Infective Disorders

Question 1

What are Herpesviridae that are pathogenic in Humans

the big graph will be provided on the exam

Answer 1

large enveloped double stranded DNA (dsDNA) viruses

1. Herpes simplex virus 1 (HHV-1)
2. Herpes simplex virus 2 (HHV-2)
3. Varicella-zoster virus (HHV-3)
4. Cytomegalovirus (HHV-4)
5. Epstein-Barr virus (HHV-5)
6. HHV-6
7. HHV-7
8. HHV-8

Question 2

Herpes Simplex Type 1

Signs of Primary Herpetic Attacks :

Answer 2

Acute herpetic gingivostomatitis -- Usually in kids
 Herpetic pharyngotonsillitis -- Usually in adults
 Herpetic keratitis (eye; blindness) 
 Herpetic keratoconjunctivitis
 Herpetic whitlow (finger)
 Others
-- Eczema herpeticum (skin rash) 
-- Herpes gladiatorum (scrumpox)
(abraded skin, e.g. wrestlers)

Question 3

Acute Herpetic Gingivostomatitis

• cause by
• areas it affects
• demographic affected
• percentage asymptomatic
• incubation period

Answer 3

HSV-1: spread via saliva, vesicles
Primarily oral, pharyngeal, facial, ocular
Individual lesions are identical to HSV-2

Usually: 6 months-5 years of age
– If adult: sore throat, not gingivitis

Incubation period: 3-9 days
88% = asymptomatic, but contagious

Question 4

Acute Herpetic Gingivostomatitis (HSV1)

• symptoms
• duration
• where does virus remain latent?

Answer 4

Maybe: lymphadenopathy, chills, fever (<105o F); more likely with 20 bacterial infection
Numerous oral painful vesicles/ulcers Painful, swollen gingivae
Maybe: pharyngitis, keratoconjunctivitis Lasts 5-10 days
Virus remains latent in gasserian ganglion

Question 5

HSV 2: Venereal Herpes (STD)

Answer 5

HSV-2 sexually transmitted disease (STD) – Very few genital HSV-1 infections
Spread via sexual contact Recurrent, painful, contagious No gingivitis (unlike HSV1)

scattered broken vesicles in the cheek; LACK OF gingival inflammation

Question 6

Herpetic Whitlow (HSV1)

Answer 6

Painful vesicles/pustules of finger or thumb
 Caused by HSV type 1 or 2
 High risk in health professionals
 In children: tends to co-occur with gingivostomatitis
 Saliva = source of infection
 Grouped vesicles, ulcers on red base
 Antivirals: reduce duration of symptoms
 Risk of recurrence, on finger or in mouth

Question 7

Primary Herpes Treatment

Answer 7

• Supportive care such as hydration and nutritional supplement
• Acyclovir suspension during the first 3 symptomatic days (children: 15mg/kg up to the adult dose of 200mg) in a rinse and swallow technique five times daily for five days
• Antiviral medications

Pain Control:

• Topical lidocaine
• Tetracaine lollipops (compounded): produces mucosal numbing
• Caution: avoid viscous lidocaine/topical benzocaine in kids
• • Lidocaine-induced seizures
• • Association between topical benzocaine and methemoglobinemia
• Nonsteroidal antiinflammatory medications, e.g. ibuprofen

Question 8

Treatment to avoid in kids with Primary Herpes (HSV1)

Answer 8

Caution: avoid viscous lidocaine/topical benzocaine in kids

• • Lidocaine-induced seizures
• • Association between topical benzocaine and methemoglobinemia

Question 9

Recurrent Herpes Treatment

Dental vs general

Answer 9

Dental:
Prior to dental Rx; 2 grams valacyclovir BID on the day of
procedure, 1 gram BID next day
Prior to “trigger” events: acyclovir, 400 mg BID; valacyclovir 1 gram daily; or famciclovir 250mg BID

General:
Acyclovir ointment: in polyethylene glycol = limited benefit in immunocompetent patients,
– Its base prevents significant absorption

Penciclovir cream: (absorbed through vermilion): Works best if applied during prodrome

Abreva

Systemic acyclovir, valacyclovir,

Valacyclovir: initial 2 grams taken upon during prodrome, then 2 grams 12 hours later = minimizes recurrences

Acyclovir: 400mg taken five times daily for five days

Prior to dental Rx; 2 grams valacyclovir BID on the day of
procedure, 1 gram BID next day
Prior to “trigger” events: acyclovir, 400 mg BID; valacyclovir 1 gram daily; or famciclovir 250mg BID

Question 10

Herpes Labialis 
( recurrent, secondary herpes type 1)

Answer 10

HSV-1 recurrence on lip vermilion, skin
 1/3 of adults: intermittent asymptomatic
virus shedding in saliva throughout life
– Latent virus in gasserian ganglion
– Virus travels down trigeminal nerve – Then “jumps” into epithelial cells
– Then incorporates into cell’s DNA and “takes over production”
 Prodromal stage: pain, pruritus, tingling –1-3 days before blisters
 Then: erythema&raquo_space; vesicle&raquo_space; pustule&raquo_space; crusted
 Lasts for 4-8 days
– Virus in saliva, usually (contagious)

Question 11

KNOW the name of the ganglion Herpes resides in:*****

Answer 11

Gasserian Ganglion

Question 12

** Prodromal Stage of Herpes Labialis

Answer 12

Prodromal stage: pain, pruritus, tingling –1-3 days before blisters

crusted stage: means it’s at the end, low viral load at that point