VIRAL DISEASES

Common trait of Herpes Simplex Virus (HSV) 1-4

Primary infection > latency > reactivation of infection

What four things does Herpes 1 and 2 cause

Primary herpetic gingivostomatitis

Recurrent herpes (oralis and labialis)

Ocular herpes

Gential herpes

What is HSV3

what does it cause

Varicella Zoster Virus

Chicken pox and herpes zoster

What is HSV4

What does it cause (4)

Epstein barr

Mono, hairy leukoplakia, nasopharyn. carcinoma, certain lymphomas

What is HSV 5

Where (2)

Cytomegalovirus

Salivary glands and lymph nodes

What three diseases does HSV 6 and 7 cause

Exanthum subitum

Exanthema Infantum

Roseaola Infantum

What does HSV 8 cause

Kaposis sarcoma

HSV is ______tropic

What does this mean

Neurotropic

Transported via nerves to sensory ganglia

HSV is spread through ____ usually early in _______

___% of primary cases are subclinical

Saliva - childhood

95

Clinical infections caused by Primary herpes simples:

Fever?

_______ lymphadenopathy

_____ sores - begin as ________ that rupture and cause ________

What kind of borders or lesions?

Most common parts of oral mucosa?

Yes

Cervical

Oral - vesicles - ulcers

Serpentine

Gingival, labial and buccal

Diagnosis of Primary Herpes Simplex Virus:

______ clinical pressenation

Exfoliative ________ or ______ of infected cells showing _______ and ________ degeneration of nuclei

______ culture

Sequential serum _______ titers

___________ on sampled tissue

Characteristic

Cytology or biopsy - multinucleation and ballooning

Viral

Antibody

Immunohistochemistry

Managment of HSV 1

If identified within first 2-3 days ___________ / one of its analogues

________ is absorbed better than ^^ and is eventually metabolized by ^^

Dx and Tx must occur within _______ otherwise antiviral meds will have little effect

Acytlovir

Valacyclovier (Valtrex)

2-3 days

Drug Rx for HSV1 (2)

Valacyclovir (Valtrex) - 500 mg, 28 tabs, 2 tabs every 12 hours until finished

Acyclovir (Zovirax) - 800 mg, 28 tabs, 2 tabs every 12 hours until finished

Symptomatic care of HSV involves what

_______ so patient can eat and drink

Important to avoid ______

_________ can be soothing for peds patients

Analgesics, antipyretics

Topical anesthetics

Dehydration

Popsicles

What do we NOT prescribe children under 16

Why?

Aspirin

Reyes syndrome

Prognosis for HSV 1:

One episode may last how long without tx?

What % of cases develop atleast one episode of recurrent disease

Good

10-14 days

25%

Recurrent herpes labialis:

Triggered by ______ or ______

Affects _______ or ______

Prodromal _______ or _______

_______ followed by cluster of _______

WIth no tx - _______ rupture, form a ______ and heal within _______

UV light or trauma

Vermillion zone or perioral skin

Itching or tingling

Erythema - vesicles

Vesicles - crust - 7-10 days

Patients with Recurrent herpes labialis should avoid ________

_____ may be helpful to prevent lesion development

Topical antiviral agents cause a ________ in healing time

Systemic _____ or ________ seem to have best results

Sun exposure

Sunblock

Statistically significant

acyclovir or valacyclovir

Recurrent intraoral herpes:

Relatively _____

Symptoms ______ or _____ feeling

Cluster of _______ ulcers

Confined to ______ bound to _______ (where?)

Heal in how long w no tx?

Uncommon

Irritated or rough

Shallow

Mucosa - periosteum (hard palate and attached gingiva)

1 week

One of the hazards of HSV associated with not wearing gloves

Consequence?

Herpetic Whitlow - you cannot practice until this is gone

Chicken pox represents a _______ infection of ________ virus

Spreads through ______ or ______ with vesicle fluid

Primary - varicella zoster

droplets or direct contact

Most cases of chicken pox is between what ages?

Incubation is how many days?

Most cases are ________, unlike what

5-9

10-20

Symptomatic - HSV 1 or 2

Clinical Features of Chicken Pox:

_______, ___itis, _____itis

Intensely pruritic ________

Begins on _____ and spreads to _______

Malaise, pharyngitis, rhinitis

Exanthem (skin eruption)

Face and trunk - extremities

The exanthem from chicken pox progresses through phases from _______ to ______ to______ then ________

May continue to form for how long?

Patient is contagious from _________ to _________

erythema, vesicle, pustule, hardened crust

7+

2 days before exanthem - all lesions crust

Oral chicken pox:

_____- and _______ lesions are common

Where? (3)

Resember lesions of _____ HSV

Size and color of vesicles? what do they form?

Severity and duration of lesions parallel what

Perioral and oral

Vermillion of lips, palate, buccal mucosa

Primary HSV

3-4mm, white opaque

Skin lesions

What disease looks like a dew drop on a rose petal

Chicken pox / Herpes Zoster

Complications of chicken pox:

More severe in ______ - can become _______ and ______

_____ syndrome

Secondary ____ infections

____ disturbances

________penia

Adults - pneumonia, encephalitis

Reys

Secondary

GI

Pancyto

Histopathology of Chicken Pox:

Virus causes ______- and free floating ______ cells - ______ epithelial cells

Acantholysis - tzanck - multinucleated

Diagnosis of chicken pox:

History of _____

Characteristic ______

Rapid Dx from _____ antibodies during ____- stage and _____ days later demonstrating ______ antibody titer later

Exposure

Exanthem

VZV - acute - 14-28 - increased

Tx of chicken pox:

Anti_____

Avoid _____

Duration and severity is reduced if antivirals are started when?

what ones?

Pyretics

Aspirin

Within first day

Acyclovir, valacyclovir, famciclovir

Prevention of chicken pox

Vaccine and avoid contact

Herpes zoster (shingles):

Reactivaton of _______ occurs in what % of population

Increasing frequency with ____

Painful erythema and vesicles where?

May occur in ______ and _____ region

Lesions stop at ______

VZV - 10-20%

Aging

Trunk

Head and neck

Midline

Herpes Zoster:

Antibiotics? When?

Prognosis? When do lesions resolve?

With multple episodes and immune problems, what can develop?

Systemic acyclovir 5x dosage of HSV in early course

Good - 2-3 weeks

Post herpetic neuralgia

What is post herpetic neuralgia

What disease

Super intense severe pain - lasting after virus is gone

Zoster

Epstein Barr Virus:

Exposure during childhood is usually _______

Most symptomatic primary infections occur in who?

What is it called?

Spread by what?

Asymptomatic

Young adults

Infectious mono

Intimate contact - Kissing disease

Exposure of what disease is delayed in the US compared to developing nations?

What % of college kids are unexposed?

Epstein barr - mono

50

EBV is related to what other diseases (5)

Oral hairy leukoplakia

burkitt lymphoma

Nasopharyngeal carcinoma

Some forms of hodgkin lymphoma

Lymphoma in AIDS

Infectious mono has a prodrome of what three things

When do they occur?

Fatique, malaise, anorexia

2 weeks before other symptoms

Clinical features of mono (4)

fever

Cervical lymphadenopathy

Hepatosplenomegaly

Rash - measles like

What % of mono cases have cervical lymphadenopathy

90% +

Oral manifestations of mono (4)

Tonsillitis

Pharyngitis

Palatal Petechiae

Necrotizing ulcerative gingivitis

Tonsillitis caused by mono has what

Which ones are enlarged?

Diffuse surface exudate

Pharyngeal and lingual tonsils

Tx and prognosis of mono:

What drugs (2)

Resolves in how long?

Patients with hepatosplenomegaly should avoid _______ Why?

Non aspirin antipyretics and NSAIDs

4-6 weeks

Contact sports - splenic rupture

Infrequent potential complications of mono (3)

Splenic Rupture

EBV related hepatitis and encephalitis

Bells palsy

Enteroviruses are what types of viruses

WHen do most cases occur

What age?

What aids in spread?

RNA

Summer or early fall

Infantnts and young children

Crowding and poor hygeine

Infection with enteroviruses confers immunity against how many strains?

Transmission is via ________, _______ or _______ infection

Oral fecal, salivary or respiratory

Herpangina and Hand-foot-mouth disease are what types of infections

Enteroviruses

Herpangina:

Affects what age?

Acute onset of ______ and ______

Size of oral ulcers?

Localized to what region?

1-4

Sore throat, fever

1-2mm

Posterior soft palate/tonsillar pillar region

Diagnosis of herpangina is based on what

When does it heal?

Tx is what

Avoid what?

Clinical findings

Self limiting usually 7-10 days

Supportive care, analgestics, anrigpyretics, topical angesthetics

Aspirin

Hand Foot and Mouth Disease:

______ like symptoms

______ and _____ lesions are most common

Skin lesions consist of ____mm ______ macules that may develop a ________

Flu

Oral and hand

1-3mm - erythematous - central vesicle

Oral lesions in Hand foot and mouth consist of ____ ulcers, _______mm in diameter

Most common sites (3)

Most lesions resolve in how long?

Shallow - 2-7mm

Buccal and labial mucosa, tongue

1 week

Diagnosis of hand foot and mouth is based on what?

______ is indicated?

Condition resolves in how lnog?

Prognosis?

Clinical manifestations

Supportive care

7-10 days

Good