Herpes is DNA/RNA virus
which herpes is oral? which is genital?
1 = oral 2 = genital
what causes primary infection of herpes simple virus?
initial contact with the virus
another name for primary herpes
how is primary herpes spread?
in saliva usually as a child
what happens to the ulcers in primary herpes?
small ulcers often coalesce, resulting in larger ulcers having serpentine borders
how do you make a dx of primary herpes?
exfoliative cytology or (rarely) biopsy
-infected cells show ballooning or more commonly known as TZANCK CELLS
what is the tx for PRIMARY herpes
acyclovir (if identified in the first 2-3 days)
-valacyclovir is absorbed better than acyclovir and is eventually metabolized to acyclovir
what else can be used to tx PRIMARY HERPES?
topical anesthetics so pt can eat and drink, important to avoid dehydration
-popsickles can be soothing for pediatric pts
what is the px for PRIMARY herpes
-only one episode that lasts 10-14 days even w/o tx
what are the chances of developing at least one episode of recurrent disease from primary herpes?
what are the two forms of recurrent herpes?
- recurrent herpes labialis
- recurrent intraoral herpes
- only 12% of affected ppl will remember primary infection (subclinical/mild symptoms)
what is RECURRENT herpes labialis also called?
what is recurrent herpes labialis triggered by?
UV light exposure or trauma
where does recurrent herpes labialis affect?
vermillion zone or perioral skin
with no tx, what happens to the vesicles of recurrent herpes labialis?
vesicles rupture, form a crust, and lesions heal in 7 - 10 days
what is the tx of recurrent herpes labialis?
- avoid sun exposure
- topical antiviral agents
- pt initiated systemic valacyclovir (must be started in first two days of onset)
is recurrent INTRAORAL herpes common?
what are the usual symptoms with recurrent intraoral herpes?
irritated or rough feeling, cluster of shallow ulcers
where are recurrent INTRAORAL herpes usually found?
confined to mucosa bound to periosteum (hard palate and attached gingiva) *****
how long does is take recurrent intraoral herpes to heal with NO tx?
what is the major difference for herpes in an immunosuppressed pt?
- ANY oral mucosal surface can be affected
- large shallow ulcers with elevated, scalloped borders
- looks like primary herpes but is actually recurrent
what is the tx for herpes in an immunocompromised pt?
- INTRAVENOUS acyclovir for acute cases
- maintanence therapy with oral acyclovir may be necessary
what is herpetic whitlow?
- 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
represents PRIMARY infection with varicella-zoster virus
- has been described as “dew drops on rose pedals”
how is varicella spread?
direct contact or air-borne droplets
what systemic things are present with varicella?
fever and malaise
are oral lesions from varicella common?
what are the intraoral lesions for varicella?
a few 1-2mm shallow oral ulcers may develop at any intraoral site
*generally not as symptomatic as the cutaneous lesions
how is varicella dx?
what is the tx of varicella?
acyclovir if detected in 1 day of onset
is the px of varicella zoster good?
how many ppl in the population get the reactivation of varicella (herpes zoster)
*frequency inc with aging
what are the symptoms of shingles?
painful erythema and vesicles usually on trunk
-LESIONS STOP AT THE MIDLINE
what is the tx of herpes zoster?
systemic acyclovir or valacyclovir (5X the dosage for HSV) if early in the course of disease
what is the px for herpes zoster?
good, lesions resolve in 2-3 weeks
what can develop in 15% of herpes zoster pts?
enterovirus infection caused by any one of several strains of coxsackievirus A or B, or echovirus
how does herpangina primarily affect?
children 1-4 years of age
what are the symptoms of herpangina?
acute onset of sore throat, fever and 2-4mm oral ulcers localized to posterior soft palate/tonsillar pillar region
how do you dx herpangina?
clinical findings and the setting of a local epidemic
how long does herpangina last for?
self limiting process, usually resolving within 7-10 days
what is the tx for herpangina?
supportive care, including analgesics, antipyretics, and topical anesthetics
enterovirus infection usually caused by coxsackievirus strains as well as echovirus or enterovirus strains
hand, foot, and mouth disease
what re the systemic symtoms of hand, foot, and mouth disease?
flu-like symptoms with sore throat and fever
what are the oral symptoms of hand, foot, and mouth disease?
oral lesions consist of shallow ulcers typically 2-7mm in diameter
-buccal mucosa, labial mucosa, tongue are most common sites
what are the extraoral symptoms of hand, foot, and mouth disease?
skin lesions consist of 1-3mm erythematous macules that may develop a central vesicle
how do you dx hand foot and mouth disease?
what is the px for hand foot and mouth disease?
good, condition resolves within 7 - 10 days
a pt is considered to have HIV+ when their CD4 count goes below ____ cells
tx of HIV started in 1998 that dec mortality rates by 80% and made HIV to be considered managable
highly active antiretroviral therapy (HAART)
may be the first sign of HIV infection
head and neck manifestations
can you use head and neck exam to dx AIDS?
generalized non-tender lymphadenopathy, cervical lymph nodes are most commonly affected
type of fungal infection in which pulmonary aspect predominates, but dissemination to oral mucosa may occur
*presents as non-healing ulceration or granular lesion
unusual pattern of gingivitis that is a red, linear band at the marginal gingiva and spontaneous bleeding may be noted
linear gingiva erythema
does gingival erythema respond well to improved oral hygiene?
*abnormal response to subgingival bacteria
bacterial infection that may be seen in a setting of relatively few apparent local factors
what is the tx for NUG
responds to standard therapy, but prophylactic CHX used twice daily for maintenance
bacterial infection that causes pain and spontaneous gingival bleeding and interproximal necrosis and cratering and edema dn intense erythema
*extremely rapid bone loss that occurs concurrently with soft tissue destruction, therefore no pocketing is evident
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
waht is the managment of necrotizing stomatitis?
extensive debridement, topical anesthetics, and systemic antibiotics
what is the px of necrotizing stomatosis
what are the HIV related viral infections?
- molluscum contagiosum
- herpes simplex virus
- varicella zoster
facial skin infection caused by poxvirus
-many more lesions develop compared to non-immunocompromised pt
what is the deal with mulluscum contagiosum in immunocompromised pts?
lesions tend not to regress, unlike their normal course in immune competent person
what is the deal with herpes simplex virus in HIV pt?
- usually represent reactivation fo virus
- may affect ANY oral mucosal surface
- typically present as persistent painful diffuse shallow ulcerations
what is the tx for herpes simplex with HIV pt
must be tx with acyclovir or one of the acyclovir analogues
what is the deal with herpes zoster infection in HIV pt
gernerally more of a problem from a cutaneous standpoint
what causes oral hairy leukoplakia?
EBV in HIV infected pts
what is oral hairy leukoplakia?
non-removable white plaques of the lateral tongue, vertical parallel lines
how do you dx oral hairy leukoplakia?
biopsy reveals parakeratosis with “balloon cells” of upper spinous layers of epithelium
what is the tx of oral hairy leukoplakia?
exophytic lesions, solitary or multiple (more common), taht may resemble routine squamous papilloma, condyloma, or focal epithelial hyperplasia
also known as chanchre sores, these are ulcerations taht may be solitary or multiple that most likely have an immune-mediated etiology
what is the tx for aphthous-like ulcerations?
multifocal malignancy of vascular endothelial cell origin
AIDS related kaposi sarcoma
what is the etiology of AIDS related kaposi sarcoma?
what normally happens to pts with AIDS related karposi sarcoma?
usually expire due to infectious causes, rather than KS
what is the tx of AIDS related karposi sarcoma?
typically treated only if a cosmetic or functional problem
- 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
AIDS related lymphoma