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Flashcards in Viral Infections Deck (81)
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1
Q

Herpes is DNA/RNA virus

A

DNA

2
Q

which herpes is oral? which is genital?

A
1 = oral
2 = genital
3
Q

what causes primary infection of herpes simple virus?

A

initial contact with the virus

4
Q

another name for primary herpes

A

herpetic gingivostomatitis

5
Q

how is primary herpes spread?

A

in saliva usually as a child

6
Q

what happens to the ulcers in primary herpes?

A

small ulcers often coalesce, resulting in larger ulcers having serpentine borders

7
Q

how do you make a dx of primary herpes?

A

exfoliative cytology or (rarely) biopsy

-infected cells show ballooning or more commonly known as TZANCK CELLS

8
Q

what is the tx for PRIMARY herpes

A

acyclovir (if identified in the first 2-3 days)

-valacyclovir is absorbed better than acyclovir and is eventually metabolized to acyclovir

9
Q

what else can be used to tx PRIMARY HERPES?

A

topical anesthetics so pt can eat and drink, important to avoid dehydration

-popsickles can be soothing for pediatric pts

10
Q

what is the px for PRIMARY herpes

A

generally good

-only one episode that lasts 10-14 days even w/o tx

11
Q

what are the chances of developing at least one episode of recurrent disease from primary herpes?

A

25%

12
Q

what are the two forms of recurrent herpes?

A
  • recurrent herpes labialis
  • recurrent intraoral herpes
  • only 12% of affected ppl will remember primary infection (subclinical/mild symptoms)
13
Q

what is RECURRENT herpes labialis also called?

A

cold sore

fever blister

14
Q

what is recurrent herpes labialis triggered by?

A

UV light exposure or trauma

15
Q

where does recurrent herpes labialis affect?

A

vermillion zone or perioral skin

16
Q

with no tx, what happens to the vesicles of recurrent herpes labialis?

A

vesicles rupture, form a crust, and lesions heal in 7 - 10 days

17
Q

what is the tx of recurrent herpes labialis?

A
  • avoid sun exposure
  • topical antiviral agents
  • pt initiated systemic valacyclovir (must be started in first two days of onset)
18
Q

is recurrent INTRAORAL herpes common?

A

no

19
Q

what are the usual symptoms with recurrent intraoral herpes?

A

irritated or rough feeling, cluster of shallow ulcers

20
Q

where are recurrent INTRAORAL herpes usually found?

A

confined to mucosa bound to periosteum (hard palate and attached gingiva) *****

21
Q

how long does is take recurrent intraoral herpes to heal with NO tx?

A

one week

22
Q

what is the major difference for herpes in an immunosuppressed pt?

A
  • ANY oral mucosal surface can be affected
  • large shallow ulcers with elevated, scalloped borders
  • looks like primary herpes but is actually recurrent
23
Q

what is the tx for herpes in an immunocompromised pt?

A
  • INTRAVENOUS acyclovir for acute cases

- maintanence therapy with oral acyclovir may be necessary

24
Q

what is herpetic whitlow?

A
  • one of the hazards associated with not wearing gloves

- despite the host having antibodies to herpesvirus, infection can still be induced with a sufficient viral inoculum

25
Q

represents PRIMARY infection with varicella-zoster virus

- has been described as “dew drops on rose pedals”

A

varicella (chickenpox)

26
Q

how is varicella spread?

A

direct contact or air-borne droplets

27
Q

what systemic things are present with varicella?

A

fever and malaise

28
Q

are oral lesions from varicella common?

A

yes

29
Q

what are the intraoral lesions for varicella?

A

a few 1-2mm shallow oral ulcers may develop at any intraoral site

*generally not as symptomatic as the cutaneous lesions

30
Q

how is varicella dx?

A

clinical signs

31
Q

what is the tx of varicella?

A

acyclovir if detected in 1 day of onset

32
Q

is the px of varicella zoster good?

A

yes

33
Q

how many ppl in the population get the reactivation of varicella (herpes zoster)

A

10-20%

*frequency inc with aging

34
Q

what are the symptoms of shingles?

A

painful erythema and vesicles usually on trunk

-LESIONS STOP AT THE MIDLINE

35
Q

what is the tx of herpes zoster?

A

systemic acyclovir or valacyclovir (5X the dosage for HSV) if early in the course of disease

36
Q

what is the px for herpes zoster?

A

good, lesions resolve in 2-3 weeks

37
Q

what can develop in 15% of herpes zoster pts?

A

post-herpetic neuralgia

38
Q

enterovirus infection caused by any one of several strains of coxsackievirus A or B, or echovirus

A

herpangina

39
Q

how does herpangina primarily affect?

A

children 1-4 years of age

40
Q

what are the symptoms of herpangina?

A

acute onset of sore throat, fever and 2-4mm oral ulcers localized to posterior soft palate/tonsillar pillar region

41
Q

how do you dx herpangina?

A

clinical findings and the setting of a local epidemic

42
Q

how long does herpangina last for?

A

self limiting process, usually resolving within 7-10 days

43
Q

what is the tx for herpangina?

A

supportive care, including analgesics, antipyretics, and topical anesthetics

44
Q

enterovirus infection usually caused by coxsackievirus strains as well as echovirus or enterovirus strains

A

hand, foot, and mouth disease

45
Q

what re the systemic symtoms of hand, foot, and mouth disease?

A

flu-like symptoms with sore throat and fever

46
Q

what are the oral symptoms of hand, foot, and mouth disease?

A

oral lesions consist of shallow ulcers typically 2-7mm in diameter

-buccal mucosa, labial mucosa, tongue are most common sites

47
Q

what are the extraoral symptoms of hand, foot, and mouth disease?

A

skin lesions consist of 1-3mm erythematous macules that may develop a central vesicle

48
Q

how do you dx hand foot and mouth disease?

A

clinical characteristics

49
Q

what is the px for hand foot and mouth disease?

A

good, condition resolves within 7 - 10 days

50
Q

a pt is considered to have HIV+ when their CD4 count goes below ____ cells

A

200

51
Q

tx of HIV started in 1998 that dec mortality rates by 80% and made HIV to be considered managable

A

highly active antiretroviral therapy (HAART)

52
Q

may be the first sign of HIV infection

A

head and neck manifestations

53
Q

can you use head and neck exam to dx AIDS?

A

sometimes

54
Q

generalized non-tender lymphadenopathy, cervical lymph nodes are most commonly affected

A

persistent lymphadenopathy

55
Q

type of fungal infection in which pulmonary aspect predominates, but dissemination to oral mucosa may occur

*presents as non-healing ulceration or granular lesion

A

histoplasmosis

56
Q

unusual pattern of gingivitis that is a red, linear band at the marginal gingiva and spontaneous bleeding may be noted

A

linear gingiva erythema

57
Q

does gingival erythema respond well to improved oral hygiene?

A

no

*abnormal response to subgingival bacteria

58
Q

bacterial infection that may be seen in a setting of relatively few apparent local factors

A

NUG

59
Q

what is the tx for NUG

A

responds to standard therapy, but prophylactic CHX used twice daily for maintenance

60
Q

bacterial infection that causes pain and spontaneous gingival bleeding and interproximal necrosis and cratering and edema dn intense erythema

A

NUP

*extremely rapid bone loss that occurs concurrently with soft tissue destruction, therefore no pocketing is evident

61
Q

much more severe presentation of NUG that is extensive painful tissue destruction that not only affects gingiva and supporting alveolar bone, but also adjacent soft tissue and deeper osseous structures

A

nectrotizing stomatitis

62
Q

waht is the managment of necrotizing stomatitis?

A

extensive debridement, topical anesthetics, and systemic antibiotics

63
Q

what is the px of necrotizing stomatosis

A

guarded

64
Q

what are the HIV related viral infections?

A
  • molluscum contagiosum
  • herpes simplex virus
  • varicella zoster
  • EBV
  • HPV
65
Q

facial skin infection caused by poxvirus

-many more lesions develop compared to non-immunocompromised pt

A

mulluscum contagiosum

66
Q

what is the deal with mulluscum contagiosum in immunocompromised pts?

A

lesions tend not to regress, unlike their normal course in immune competent person

67
Q

what is the deal with herpes simplex virus in HIV pt?

A
  • usually represent reactivation fo virus
  • may affect ANY oral mucosal surface
  • typically present as persistent painful diffuse shallow ulcerations
68
Q

what is the tx for herpes simplex with HIV pt

A

must be tx with acyclovir or one of the acyclovir analogues

69
Q

what is the deal with herpes zoster infection in HIV pt

A

gernerally more of a problem from a cutaneous standpoint

70
Q

what causes oral hairy leukoplakia?

A

EBV in HIV infected pts

71
Q

what is oral hairy leukoplakia?

A

non-removable white plaques of the lateral tongue, vertical parallel lines

72
Q

how do you dx oral hairy leukoplakia?

A

biopsy reveals parakeratosis with “balloon cells” of upper spinous layers of epithelium

73
Q

what is the tx of oral hairy leukoplakia?

A

none indicated

74
Q

exophytic lesions, solitary or multiple (more common), taht may resemble routine squamous papilloma, condyloma, or focal epithelial hyperplasia

A

HPV

75
Q

also known as chanchre sores, these are ulcerations taht may be solitary or multiple that most likely have an immune-mediated etiology

A

aphthous-like ulcerations

76
Q

what is the tx for aphthous-like ulcerations?

A

topical corticosteroids

77
Q

multifocal malignancy of vascular endothelial cell origin

A

AIDS related kaposi sarcoma

78
Q

what is the etiology of AIDS related kaposi sarcoma?

A

HHV- 8

79
Q

what normally happens to pts with AIDS related karposi sarcoma?

A

usually expire due to infectious causes, rather than KS

80
Q

what is the tx of AIDS related karposi sarcoma?

A

typically treated only if a cosmetic or functional problem

*surgical excisions

81
Q
  • not as common as karposi sarcoma
  • often extra nodal (CNS or GI tract)
  • clinically may resemble KS
  • very poor px in most cases with median survival rate of 3-4 months
A

AIDS related lymphoma