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OPath Block 2 > 6. Viral Infection II > Flashcards

6. Viral Infection II Flashcards

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1
Q

What is the most common clinical presentation for patients that develop symptoms from primary herpes?

A

Primary herpetic gingivostomatitis

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2
Q

What population does primary herpetic gingivostomatitis tend to affect?

A

Children

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3
Q

What are the clinical presentations of gingivostomatitis?

A

Vesiculo-ulcerative eruptions (not limited to bone-bound mucosa)

numerous pin head vesicles which quickly ulcerate and merge

gingiva is always involved, extremely erythematous

May involve vermillion and perioral tissue

Older pts develop vesicles in pharynx and mimics pharyngostonsillitis

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4
Q

What are the systemic symptoms of primary herpetic gingivostomatitis?

A

fever

malaise

headache

cervical lymphadenopathy

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5
Q

How does primary herpetic gingivostomatitis resolve?

A

Heals in a week as virus migrates to trigeminal ganglion (latnecy)

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6
Q

What allows a secondary/recurrent HSV to occur?

A

A breakdown in local immunosurveillance allows the virus to reactivate

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7
Q

What kind of symptoms occur at the site where secondary HSV lesions will appear?

A

Prodromal symptoms (pain or tingling)

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8
Q

S/S of 2nd HSV infection

A

Vesiculo-ulcerative process

clusters of pin head vesicles that rupture quickly

In oral cavity, limited to mucosa that is bound to bone (hard palate and gingiva)

Vermillion and surrounding skin can have lesions (esp commissure area): herpes labialis

No systemic symptoms

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9
Q

How does secondary HSV infection resolve?

A

Selt-limited

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10
Q

How does secondary HSV infection affect immunodeficient pts?

A

Atypical presentation

lesions not limited to bound muscoa (will see on tongue)

vesicles are bigger, chronic and destructive

Presdisposes pt to bacteria infection andusually con-infected with CMV

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11
Q

What is herpetic whitlow?

A

infection of the finger by the HSV

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12
Q

S/S of herpetic whitlow

A

Vesiculo-ulcerative eruptions

very painful and lasts for 4-6 weeks

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13
Q

Do herpetic whitlow lesions occur in primary or secondary infection?

A

both

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14
Q

What population was once often affected by herpetic whitlow?

A

dentists before use of gloves

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15
Q

What are other conditoins that must be listed as a DDH when thinking about primary oral HSV infection? What differentiates each condition from primary HSV?

A

Erythema multiforme

  • spares gingiva whereas gingivostomatitis always involves gingiva

Acute necrotizing ulcerative gingivitis

  • no vesicles whereas gingivostomatitis has vesicles
  • do not involve other mucosa whereas gingivostomatitis can involve palate, tongue, etc
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16
Q

What are other conditions that must be considered for an secondary oral HSV infection? How do they differ from secondary oral HSV?

A

Apthous ulcers

  • movable ulcers
  • non-keratinized mucosa
  • no vesicles

Traumatic ulcers

  • one single large lesion whereas HSV tends to be multiple small vesicles
  • no vesicles
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17
Q

Dx for oral HSV infection

A

Clinical symptoms unless for atypical or immunocompromised pts

Culture is difficult for herpes

Serology only works for primary HSV infection

Cytology smear or biopsy:

  • Ballooning degeneration
    • acantholysis
    • Tzanck cells
    • intraepithelial vesicles
  • Cytopathologic effects on virus infection
    • herpes infection causes keratinocytes to fuse resulting in below features
    • multinucleation
    • margination of chromatin
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18
Q

Tx for oral HSV infection

A

Ideal treat within 48 hours fro monset of symptoms

Normal pts don;t need any antiviral drugs. Just supportive treatment

Immunodeficient pts always need antiviral treatment

Primary

  • supportive therapy w/o antiviral agents

Secondary

  • Normal pts usually dont need tx
  • prophylactic Tx is reserved for problematic cases
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19
Q

What are the general clinical features of varicella-zoster virus?

A

Vesiculoulcerative eruption on skin and mucosa

Self-limiting in immunocompetent patients

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20
Q

What are the two classifications of varical-zoster virus infections?

A

Primary infection = Varicella (chickenpox)

Secondary/recurrent infection = Herpes zoster (shingles)

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21
Q

How does chickenpox differ in adults vs children?

A

adults usually suffer from severe symptom and may develop complications

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22
Q

how is chickenpox transmitted?

A

Inhalation of contaminated droplets, readily spread from child to child

Pts are very contagious, readily spread from child to child

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23
Q

Clinical features of varicella?

A

Rash + systemic symptoms (fever + malaise)

Generalized eruption of vesicles

Start as skin rash, progress to vesicles and pustules that rupture and ulcer

For about a week, a mixture of lesions at various stages of development and resolution is present

Oral invovlement is common but minor

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24
Q

Varicella Dx

Study These Flashcards
A

Based on clinical presentation

25
Varicella complications
Secondary skin infections, encephalitis, pneumonia infection during pregnancy may result in spontaneous abortion or congenital defects Most common in adults Prevention is the best Tx, get vaccinated
26
What populatin does herpes zoster (shingles) affect?
elderly and immunocompromised
27
S/S of shingles
Prodromal: pain or paresthesia in the affected dermatome Develop unilateral rash along the nerve distribution and terminate at the midline (coalescence of the vesicles followed by crusting) Vesicles develop in one dermatome - waistline = common location Postherpetic neuralgia (15%) - resolves in a year and uncomon in young pts Trigeminal ganglia presence: * Oral lesions * both movable and bound mucosa, terminate at the midline * skin overlying the affected quadrant is affected * Ocular involvement may result in blindness
28
Herpes Sozter Dx
Clinical presentation Unilateral lesions along dermatome of the peripheral nerves Lab tests are req'd for atypical presentation: * Immunocompromised pts wide spread and chornic lesions that cross the midline with severe complications * histopathology is the same as HSV
29
Tx for Zoster
normal patients only need symptomatic and supportive treatment immunocompromised pts need antivirals (acyclovir and analogs) Vaccine for shingles is available and recommended for elderly but not 100% effective
30
What diseases are caused by EBV?
Infectious mononucleosis Oral hairy leukoplakia Lymphoproliferative disorders (NHL, African Burkitt lymphoma) Nasopharyngeal carcinoma Chronic fatigue syndrome
31
How is CMV transmitted?
Exchange of body fluid organ transplant
32
S/S of CMV infection in normal pts
almost everyone is infected by CMV asymptomative in healthy individuals
33
S/S of CMV in immunocompromised pts
Affects many organs Oral manifestations: * chronic oral ulcer: often co-infect with HSV * CMV sialadenitis (salivary gland enlargement)
34
CMV Dx
Clinical + lab test Histopathology: * CMV infected cells are HUGE * Cells have owl eye presentation * Cells contain intranuclear and cytoplasmic inclusions
35
Tx for CMV
Only necessary for immunocompromised pts
36
Which enterovirus causes head and neck conditions?
Coxsackie virus
37
How is coxsackie virus transmitted?
Inhalation of resp droplets Fecal-oral route
38
Population most affected by coxsackie?
Children
39
3 diseases caused by coxsackie
Herpangina Hand,foot, mouth dz Acute lymphonodular pharyngitis
40
Dx for coxsackie infection?
Clinically Specific lab tests are available
41
S/S of herpangina
sore throat dysphagia mild flu-like symptom small number of vesicles develop in oropharynx area vesicles ulcerate very quickly self-limiting process with recovery in 1 week
42
S/S of hand-foot-mouth disease
skin rash (eruption of small vesicles on the hands and the feet, including fingers and toes) oral lesions (oral vesicles and uclers on any mucosa) flu-like smyptom
43
S/S of acute lymphnodular pharyngitis
No vesicles or ulcers Low number of yellow nodules develop in oropharynx area (nodules caused by lymphoid hyperplasia) sore throat flu like symptoms Usually recover in 1 week without Tx
44
How are rubeola, rubella and mumps transmitted?
respiratory droplets, highly contagious
45
S/S of rubeola infectoin (measles)
Koplik's spots (clusters of tiny white papules; preceed the skin rash and are pathognomonic) Skin rash: spread from face to trunk and extremities Rash fades and followed by desquamation pt feels very sick Self limiting but can be complicated by significant morbidity and mortality
46
Rubeola (measles) Dx
clinical and confirm with lab tests such as serology
47
Rubella (german measles) S/S
Similar to measles but milder and shorter Skin rash all over body that fades in ~3 days low fever mild symptoms (pt doesnt feel sick)
48
What is congenital rubela syndrome?
Rubella infects fetus and induces birth defects
49
What happens to most fetus that contract a rubella infection?
spontaneous abortion
50
How to prevent congenital rubella syndrome
80% transmission from mother to child in first trimester Check mother's immunity to ensure she's immune bc vaccine does not provide lifetime protection
51
Rubella Dx
Clinicaland confirmed by lab tests
52
What structure does mumps attack?
Excorine glands esp salivary glands (parotid gland = #1 target)
53
S/S of parotid gland infection by mumps
Swelling pain discomfort mostly bilateral
54
What population often only has salivary gland involvement in mumps infection?
Children
55
What occurs in mumps infection of postpubertal males?
Epididymis and testis involvement (epididymo-orchitis) Swelling, pain, atrophy on affected testes Permanent sterility is rare
56
Tx for mumps?
self limited dz control symptoms with pain meds
57
Oophoritis?
Ovary affected by mumps
58
Mastitis?
Breast affected by mumps
59
What does the MMR vaccine protect from?
Measles (98%) Mumps (95%) Rubella (protection doesnt last as long as other two)

OPath Block 2 (10 decks)

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