Viral Infections Flashcards
(44 cards)
What is the primary occurrence of HSV1?
Primary herpetic gingivostomatitis
How is HSV1 spread & what is the incubation period?
Via saliva
4-7 day incubation period
Most common in young children
Clinical presentation of primary herpetic gingivostomatitis?
2-3mm vesicles on keratinised tissue which rupture => painful ulcers which heal in 7-10 days
Diffuse gingivitis
Lip erosions
Cervical lymphadenopathy
Prodromal symptoms of primary herpetic gingivostomatitis?
Malaise, irritability & fever
How to diagnose primary herpetic gingivostomatitis?
Usually clinical observations alone
Can be confirmed through viral culture, electron microscopy & PCR
How to manage primary herpetic gingivostomatitis?
Reassure pt (resolution in 2-3 weeks)
Encourage rest & fluid intake (dehydration risk)
Prevention of spread (limit close contact to reduce spread)
Antiseptic mouthwash (e.g. CHX) to prevent secondary bacterial infection
Simple analgesics/antipyretics (e.g. paracetamol)
How to to manage severe cases of primary herpetic gingivostomatitis?
Aciclovir suspension or tablets
Where does HSV1 virus remain?
Latent/dormant in the dorsal root of trigeminal ganglion or localised neural tissue
How can HSV1 recur?
Herpes labialis (cold sore)
Intra-oral reactivation
Herpetic whitlow
Erythema multiforme
What can trigger HSV1 reactivation?
Sunlight (UV radiation)
Trauma (e.g. post-op onset)
Menstruation
Immunosuppression (e.g. HIV, transplants or chemotherapy)
Infection (e.g. pneumonia)
Prevention/management of HSV1 recurrence?
Prevention = Suncreen & PPE (hand/eye protection)
Topical acyclovir or peniciclovir => reduced severity & duration of attack
Systemic acyclovir prophylaxis (severe)
Clinical features of intra-oral reactivation of HSV1?
Occurs on keratinised tissue - often on hard palate (near greater palatine foramen) or attached gingiva
Prodromal tingling followed by painful localised collection of vesicles which ulcerate
Usually follows dental tx
Clinical features of herpetic whitlow?
Oedema
Intense pain
Erythema
Followed by crusting vesicular lesion on digits
Occupation risk associated with herpetic whitlow?
HSV acquired from pt saliva => affects skin of digits
Highly infective
Aetiology of erythema multiforme?
Infections - HSV (70%), hepatitis, mycoplasma, bacterial, fungal or parasites
Medication - NSAIDs, anti-fungals or barbiturates
Systemic - SLE, malignancy or pregnancy
Idiopathic (50%)
Clinical features of erythema multiforme?
Oral lesions:
- Bullae or erythematous blister break to form irregular ulcers that bleed & crust over
- Lip crusting common
Skin lesions:
- ‘Target/iris lesion’ of macules & papules, pale area surrounding by oedema & bands of erythema
- Often affects extremities (palms & soles)
Dental tx for patients with active herpetic lesions?
Postpone elective dental treatment due to infectious nature
Complete emergency treatment only (avoid aerosols)
How to treat recurrent herpes lesions?
Topical use (5%) QDS - used early on
Systemic use - prophylaxis or tx
What is caused by the primary infection of HH3/VZV?
Chicken pox
Clinical features of primary HH3/VZV infection?
Initial site = upper respiratory tract (14 day incubation period)
2-3 weeks after initial infection: Itchy, maculopapular rash on back, chest & face
Oral presentation:
- Vesicles/ulceration
- Most common on hard palate/fauces/uvula
How can VZV/HHV3 recur?
Shingles
Post herpetic (Trigeminal) neuralgia
Ophthalmic shingles
Ramsay-Hunt Syndrome
Where does HHV3/VZV remain latent?
In dorsal root or cranial ganglia
What can trigger VZV/HHV3?
Immunosuppression (e.g. AIDS, Hodgkin’s lymphoma, transplant, age)
Clinical presentation of shingles?
On trunk - erythematous painful lesion
Systemic illness - malaise, pyrexia & lymphadenopathy
