7: Viral Infections

Question 1

What are six members of the herpetoviridae family?

Answer 1

HSV-1, HSV-2, Varicella Zoster (HSV-3), EBV (HSV-4), CMV, Kaposi Sarcoma

Question 2

Which is oral herpes? Genital?

Answer 2

HSV-1; HSV-2

Question 3

T/F. Most of those with primary herpetic gingivostomatitis show signs.

Answer 3

F. Only ~12% are symptomatic

Question 4

Other than the oral lesions, what are five other signs of primary herpetic gingivostomatitis?

Answer 4

Fever (103-105F), nausea, anorexia, irritability, cervical lymphadenopathy

Question 5

What are two ways HSV-1 is spread?

Answer 5

Infected saliva or active perioral lesions

Question 6

When is the only time HSV-1 presents on the lips and gums?

Answer 6

Primary infection

Question 7

What is the only thing that has been proven to induce herpetic lesions after infection?

Answer 7

UV light

Question 8

What are six general things that can reactivate HSV-1?

Answer 8

UV light, emotional stress, trauma, respiratory illness, systemic disease, malignancy

Question 9

What is the primary HSV-1 infection age range?

Answer 9

Young (6mo-5yr) with the highest incidence in 2-3 year olds due to day care

Question 10

What are four characteristics of the mouth lesions in primary HSV-1 infection?

Answer 10

Distinctive punched-out erosions, enlarged gingival, erythematous, can be anywhere in the mouth (almost always on lip)

Question 11

Where does secondary HSV-1 infection most commonly present and what is it called?

Answer 11

Vermillion border and adjacent skin of lips; herpes labials (aka cold sore/fever blister)

Question 12

What are four herpes labials symptoms?

Answer 12

Pain, burning, itching, local warmth

Question 13

What is the herpes labialis course?

Answer 13

6-24 hrs: Prodromal stage
2+ Days: Vesicles rupture and crust
7-10 days: healing

Question 14

What pathology may have cases that are preceded by a symptomatic recurrence of HSV?

Answer 14

Erythema multiforme (3-10 days earlier)

Question 15

What are three characteristics of HSV-1 and 2 histology?

Answer 15

Ballooning degeneration, Tzanck cells, multinucleate giant cells

Question 16

What are three topical anti-virals for HSV-1? Three systemic?

Answer 16

1: Acyclovir, docosonal, penciclovir

2. Acyclovir (200mg), Famciclovir (125mg), Valcyclovir (500mg)

Question 17

What is the holistic approach for HSV-1 tx?

Answer 17

L-lysine 500mg

Question 18

T/F. You can only give treatment during prodromal stage.

Answer 18

T. If given during vesicle rupture, you are too late and anti-virals will not help healing.

Question 19

When is HSV-2 most dangerous?

Answer 19

During the delivery of a baby

Question 20

Why do women have more risks of getting an STD?

Answer 20

Anatomy

Question 21

When is the primary infection of chicken pox? Its other name? Adult reactivation’s name?

Answer 21

5-9yo, Varicella Zoster (HSV-3); shingles

Question 22

How long is the incubation period for varicella zoster and where does the rash typically begin?

Answer 22

10-21 days; face and trunk

Question 23

How long is a person contagious with chicken pox?

Answer 23

2 days before exanthema and until all the pustules crust

Question 24

What is the classic findings of reactivated loser and in what age?

Answer 24

Pt over 60, pain along nerve from back to front, then get lesions that scab in the area that look like shingles

Question 25

Where does Herpes Zoster remain latent (dormant)? HSV-1 dormancy?

Answer 25

Dorsal spinal ganglion (transported up sensory nerves); trigeminal nerve

Question 26

What is the histology of HSV-1? Describe

Answer 26

Tzanck cells: free floating epithelial cell in any intraepithelial vesicle

Question 27

What is the vaccine for Herpes Zoster? Other tx?

Answer 27

Live attenuated varicella zoster virus for adults; capsaicin may provide relief

Question 28

Is Herpes Zoster painful? Unilateral or bilateral?

Answer 28

Painful and unilateral

Question 29

Syndrome associated with Herpes Zoster (Shingles) that is a combination of cutaneous lesions of the external auditory canal and involvement of the ipsilateral facial and auditory nerves leading to facial paralysis, hearing defects, vertigo?

Answer 29

Ramsay-Hunt Syndrome

Question 30

Symptomatic disease form exposure to Epstein-Barr Virus (HHV-4)

Answer 30

Infectious mononucleosis

Question 31

When is Epstein Barr Virus (HHV-4) symptomatic: children or young adults?

Answer 31

Young adults; children do not display symptoms

Question 32

Infectious Mononucleosis (Epstein Barr Virus/HHV- 4) symptoms (6)?

Answer 32

Fever, Lymphadenopathy, Tonsilitis, Pharyngitis | Hepatosplenomegaly & rash (less frequent)

Question 33

2 tests that confirm Epstein Barr Virus?

Answer 33

Paul-Bunnell heterophil antibody & Indirectimmunofluorescent test for EBV-specific antibodies

Question 34

2 tx's for Epstein Barr Virus? Prognosis?

Answer 34

Non-aspirin antinpyretics and NSAIDS & No contact sports if enlarged spleen; good- will usually resolve itself in 4-6 weeks

Question 35

What virus can reside latently in salivary gland cells, endothelium, macrophages, and lymphocytes? What % of pt have symptoms?

Answer 35

CMV (HHV-5); 10%

Question 36

What are 3 Enteroviruses of dental significance?

Answer 36

Herpangina, hand-foot-and-mouth disease, Acute Lymphonodular pharyngitis

Question 37

Most well-known enterovirus infection?

Answer 37

Hand-foot-and-mouth disease

Question 38

What enterovirus does not have skin lesions but pt may have a sore throat, dysphagia or fever? Why the sore throat?

Answer 38

Herpangina; ulcerated lesions occur on posterior oropharnyx

Question 39

What is the course of herpangina?

Answer 39

Red macules that ulcerate into 2-4mm ulcer; 2-6 oral lesions of soft palate and tonsillar pillar that heal in 7-10 days

Question 40

How is HFM disease different from herpangina?

Answer 40

Will have oral lesions, but HFM will also have skin rash and oral lesions ass'd with flu-like symptoms; also the oral lesions in HFM will be numerous and can be anywhere in the oral cavity

Question 41

In HFM diease, which comes first, the oral lesions or skin lesions?

Answer 41

Oral lesions

Question 42

What Enterovirus is characterized by 1-5 yellow to dark pink nodules on the soft palate and tonsillar pillars representing hyperplastic lymphoid tissue?

Answer 42

Acute Lymphonodular pharyngitis

Question 43

Does ALP ulcerate?

Answer 43

No

Question 44

How do we diagnose enteroviruses?

Answer 44

Clinical presentation

Question 45

Treatment of Enteroviruses?

Answer 45

Self-limiting, so direct therapy toward symptomatic relief w/ non-aspirin anti-pyretics and topical anesthetics

Question 46

)Infection produced by a paramyxovirus that has largely been controlled with vaccines

Answer 46

Measles/rubeola

Question 47

What is the most distinctive oral manifestion of Rubeola/Measels in its initial stage? Define.

Answer 47

Koplik's spots: mucosal erythema w/ numerous small blue-white macules within

Question 48

What are the Pathoneumonic histologic cells for Measels?

Answer 48

Warthin Finkeldey Giant Cells

Question 49

This sounds like the virus that causes normal measles, but this is a mild viral illness produced by a Togavirus, and has capacity to cause birth defects

Answer 49

Rubella/ German Measles

Question 50

What is the classic triad of congenital rubella syndrome?

Answer 50

Deafness, heart disease, and cataracts

Question 51

What virus is spread via respiratory droplets and infectious from 2 days before symptoms until 4 days after appearance of rash?

Answer 51

Measles/Rubeola

Question 52

This is a virus also caused by a Paramyxovirus, but this causes a diffuse disease of exocrine glands. Which gland does it most commonly affect?

Answer 52

Mumps/endemic parotitis; the Parotic salivary glands being the best known site of involvement

Question 53

What is a clinical symptom of Mumps/Endemic Parotitis?

Answer 53

Pain during initial parotid enlargement, then pain w/ chewing and salivation

Question 54

What is the 2nd most common place, beside the Parotid, that can swell due to Mumps/Endemic Parotitis?

Answer 54

Testicles (Epididymoorchitis)

Question 55

What are oral infections associated with Human immunodeficiency Virus (HIV)?

Answer 55

Candidiasis, HIV ass'd Kaposi’s Sarcoma, and HIV ass'd Oral Hairy Leukoplakia

Question 56

What does HIV-associated Kaposi’s Sarcoma look like?

Answer 56

Multiple lesions of skin and oral mucosa. Brown or reddish purple that do no blanch under pressure

Question 57

What are the common oral areas for HIV associated Kaposi’s Sarcoma?

Answer 57

Hard palate, gingiva and tongue