Viral infections of Oral Cavity

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A presentation of around sixty slides giving an overview of general viral infections that can occur in oral cavity...

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Viral infections of Oral Cavity

  1. 1. Viral Infections... Dr Ravikumar V, JR II, Dept Of Oral Path, GDC, Kottayam
  2. 2. Intro  What is a Virus..?  Basic structure  Sequlae of infection  Classification
  3. 3. Herpes Simplex  HSV I and II  Skin, mucosa, eye and CNS
  4. 4.  Herpes genitalis  Herpes meningoencephalitis  Herpetic conjunctivitis
  5. 5.  Herpetic eczema  Disseminated HS of newborn  Herpetic whitlow  Herpes gladiatorum
  6. 6. Primary Herpetic Stomatitis  Infancy and adult  Spread – droplets, contact  Fever, irritation, headache, pain on swallowing, regional lymphadenopathy  Yellow fluid filled vesicles which rupture to form characteristic ulcers
  7. 7. Vesicles Erythematous halo Shallow Ulcer with Gray membrane
  8. 8.  HSV culture from sites  HSV DNA demonstration in lumbar and trigeminal ganglia  Histology – ballooning degeneration - Lip schutz bodies Diagnosis – clinical, stains, cytology, DNA, PCR Treatment – Antiviral drugs, NSAID
  9. 9. Reccurent Herpes Labialis / Stomatitis  Attenuated form of primary disease  Reactivation – ganglion trigger, skin trigger, emotional theory  The viruses spread through nerves and act on epithelial cells and cause inflammation
  10. 10.  Lesions may recur at any interval  May occur on lips, intraoral, or along area of distribution of nerve  Preceded by tingling or burning sensation
  11. 11.  Vesicles less than a mm appear as clusters which coalasce  Associated pain  Lesions heal by a week
  12. 12. Diagnosis  Histology  Viral identification and isolation  Immunofluorescent tests  Immunoperoxide test  RIA and ELISA  Treatment
  13. 13. Herpangina  Coxsakie group A virus  Ingestion, contact, droplet  Seen in summer, in young  Symptoms – sore throat, cough, rhinorhea, fever, vomiting and even abdominal pain  Vesicles which rupture to form ulcers  All of these heal by 7 days
  14. 14.  No treatment needed as it is self limiting
  15. 15. Hand Foot and Mouth Disease  Coxsakie and entero virus  Multiple ulcers with dysphagia  Intracytoplasmic viral inclusions, high antibody titer to Coxsakie  Self limiting
  16. 16. RUBEOLA (MEASLES)  produced by a paramyxovirus  Affected individuals are infectious from 2 days before becoming symptomatic until 4 days after appearance of the rash  Incubation period of 8 to 12 days
  17. 17.  Pre erutive, eruptive and post eruptive stage  Small red macules or papules appear which enlarge and coalesce to form irregular lesions which blanch on pressure and gradually fade in 4 or 5 days.  Koplik’s Spots  Warthin Finkeldey giant cells
  18. 18. RUBELLA (GERMAN MEASLES)  capacity to induce birth defects  Forchheimer spots- small discrete dark-red papules that develop on the soft palate and may extend onto the hard palate
  19. 19.  The classic triad of CRS consists of deafness, heart disease, and cataracts
  20. 20. Molluscum Contagiosum  Caused by virus of pox group  Considered tumor like  Occur as single or multiple discrete elevated nodules with central crustation  Cowdry A inclusion bodies  Henderson Paterson inclusions
  21. 21. Varicella
  22. 22.  Oral lesions
  23. 23. Herpes Zoster  James Ramsay Hunt’s syndrome
  24. 24.  Tzank smear
  25. 25. Mumps
  26. 26. Non Specific Mumps  C/c Non Specific Sialadenitis  Acute Post operative Parotitis  Nutritional Mumps  Chemical Mumps  Miscellaneous
  27. 27.  Human Immuno Deficiency Virus  Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS).  Characterized by severe depletion of CD4 cells.
  28. 28. MODES OF TRANSMISSION  Sexual transmission  Blood or blood products  Maternal-fetal  Infected needles
  29. 29.  Transmission routes 
  30. 30. CLASSIFICATION OF CLINICAL MANIFESTATIONS  Group I : Acute Infection  Group II : Chronic Asymptomatic Infections  Group III : Persistent Generalized Lymphadenopathy  Group IV : Aids Related Complex
  31. 31. CHRONIC ASYMPTOMATIC INFECTIONS  Most dangerous group  Seropositive pt who is apparently healthy capable of infection  Enlarged axillary glands  Hematological & immunological abnormalities
  32. 32. PERSISTENT GENERALISED LYMPHADENOPATHY  LYMPHADENOPATHY in 2 or more extrainguinal sites persisting for more than 3 months
  33. 33. AIDS RELATED COMPLEX  OPPORTUNISTIC INFECTIONS -Pneumonia, Cryptococcosis, Viral Infections, Toxoplasmosis, TB etc.  NEOPLASMS - KS, Lymphoma, SCC
  34. 34.  NEUROLOGIC DISEASES - Meningocephalitis  OTHERS - Encephalopathy, Purpura, Thrombocytopenia
  35. 35.  Oral lesions in HIV...
  36. 36. Candidiasis PSEUDOMEMBRANOUS ERYTHEMATOUS ANGULAR CHEILITIS
  37. 37. HISTOPLASMOSIS  Histoplasma capsulatum Nodules over the mucosa which undergoes ulceration Gingiva, tongue, palate, buccal mucosa
  38. 38. LINEAR GINGIVAL ERYTHMA Very fine red band along gingival margin and attached gingiva with profuse bleedin
  39. 39. NECROTIZING ULCERATIVE PERIODONTITIS Advanced destruction of peridontium, rapid bone loss, loss of PDL
  40. 40. Oral Hairy Leukoplakia
  41. 41. WART (HPV)1 Painless papule or nodule with papillary projections or rough surface Pedunculated or Sessile
  42. 42. APHTHOUS ULCER (MINOR) Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded b Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
  43. 43. APHTHOUS ULCER (MAJOR)
  44. 44. KAPOSI’S SARCOMA  Predominantly in homosexuals.  lesions are vascular, angiomatous neoplasms that begin as red macule & progress to large tumefactive red & purple lesions.  Oral lesions: multifocal & typically seen on palate & gingiva
  45. 45. LYMPHOMA  Most are of B cell origin and Epstein-Barr virus occurs in cells from several cases.  Lymphoma can occur anywhere in the oral cavity & there may be soft tissue involvement with or without involvement of underlying bone.
  46. 46. Diagnosis of HIV  Viral Culture  PCR  P24 antigen detection  ELISA  Western Blot Treatment - HAART
  47. 47. TREATMENT  Haart - zidovudine, stavudine, lamivudine, didanosine  Symptomatic treatment  Precautions
  48. 48. Thank u...
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