Viral diseases 2/cosmetic dentistry courses

Learning Objectives
At the end of the lecture the student should be able to
•describe the Clinical features & histopathology of
Herpangina ,Hand Foot & Mouth Disease,Acute
Lymphonodular Pharyngitis,Measles ,German
Measles,Mumps,Molluscum Contagiosum,Condyloma
Acuminatum.
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 Coxsackievirus A 1 to 6,8,10,16 & 22 as well as other
enteroviruses.,
 Most commonly seen in young children
 Chiefly summer disease
 Clinical manifestation :- mild and of short duration

Begins with acute onset of sore throat, dysphagia and
low grade fever, headache, sometimes vomiting,
prostration and abdominal pain.
Occasionally accompanied by cough, rhinorrhea,
anorexia, vomiting, diarrhoea, myalgia and headache

 Oral lesions appear on soft palate and tonsillar pillars
 Affected areas begins as red macules – fragile vesicles –
ulcerations with gray base and inflamed periphery (2-4
mm)
 systemic symptoms resolve within few days
 The ulceration takes 7 to 10 day to heal

 Entero Coxsackievirus A 16, A5 & A6, enterovirus 71
 Primarily young children
 Maculopapular, exanthematous and vesicular lesions
of the skin particularly involving the hands, feet, legs,
arms and occasionally the buttocks

The skin rash and oral lesions typically are associated
with sore throat, dysphasia, fever
The oral lesions precede the cutaneous lesions.
Sore mouth and unable to eat

 Oral lesions more numerous, mostly involving hard
palate, tongue and buccal mucosa
 Vesicles - rapidly ulcerate (2-7 mm)
 Most of ulcers resolve within 1 week
 Differential diagnosis: Herpetic Gingivostomatitis,
Herpangina, Erythema Multiforme, Recurrent Apthous
Ulcers.

Histopathological features
 Herpangina and HFM :- intracellular and intercellular
edema – extensive spongiosis – intraepithelial vesicle
formation – rupture through basal cell layer- resultant
formation of sub epithelial vesicle
 Epithelial necrosis and ulceration

Diagnosis
 Usually from distinctive clinical appearance
 Viral isolation
 Enteroviral antibody

 Acute febrile disease by Coxsackievirus A 10
 Predominantly children and young adults
 Sore throat, fever, and mild headache, anorexia,
lasting from 4 to 14 days
 Low nu. (1 to 5) raised, discrete, whitish or yellow to
dark pink nodules surrounded by a narrow zone of
eythema
 Appear on uvula, soft palate, anterior pillars and
posterior oropharynx.

 Acute, contagious, dermatropic viral infection,
primarily affecting children
 Paramyxovirus
 Most cases are arises in spring
 Spread by direct contactor by droplet infection, the
portal of entry the respiratory tract
 Infectious from 2 days before becoming symptomatic

 Incubation period from 8 – 12 days
 Prodromal symptoms
 Skin eruption usually begins on face, in the hair line
and behind the ears
 Spread to the neck, chest, back and the extremities
 Appears as tiny red macules or papules which enlarge
and coalesce to form blotchy, discolored, irregular
lesions - blanch on pressure – gradually fade away in
4 to 5 days – fine desquamation.

Oral lesions are prodromal, occur 2 to 3 days before
cutaneous rash.
Koplik’s spots :- small irregular shaped flecks -
bluish, white specks surrounded by a bright red margin
Usually on buccal and labial mucosa.

 Pathognomic spots represent foci of epithelial necrosis
(grains of salt on a red background)
 Palatal and pharyngeal petechiae as well as generalized
inflammation, congestion, swelling and focal ulceration
of the gingiva, palate throat may occur
 Severe measles in early childhood result in pitted
enamel hypoplasia
 Enlargement of accessory lymphoid tissue

 Togavirus, its capacity to induce birth defects in the
developing fetus (blindness, deafness and cardiovascular
abnormalities)
 Enamel hypoplasia, a high caries incidence and delayed
eruption.
 Contracted through respiratory droplets, transmitted
nearly 100% individuals

Incubation time 10 to 14 days
The exanthematous rash often first sign begins on the
face and neck, with spread to entire body
Oral lesions K/as Forchheimer’s sign (20%) consists of
small, discrete, dark-red papules – soft palate extending to
hard palate

 Simultaneously with rash
 Palatal petechiae may occur
Diagnosis
 Depend on lab tests
Treatment and prognosis
 Vaccination (12 to 15 month and 4 to 6 yrs age)
 Non-aspirin and antipruritics.

 Paramyxovirus
 Transmitted through urine, saliva or respiratory droplets
 Incubation period 16 to 18 days
 Contagious from 1 day before the clinical appearance to
14 days after its clinical resolution
 30% are subclinical

Prodromal symptoms followed one day before
salivary gland changes
Parotid gland involved most frequently
Discomfort and swelling in lower half of the
external year

 The associated pain is intense during maximum
enlargement, jaw movements and eating aggravates
 Usually begins on one side followed by contra lateral
glandular changes within few days
 The most frequent oral manifestation redness and
enlargement of Wharton's and Stensen’s salivary gland
duct opening.

 Virus of pox group
 More common in children and young adults
 Manifest itself as single or multiple discrete elevated
nodules usually occurring on the arms and legs, trunk and
face
 The virus replicate in the stratum spinosum and forms
inclusion bodies,
 Lesion heal in 30 to 60 days
 Oral cavity involvement rare (lips, tongue and BM)

Histological features
 Thickening and down growth of the epi. with the
formation of large eosinophilic intracytoplasmic
inclusion bodies
 K/As Henderson-Paterson inclusions or simply
molluscum bodies (25 microns)
Treatment:-
 Surgical excision or by topical application of
Podophyllin or Catharidin.

 Human Papillomavirus
 The oral lesions due to HPV 6
 Most common sexually transmitted disease
 Transmission by close contact, autoinoculation, and
orogenital sexual practice
 Oral lesion are small, multiple, white or pink nodules
which enlarge proliferate and coalesce or as
papillomatous, bulbous masses scattered over tongue,
BM, palate, gingiva or alveolar ridge

Summary
Clinical features & histopathology of
Herpangina
Hand Foot & Mouth Disease
Acute Lymphonodular Pharyngitis
Measles
German Measles
Mumps.
Molluscum Contagiosum.
Condyloma Acuminatum.

Text Book of Microbiology Ananthanarayan R 7th
Edition
Text book of oral pathology Shafer's, 5 & 6th
edition
Color Atlas of Oral Diseases Cawson, R. 2nd
edition
Oral and Maxillofacial Pathology Neville, Brad
W. 2nd
Lucas’s Pathology Of Tumor’s of the Oral
Tissues
Cawson, R. A., Bennie, W. H 5th
edition

Viral diseases 2/cosmetic dentistry courses

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