viral infections of oral cavity
DESCRIPTION
A presentation of around sixty slides giving an overview of general viral infections that can occur in oral cavity...TRANSCRIPT
Viral Infections...
Dr Ravikumar V,JR II, Dept Of Oral Path,GDC, Kottayam
IntroWhat is a Virus..?Basic structure Sequlae of infectionClassification
Herpes SimplexHSV I and IISkin, mucosa, eye and CNS
Herpes genitalisHerpes meningoencephalitisHerpetic conjunctivitis
Herpetic eczemaDisseminated HS of newbornHerpetic whitlowHerpes gladiatorum
Primary Herpetic StomatitisInfancy and adultSpread – droplets, contactFever, irritation, headache, pain
on swallowing, regional lymphadenopathy
Yellow fluid filled vesicles which rupture to form characteristic ulcers
Vesicles
Erythematous halo
Shallow Ulcer withGray membrane
HSV culture from sitesHSV DNA demonstration in lumbar
and trigeminal gangliaHistology – ballooning degeneration
- Lip schutz bodiesDiagnosis – clinical, stains, cytology,
DNA, PCR Treatment – Antiviral drugs, NSAID
Reccurent Herpes Labialis / StomatitisAttenuated form of primary
diseaseReactivation – ganglion trigger,
skin trigger, emotional theoryThe viruses spread through
nerves and act on epithelial cells and cause inflammation
Lesions may recur at any intervalMay occur on lips, intraoral, or
along area of distribution of nervePreceded by tingling or burning
sensation
Vesicles less than a mm appear as clusters which coalasce
Associated painLesions heal by a week
DiagnosisHistologyViral identification and isolationImmunofluorescent testsImmunoperoxide testRIA and ELISATreatment
HerpanginaCoxsakie group A virusIngestion, contact, dropletSeen 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
No treatment needed as it is self limiting
Hand Foot and Mouth Disease
Coxsakie and entero virusMultiple ulcers with dysphagiaIntracytoplasmic viral inclusions,
high antibody titer to CoxsakieSelf limiting
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
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 SpotsWarthin Finkeldey giant cells
RUBELLA (GERMAN MEASLES)capacity to induce birth defectsForchheimer spots- small
discrete dark-red papules that develop on the soft palate and may extend onto the hard palate
The classic triad of CRS consists of deafness, heart disease, and cataracts
Molluscum ContagiosumCaused by virus of pox groupConsidered tumor likeOccur as single or multiple
discrete elevated nodules with central crustation
Cowdry A inclusion bodiesHenderson Paterson inclusions
Varicella
Oral lesions
Herpes ZosterJames Ramsay Hunt’s syndrome
Tzank smear
Mumps
Non Specific MumpsC/c Non Specific SialadenitisAcute Post operative ParotitisNutritional MumpsChemical MumpsMiscellaneous
Human Immuno Deficiency VirusEtiologic agent of Acquired
Immunodeficiency Syndrome (AIDS).Characterized by severe depletion of
CD4 cells.
MODES OF TRANSMISSION
Sexual transmissionBlood or blood productsMaternal-fetal Infected needles
Transmission routes
CLASSIFICATION OF CLINICAL MANIFESTATIONS
Group I : Acute Infection Group II : Chronic Asymptomatic
InfectionsGroup III : Persistent Generalized
LymphadenopathyGroup IV : Aids Related Complex
CHRONIC ASYMPTOMATIC INFECTIONSMost dangerous groupSeropositive pt who is apparently
healthy capable of infectionEnlarged axillary glandsHematological & immunological
abnormalities
PERSISTENT GENERALISED LYMPHADENOPATHYLYMPHADENOPATHY in 2 or more
extrainguinal sites persisting for more than 3 months
AIDS RELATED COMPLEXOPPORTUNISTIC INFECTIONS-Pneumonia, Cryptococcosis,
Viral Infections, Toxoplasmosis, TB etc.
NEOPLASMS- KS, Lymphoma, SCC
NEUROLOGIC DISEASES- Meningocephalitis
OTHERS- Encephalopathy, Purpura,
Thrombocytopenia
Oral lesions in HIV...
Candidiasis
PSEUDOMEMBRANOUS ERYTHEMATOUS
ANGULAR CHEILITIS
HISTOPLASMOSIS
Histoplasma capsulatum
Nodules over the mucosa which undergoes ulcerationGingiva, tongue, palate, buccal mucosa
LINEAR GINGIVAL ERYTHMA
Very fine red band along gingival margin and attached gingiva with profuse bleeding
NECROTIZING ULCERATIVE PERIODONTITIS
Advanced destruction of peridontium, rapid bone loss, loss of PDL
Oral Hairy Leukoplakia
WART (HPV)1
Painless papule or nodule with papillary projections or rough surfacePedunculated or Sessile
APHTHOUS ULCER (MINOR)
Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded by Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
APHTHOUS ULCER (MAJOR)
KAPOSI’S SARCOMAPredominantly 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 of HIVViral CulturePCRP24 antigen detectionELISAWestern BlotTreatment - HAART
TREATMENT
Haart - zidovudine, stavudine, lamivudine, didanosine
Symptomatic treatmentPrecautions
Thank u...