This document summarizes various viral infections that can affect the oral cavity, including herpes simplex virus, which causes recurrent lesions. It also discusses measles, rubella, molluscum contagiosum, varicella, herpes zoster, and mumps. The document provides details on HIV/AIDS transmission and stages of infection. Finally, it outlines several oral manifestations that can occur in HIV/AIDS patients, such as candidiasis, histoplasmosis, linear gingival erythema, and Kaposi's sarcoma. Treatment involves highly active antiretroviral therapy and managing symptoms.

1. Viral Infections...
Dr Ravikumar V,
JR II, Dept Of Oral Path,
GDC, Kottayam

2. Intro
 What is a Virus..?
 Basic structure
 Sequlae of infection
 Classification

3. Herpes Simplex
 HSV I and II
 Skin, mucosa, eye and CNS

6.  Herpes genitalis
 Herpes meningoencephalitis
 Herpetic conjunctivitis

7.  Herpetic eczema
 Disseminated HS of newborn
 Herpetic whitlow
 Herpes gladiatorum

8. 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

9. Vesicles
Erythematous halo
Shallow
Ulcer with
Gray
membrane

10.  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

11. 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

12.  Lesions may recur at any interval
 May occur on lips, intraoral, or along
area of distribution of nerve
 Preceded by tingling or burning
sensation

13.  Vesicles less than a mm appear as
clusters which coalasce
 Associated pain
 Lesions heal by a week

14. Diagnosis
 Histology
 Viral identification and isolation
 Immunofluorescent tests
 Immunoperoxide test
 RIA and ELISA
 Treatment

15. 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

16.  No treatment needed as it is self
limiting

17. Hand Foot and Mouth
Disease
 Coxsakie and entero virus
 Multiple ulcers with dysphagia
 Intracytoplasmic viral inclusions, high
antibody titer to Coxsakie
 Self limiting

18. 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

19.  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

21. 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

22.  The classic triad of CRS consists of
deafness, heart disease, and
cataracts

23. 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

25. Varicella

26.  Oral lesions

27. Herpes Zoster
 James Ramsay Hunt’s syndrome

28.  Tzank smear

29. Mumps

30. Non Specific Mumps
 C/c Non Specific Sialadenitis
 Acute Post operative Parotitis
 Nutritional Mumps
 Chemical Mumps
 Miscellaneous

31.  Human Immuno Deficiency Virus
 Etiologic agent of Acquired
Immunodeficiency Syndrome (AIDS).
 Characterized by severe depletion of CD4
cells.

33. MODES OF TRANSMISSION
 Sexual transmission
 Blood or blood products
 Maternal-fetal
 Infected needles

34.  Transmission routes


35. CLASSIFICATION OF CLINICAL
MANIFESTATIONS
 Group I : Acute Infection
 Group II : Chronic Asymptomatic
Infections
 Group III : Persistent Generalized
Lymphadenopathy
 Group IV : Aids Related Complex

37. CHRONIC ASYMPTOMATIC
INFECTIONS
 Most dangerous group
 Seropositive pt who is apparently healthy
capable of infection
 Enlarged axillary glands
 Hematological & immunological
abnormalities

38. PERSISTENT GENERALISED
LYMPHADENOPATHY
 LYMPHADENOPATHY in 2 or more
extrainguinal sites persisting for more than
3 months

39. AIDS RELATED COMPLEX
 OPPORTUNISTIC INFECTIONS
-Pneumonia, Cryptococcosis,
Viral Infections, Toxoplasmosis, TB etc.
 NEOPLASMS
- KS, Lymphoma, SCC

40.  NEUROLOGIC DISEASES
- Meningocephalitis
 OTHERS
- Encephalopathy, Purpura,
Thrombocytopenia

42.  Oral lesions in HIV...

43. Candidiasis
PSEUDOMEMBRANOUS ERYTHEMATOUS
ANGULAR CHEILITIS

44. HISTOPLASMOSIS
 Histoplasma capsulatum
Nodules over the mucosa which undergoes ulceration
Gingiva, tongue, palate, buccal mucosa

45. LINEAR GINGIVAL ERYTHMA
Very fine red band along gingival margin and attached gingiva with profuse bleedin

46. NECROTIZING ULCERATIVE
PERIODONTITIS
Advanced destruction of peridontium, rapid bone loss, loss of PDL

47. Oral Hairy Leukoplakia

49. WART (HPV)1
Painless papule or nodule with papillary projections or rough surface
Pedunculated or Sessile

50. APHTHOUS ULCER (MINOR)
Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded b
Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.

51. APHTHOUS ULCER (MAJOR)

52. 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

53. 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.

54. Diagnosis of HIV
 Viral Culture
 PCR
 P24 antigen detection
 ELISA
 Western Blot
Treatment - HAART

55. TREATMENT
 Haart - zidovudine, stavudine, lamivudine,
didanosine
 Symptomatic treatment
 Precautions

56. Thank u...