Differential Diagnosis for HSV secondary - disease - Reason it is not (3)

Aphthous ulcers - No tingling prodromal phase - Non-keratinized tissue ONLY!!!! - Never has a vesicle or bulla prior to the ulcers

week 1 Flashcards by Nathan Ideus

Why is it called primary GINGIVOSTOMATITIS?

Due to the site of lesions on the gingiva

AND/OR on ANY: oral mucosa

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secondary HSV

age
systemic
oral 1 (3 locations)

Age: Usually puberty and after…
Systemic: none
Oral: Vesicles->ulcers
located: 1. Gingiva 2. Hard palate 3. Lips

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Differential diagnosis HSV primary (3)

Streptococcal Pharyngitis

Erythema multiforme

ANUG

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Differential HSV primary (3) reasons it is not each

SP (1)
EM (4)
AN (3)

Strep- Pharyngeal (posterior lesions) palate/post mouth
Erythema Multi- requires a sensitivity (usually very immediate timing. Target lesion. LARGE crusty lesions on LIP/Buccal mucosa NOT ON GINGIVA!!!!

ANUG-STENCH, [Bleeding gums w/o brushing], commonly has stress or immunocompromised host]

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Treatment for Diff diagnosis HSV
(3)
SP EM ANUG

Strep- Streptococcal antibiotics
Erythema Multi- Steroids for type 3/2 hypersens.
ANUG- Oral hygeine and ANUG specific Antibiotics

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Differential Diagnosis for HSV secondary

disease
Reason it is not (3)

Aphthous ulcers

No tingling prodromal phase
Non-keratinized tissue ONLY!!!!
Never has a vesicle or bulla prior to the ulcers

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What is a cause for secondary HSV lesions to not be restricted to Ging, Hard palate, or lips? (2)

Immunocompromised - AIDS etc

Chemotherapy

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What are 4 ways to determine HSV diagnosis if the clinical signs are insufficient?

Biopsy (painful and invasive)
Fluorescent antibody test (via smear) can be inconclusive with other similar viral DNA (Herpetic family etc)
Insitu hybridization (expensive)
Culture (1-3 days)

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Pro / con of Biopsy vs smear cytology

Biopsy is invasive/painful

Smear will not show tissue architecture (may be inconclusive or lack specificity)

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Tzanck (z-(t)ank) Tank but starts with a z sound…

-indicates it could be what possible diseases? (4)

HSV 
VZV
Cytomegalovirus
or
Pemphigus vulgaris (common pemphigus)

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Describe a Tzanck cell (2)

-what cells are they initially?*

Balloon and glassy

-initially prickle cells of epithelium (obviously of Keratinized tissue)

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What is the primary systemic concern for prescribing valtrex for a viral infection?

Kidney function

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Supportive care for Primary HSV infection: non-immunocompromised (4) and if fever 1 more (children vs adults)

Rest
Fluids
Soft food
Xylocaine 2%
* Fever
5c. Tylenol (often children so no aspirin)
6a. Aspirin (adults)

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What timing window must be met before giving medication for any HSV?

48 hrs of onset of prodromal symptoms (tingling)

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Can we treat a patient for a TOOTH problem if they have an active secondary HSV infection?
-Why might you not treat?

CAREFULLY and only if they have an emergent issue.

otherwise reschedule them
-We do not want to spread the involved tissues to another area of the patients face or mouth

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Can you premed a patient that has NO signs of a secondary HSV infection (not even tingling)?
-What are they? (3)

Yes

Lysine (consistent preventative)
Valcyclovir (expensive but bid)
Acyclovir (cheap but 5x a day)

Mode of infection VZV

Droplets

People infected with chicken pox

usually children

Adults are either old or immunocompromised

Zoster (shingles)

who
Where (2)
PAIN?
Lesions? (2)

Age- old / immunocompromised
Where- Follows dermatomes AND UNILATERAL!!!
Pain is severe
Lesions- MACULES and papules (maculo-papular lesions)

Ramsay hunt syndrome is related to ______ specifically in the ______ ganglion?

VZV (zoster) in the Geniculate ganglion (facial nerve)

***VZV still means it is unilateral!!!!

4 general complications of zoster?

Infection of maculo-papule lesions -> ulcers
Neuralgia
Motor paralysis
Ocular inflammation

differential for VZV (2)

why is it not each

HSV-shorter term less pain

Hand foot and mouth disease-lesions on hands and feet…

HSV scenario

age
systemic symptoms 5
Oral symptoms 4

Age: young
Systemic: Fever, malaise, lymphadenopathy, ARTHRALGIA, ANOREXIA
Oral: TINGLING, red, swollen, bleeding gums

Traits of VZV

Virus type
Age(s) involved
Route of infection
Lesions (describe location, secondary problems, symptom(s))

DNA virus
young, or OLD/immunocompromised
Droplet infection (pneumonia like symptoms for varicella)
Lesions: trunk,head/neck
-often get bacterial infections in lesions
-intense pruritus

Days knocked off of HSV infection by use of prompt (w/in 48 hrs)

At best 2 days... more like 1.5

Theapies for Zoster infections - Supportive - Immunocompromised(3)

Supportive Acyclovir: 800mg 5xa-day 7-10 days Immuno: Systemic antiviral vidarabine human leukocyte interferon

Hand foot and mouth disease description - Virus nucleic acids and type and family - GROUP infection class - Route of infection - Age

- RNA of piconavirus/Coxsackie Group - Endemic/epidemic - Airborne OR fecal-oral - Usually under age 5

Hand foot and mouth description cont - Incubation time - Symptoms (4)

Incubation time: Short (fast onset) Sypmtoms: 123 Low fever, Malaise, Lymphadenopathy 4 SORE MOUTH

Hand foot and mouth cont again...description - Disease progression? - Treatments (2)

The disease usually does not progress (self-limiting AND spontaneous resolution) Treatment: 1 WARM sodium bicarb mouth wash AND 2 tylenol

Herpangina description - age - Time of year - Route of infection

kids summer fecal oral

``` herpangina cont symptoms -Location (3) OF VESICLES -vesicles manifest as ______ -Non-lesion sypmtoms (4) -Self limiting? ```

Vesicle location: Soft palate, faucial pillars and tonsils They manifest in crops (like VZV) Fever and malaise AND sore throat/dysphagia IS self limiting

Measles A.K.A. - Virus type and Nucleic acids - Spread via - Age/time of year - Prodromal symptoms (3)

- paramyxovirus RNA A.K.A: Rubeola - Airborne droplets - Kids in WINTER - Prodromal: fever and lesion tingling! (like HSV) - --Oral lesions!

Measles: Rubeola classic oral symptom: -specific location -describe oral alteration (3)

Koplik's Spots - Found on BUCCAL mucosa - Red MACULE - Necrotic center

Measles: Rubeola | -Histo path-- cell name, location and description

Histopathology: Warthin-Finkeldey Giant cells - found in: Lymph tissues - Desc: Multinucleated Macrophages

-4 dangerous complications of measles

``` Encephalitis Throbocytopenic purpura -Secondary infections: ---Otitis media ---Pneumonia ```

Treatment of Measles/Rubeola

Treat the symptoms - Fever (NSAIDS) - Fluids - (etc....)

German measles A.k.A and Family - Spread via? - Similar to _______ but more MILD or SEVERE?

Aka Rubella of the TOGA family Spread via: "contagious" i would assume aerosols Similar to Measles (rubeola) but more MILD