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OMPR > HSV > Flashcards

HSV Flashcards

1
Q

Types of Herpes Viruses

A 
HHV-1: HSV-1-Herpes simplex virus type 1
HHV-2: HSV-2-Herpes simplex virus type 2 
HHV-3: VZV-Varicella zoster virus
HHV-4: EBV-Epstein Barr virus 
HHV-5: CMV-Cytomegalovirus
HHV-6: Sixth disease/Roseola
HHV-7: Roseola 
HHV-8: KSHV-Kaposi sarcoma-associated herpesvirus
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2
Q

HHV-1/HSV1 Cells of Latency

A

Sensory Ganglia

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3
Q

HHV-2/HSV2 Cells of Latency

A

Sensory Ganglia

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4
Q

HHV-3/VZV: Cells of Latency

A

Sensory ganglia (dorsal root ganglia)

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5
Q

HHV-4/EBV: Cells of Latency

A

B-Lymphocytes

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6
Q

HHV-5/CMV Cells of Latency

A

Myeloid cells, salivary gland cells, endothelium

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7
Q

HHV-6 Cells of Latency

A

CD4+ T-Lymphocytes

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8
Q

HHV-7 Cells of Latency

A

CD4+ T-Lymphocytes

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9
Q

HHV-8 Cells of Latency

A

B-lymphocytes (latency), endothelial cells (Kaposi sarcoma)

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10
Q

Primary Infection of Herpes

A

Acute (primary) herpetic gingivostomatitis

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11
Q

Recurrent Infection of Herpes

A

Herpes labialis

Intra-oral herpes

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12
Q

HSV-pathogenesis-Primary Infection

A
  • Usually young age
  • Often asymptomatic
  • Symptomatic=Primary herpetic gingivostomatitis
  • In adults is usually pharyngotonsillitis
  • Spread through infected saliva or active lesions
  • Incubation period=3-9 days
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13
Q

Primary Herpetic Gingivostomatitis Clinical Features

A
  • Cervical lymphadenopathy
  • Chills
  • Fever
  • Nausea
  • Anorexia
  • Irritability
  • Sores in mouth
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14
Q

Primary Herpetic Gingivostomatitis Oral Lesions

A
  • Ulcerations on fixed and movable mucosa
  • Variable number of lesions
  • Ulcers coalesce and form larger irregular ulcerations
  • Gingiva enlarged and painful
  • Resolution in 5-7 days (latency in trigeminal ganglion)
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15
Q

HSV- diagnosis

A 
Clinical**
Culture (may take 2 weeks)
Tissue biopsy
Cytologic smear (less invasive)**
Serologic testing
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16
Q

HSV-Histopathology

A

Molding
Margination
Multinucleation

Also Tzanck cells

17
Q

Lab Results

A

Positive IgM and Negative IgG = Acute/Recent Infection

Negative IgM and positive IgG = established infection

18
Q

Treatment primary HSV

A
  • Supportive/Palliative Treatment
  • Fluids, nutrition, rest, avoid spreading to others
  • Avoid touching eyes, genitals
  • Possible referral to MD if infant is not drinking because of pain

**ACYCLOVIR NOT RECOMMENEDED ANYMORE

Medications:

  1. Topical anesthetic (OTC vs Rx)
  2. Mucosal coating (OTC)
  3. Analgesic (OTC vs Rx)
  4. Antiviral (Rx) (for immunocompromised or dehydrated pts)
19
Q

Warning about Primary HSV Meds

A

Rinses may diminish the gag reflex therefore better suited for older patients, but remember serious side-effects of seizures and methemoglobinemia in pediatric population.

20
Q

HSV-1 Recurrent infection

A 
Secondary herpes
Mild, self-limiting
Latency in trigeminal ganglion
Vermilion border
Intraorally on fixed keratinized mucosa
Prodrome> papules > vesicles > ulcer > crust > heals > no scar
7-10 days
Unilateral
21
Q

Recurrent HSV-Triggers

A 
Old age
UV light
Physical/emotional stress
Fatigue
Heat 
Cold
Pregnancy
Allergy
Trauma
Dental treatment
Respiratory illnesses
Fever
Menstruation
Systemic Diseases
Malignancy
22
Q

Can you give someone Herpes if you’re asymptomatic?

A

Asymptomatic shedding can occur in seropositive patients

More common after surgical procedures and in immunocompromised patients

Universal precautions

23
Q

What is the difference clinically between Recurrent HSV infection and Primary?

A

Intraoral colescing lesions are NOT ON MOVABLE MUCOSA FOR RECURRENT!! (palate and keratinized gingiva)

24
Q

Recurrent HSV-Treatment

A
  • Depends on severity/frequency
  • Preventive/suppressive vs episodic/abortive strategies
  • Antiviral agents/antiviral-steroid combination agents
  • Remove precipitating factors
25
Q

Recurrent Herpes Labialis-FDA approved topical treatments

A

Rx: Acyclovir cream 5% (Zovirax)
Disp: 5g tube
Label: dab on lesion every 2 hours for 4 days

Rx: Penciclovir cream 1% (Denavir)
Disp: 5g tube
Label: dab on lesion every 2 hours for 4 days

Rx: Docosanal cream (Abreva) OTC
Disp: 2g tube
Label: dab on lesion five times per day for 4 days

Rx: Acyclovir 5%/ hydrocortisone 1% cream (Xerese)
Disp: 5g tube
Label: dab on lesion 5 times a day for 5 days

Rx: Acyclovir buccal tablets 50mg
Disp: 2 dose pack
Label: apply to canine fossa within 1 hour of symptoms (single dose)

26
Q

Recurrent Herpes Labialis-FDA approved systemic antivirals

A 
Rx: Valacyclovir 1g tablets 
	Disp: 4 tabs 
	Label: 2 tabs stat PO, then again in 12 hours (ie 2 doses) 
Rx: Famciclovir 500mg tablets
	Disp: 3 tabs 
	Label: 3 tabs stat PO
27
Q

Recurrent Herpes Labialis-OTHER Topical AGENTS

A

Ice
L-lysine
Bioflavonoids
Evaporants-Dessicants
Emollients
Bioadhesives (Zilactin-benzyl alcohol, topical pain reliever)
Wound-healing modification/occlusive agents

28
Q

Suppression of Dentally Induced recurrent HSV

A

2-day prophylactic course of valacyclovir

  1. 2g taken 1 hr before dental tx
  2. 2g taken same evening
  3. 1g taken bid the next day

**STUDY WAS FUNDED BY MANUFACTURER OF VALTREX

29
Q

HSV-ATYPICAL PRESENTATION

A

Immunocompromised host
Location and extent of lesion

Usually do not see necrotic, large, lesions or lesions on movable mucosa

30
Q

HSV Associated Erythema multiforme

A

HSV implicated in trigger for erythema multiforme
Skin immune reaction in response to infection
Rx antiviral prophylaxis

31
Q

Varicella Zoster Virus Infection

A
  • HHV3
  • Primary infection is Varicella/Chicken pox
  • Secondary infection is Zoster/Shingles
  • May affect oral cavity/face if reactivation along distribution of V1/2/3
32
Q

Cytomegalovirus Infection

A

-HHV-5
-Latency in myeloid cells, salivary gland cells and endothelium (“OWL EYES”)
-Disease states found predominantly in:
> pregnancy/neonates (congenital infection)
> immunocompromised patients, particularly transplant and HIV+ patients

33
Q

Epstein-Barr Virus Infection

A
  • HHV-4
  • Latency in lymphocytes
-EBV-induced diseases with oral manifestations:
    > Infectious mononucleosis
    > Oral hairy leukoplakia 
    >Nasopharyngeal carcinoma
    >EBV mucocutaneous ulceration
    > Burkitt lymphoma

Burkitt lymphoma histology is
Sheets of diffuse B cells
“starry sky” is lymphocytes with center of macrophage

34
Q

Kaposi sarcoma

A

-HHV-8, KSHV
-Vascular neoplasm of endothelium
-Associated with immunosuppression
-Usually evolves through 3 stages:
Patch-plaque-nodular

DOES NOT BLANCH ON PALPATION

OMPR (8 decks)

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