Oral Viral conditions

Oral Viral conditions

1. Herpes

   • Double stranded DNA, enveloped
   • Herpes Simplex (1+2)
     • HSV 2 = genital
     • HSV 1 = oral
       • Primary Herpetic gingivostomatitis
         • Onset = <5yrs or 20s
         • Clinical features
           • Fever, malaise, poor appetite
           • Bilateral cervical lymphadenopathy
           • Oral
             • Gingivitis (boggy, swelling) esp. anteriorly
             • Stomatitis
               • Most common = lips
               • Vesicles -> small, painful ulcers
               • May be widespread
                 • Gingiva, palate, mucosa
         • Management
           • Soft diet, fluids
           • Chx MW
           • Acyclovir - oral, 200mg 5xday
           • Paracetamol
       • Reactivation
         • Herpes labialis = most common
           • = cold sore
           • Lip lesion
             • Unilateral
             • Macule -> vesicle -> crusted scab/ulcer
           • Severity < primary infection
           • Burning, paraesthesia, pain in area
         • Recurrent intra-oral herpetic infection
           • Crop of small ulcers
             • Keratinised mucosa
             • >10 in no.
             • 1-2mm in size
           • Diff. diagnosis = RAS
           • Can occur after palatal LA injection
         • Management
           • Acyclovir cream 5%, 4-6xday
           • Acyclovir oral if immunocompromised
   • Varicella-Zoster (3)
     • Chickenpox
       • Onset = children
       • Clinical features
         • Itchy rash
           • Papules -> vesicles -> pustules -> crusty erosions
           • Begins on trunk -> centrifugal distribution
         • Oral ulcers
           • Same as HSV
           • Not on gingiva
         • Fever, malaise
       • Management
         • Soft diet, fluids
         • Chx MW
         • Paracetamol
     • Reactivation = shingles
       • Onset = >50yrs
       • Clinical features
         • Tenderness & pain in dermatome 2-4 days before rash
         • Most common = thoracic then trigeminal
         • Trigeminal
           • Confined to dermatome
           • Can have post-herpetic neuralgia
           • Ophthalmic div -> sight-threatening
         • Geniculate ganglion of CN 7
           • Ramsay Hunt syndrome
             • Facial palsy
             • Vesicles in ear
         • Unilateral
         • Vesicles -> scabs
       • Management
         • 1st choice = Valcyclovir oral, 3g daily for 7 days
         • Acyclovir oral, 800mg 5xday for 7 days
   • Epstein-Barr (4)
     • Infective mononucleosis = glandular fever
       • Clinical features
         • Sore throat
         • Fever, malaise
         • Lymphadenopathy
         • Rashes
         • Oral
           • Petechiae on soft palate
           • White exudate from oedematous tonsils
       • Diagnosis
         • MONO test
         • FBC
     • Oral hairy leukoplakia
       • Immunocompromised e.g. HIV
       • White vertical corrugations
         • Lateral border of tongue
         • Bilateral
         • Painless
         • Not pre-malignant
   • Cytomegalovirus (5)
     • Primary infection
       • Glandular fever symptoms
         • Mono test = -ve
       • Life-threatening in immunocompromised
       • Oral aphthous-like ulcers
   • Karposi's sarcoma (8)
     • Epidemic type
       • HIV
       • Most aggressive
       • Widespread skin & oral lesions
       • Most assoc. with HHV-8
       • Poor prognosis
     • Oral lesions
       • May be 1st sign & lead to HIV diagnosis
       • Early
         • Red/purple spots
       • Late
         • Blue
         • Nodulated, ulcerated
       • Diff. diagnosis
         • Haemangioma
           • Doesn't blanch under pressure like haemangioma
         • Purpura, pyogenic granuloma
       • Most common site = palate & gingiva
     • Diagnosis
       • Biopsy
       • Immunohistochemistry
     • Predominant infected cell = B lymphocytes

2. Human Papilloma Virus

   • Assoc. with cancer
     • Most carcinogenic = HPV-16 & 18
       • Oropharyngeal cancer
     • Causes 70% of cervical cancer
   • Papillomas
     • Most assoc. HPV-6 & 11
     • Benign
     • Not pre-malingnant
     • Oral clinical features
       • Spiky exophytic growths or cauliflower-like
       • Pedunculated
       • Sites
         • Most common = lip
         • Palate
         • Labial & buccal mucosa
         • Gingiva
       • White or Pink
     • Management = surgical exicision
     • If multiple -> may be immunocompromised
   • Condyloma acuminatum
     • = genital warts
     • Sessile
     • Broad, cauliflower-like
     • Sexually transmitted

3. Cocksackie

   • Hand, foot & mouth disease
     • Cocksakie A
     • Small epidemics in children
     • Clinical features
       • Rash on palms & soles
         • Red papules -> vesicles
       • Oral lesions similar to herpetic stomatitis
         • No gingivitis
       • Fever, malaise, poor appetite
   • Herpangina
     • Cocksakie A or B
     • Uncommon
     • Small children
     • Clinical features
       • Pharyngeal ulcers
       • Fever, malaise, poor appetite
       • Vomiting