Published on March 13, 2014
Viral Infections... Dr Ravikumar V, JR II, Dept Of Oral Path, GDC, Kottayam
Intro What is a Virus..? Basic structure Sequlae of infection Classification
Herpes Simplex HSV I and II Skin, mucosa, eye and CNS
Herpes genitalis Herpes meningoencephalitis Herpetic conjunctivitis
Herpetic eczema Disseminated HS of newborn Herpetic whitlow Herpes gladiatorum
Primary Herpetic Stomatitis Infancy and adult Spread – droplets, contact Fever, irritation, headache, pain on swallowing, regional lymphadenopathy Yellow fluid filled vesicles which rupture to form characteristic ulcers
Vesicles Erythematous halo Shallow Ulcer with Gray membrane
HSV culture from sites HSV DNA demonstration in lumbar and trigeminal ganglia Histology – ballooning degeneration - Lip schutz bodies Diagnosis – clinical, stains, cytology, DNA, PCR Treatment – Antiviral drugs, NSAID
Reccurent Herpes Labialis / Stomatitis Attenuated form of primary disease Reactivation – ganglion trigger, skin trigger, emotional theory The viruses spread through nerves and act on epithelial cells and cause inflammation
Lesions may recur at any interval May occur on lips, intraoral, or along area of distribution of nerve Preceded by tingling or burning sensation
Vesicles less than a mm appear as clusters which coalasce Associated pain Lesions heal by a week
Diagnosis Histology Viral identification and isolation Immunofluorescent tests Immunoperoxide test RIA and ELISA Treatment
Herpangina Coxsakie group A virus Ingestion, contact, droplet Seen in summer, in young Symptoms – sore throat, cough, rhinorhea, fever, vomiting and even abdominal pain Vesicles which rupture to form ulcers All of these heal by 7 days
No treatment needed as it is self limiting
Hand Foot and Mouth Disease Coxsakie and entero virus Multiple ulcers with dysphagia Intracytoplasmic viral inclusions, high antibody titer to Coxsakie Self limiting
RUBEOLA (MEASLES) produced by a paramyxovirus Affected individuals are infectious from 2 days before becoming symptomatic until 4 days after appearance of the rash Incubation period of 8 to 12 days
Pre erutive, eruptive and post eruptive stage Small red macules or papules appear which enlarge and coalesce to form irregular lesions which blanch on pressure and gradually fade in 4 or 5 days. Koplik’s Spots Warthin Finkeldey giant cells
RUBELLA (GERMAN MEASLES) capacity to induce birth defects Forchheimer spots- small discrete dark-red papules that develop on the soft palate and may extend onto the hard palate
The classic triad of CRS consists of deafness, heart disease, and cataracts
Molluscum Contagiosum Caused by virus of pox group Considered tumor like Occur as single or multiple discrete elevated nodules with central crustation Cowdry A inclusion bodies Henderson Paterson inclusions
Herpes Zoster James Ramsay Hunt’s syndrome
Non Specific Mumps C/c Non Specific Sialadenitis Acute Post operative Parotitis Nutritional Mumps Chemical Mumps Miscellaneous
Human Immuno Deficiency Virus Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). Characterized by severe depletion of CD4 cells.
MODES OF TRANSMISSION Sexual transmission Blood or blood products Maternal-fetal Infected needles
CLASSIFICATION OF CLINICAL MANIFESTATIONS Group I : Acute Infection Group II : Chronic Asymptomatic Infections Group III : Persistent Generalized Lymphadenopathy Group IV : Aids Related Complex
CHRONIC ASYMPTOMATIC INFECTIONS Most dangerous group Seropositive pt who is apparently healthy capable of infection Enlarged axillary glands Hematological & immunological abnormalities
PERSISTENT GENERALISED LYMPHADENOPATHY LYMPHADENOPATHY in 2 or more extrainguinal sites persisting for more than 3 months
AIDS RELATED COMPLEX OPPORTUNISTIC INFECTIONS -Pneumonia, Cryptococcosis, Viral Infections, Toxoplasmosis, TB etc. NEOPLASMS - KS, Lymphoma, SCC
NEUROLOGIC DISEASES - Meningocephalitis OTHERS - Encephalopathy, Purpura, Thrombocytopenia
Oral lesions in HIV...
Candidiasis PSEUDOMEMBRANOUS ERYTHEMATOUS ANGULAR CHEILITIS
HISTOPLASMOSIS Histoplasma capsulatum Nodules over the mucosa which undergoes ulceration Gingiva, tongue, palate, buccal mucosa
LINEAR GINGIVAL ERYTHMA Very fine red band along gingival margin and attached gingiva with profuse bleedin
NECROTIZING ULCERATIVE PERIODONTITIS Advanced destruction of peridontium, rapid bone loss, loss of PDL
Oral Hairy Leukoplakia
WART (HPV)1 Painless papule or nodule with papillary projections or rough surface Pedunculated or Sessile
APHTHOUS ULCER (MINOR) Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded b Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
APHTHOUS ULCER (MAJOR)
KAPOSI’S SARCOMA Predominantly in homosexuals. lesions are vascular, angiomatous neoplasms that begin as red macule & progress to large tumefactive red & purple lesions. Oral lesions: multifocal & typically seen on palate & gingiva
LYMPHOMA Most are of B cell origin and Epstein-Barr virus occurs in cells from several cases. Lymphoma can occur anywhere in the oral cavity & there may be soft tissue involvement with or without involvement of underlying bone.
Diagnosis of HIV Viral Culture PCR P24 antigen detection ELISA Western Blot Treatment - HAART
TREATMENT Haart - zidovudine, stavudine, lamivudine, didanosine Symptomatic treatment Precautions
Members of the human herpesvirus (HHV) and human papillomavirus (HPV) families cause the most common primary viral infections of the oral cavity ...
Human Papillomavirus lesions (warts) Warts are caused by a virus. In the oral cavity, they tend to be somewhat flatter than the type ...
These specific conditions in the oral cavity may create foci of infection that can affect many other vital systems, ... and viral species.
VIRAL AND FUNGAL INFECTIONS OF THE ORAL CAVITY IN IMMUNOCOMPETENT PATIENTS. ... As with most other viral infections affecting the oral cavity, ...
Oral and maxillofacial pathology ... refers to the diseases of the mouth ("oral cavity" or ... Mumps of the salivary glands is a viral infection of the ...
Primary herpetic gingivostomatitis is the most common viral infection of ... with primary oral herpetic infection ... in the oral cavity of ...
... infectivity, transmission, reactivation and pathotropic spread of viral infections in the oral cavity of the immunocompromised host.