Viral infections in children and their oral manifestations.

1. VIRAL INFECTIONS IN
CHILDREN
PRESENTED BY
DR REHNA S
JR1
DEPARTMENT OF
PEDODONTICS

2. CONTENTS
 Introduction
 Properties of virus
 Morphology
 Symmetry
 DNA viruses
 RNA viruses
 Hepatitis viruses
 Retro virus- HIV

3. INTRODUCTION
 A virus is a non-cellular particle made up of genetic material and
protein that can invade living cells.
 Virus particles can only be observed by an electron microscope
Martinus Beijerinck

4. Properties of viruses
 Only one type of nucleic acid (DNA or RNA) as their genome
 Do not grow in inanimate media
 Have no metabolic activity outside the cell
 Do not possess a cellular organisation
 Lack the enzymes necessary for protein and nucleic acid
synthesis
 Resistant to Antibiotics

5. MORPHOLOGY
Size --- 20-300 nm
small pox-largest(300nm)
parvo virus-smallest(20nm)
Structure----

6.  Symmetry

7. DNA virus RNA virus
Hepatitis
virus
Retro virus

9. DNA virus

10. I HERPES SIMPLEX VIRUS

11. Human Herpes virus 1/HSV 1
1. Acute gingivostomatitis
2. Recurrent herpes labialis
3. Herpetic whitlow
4. Keratoconjunctivitis
5. Encephalitis

12. 1. Acute Herpetic Gingivostomatitis
 Most common in children before the age of 5.
 most frequent cause of acute stomatitis in children.
 malaise, anorexia, irritability, fever, anterior cervical lymphadenopathy.
 occasionally in adults
Tovaru S, Parlatescu I, Tovaru M, Cionca L. Primary herpetic gingivostomatitis in children and
adults. Quintessence Int. 2009 Feb;40(2):119-24

13. Oral manifestations
 Misdiagnosed as “teething”
 Diffuse, purple, boggy gingivitis
 Multiple yellow vesicles on mucosa,
gingiva, tongue or pharynx
 Painful, ulcerative lesions (1-3mm)
 Ulcer- raised, white border
 Difficulty in swallowing
 Treatment:
-symptomatic
-acyclovir (systemic)-severe cases

14. 2. Recurrent Herpes Labialis
/Stomatitis
 Common site: vermilion border & adjacent skin of lip.
 Pain, Burning, Itching, tingling,
 Localized warmth, erythema of involved epithelium.
 Triggering factors include
 Menstruation
 common cold
 exposure to strong sunshine
 emotional upsets
 dental treatment.

15. Oral manifestations
 Vesicles forms after an hour or two usually in clusters along the
mucocutaneous junction of the lips, but can extend to adjacent skin also.
 Painful lymphadenopathy occurs after vesicle formation
 Vesicles rupture cause erosion.
 Crusts over erosion and heals.

16. Herpetic whitlow
 Also known as: herpetic paronychia
 Medical & Dental personnel infect their digits by contact
with infected patients.
 Can cause permanent scarring
Herpetic gladiatorum
 Also known as: scrum pox
 Etiology: self inoculation
 Occurs in athletes who involved in contact
sports such as wrestling(transmitted via direct skin
to skin contact)

17. COMPLICATIONS
 Meningitis
 Encephalitis
 Eczema herpetiform
 Keratoconjunctivitis
 Pneumonia
 Infection of the trachea

18. DIAGNOSIS
 Clinical presentation
 Viral isolation from tissue culture
 HSV antigens.
 Serologic test for HSV antibodies (4-8 wks after infection)
TREATMENT
Usually no treatment
If required – Acyclovir,famiciclovir,Valaciclovir can be given in reduced doses

19. Human herpes virus- 2/HSV -2
1. Genital herpes
2. Neonatal herpes

20. Genital herpes
 This usually involves the skin below the waist.
 More virulent than HSV 1
 Termed “New epidemic veneral disease”
 Uncommon in children
 occasionally causes oral disease that is clinically similar to that of HHV-1
infection.
TREATMENT
Famiciclovir 250 mg TID 1 week
Oral Acyclovir 400 mg TID 1 week
Valaciclovir 1 gm BD 1 week

21. Neonatal herpes
 Transmitted from an infected mother vertically, during delivery.
 devastating to newborn.
 Premature birth and Low birth weight.
 Congenital HSV infection (approx4% of neonatal HSV infections) can
result in an infant born with microcephaly, hydrocephalus, chorioretinitis
and vesicular skin lesions.
 Diagnosis difficult- encephalitis can occur later

22. Clinical Presentations
 Skin, eye and mouth disease
 Localized central nervous system disease
 Disseminated state involving multiple organs
 Nonspecific symptoms such as irritability, fever, poor feeding or lethargy
Complications
 Seizures
 Psychomotor retardation
 Spasticity
 Blindness
 Encephalitis
 Death

23.  infants who survive encephalitis, may have seizures, psychomotor
retardation, spasticity, blindness or learning disabilities
TREATMENT
 oral acyclovir 300 mg 3 times a day for 6 months; this long-term regimen
improves neurodevelopmental outcomes at 1 year of age but may cause
neutropenia.

24. HHV 3 Varicella Zoster Virus
 Two clinically distinct syndromes
 Chickenpox
 Shingles.
 Acquired by inhalation or contact, with primary infection of conjunctiva or
upper airway mucosa.

25. Chicken pox
 Age: Children
 Sex: No predilection
 incubation period lasts 2 to 3 weeks
 Early onset of vesicles that rapidly rupture & leave
 erosions with a surface pseudo membrane
 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

26. Oral manifestations
 Blister like lesions involves buccal mucosa,
gingiva,tongue,palate and pharyngeal mucosa
 Rupture to form eroded ulcers with
red margins(not painful)
Treatment
 Vaccination can be given for prevention
 Exclude kids from school until sixth day of rash

27. Herpes zoster
 Age: Adults and elderly people
 VZV spreads from skin/mucosa into sensory nerve endings
 Virus travels to dorsal root ganglionand becomes latent
 maculopapular vesicles form over several days, then crust
over
 Full resolution in 2-4 weeks

28. Prodromal symptoms:
 Headache
 photophobia
 malaise, fever
 Pain
Rash:
 Thoracic , cervical,
 ophthalmic most common
TREATMENT
 Acyclovir
 VZIG as post-exposure prophylaxis in
individuals at high risk

29. HHV 4 Epstein Barr Virus
Infectious mononucleosus
 Also known as: Glandular Fever & Kissing Disease
 because spread of virus occur through direct salivary transfer like straws
or kissing
 Incubation period : 7-10 days
 Acute self-limiting infection
 Age : Young Adults
 Sex : no predilection

30. Clinical features
 Hematology: High WBC, over 20% atypical
reactive
 lymphocytes also known as Downey cells.
 Lymphadenopathy, Pharyngitis, Tonsillitis.
 Petechiae on hard palate
 Sore throat, rash
 NUG is common.
Oral manifestations

31.  Supportive
 Bed rest and high liquid intake.
 Mild analgesic and antipyretic
 Antivirals are mostly ineffective
 Prednisolone is given
TREATMENT

32. HHV- 5 Cytomegalo virus
 CMV infections are very common
 Infected person carries virus for lifetime
Transmission
Clinical features
 Hepatomegaly is common,
 Uncommon features include lymphadenopathy,
splenomegaly, pharyngitis,tonsillitis.

33. Congenital CMV infection

34. TREATMENT
 Symptomatic treatment
 Immunocompromised patients treated with ganciclovir and oral
valganciclovir for 2 weeks

35. HHV -6 and HHV -7
 Responsible for childhood exanthem(exanthem subitum)
 Also known as Roseola infantum/sixth disease
 95% children aquire this virus by age 2 .
 Fever,Maculopapular rash,febrile convulsions can occur
Management
Ganciclovir in immunocompromised patients.

36. HHV -8
 Causes Kaposi’s sarcoma in both AIDS related and endemic non AIDS
related forms.
 Causes rare diseases
1. Primary effusion lymphoma
2.Multicentric castleman’s disease
 Uncommon in children
 Currently no antivirals are effective

37. II POX VIRUS
 Poxviruses are brick or oval shaped viruses with large double-stranded
DNA genomes.
 Poxviruses are the largest and most complex viruses
 2 common infections
 Small pox
 Molluscum contagiosum

38. Small pox
 Variola major and Variola minor
 The last naturally occurring case was diagnosed in October 1977
 WHO certified the global eradication of the disease in 1980.
Clinical features
 Influenza , common cold
 fever, of at least 38.3 °C (101 °F) precede the rash
 muscle pain, malaise headache and fatigue.

39. Oral Manifestations
 small reddish spots called enanthem – appeared on mucous membranes
of the mouth, tongue, palate, and throat.
 Ulcerations of oral mucosa
 Tongue becomes swollen making swallowing difficult
 Transmission occurred through inhalation of airborne Variola virus.
Complications
 serious ocular complications, including eyelid and conjunctival
infection, corneal ulceration, disciform keratitis, iritis, optic
neuritis, and blindness.
 Encephalitis
 Fatal pneumonia

40. Edward Jenner
 who pioneered the concept of vaccines including creating the small pox
vaccine, the world's first vaccine.
 There is no cure or treatment for the disease but prevention with
vaccination.

41. Molluscum contagiosum
 caused by the virus Molluscum contagiosum
 Children and young adults
 HIV infected individuals
Clinical features
 Single/multiple discrete elevated nodules
 Arms,legs,trunk,face(eyelids)
Spread
 Autoinoculation
 Skin to skin contact
 Fomite transmission

42. Oral manifestations
 Mucous membrane involvement- uncommon
 Lesions similar to skin will be found on lips,tongue,and buccal mucosa
 Dome shaped papules are found
TREATMENT
 Surgical excision
 Topical application of podophyllin or cantharidin

43. III ADENO VIRUS
 More than 100 serologically distinct types of adenovirus have been
identified, including 49 types that infect humans.
 Adenoviruses cause acute respiratory disease (usually), pneumonia
(occasionally), acute follicular conjunctivitis, epidemic
keratoconjunctivitis, cystitis, and gastroenteritis (occasionally).
 In infants, pharyngitis and pharyngeal-conjunctival fever are common.
1. Pharyngoconjunctival fever
2.Epidemic keratoconjunctivitis

44. Pharyngoconjunctival fever
 acute and highly infectious illness characterized by
 fever,
 Pharyngitis
 acute follicular conjunctivitis,
 regional lymphoid hyperplasia with tender
enlarged preauricular adenopathy.
 Children between the ages of 5 and 18
 institutionalised children
 People who have PCF often complain of fatigue and upset stomach

45. Oral manifestations
 Pharyngitis
 Inflammed lymph nodes(tender and sore)
Eye symptoms appear within 48 hours of onset.
 Itching
 Burning
 Gritty sensation
 Tearing
 Discharge
 Mild light sensitivity
 Swollen eyelids
 Redness

46. Epidemic Keratoconjunctivitis
 A highly contagious viral conjunctivitis caused by adenoviruses.
 The inflammation results in a pink or red coloration of the eye -
commonly referred to as “pink eye”.
 Systemic signs and symptoms
 Lymphadenopathy (preauricular lymph nodes)
 Fever
 Headache
 Fatigue

47. Features
 erythema (redness) of bulbar
and palpebral conjunctiva
 Ocular itchiness and irritation
 conjunctival edema
 Photophobia
 Epiphora (excessive tearing)
 Foreign body sensation
 Blurred vision/loss of visual
acuity
 Eyelid swelling
 Follicular reaction
 Clear or yellow discharge from
the eye(s)
 Epithelial keratitis

48. Treatment
 usually resolves on its own and there is no effective treatment.
 Topical corticosteroids are often prescribed in severe cases and while
they do assist in reducing symptoms related to inflammation
 cold compression, artificial tears can be used

49. IV PARVOVIRUS
 Parvovirus B19 infects only humans.
1. Classic fifth disease
2. Aplastic crisis
4. Hydrops foetalis(Congenital parvovirus infection)
are caused almost exclusively by parvovirus B19

50.  Six separate childhood exanthems were defined from what was once
called the “measles” (Early 20th Century)
 1st Measles (rubeola) Morbillivirus
 2nd Scarlet fever (Streptococcus pyogenes )
 3rd Rubella (German measles)
 4th Atypical scarlet fever Duke Filatow's disease
 5th Erythema infectiosum
 6th Roseola herpesviruses (HHV 6)

51. Fifth disease/ Erethema infectiosum
 Also called slapped cheek syndrome
 Commonly affecting children aged between 3 and 15 years
 Mild non specific symptoms initially
 Low grade fever
 Runny nose
 Head ache
 Joint pain(in adults)
 After several days erethematous rash appears on the face of infected
child giving him a slapped face appearance

52. Treatment
 There are no known vaccines that can protect against slapped cheek
syndrome.
 Symptomatic treatment can be given.
 The infection itself is mild and self remitting and usually resolves within a
week without complications while providing the child with a lifelong
immunity against the virus.

53. Aplastic crisis
Anemic patients
 Pallor, fatigue, drop in hemoglobin -1g/dL
 Destroys infected red blood cells
 No reticulocytes to replace aging or damaged erythrocytes
 This normally happens in disease but is symptomatic in anemic patients
Thrombocytopenic patients
 Bruising

54. Hydrops fetalis
 Severe, life-threatening problem of severe edema (swelling) in the fetus
and newborn. It is also called hydrops.
 Presence of excess extra-cellular fluid in two or more sites
 Pericardial effusion
 Pleural Effusion
 Ascites
 Placental Enlargement
 Hydrops develops when too much fluid leaves the bloodstream and
goes into the tissues.

55. Symptoms
 During pregnancy,
 After birth,
 pale coloring
 severe edema overall, especially in the baby's abdomen
 enlarged liver and spleen
 respiratory distress

56. Treatment for hydrops fetalis
Based on
 Gestational age
 Overall health
 Extent of the disease
Depends on cause of hydrops
 Rx for respiratory distress
 removal of excessive fluid from spaces
 medications to help the kidneys remove excess fluid

57. V PAPOVA VIRUS
 Papovavirus, can be any viruses in the families
Pappilomaviridae Polyomaviridae

58. Human Papilloma virus
Human warts/Papillomas
 In most cases,our body's immune system defeats an HPV infection
before it creates warts.
1. Genital warts. (STD)-These appear as flat lesions, small cauliflower-like
bumps or tiny stemlike protrusions. Genital warts rarely cause
discomfort or pain, though they may itch or feel tender.
2. Common warts. Common warts appear as rough
raised bumps and usually occur on the hands
and fingers.

59. 3. Plantar warts. Plantar warts are hard, grainy growths that usually
appear on the heels or balls of your feet. These warts might cause
discomfort.
4.Flat warts. Flat warts are flat-topped, slightly raised lesions. They can
appear anywhere, but children usually get them on the face and men
tend to get them in the beard area. Women tend to get them on the
legs.

60. Treatment
 The Centers for Disease Control and Prevention (CDC) recommends
routine HPV vaccination for girls and boys ages 11 and 12, although it
can be given as early as age 9.

61. Polyoma virus
 Diseases caused by human polyomavirus infections are most common
among immunocompromised people.
 3 types of strains are present
 BK virus
 JC virus
 MC virus
 BK virus causes nephropathy in renal transplant and non-renal solid
organ transplant patients,
 JC virus causes progressive multifocal leukoencephalopathy
 Merkel cell virus (MCV) causes Merkel cell cancer.

62. VI HEPADNA VIRUS
 Hepatitis B virus belongs to this family.
Main disease caused by this HBV include
 Hepatitis B
 Cirrhosis
 Hepatocellular carcinoma

63. Hepatitis B
 Caused by Hepatitis B virus.
 Transmission

64. Symptoms
 Hepatomegaly.
 Symptoms lasts for several weeks but may exist upto 6 months.
Acute Chronic

65. Oral manifestations
 bleeding disorders,
 Jaundice
 fetor hepaticus,
 xerostomia.
 lichen planus
 Sjögren's syndrome
 sialadenitis.
 Palatal petechiae

66. Treatment
 Hepatitis B infection can be prevented by getting vaccine and HBIG
(hepatitis B immune globulin) preferably within 24 hours, but not more
than 2 weeks after the exposure.
 The hepatitis B vaccine protects infants, children, and adults from
hepatitis B
 Interferon (3 injections per week)or PEG interferon alpha-2a( once in a
week) for 6 months
OR
 Ribavirin+ Lamivudine or Adevofir

67. VIRAL INFECTIONS IN
CHILDREN (PART II)
PRESENTED BY
DR REHNA S
JR2
DEPARTMENT OF
PEDODONTICS

69. RNA virus

70. I ORTHOMYXO VIRUS
 Comprises the genus influenza virus(A,B,C subtypes) and many more.
 The type A viruses are the most virulent among the three influenza
types caused the most severe pandemics of the time.
 HI1N1 caused “Spanish flu" in 1918
and “Swine flu" in 2009.
 H2N2 caused "Asian Flu".
 H3N2 caused “Hong kong flu".
 H5N1, "avian" or "bird flu".

71. Influenza(Flu)
 viral infection that attacks our respiratory system -nose, throat and lungs.
Symptoms
Human seasonal influenza

 Fever last for 1-5 days and average 3 days in adults

72. Prevention
The influenza vaccine is recommended by the (WHO) for high-risk
groups, such as
 pregnant women,
 children aged less than five years,
 the elderly,
 health care workers, and
 people who have chronic illnesses such as HIV/AIDS,
 asthma,
 diabetes,
 heart disease, or
 are immunocompromised among others.

73. Symptomatic management
 Cough suppression
 Decongestants
 Paracetamol for fever (Salicylates must be avoided)
Antiviral drugs
 M2 inhibitors –Amantadine, Rimantadine
 Neuraminidase inhibitors – Oseltamivir, Zanamivir
 Influenza A is treated with zanamivir or combination of oseltamivir and
rimantadine
 Influenza B is treated with osaltamivir
Supportive management
Oxygen therapy, Antibiotics, steroids etc.

74. II PARAMYXOVIRUS
 Vertebrates serve as natural hosts; no known plants serve as vectors.
Some genera of this family:
 Paramyxovirus-parainfluenza viruses and mumps virus
 Pneumovirus, -respiratory syncytial virus
 Morbillivirus, -measles virus.
 Henipavirus- Nipah virus

75. Mumps/Epidemic parotitis
 Mumps is an acute viral infection of childhood that typically involves
swelling of one or both parotid glands
 Affects both sexes equally
 The incubation period ranges from 14-24 days,
 Transmitted by direct contact with saliva and discharges from the nose
and throat

76. Clinical manifestations
 The swollen parotid gland lifts the earlobe upward and outward, and the
angle of the mandible is obscured

77. Oral manifestations
 the opening of the Stensen duct on the buccal mucosa is edematous and
erythematous.
 Trismus (spasm of the masticatory muscles)
 In 10-15% of patients only the submandibular gland(s) may be swollen
Diagnosis
 Complement fixation test
 Hemagglutination inhibition
 ELISA
 IgG and IgM antibodies are most commonly used for diagnosis.

78. Complications
Treatment
 MMR vaccine
 Warm or cold packs for tenderness and swelling
 Pain relievers acetaminophen is given

79. Measles/ Rubeola
 highly contagious infectious disease caused by morbilli virus.
 Primarily affects children
 Incubation period is 8-12 days
 Out break occurs in large families, crowded homes and slums.
Clinical features
 Prodromal Symptoms, irritability, runny nose, eyes that are red and
sensitive to light, cough, and high fever

80. Oral manifestations
 Occur 2-3 days before cutaneous rash
 Eruptive leisons on oral mucosa
 Koplicks spots(white spots surrounded by erethema) on buccal mucosa
 Palatal and pharyngeal petechiae
 Focal ulceration in gingiva,palate and throat.

81. Complications
 bronchitis
 conjunctivitis
 myocarditis
 Hepatitis
Treatment
 Self limiting
 vaccines-MMR

82. Nipah virus disease
 Symptoms vary from none to fever,cough headache,shortness of
birth,confusion- can lead to coma
 Nipah virus normally circulates among specific types of fruitbats.
Out breaks
Nipah virus was first seen in 1998 in peninsular Malaysia in pigs and pig
farmers.

83.  Last outbreak reported was on 2018 May lead to deaths of seventeen people
in Perambra near Calicut,Kerala.
Complications
 Encephalitis
 inflammation of the brain
Treatment
 Management is restricted to supportive care, because as of 2020 there is
neither vaccine nor specific treatment.
 Management using Ribavirin is initiated in the last outbreak.

84. III Rhabdo virus
 Called Bullet shaped virus
 Two major infections caused are
 Rabies
 Haemorrhagic fever
Haemorrhagic fever is also caused by
 Filovirus
 Arena virus
 Bunya virus
 Flavi virus

85. Rabies
 Natural infection of dogs,foxes,cats
,wolves and bats.
 Salivary transmission to man(Zoonotic)
 Incubation period is 3-8 weeks
SYMPTOMS

86. Hydrophobia ( Fear of water)
 sight or sound of water may produce spasm of deglutition
 the duration of illness is 2-3 days may be prolonged to 5-6 days
 Stage of paralysis & coma
 DEATH / Recovery
Treatment
 A fast-acting dose of rabies immune globulin: Delivered as soon as
possible, close to the bite wound, this can prevent the virus from
infecting the individual.

87. Viral Haemorrhagic fever
The most famous hemorrhagic fevers are produced by infection with
filoviruses like Ebola virus, and viral families –
 Arenaviridae,
 Bunyaviridae,
 Flaviviridae .
 The isolation of a novel rhabdovirus from a 2009 outbreak of 3 human
cases of acute hemorrhagic fever in Democratic Republic of Congo
(DRC), Africa with hemorrhagic fever suggests that members of a fifth
viral family can also cause this disease.

88. Viral Haemorrhagic fever is a feature in
 Lassa fever
 Ebola fever
 Yellow fever
 Dengue fever
 Kyasanur fever
 Hantaan fever
Treatment
 Ribavirin- Prophylaxis

89. Ebola fever
 Ebola virus disease (EVD) or Ebola hemorrhagic fever (EHF caused
by ebolaviruses.
 The disease has a high risk of death, killing 25% to 90% of those
infected

90.  first identified in 1976, in two simultaneous outbreaks: one in a town
in South Sudan and the other in Democratic Republic of the Congo.
 largest outbreak to date was the Epidemic in West Africa, which occurred
from December 2013 to January 2016, with 28,646 cases and 11,323
deaths.
 Other outbreaks in Africa began in the Democratic Republic of the Congo
in May 2017, and 2018.
Prevention
 An Ebola vaccine, rVSV-ZEBOV, was approved in the United States in
December 2019.
 It was approved for medical use in the European Union in July 2020.[

91. IV CORONA VIRUS
 Group of positive RNA viruses causes respiratory tract infections in
mammals and birds, which can be mild to lethal.
 Alpha, beta, gamma, delta are the subtypes present
Major infections caused in humans include
 Common cold
 SARS
 MERS
 COVID 19

92. Severe Acute Respiratory Syndrome
( SARS )
 Severe acute respiratory syndrome (SARS) is a respiratory disease in
humans which is caused by the SARS coronavirus
 Between November 2002 and July 2003 an outbreak of SARS in Hong
Kong became a pandemic, with 8,422 cases and 916 deaths
worldwide.(China, Canada,Singapore,Vietnam)
Clinical features in children and adults
 fever (more than 38°C), Cough ,shortage of breath
 underlying atypical pneumonia (inflammation of the lungs).

93. Oral manifestations
 No specific oral manifestations seen
 Except for sore throat and cough
 No Dental Personnel were reported affected with SARS during the time
of pandemic in 2003.

94. Confirmatory testing
 RT-PCR tests.
Protection of Healthcare Personnel
During Aerosol-Generating
Procedures
 Limit personnel to those essential for performing procedure
 Wear appropriate personal protective equipment
 Gowns and gloves
 Sealed eye protection (i.e., goggles)
 Respiratory protection device

95. Management of SARS
 Antibiotics are ineffective
 Supportive therapy with antipyretics, supplemental oxygen and
ventilatory support as needed.
 Suspected cases of SARS must be isolated, preferably in negative
pressure rooms, with complete barrier.
 There was initially anecdotal support for steroids
and the antiviral drug ribavirin, but no published
evidence has supported this therapy

96. Middle East respiratory syndrome
(MERS)
 Respiratory disease caused by MERS-Corona virus (MERS CoV).
 It was first reported in 2012 in Saudi Arabia and is so far linked to
countries in or near the Arabian Peninsula (France, Germany, Italy
Jordan, Qatar, Saudi Arabia, Tunisia, the UAE, and UK)
 Camels were found to be the reservoir.
Transmission
Virus is transmitted from human to human by
 direct contact
 fomites
 aerosalisation of virus

97.  Human to human transmission is not sustained and hence doesn’t
cause pandemic Reservoirs – bat and Omani camel acts as reservoir
of virus.
Clinical features
 If not treated, patient may present with ARDS, Acute kidney injury,
MODS.
 Few present with Gastrointestinal symptoms like diarrhoea , pain in
abdomen

98. Conclusion from the study
 the mortality rate in children is lower than that in adults.
 may also involve central nervous system in children
 No evident Oral Manifestations were found so far.

99. Diagnosis
RT-PCR test
Treatment
 No effective antiviral available.
 Supportive care
 oxygenation and maintaining hemodynamic stability is the priority .
Vaccine
Recombinant MERS-CoV Spike (S) Nanoparticle Vaccine is under
clinical trial

100. Corona Virus Disease 2019
(COVID-19)
 Infectious respiratory disease caused by SARS-CoV-2.
 It was first identified in December 2019 in Wuhan,
China, and has resulted in the ongoing pandemic.
 As of 26 October 2020, more than 43 million cases have been
confirmed, with more than 1.15 million deaths attributed to COVID-19.
 In October 2020, medical scientists reported evidence of reinfection in
one patient.[

101. Clinical features
 .
 some people develop acute respiratory distress syndrome (ARDS) ,multi
organ failure, septic shock, and kidney failure.
 There is currently no significant evidence of COVID-19 virus
transmission through feces,urine,breast milk,food, waste water,drinking
water, animal disease vectors, or from mother to baby during pregnancy,
although research is ongoing and caution is advised.

102. Covid 19 in children
MIS-C include
 Kawasaki like disease
 rash or changes in skin color
 bloodshot eyes
 seems extra tired
 pain or pressure in the chest that doesn't
go away
 becoming confused
 unable to wake up or stay awake
 bluish lips or face

103. Oral manifestations
 Loss of taste and smell in common
 Sore throat
 Candidiasis(Thrush)
 petechiae (oral and facial mucosa)
 melanin hyperpigmentation at the gingiva
 Erethematous lesion on tongue,buccal mucosa
 recurrent herpes simplex
 geographic tongue
 Altered functioning of salivary gland
 Desquamative gingivitis
 Vesiculobullous lesions
AND STILL COUNTING……..

104. Prevention
 include frequent hand washing,social distancing,quarantine.
Management
 Management involves the treatment of symptoms, supportive
care, isolation, and experimental measures. Vaccines are under
experimentation

105. V PICORNA VIRUS
Notable members of this family are
 Enterovirus(Rhino and polio viruses)
 Hepatovirus
 Cardiovirus
 Aphthovirus
 Coxsackie virus

106. Polio myelitis/Infantile paralysis
 Virus localized in the anterior horn cells of the spinal cord and certain
brain stem motor nuclei
 It is contagious: usually spread from person to person.
 Only harmful to humans
 Found in Infants and Elderly.
 Incubation period is 6-20 days

107. Clinical features
 Affects CNS
Treatment
 Pain killers
 Physiotherapy
Prevention
 Inactivated Poliovirus Vaccine
 Oral polio vaccine
6weeks, 10 weeks, 14 weeks

108. Coxsackie virus diseases
1.Herpangina
 Causative agent: Coxsackievirus and enterovirus
 Age: Children
 Sex: No predilection
 Most cases arise in summer with crowding & poor oral hygiene.
 Fecal-oral route of transmission
Cinical features

109. Oral manifestations
 Sore throat
 Dysphagia
 Mostly soft palate or tonsillar pillars involved
 affected areas begin as red macules which form fragile
vesicles that rapidly ulcerate.
Treatment
 Self limiting
 Analgesics

110. 2.Hand-foot-and-mouth
Disease
 Causative agent: Coxsackievirus A 5,9,10,16
 Age: Children and young adults
 Sex: No predilection
Clinical features
 Like Herpangina skin rash & oral lesions with flu like symptoms like fever,
Dysphagia, sore throat
 associated with cough, anorexia, vomiting, diarrhea.

111. Oral manifestations
 Vesicles appear in the buccal mucosa, labial mucosa and tongue
 after a short incubation period, vesicles with an erythematous halo
appear in the oral cavity, on the hands, and on the feet.
Treatment
 Symptomatic treatment

112. ACUTE LYMPHONODULAR
PHARYNGITIS
 Coxsakievirus A 10
 fever, mild headache present
Oral manifestations
 Sore throat
 Yellow to dark pink nodules on soft palate and tonsillar pillars
Diagnosis
 Virus Isolation
 Serology
Treatment
 Symptomatic relief: Topical anesthetics, Nonaspirin antipyretics

113. VI REOVIRUS
 Reovirus infection occurs often in humans, but most cases are mild or
subclinical.
 Rota virus(a subtype), however, can cause severe diarrhoea and
intestinal distress in children
 Orthoreovirus in the expression of coeliac disese in pre-disposed
individuals.

114. Rota virus infection
Prevention
 RotaTeq. This vaccine is given by
mouth in three doses, at 2
months, 4 months and 6 months.
Should not use in older children or
adults.
 Rotarix. This vaccine is a liquid
given in two doses at 2 months
and 4 months.

115. VII TOGA VIRUS
 Only genus present is Alphavirus
 Transmission between species and individuals occurs mainly
via mosquitoes- arboviruses– or arthropod -borne viruses.
 Genus flavi viridae causes a number of infections
Major infections caused are
 Rubella
 Yellow fever
 Dengue fever
 St Louis encephalitis
 Murray valley encephalitis
 Zika virus disease

116. Rubella/German measles
 Caused by Rubella virus
 Occurs in Neonates and Childhood
 Leads to development of antibodies
The classic triad of Congenital Rubella Syndrome consists of
Postnatal Rubella
Clinical features
 Fever
 Morbilliform rash

117. Oral manifestations
 Forchheimer spots- small discrete dark-red papules
that develop on the soft palate and may extend
onto the hard palate
Complications
 Thrombocytopenia
 Purpura
 Encephalits
Treatment And Prevention
 Self limiting
 MMR vaccine

118. Yellow fever
 An acute viral haemorrhagic disease caused by genus flavivirus
 Transmitted by infected mosquitos and ticks
 Incubation period is 3-5 days
Signs and symptoms
 Death occurs on day 7–10 of illness.

119.  About 15% of cases, the disease progresses to a more severe
form, with fever, jaundice, renal failure, and hemorrhagic
manifestations.
Diagnosis
 ELISA
Treatment
 supportive care and close observation.
 Yellow fever patients should be protected from further mosquito exposure
for up to 5 days after the onset of fever.

120. Dengue fever
 Caused by Dengue virus of flavi viridae family
 Mosquito borne tropical disease(Female aedes egypti)
Symptoms

121.  Critical phase is commonly affecting children and yound adults
 Pregnant women with dengue fever have high risk of miscarriages,low
birth weight babies,premature birth
Prevention and Treatment
 As of 2018, the vaccine found is only recommended in individuals who
have been previously infected, or in populations with a high rate of prior
infection by age nine.
 Otherwise symptomatic treatment is done

122. Saint Louis encephalitis
 Saint Louis encephalitis virus belongs to flavivirus family.
Prevention
 No vaccines so far identified.
 Symptomatic treatment

123. Murray Valley Encephalitis

124. Zika virus disease
 Also known as Zika fever
 Caused by Zika virus, a member of flaviviridae family.
 Sometimes similar to dengue fever,
 Mosquito borne transmission
Symptoms

125.  First identified in monkeys in 1947- Uganda
 Later identified in humans in 1950- Uganda
 Mother to child transmission causes microcephaly and other brain
malformations in children
 In adults- Gullian Barre syndrome
Prevention and Treatment
 No vaccine available
 Symptomatic treatment

126. •Hepatitis means inflammation of the liver
•5 types- A,B,C,D and E

127. Hepatitis A(Hep A)
 A highly contagious liver infection caused by the hepatitis A virus(HAV)of
the enterovirus family.
Symptoms
(anorexia,nausea,
vomitting,fatigue)

128. Spread
Foeco-oral route
Treatment
 No specific medicine
 Take rest, increase fluid intake ,
 Vaccine is available(Havrix,Vaqta)

129. Hepatitis C
 Caused by Hepaci virus of flaviviridae family.
Symptoms
 Influenza like symptoms
 Pruritis
 Severe joint pain
 Ascites
 Abdominal pain
Oral manifeststions
 Sjogrens syndrome
 Lichen planus
 Xerostomia
 Salivary duct stones
 crusted lesions around the mouth

130. Transmission
 Blood transfusion
 Unsafe medical procedures
 Sexual transmission and vertical
transmission are rare.
Prevention and Treatment
 No approved vaccine
 Symptomatic treatment
Hepatitis C infection in children is very rare.

131. Hepatitis D
 Caused by hepatitis delta virus
 It is considered a satellite, because it can propagate only in presence of
Hepatitis B
 HDV and HBV infecting a person simultaneously is having most fatality
rate compared to other hepatitis infections.
 The vaccine against HBV must be given soon after birth in risk groups

132. Hepatitis E
 Caused by Hepatitis E virus
 Foeco oral route of transmission
 In pregnancy- Fulminant liver failure can occur
 Fatal in immunocompromised people and patients undergoing organ
transplantation
 No treatment modality at present.
 Self limiting course of illness
 Recent outbreak occurred in Namibia from a period of 2018- 2019

134. HUMAN IMMUNODEFICIENCY
VIRUS
 Belongs to retrovirus family
 HIV infects vital cells in the human immune system, such as helper T
cells (specifically CD4+ T cells), macrophages, and dendritic cells.
 Over time, they cause Aquired Immunodeficiency Syndrome (AIDS).
 Average survival time after infection with HIV is estimated to be 9 to
11 years, depending on the HIV subtype.

135. Aquired Immuno Deficiency
Syndrome
(AIDS)
MODES OF TRANSMISSION
Blood or blood products
Sexual transmission
Maternal-fetal
Infected needles

136. CLASSIFICATION OF CLINICAL
MANIFESTATIONS
 Group I : Acute Infection
 Group II : Chronic Asymptomatic Infections
 Group III : Persistent Generalized Lymphadenopathy
 Group IV : Aids Related Complex
Group 1-Acute infections

137. Group 2 -Chronic asymptomatic infections
 Most dangerous group
 Seropositive pt who is apparently healthy capable of infection
 Enlarged axillary glands
 Hematological & immunological abnormalities
Group 3- Persistent generalised Lymphadenopathy
 Lymphadenopathy in 2 or more extrainguinal sites persisting for more
than 3 months

138. Group 4 -
Aids related complex
Opportunistic Infections
 Pneumonia, Cryptococcosis,
 Viral Infections, Toxoplasmosis, TB etc.
 Neoplasms
 KS, Lymphoma, SCC

139. Oppurtunistic Infections in children with HIV
 Pneumocystis pneumonia, a fungal infection of the lungs
 Cytomegalovirus (CMV)
 A kind of lung scarring called lymphocytic interstitial pneumonitis (LIP)
 Oral thrush or severe diaper rash from a yeast infection
Neurologic diseases
- Meningocephalitis
Others
- Encephalopathy, Purpura,
-Thrombocytopenia

140. Oral Manifestations Of Pediatric
HIV disease

141. Candidiasis
PSEUDOMEMBRANOUS
ERYTHEMATOUS
ANGULAR CHEILITIS

142. Histoplasmosis
 Histoplasma capsulatum
Nodules over the mucosa which undergoes ulceration
Gingiva, tongue, palate, buccal mucosa

143. Linear gingival erythma
Very fine red band along gingival margin and attached gingiva
with profuse bleeding

144. Necrotizing ulcerative
periodontitis
Advanced destruction of peridontium, rapid bone loss, loss of PDL

145. Parotid enlargement

146. Recurrent aphthous stomatitis

147. Diagnosis of HIV
 Viral Culture
 PCR
 P24 antigen detection
 ELISA
 Western Blot
Treatment
 Haart - zidovudine, stavudine, lamivudine,didanosine
 Symptomatic treatment
 Precautions

148. CONCLUSION
 Bacterial and viral infections are important oral complications in children
 Knowledge about their presentation and management is relevant to oral
health care providers, as they may encounter these diagnoses in
practice.
 Prompt recognition will lead to adequate management, parental
reassurance about their child’s complaint and improve the quality of life
and long-term outcomes in young patients.

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