spread

through infected saliva or active peri-oral lesions

HSV-1 is known to affect ___ the waist

above

Pharynx, oral mucosa, lips, eyes, skin above waist

HSV-2 is known to spread predominantly through

sexual contact

HSV-2 is known to affect _____ the waist

below

Genitalia and skin below waist

mostly through sexual contact, but can get to above waist with oral sex practices

poor ___ and ___ promotes infection woth HSV-1 and HSV2

hygiene

crowding

lower _____ status correlated with earlier exposure to HSV-1 and HSV-2

SE
teen to young adult age group in the US< but can happen as early as 5 in developing countries

what causes Acute Herpetic Gingivostomatitis

HHV-1

acute viral infection

acute Herpetic gingivostomatitis is Spread predominantly via infected ____ or direct contact with active perioral ____

saliva

lesions

most common age for acute herpetic gingivostomatitis (HHV1)

6 mo-5 years

dont get prior to 6 months bc babies still have anti HSV antibodies from mom until then

this is an example of a primary infection - very first infection

does acute herpetic gingivostomatitis has prodromal symptoms

yes - acute onset of malaise, fever, and lymphadenopathy

acute herpetic gingivostomatitis (HHV-1) is characterized by gingival ____ and ____

erythma and ulcers

with acute gingival ertythma, there are Multiple ____ and ____ can occur anywhere in the oral cavity.

vesicles (only for a short period before they burst)

ulcers

is acute herpetic gingivostomatitis painful

yes

how long does acute herpetic gingivostomatitis last

1-2 weeks

management for acute herpetic gingivostomatitis

antiviral meds (if caught in 72 hours), palliative therapy, maintenance of fluids and electrolytes

lower exposure can have a more mild presentation

acute herpetic gingivostomatitis is found on _____ and _____ tissues

keratinized and non-kertainized

Primary HHV-1 infection (image)

.

HHV1 goes dormant where

in the trigeminal ganglion

HHV2 goes dormant where

in the neuron sacral ganglion

HSV remains latent in ____ ganglia

regional

what causes recurrent herpes simplex virus

reactivation

UV radiation, trauma, immunosupression, stress, dental procedures

when recurrent herpes simplex virus is reactivated, it will present at the end of the nerve coming off the ____ in which it goes dormant

ganglia

does recurrent herpes look like primary herpes

no

what are the prodrome symptoms of recurrent herpes

tingling, burning, itching, localized warmth (6-24 hours prior to the lesions show)

what does recurrent herpes simplex virus look like

small clusters of microvesicles and ulcers which often coalesce together

ulcers coalese and wont be pinpoint, vesicles will be pinpoint

where does recurrent herpes simplex present

on keratinized mucosa

unless immunocompromised then it can present wherever it wants

is recurrent herpes painful

pain will vary, intraoral less symptomatic and sometimes pain on lip

are there any systemic manifestations with recurrent herepes

no

how long does recurrent herpes take to heal

7-10 days unless immunocompromised, then can last longer

Recurrent Herpes Simplex locations (image)

.

Recurrent Herpes Simplex Infection (Image)

.

Recurrent Herpes Simplex Infection (Image)

coalescing together

Recurrent Herpes Simplex Infection (Image)

said these are very good example pictures

pinpoint and coalescing

Recurrent Herpes Simplex Infection progression (Image)

first image: fluid filed blisters

2nd: reputured

Recurrent Herpes Simplex Infection - herpes labialis (Image)

classic cancker sores, lip area

Recurrent Herpes Simplex Infection - herpatic whitlow (Image)

common before gloves

Treatment of Human Herpes Virus 1 and 2

Antivirals - if caught in the forst 72 hours

supportive (dependent on pain level)

Varicella Zoster virus remains latent in ____ nerve ganglion

regional

what can cause reactivatino of varicella zoster virus

age, immunosupression, stress (extreme), dental manipulation

needs a decently strong trigger

what is varicella zoster virus

what causes chicken pox as a childwh

what manifests with recurrent varicella zoster virus

shingles

prodrome of shingles occurs how far before lesions show

1-4 days

what are the symptoms of shingles prodrome

pain which may masquerade as a toothache, otitis media (middle ear infection), migraine, appendicitis, may manifest as a MI

______ before shingles reactivatino can be very painful

neuralgia

what may make it feel like your tooth is in extreme pain, even though there is nothing wrong with it

may also manifest as MI pain

skin lesions of recurrent varicella zoster (shingles) appears as

cluster of vesicles on erythmatous base, become pustular, ulcerate, and may scar

how long do lesions from recurrent varicella zoster (shingles) take to heal

2-3 weeks

if shingles is present on the nose, this is a positive ______ sign and they need to go to the hospital ASAP

Hutchinsons

certain branch involved that may cause blindnes

does shingles manifestation cross the midline

NO - will follow the nerve distribution

Recurrent Varicella Zoster Infection: Zoster, Shingles (image)

.

Varicella Zoster Virus Infection Human Herpes Virus 3 Shingles

.

Varicella Zoster Virus Infection Human Herpes Virus 3 Shingles - Thoracic manifestation (image)

this is what may manifest as MI pain

Varicella Zoster Virus Infection Human Herpes Virus 3 Shingles (image)

very well demarcated halfway mark

Treatment of Recurrent Varicella Zoster VIrus

Supportive (medications)

Antivirals

Vaccine

what do you give as treatment for post herpetic neuralgia associated with Varicella zoster - shingles

Benzodiazepines

Gabapentin

these are the patients that are experiencing pain after symptoms of shingles have gone away - these can persist for up to a year after

Epstein Barr Virus Infectious Mononucleosis is also known as

kissing disease or mono

Infections mononucleosis is primarily transmitted by _____

saliva

Infectious mononucleosis Actively replicates in the epithelial cells of the _____ and can subsequently infect recirculating ___ ____

oropharynx

b lymphocytes

big affinity for lymphatic tissue (tonsils)

Most cases of EBV infection occur in _____ _____ and are _____

early childhood

asymptomatic

prodromal symptoms of infectious mononuclosis

fatigue, malaise, and anorexia for about 2 weeks before fever

this is pretty long - the longest prodromal disease

How does infectious mononucleosis present

Prominent lymphadenopathy (bilateral) - lymph node involvement

Oropharyngeal tonsillar involvement may exhibit exudate and abscesses

May also have necrotizing gingivitis

infectious mononucleosis may have transient ____ ____

palatal petichiae

will show up in the 1st 24-48 hours - not there during entire disease process

Diagnosis of mononucleosis should be confirmed with ____ ____

lab studies

• Increased WBC

• Relative lymphocytosis

• Atypical lymphocytes

• Heterophil antibody (Mono-spot test) will be positive in 90% of young adults

• Indirect immunofluorescence for EBV-specific antibodies

Treatment of mononucleosis

Supportive

Non-aspirin antipyretics and NSAIDs

Rest

for patients with infectious mononucleosis we want to avoid ____ and _____

antibiotics

corticosteroids

why avoid antobiotics with mononucleosis

causes increased rate of morbilliform skin rash

why avoid corticosteroids with mononucleosis

Interferes with ability to fight the infection and can result in polyclonal B-lymphocyte proliferation

has been fatal in immunocompromised patients

classes with cocksackie A virus

Herpangina

Hand foot mouth

acute lymphonodular pharyngitis

how is herpangina transmitted

fecal oral rout, saliva and respiratory droplets

Herpangina is most common in ____ and _____ _____

infants and young children

Herpangina has an ____ onset with symptoms:

acute

sore throat

difficulty swallowing

fever

Where does herpangina present

mainly soft palate, tonsillar pillar, and uvula

how does herpangina present

Red macules -> vesicles -> ulcers

~ 2-6 lesions on the soft palate or tonsillar pillars; 2-4 mm (very few in number)

Hand foot and mouth is the most common presentation of _____

enterovirus

hand, foot, mouth has ___ and ____ lesions associated with ___-like symptoms

oral and skin

flu - sore throat, difficulty swallowing, fever

may have cough, runny nose, anorexia, vomiting, diarrhea, myalgia, headaches

_____ and ____ lesions always present with hand, foot mouth

oral and hand

not always foot

Hand foot mouth

Skin lesions start as ____ macules, develop central ____ and heal without crusting

erythematous

vesicles

hand foot mouth

Oral lesions – numerous aphthous like _____ – in the _____ region of mouth

ulcerations

anterior (buccal mucosa, labial mucosa, tongue)

keratinized and non- keratinized

Hand, foot, mouth (imaege)

.