Viral Infections

Question 1

Who are viral infections common in

Answer 1

Children and immunocompromised

Question 2

What does HSV 1 cause orally

Answer 2

Herpes
Oral ulcers

Question 3

What does herpes varicella zoster cause orally

Answer 3

Shingles

Question 4

What does Epstein Barr virus cause orally

Answer 4

Hair leukoplakia
Lymphoma

Question 5

What does HHV-8 cause orally

Answer 5

Kaposi sarcoma

Question 6

Presentation of primary hermetic gingivostomatitis

Answer 6

Acute gingivitis
Oral ulceration
Crusting of lips
Submandibular lymphadenopathy
Malaise
Fever
Widespread multiple ulcers

Question 7

Diagnosis of PHG

Answer 7

Based on clinical signs and symp

Question 8

Differential for PHG

Answer 8

Erythema multiforme
Herpetiform recurrent apthous stomatitis
Herpangina
Hand foot and mouth (cocksaki)

Question 9

Management of PHG

Answer 9

Primarily supportive
Chlorhex MW
2% lidocaine MW
Paracetamol
High fluids
Resolves in 7-10 days

Question 10

PHG antivirals

Answer 10

Not routinely used unless severe or immunocompromised

Acyclovir 200mg 5TD

Question 11

What are trigger factors for HSV1

Answer 11

Stress
Exposure to UV light
Cold weather
Flu
Period
Pregnancy
Trauma
Immunsuppression

Question 12

% of herpes labialis

Answer 12

30-40%

Question 13

Features of herpes labialis

Answer 13

Pro drome burning in 40-60%
Initiates as vesicle
Erupts to leave erosion
Crusts after 48 hours
Heals in 7-10 days
Recurrent episodes

Question 14

Treatment of herpes labialis

Answer 14

Topical aciclovir 5%
Penciclovir 1%
Reduce duration doesn’t prevent
Systemic
Aciclovir 200-400mg 5TD 5-7 days
Valaciclovir 1g TDS 3-5 days

Question 15

Features of oral herpetif ulcer

Answer 15

Multiple small ulcer
Prodromal burn
Local trauma
Palate most frequent

Question 16

Features of heroes zoster (shingles)

Answer 16

Headache malaise and fever
Small vesicles or ulceration confined to sensory nerve distribution
Burning and allodynia

Question 17

When would you need urgent referral of shingles

Answer 17

If ophthalmic nerve involved

Question 18

Management or HHV - 3 herpes zoster

Answer 18

Antivirals - systemic aciclovir 10 days 800mg 5TD
Valacyclovir 1g every 8 hours for 10 days
Early antivirals to avoid post herpetic neuralgia

Question 19

What are complications of herpes zoster

Answer 19

Post hermetic neuralgia
Ramsay-Hung syndrome
Meningitis

Question 20

Presentation of EBV (HHV4)

Answer 20

Headache
Fever
Malaise
Myalgia
Lymphadenopathy
Fatigue

Question 21

Where does EBV replicate

Answer 21

Acquired in saliva
Replicates in mucosa and salivary glands
Spreads to B lymphocytes and blood

Question 22

What is EBV associated with orally

Answer 22

Hairy oral leukoplakia

Question 23

What is OHL associated with

Answer 23

Immune deficiency secondary to HIV
Organ transplant
Immunocompetent

Question 24

Dx of OHL

Answer 24

Benign
Painless white patch
Vertical folds or ridges involving lateral briefer of tongue
Can’t be scraped away

Question 25

Investigation for OHL

Answer 25

Biopsy and histopathology

Question 26

Management of OHL

Answer 26

Exclude immunocompromised
Monitor
Systemic antivirals will resolve but will recur when med stopped

Question 27

What is Kaposis sarcoma caused by

Answer 27

HHV 8
Oral manifestation of HIB or immunosuppression

Question 28

What can kaposis sarcoma mimic

Answer 28

Amalgam tattoo

Question 29

How do you diagnose kaposi sarcoma

Answer 29

Clinical appearance and histopathological findings

Question 30

Management of kaposis sarcoma

Answer 30

Intralesional injections of chemotherapeutic drugs
Chemotherapy or local radiotherapy