BYDR. ABHISHEK SOLANKI
VIRAL INFECTION HERPES SIMPLEX VIRUS    ENTEROVIRUS VARICELLA               RUBEOLA HERPES ZOSTER           RUBELLA...
HERPES SIMPLEX VIRUS Members of the Herpes Virus Family which are some of the  most common human viruses The Type 1 viru...
Acute Herpetic Gingivostomatitis 6 mon – 5 yrs (peak 2-3 yrs) before 6 months rare because of protection by maternal ant...
Pharyngotonsillitis Sore throat, Fever, Malaise & Headache. Numerous vesicles develops on the tonsils & posterior pharyn...
Herpes Labialis "labia" = "lip” Age: Adults Sex: No predilection Most common recurrent site for HSV-1 is vermilion  bo...
 In some pt UV light & trauma trigger recurrence. Pain, Burning, Itching, tingling, Localized  warmth, erythema of invol...
DIFFERENTIAL DIAGNOSIS Impetigo Contact dermatitis
HERPETIC WHITLOW A/k/a herpetic paronychia Medical & Dental personnel infect their digits by contact with infected patie...
Herpes gladiaotorum a/k/a scrumpox Ocular involvement may occur d/t self inoculation Pt with diffuse chronic skin dise...
COMPLICATIONS Meningitis Encephalitis Eczema herpetiform-- widespread herpes across the skin)
 Keratoconjunctivitis-- Infection of the eye Pneumonia Infection of the trachea Keratitis-- Corneal infection, irritat...
H/P Infected epithelial cells exhibit acantholysis, nuclear  clearing, nuclear enlargement which has been termed  balloon...
 Intra-epithelial vesicles.
Diagnosis Clinical presentation Viral isolation from tissue culture HSV antigens. Serologic test for HSV antibodies (4...
TREATMENT & PROGNOSIS Acyclovir suspensions Viscous lidocaine (not in pediatrics) NSAIDS Anti-viral vaccines (studies)
VARICELLA VZV or HHV – 3 DNA virus Two clinically distinct syndromes Chickenpox Shingles. Acquired by inhalation or ...
Primary Varicella (Chicken Pox) Age: Children Sex: No predilection Dermal vesicular exanthem incubation period lasts 2...
 Early onset of vesicles that rapidly rupture & leave  erosions with a surface pseudomembrane lesions located on the tru...
H/P Superficial intraepithelial vesicle formation. vesicular contents contain eosinophilic exudate, inflammatory  cells ...
Herpes zoster Age: Adults and elderly people Sex: Slight male predilection VZV spreads from skin/mucosa into sensory ne...
 Virus travels to dorsal root ganglion and becomes  latent Reactivation occurs with decreased cell-mediated  immunity I...
Clinical FeaturesProdrome:Headachephotophobiamalaisefeverabnormal skin sensationspain
Rash: Vesicular eruption follows the  distribution of sensory nerves,  being segmental and unilateral. Thoracic , cervic...
Complications of Herpes Zoster Postherpetic Neuralgia (PHN) Herpes Zoster Ophthalmicus VZV viremia Dermatologic compli...
Histopathologic Features Same as HSVTreatment and prevention Vaccination Acyclovir VZIG as post-exposure prophylaxis i...
Infectious Mononucleosis Aka Glandular Fever & Kissing Disease because adult  contract the virus through direct salivary ...
Clinical Features Age : Young Adults Sex : no prediliction Petechiae on hard palate Lymphadenopathy, Pharyngitis, Tons...
 NUG is common. Malaise, lethargy, extreme tiredness Liver and spleen involvement and enlargement Hematology: High WBC...
Histopathologic feature Downey cells – atypical lymphocytes diagnostic featureDIFFERENTIAL DIAGNOSIS Platelet disorders...
T/t Supportive Bed rest and high liquid intake. Mild analgesic and antipyretic
Cytomegalovirus HHV-5 Transmission occurs from person to person. Close intimate contact    Sexual contact    During d...
Clinical features Symptoms resemble IM In babies may cause life threatening illness Patients with deficient immune syst...
 90 % of CMV are infections are assymptomatic Typical Features Hepatosplenomegaly Thrombocytopenia• Fever• Malaise• My...
H/P Scattered infected cells are extremely swollen, showing both intracytoplasmic and intranuclear inclusions and promine...
Diagnosis Clinical Features Viral AntigenTreatment CMV infection resolve spontaneously Gancyclovir in immunocompromise...
Enteroviruses Genus of the picornavirus family which replicate  mainly in the gut. Single stranded RNA virus
 Divided into 5 groups   Polioviruses   Coxsackie A viruses & Coxsackie B viruses   Echoviruses   Enteroviruses Herp...
Herpangina Caused by Coxakievirus A 1 to 6, 8, 10, 22 Coxakievirus A7, 9 or 16; Coxakievirus B 2 to 6; Echovirus 9,16,17;...
 Most cases arise in summer with crowding & poor oral hygiene. Fecal-oral route : major path of transmission
Clinical Features Sore throat Dysphagia Fever, cough Rhinorrhea Anorexia.
 Vomiting, diarrhea and headache. Mostly soft palate or tonsillar pillars involved affected areas begin as red macules ...
H/P Intraepithelial vesicles contain eosinophilic exudate. Nuclear ballooning degeneration of epithelial cells.DIFFERENT...
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...
 Buccal mucosa, labial mucosa and tongue most  affected. after a short incubation period, vesicles with an  erythematous...
H/P Intraepithelial vesicles – early stages with intra-  cytoplasmic eosinophilic inclusion bodies. Later stages - shall...
DIFFERENTIAL DIAGNOSIS Herpetic gingivostomatitis, Herpangina, Varicella, and Aphthous stomatitis
Acute Lymphonodular pharyngitisClinical Features Coxsakievirus A 10 Sore throat, fever, mild headache Yellow to dark pi...
H/P Affected epithelium exhibit intracellular & intercellular edema leads to intraepithelial vesicle. Vesicle enlarges a...
Treatment Most cases self limited Symptomatic relief  Topical anaesthetics  Nonaspirin antipyretics
Rubeola (Measles) Paramyxo RNA virus Highly contagious Primarily respiratory infection Incubation approximately 10 day...
Prodromal Symptoms   irritability,   runny nose,   eyes that are red and sensitive to light,   cough, and   high feve...
Complications bronchitis bronchiolitis pneumonia conjunctivitis myocarditis Hepatitis encephalitis
T/t Self limiting vaccines
Rubella (Germen Measles) RNA virus – Toga virus Incubation 2- 3 weeks Highly contagious, spread through respiratory tra...
Mumps(Endemic Parotitis) Age: Children Sex: No predilection Single stranded RNA virus. Mumps is transmitted by direct ...
 Virus can infect many parts of body, especially parotid salivary glands & Submandibular also common. Glands usually bec...
DIFFERENTIAL DIAGNOSIS Bacterial or occlusive salivary inflammatory disease Sjögren’s syndromeComplications Inflammatio...
Laboratory Testing Complement fixation Hemagglutination inhibition ELISA
T/t MMR vaccine No specific therapy exists for mumps. Warm or cold packs for the parotid gland tenderness and swelling ...
Introduction Human Immuno Deficiency Virus Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). Characterized ...
MODES OF TRANSMISSION SEXUAL TRANSMISSION BLOOD OR BLOOD PRODUCTS MATERNAL-FETAL TRANSMISSION INFECTED NEEDLES
CDC CLASSIFICATION FOR HIV               INFECTED PATIENTSCD4 Cell                             Clinical CategoriesCategori...
CLASSIFICATION OF CLINICAL        MANIFESTATIONS GROUP I : ACUTE INFECTION GROUP II : CHRONIC ASYMPTOMATIC INFECTIONS G...
Acute Infections IM HEPATITIS MENINGITIS MENINGOCEPHALITIS
CHRONIC ASYMPTOMATICINFECTIONS MOST DANGEROUS GROUP SEROPOSITIVE PT WHO IS APARENTLY HEALTHY CAPABLE OF INFECTION ENLAR...
PERSISTENT GENERALISEDLYMPHADENOPATHY LYMPHADENOPATHY in 2 or more extrainguinal sites persisting for more than 3 months ...
AIDS RELATED COMPLEX OPPORTUNISTIC INFECTIONS-    Pneumonia, Cryptococcosis,    Viral Infections, Toxoplasmosis, TB etc....
 NEUROLOGIC DISEASES- Meningocephalitis OTHERS- Encephalopathy, Purpura, Thrombocytopenia
Oral Manifestations of AIDSINFECTION   ORAL DISEASEFUNGAL      CANDIDIASIS            HISTOPLASMOSIS            CRYPTOCOCC...
Oral Manifestations of AIDS Contd.. TYPE OF LESION   DISEASE NEOPLASTIC       KAPOSI SARCOMA                  LYMPHOMA    ...
CANDIDIASIS
PSEUDOMEMBRANOUS        ERYTHEMATOUS    ANGULAR CHEILITIS
HISTOPLASMOSIS Histoplasma capsulatum  Nodules over the mucosa which undergoes ulceration  Gingiva, tongue, palate, bucca...
LINEAR GINGIVAL ERYTHMAVery fine red band along gingival margin and attached gingiva with profuse bleeding
NECROTIZING ULCERATIVEPERIODONTITISAdvanced destruction of peridontium, rapid bone loss, loss of PDL
HAIRY LEUKOPLAKIA                Soft painless plaque on the tongue
WART (HPV)Painless papule or nodule with papillary projections or rough surfacePedunculated or Sessile
APHTHOUS ULCER (MINOR)Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded byErythamatous halo mos...
APHTHOUS ULCER (MAJOR)
KAPOSI’S SARCOMA Predominantly in homosexuals. lesions are vascular, angiomatous neoplasms that begin as red macule & pr...
LYMPHOMA Most are of B cell origin and Epstein-Barr virus occurs in  cells from several cases. Lymphoma can occur anywhe...
DIAGNOSIS CLINICAL FEATURES WESTERN BLOT ANALYSIS ELISA PCR IMMUNOLOGICAL TEST VIRAL CULTURE
TREATMENT HAART - ZIDOVUDINE, STAVUDINE, LAMIVUDINE, DIDAN OSINE SYMPTOMATIC TREATMENT PRECAUTIONS
Viral infections of oral cavity - Dr. Abhishek Solanki
Viral infections of oral cavity - Dr. Abhishek Solanki
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Viral infections of oral cavity - Dr. Abhishek Solanki

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Viral infections of oral cavity - Dr. Abhishek Solanki

  1. 1. BYDR. ABHISHEK SOLANKI
  2. 2. VIRAL INFECTION HERPES SIMPLEX VIRUS  ENTEROVIRUS VARICELLA  RUBEOLA HERPES ZOSTER  RUBELLA INFECTIOUS  MUMPS MONONUCLEOSIS  HIV CYTOMEGAVIRUS
  3. 3. 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.
  4. 4. 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).
  5. 5. Pharyngotonsillitis Sore throat, Fever, Malaise & Headache. Numerous vesicles develops on the tonsils & posterior pharynx. Vesicles ruptures to form ulcers which coalsce.
  6. 6. Herpes Labialis "labia" = "lip” Age: Adults Sex: No predilection Most common recurrent site for HSV-1 is vermilion border & adjacent skin of lip.
  7. 7.  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.
  8. 8. DIFFERENTIAL DIAGNOSIS Impetigo Contact dermatitis
  9. 9. HERPETIC WHITLOW A/k/a herpetic paronychia Medical & Dental personnel infect their digits by contact with infected patients. Can cause permanent scarring
  10. 10. 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).
  11. 11. COMPLICATIONS Meningitis Encephalitis Eczema herpetiform-- widespread herpes across the skin)
  12. 12.  Keratoconjunctivitis-- Infection of the eye Pneumonia Infection of the trachea Keratitis-- Corneal infection, irritations, and inflammations
  13. 13. 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.
  14. 14.  Intra-epithelial vesicles.
  15. 15. Diagnosis Clinical presentation Viral isolation from tissue culture HSV antigens. Serologic test for HSV antibodies (4-8 wks after infection)
  16. 16. TREATMENT & PROGNOSIS Acyclovir suspensions Viscous lidocaine (not in pediatrics) NSAIDS Anti-viral vaccines (studies)
  17. 17. 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
  18. 18. Primary Varicella (Chicken Pox) Age: Children Sex: No predilection Dermal vesicular exanthem incubation period lasts 2 to 3 weeks
  19. 19.  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.
  20. 20. H/P Superficial intraepithelial vesicle formation. vesicular contents contain eosinophilic exudate, inflammatory cells and epithelial cells. Nuclear ballooning Superficial submucosal inflammatory cell infiltrateDIFFERENTIAL DIAGNOSIS Herpes Coxsackieviruses Aphthae.
  21. 21. Herpes zoster Age: Adults and elderly people Sex: Slight male predilection VZV spreads from skin/mucosa into sensory nerve endings
  22. 22.  Virus travels to dorsal root ganglion and becomes latent Reactivation occurs with decreased cell-mediated immunity Initial replication occurs in affected ganglion after reactivation
  23. 23. Clinical FeaturesProdrome:Headachephotophobiamalaisefeverabnormal skin sensationspain
  24. 24. 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
  25. 25. Complications of Herpes Zoster Postherpetic Neuralgia (PHN) Herpes Zoster Ophthalmicus VZV viremia Dermatologic complications
  26. 26. 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
  27. 27. 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
  28. 28. Clinical Features Age : Young Adults Sex : no prediliction Petechiae on hard palate Lymphadenopathy, Pharyngitis, Tonsillitis. Sore throat, fever, rash
  29. 29.  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.
  30. 30. Histopathologic feature Downey cells – atypical lymphocytes diagnostic featureDIFFERENTIAL DIAGNOSIS Platelet disorders Hereditary hemorrhagic telangiectasia.
  31. 31. T/t Supportive Bed rest and high liquid intake. Mild analgesic and antipyretic
  32. 32. Cytomegalovirus HHV-5 Transmission occurs from person to person. Close intimate contact  Sexual contact  During delivery  Breast milk  Organ transplant  Blood transfusion
  33. 33. Clinical features Symptoms resemble IM In babies may cause life threatening illness Patients with deficient immune systems AIDS patients Transplant patients Common in AIDS pt.
  34. 34.  90 % of CMV are infections are assymptomatic Typical Features Hepatosplenomegaly Thrombocytopenia• Fever• Malaise• Myalgia
  35. 35. H/P Scattered infected cells are extremely swollen, showing both intracytoplasmic and intranuclear inclusions and prominent nuclioli - Owl Eye
  36. 36. Diagnosis Clinical Features Viral AntigenTreatment CMV infection resolve spontaneously Gancyclovir in immunocompromised patient
  37. 37. Enteroviruses Genus of the picornavirus family which replicate mainly in the gut. Single stranded RNA virus
  38. 38.  Divided into 5 groups  Polioviruses  Coxsackie A viruses & Coxsackie B viruses  Echoviruses  Enteroviruses Herpanginia, Hand-foot-and-mouth disease, Acute lymphonodular pharyngiitis
  39. 39. Herpangina Caused by Coxakievirus A 1 to 6, 8, 10, 22 Coxakievirus A7, 9 or 16; Coxakievirus B 2 to 6; Echovirus 9,16,17; enetrovirus 71. Age: Children Sex: No predilection
  40. 40.  Most cases arise in summer with crowding & poor oral hygiene. Fecal-oral route : major path of transmission
  41. 41. Clinical Features Sore throat Dysphagia Fever, cough Rhinorrhea Anorexia.
  42. 42.  Vomiting, diarrhea and headache. Mostly soft palate or tonsillar pillars involved affected areas begin as red macules which form fragile vesicles that rapidly ulcerate.
  43. 43. H/P Intraepithelial vesicles contain eosinophilic exudate. Nuclear ballooning degeneration of epithelial cells.DIFFERENTIAL DIAGNOSIS Infection by Herpes virus & Varicella zoster
  44. 44. Hand-Foot-and-Mouth Disease Coxsakievirus A 5,9,10,16 Age: Children and young adults Sex: No predilection
  45. 45.  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
  46. 46.  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
  47. 47. 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.
  48. 48. DIFFERENTIAL DIAGNOSIS Herpetic gingivostomatitis, Herpangina, Varicella, and Aphthous stomatitis
  49. 49. Acute Lymphonodular pharyngitisClinical Features Coxsakievirus A 10 Sore throat, fever, mild headache Yellow to dark pink nodules on soft palate and tonsillar pillars
  50. 50. H/P Affected epithelium exhibit intracellular & intercellular edema leads to intraepithelial vesicle. Vesicle enlarges and ruptures through the epithelial basal cell layer which leads to subepithelial vesicle.Diagnosis Virus Isolation Serology
  51. 51. Treatment Most cases self limited Symptomatic relief Topical anaesthetics Nonaspirin antipyretics
  52. 52. Rubeola (Measles) Paramyxo RNA virus Highly contagious Primarily respiratory infection Incubation approximately 10 days, ranges from 8-13. Rash appears at about day 14.
  53. 53. 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
  54. 54. Complications bronchitis bronchiolitis pneumonia conjunctivitis myocarditis Hepatitis encephalitis
  55. 55. T/t Self limiting vaccines
  56. 56. 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.
  57. 57. 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.
  58. 58.  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
  59. 59. 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
  60. 60. Laboratory Testing Complement fixation Hemagglutination inhibition ELISA
  61. 61. 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.
  62. 62. Introduction Human Immuno Deficiency Virus Etiologic agent of Acquired Immunodeficiency Syndrome (AIDS). Characterized by severe depletion of CD4 cells.
  63. 63. MODES OF TRANSMISSION SEXUAL TRANSMISSION BLOOD OR BLOOD PRODUCTS MATERNAL-FETAL TRANSMISSION INFECTED NEEDLES
  64. 64. 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
  65. 65. CLASSIFICATION OF CLINICAL MANIFESTATIONS GROUP I : ACUTE INFECTION GROUP II : CHRONIC ASYMPTOMATIC INFECTIONS GROUP III : PERSISTENT GENERALIZED LYMPHADENOPATHY GROUP IV : AIDS RELATED COMPLEX
  66. 66. Acute Infections IM HEPATITIS MENINGITIS MENINGOCEPHALITIS
  67. 67. CHRONIC ASYMPTOMATICINFECTIONS MOST DANGEROUS GROUP SEROPOSITIVE PT WHO IS APARENTLY HEALTHY CAPABLE OF INFECTION ENLARGED AXILLARY GLANDS HEMATOLOGICAL & IMMUNOLOGICAL ABNORMILITIES
  68. 68. PERSISTENT GENERALISEDLYMPHADENOPATHY LYMPHADENOPATHY in 2 or more extrainguinal sites persisting for more than 3 months in the absence of disease
  69. 69. AIDS RELATED COMPLEX OPPORTUNISTIC INFECTIONS- Pneumonia, Cryptococcosis, Viral Infections, Toxoplasmosis, TB etc. NEOPLASMS- KS, Lymphoma, SCC
  70. 70.  NEUROLOGIC DISEASES- Meningocephalitis OTHERS- Encephalopathy, Purpura, Thrombocytopenia
  71. 71. Oral Manifestations of AIDSINFECTION ORAL DISEASEFUNGAL CANDIDIASIS HISTOPLASMOSIS CRYPTOCOCCOSISVIRAL HERPES SIMPLEX HERPES ZOSTER CMV EBV(HAIRY LEUKOPLAKIA) HHV-8 (KS) ORAL WARTS(HUMAN PAPILOMA VIRUS)BACTERIAL LINEAR GINGIVAL ERYTHMA NUP TUBERCULOSIS
  72. 72. Oral Manifestations of AIDS Contd.. TYPE OF LESION DISEASE NEOPLASTIC KAPOSI SARCOMA LYMPHOMA SCC LYMHADENOPATHY CERVICAL OTHERS HIV- Necrotizing Ulceration HIV-Salivary Gland Disease / Xerostomia Thrombocytopenic Purpura Abnormal Mucosal Pigmentation APHTHOUS ULCERS
  73. 73. CANDIDIASIS
  74. 74. PSEUDOMEMBRANOUS ERYTHEMATOUS ANGULAR CHEILITIS
  75. 75. HISTOPLASMOSIS Histoplasma capsulatum Nodules over the mucosa which undergoes ulceration Gingiva, tongue, palate, buccal mucosa
  76. 76. LINEAR GINGIVAL ERYTHMAVery fine red band along gingival margin and attached gingiva with profuse bleeding
  77. 77. NECROTIZING ULCERATIVEPERIODONTITISAdvanced destruction of peridontium, rapid bone loss, loss of PDL
  78. 78. HAIRY LEUKOPLAKIA Soft painless plaque on the tongue
  79. 79. WART (HPV)Painless papule or nodule with papillary projections or rough surfacePedunculated or Sessile
  80. 80. APHTHOUS ULCER (MINOR)Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded byErythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
  81. 81. APHTHOUS ULCER (MAJOR)
  82. 82. 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
  83. 83. 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.
  84. 84. DIAGNOSIS CLINICAL FEATURES WESTERN BLOT ANALYSIS ELISA PCR IMMUNOLOGICAL TEST VIRAL CULTURE
  85. 85. TREATMENT HAART - ZIDOVUDINE, STAVUDINE, LAMIVUDINE, DIDAN OSINE SYMPTOMATIC TREATMENT PRECAUTIONS

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