HERPES SIMPLEX VIRUS Members of the Herpes Virus Family which are some of the most common human viruses The Type 1 virus causes cold sores. Most people get Type 1 infections during infancy or childhood. The Type 2 virus causes genital sores. Most people get Type 2 infections following sexual contact with an infected person.
Acute Herpetic Gingivostomatitis 6 mon – 5 yrs (peak 2-3 yrs) before 6 months rare because of protection by maternal anti- HSV antibodies. Onset is abrupt & accompanied by anterior cervical lymphadenopathy, chills, fever ( 103 to 105 F).
Pharyngotonsillitis Sore throat, Fever, Malaise & Headache. Numerous vesicles develops on the tonsils & posterior pharynx. Vesicles ruptures to form ulcers which coalsce.
Herpes Labialis "labia" = "lip” Age: Adults Sex: No predilection Most common recurrent site for HSV-1 is vermilion border & adjacent skin of lip.
In some pt UV light & trauma trigger recurrence. Pain, Burning, Itching, tingling, Localized warmth, erythema of involved epithelium. Multiple small, erythematous papules develop & form clusters of fluid filled vesicles. Persistent herpes labialis is indicative of immunocompromised status, including HIV infection.
HERPETIC WHITLOW A/k/a herpetic paronychia Medical & Dental personnel infect their digits by contact with infected patients. Can cause permanent scarring
Herpes gladiaotorum a/k/a scrumpox Ocular involvement may occur d/t self inoculation Pt with diffuse chronic skin disease, such as eczema, pemphigus and Darier’s disease may develop life threatening HSV infection ka ECZEMA HERPETICUM (KAPOSI’s VARICELLIFORM ERUPTION).
COMPLICATIONS Meningitis Encephalitis Eczema herpetiform-- widespread herpes across the skin)
Keratoconjunctivitis-- Infection of the eye Pneumonia Infection of the trachea Keratitis-- Corneal infection, irritations, and inflammations
H/P Infected epithelial cells exhibit acantholysis, nuclear clearing, nuclear enlargement which has been termed ballooning degeneration. Tzanck cells (multinucleated giant cells) Multinucleated, infected epithelial cells, infected cells are formed when fusion occurs between adjacent cells.
VARICELLA VZV or HHV – 3 DNA virus Two clinically distinct syndromes Chickenpox Shingles. Acquired by inhalation or contact, with primary infection of conjunctiva or upper airway mucosa
Primary Varicella (Chicken Pox) Age: Children Sex: No predilection Dermal vesicular exanthem incubation period lasts 2 to 3 weeks
Early onset of vesicles that rapidly rupture & leave erosions with a surface pseudomembrane lesions located on the trunk and face, are vesicular with an erythematous boundary, and are extremely pruritic. Fever, malaise mild generalized lymphadenopathy lesions resolve within 5 to 8 days.
Rash: Vesicular eruption follows the distribution of sensory nerves, being segmental and unilateral. Thoracic , cervical, ophthalmic involvement most common Initially erythematous, maculopapular Vesicles form over several days, then crust over Full resolution in 2-4 weeks
Histopathologic Features Same as HSVTreatment and prevention Vaccination Acyclovir VZIG as post-exposure prophylaxis in individuals at high risk Exclude kids from school until sixth day of rash
Infectious Mononucleosis Aka Glandular Fever & Kissing Disease because adult contract the virus through direct salivary transfer like straws or kissing 7-10 days incubation period. Acute self-limiting infection Epstein-Barr Virus
Clinical Features Age : Young Adults Sex : no prediliction Petechiae on hard palate Lymphadenopathy, Pharyngitis, Tonsillitis. Sore throat, fever, rash
NUG is common. Malaise, lethargy, extreme tiredness Liver and spleen involvement and enlargement Hematology: High WBC, over 20% atypical reactive lymphocytes also known as Downey cells.
Hand-Foot-and-Mouth Disease Coxsakievirus A 5,9,10,16 Age: Children and young adults Sex: No predilection
Like herpangina skin rash & oral lesions with flu like symptoms like fever, dysphagia, sore throat associated with cough, anorexia, vomiting, diarrhea, headache. Without prodomal symptoms
Buccal mucosa, labial mucosa and tongue most affected. after a short incubation period, vesicles with an erythematous halo appear in the oral cavity, on the hands, and on the feet
H/P Intraepithelial vesicles – early stages with intra- cytoplasmic eosinophilic inclusion bodies. Later stages - shallow ulcerations and erosions with regeneration of the marginal epithelium. Superficial inflammatory cell infiltrate in submucosa.
Rubeola (Measles) Paramyxo RNA virus Highly contagious Primarily respiratory infection Incubation approximately 10 days, ranges from 8-13. Rash appears at about day 14.
Prodromal Symptoms irritability, runny nose, eyes that are red and sensitive to light, cough, and high fever Koplik’s spot- small, red, irregular with blue white centres on mouth and conjunctiva Rash on forhead, face, neck, limbs
Rubella (Germen Measles) RNA virus – Toga virus Incubation 2- 3 weeks Highly contagious, spread through respiratory tract. Rubella vaccine has resulted in 99% decline in infections.
Mumps(Endemic Parotitis) Age: Children Sex: No predilection Single stranded RNA virus. Mumps is transmitted by direct contact with saliva and discharges from the nose and throat incubation 16-18 days.
Virus can infect many parts of body, especially parotid salivary glands & Submandibular also common. Glands usually become increasingly swollen & painful over a period of 1 to 3 days Pain is moderate to severe Both left & right parotid glands may affected
DIFFERENTIAL DIAGNOSIS Bacterial or occlusive salivary inflammatory disease Sjögren’s syndromeComplications Inflammation and swelling of the brain Orchitis Oophoritis Infection in pregnant women may result in increased risk for fetal death
T/t MMR vaccine No specific therapy exists for mumps. Warm or cold packs for the parotid gland tenderness and swelling is helpful. Pain relievers acetaminophen , ibuprofen are also helpful.
Introduction Human Immuno Deficiency Virus Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). Characterized by severe depletion of CD4 cells.
MODES OF TRANSMISSION SEXUAL TRANSMISSION BLOOD OR BLOOD PRODUCTS MATERNAL-FETAL TRANSMISSION INFECTED NEEDLES
CDC CLASSIFICATION FOR HIV INFECTED PATIENTSCD4 Cell Clinical CategoriesCategories A B C Asymptomatic, Acute HIV, or Symptomatic Conditions, AIDS-Indicator PGL not A or C Conditions≥500 cells/µL A1 B1 C1200-499 A2 B2 C2cells/µL<200 cells/µL A3 B3 C3
CLASSIFICATION OF CLINICAL MANIFESTATIONS GROUP I : ACUTE INFECTION GROUP II : CHRONIC ASYMPTOMATIC INFECTIONS GROUP III : PERSISTENT GENERALIZED LYMPHADENOPATHY GROUP IV : AIDS RELATED COMPLEX
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
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.
DIAGNOSIS CLINICAL FEATURES WESTERN BLOT ANALYSIS ELISA PCR IMMUNOLOGICAL TEST VIRAL CULTURE