Oral Viral conditions

Herpes
1. Double stranded DNA, enveloped
2. Herpes Simplex (1+2)
  1. HSV 2 = genital
  2. HSV 1 = oral
    1. Primary Herpetic gingivostomatitis
      1. Onset = <5yrs or 20s
      2. Clinical features
        Fever, malaise, poor appetite
        Bilateral cervical lymphadenopathy
        Oral
        Gingivitis (boggy, swelling) esp. anteriorly
        Stomatitis
        Most common = lips
        Vesicles -> small, painful ulcers
        May be widespread
        Gingiva, palate, mucosa
      3. Management
        Soft diet, fluids
        Chx MW
        Acyclovir - oral, 200mg 5xday
        Paracetamol
    2. Reactivation
      1. Herpes labialis = most common
        = cold sore
        Lip lesion
        Unilateral
        Macule -> vesicle -> crusted scab/ulcer
        Severity < primary infection
        Burning, paraesthesia, pain in area
      2. Recurrent intra-oral herpetic infection
        Crop of small ulcers
        Keratinised mucosa
        >10 in no.
        1-2mm in size
        Diff. diagnosis = RAS
        Can occur after palatal LA injection
      3. Management
        Acyclovir cream 5%, 4-6xday
        Acyclovir oral if immunocompromised
3. Varicella-Zoster (3)
  1. Chickenpox
    1. Onset = children
    2. Clinical features
      1. Itchy rash
        Papules -> vesicles -> pustules -> crusty erosions
        Begins on trunk -> centrifugal distribution
      2. Oral ulcers
        Same as HSV
        Not on gingiva
      3. Fever, malaise
    3. Management
      1. Soft diet, fluids
      2. Chx MW
      3. Paracetamol
  2. Reactivation = shingles
    1. Onset = >50yrs
    2. Clinical features
      1. Tenderness & pain in dermatome 2-4 days before rash
      2. Most common = thoracic then trigeminal
      3. Trigeminal
        Confined to dermatome
        Can have post-herpetic neuralgia
        Ophthalmic div -> sight-threatening
      4. Geniculate ganglion of CN 7
        Ramsay Hunt syndrome
        Facial palsy
        Vesicles in ear
      5. Unilateral
      6. Vesicles -> scabs
    3. Management
      1. 1st choice = Valcyclovir oral, 3g daily for 7 days
      2. Acyclovir oral, 800mg 5xday for 7 days
4. Epstein-Barr (4)
  1. Infective mononucleosis = glandular fever
    1. Clinical features
      1. Sore throat
      2. Fever, malaise
      3. Lymphadenopathy
      4. Rashes
      5. Oral
        Petechiae on soft palate
        White exudate from oedematous tonsils
    2. Diagnosis
      1. MONO test
      2. FBC
  2. Oral hairy leukoplakia
    1. Immunocompromised e.g. HIV
    2. White vertical corrugations
      1. Lateral border of tongue
      2. Bilateral
      3. Painless
      4. Not pre-malignant
5. Cytomegalovirus (5)
  1. Primary infection
    1. Glandular fever symptoms
      1. Mono test = -ve
    2. Life-threatening in immunocompromised
    3. Oral aphthous-like ulcers
6. Karposi's sarcoma (8)
  1. Epidemic type
    1. HIV
    2. Most aggressive
    3. Widespread skin & oral lesions
    4. Most assoc. with HHV-8
    5. Poor prognosis
  2. Oral lesions
    1. May be 1st sign & lead to HIV diagnosis
    2. Early
      1. Red/purple spots
    3. Late
      1. Blue
      2. Nodulated, ulcerated
    4. Diff. diagnosis
      1. Haemangioma
        Doesn't blanch under pressure like haemangioma
      2. Purpura, pyogenic granuloma
    5. Most common site = palate & gingiva
  3. Diagnosis
    1. Biopsy
    2. Immunohistochemistry
  4. Predominant infected cell = B lymphocytes
Human Papilloma Virus
1. Assoc. with cancer
  1. Most carcinogenic = HPV-16 & 18
    1. Oropharyngeal cancer
  2. Causes 70% of cervical cancer
2. Papillomas
  1. Most assoc. HPV-6 & 11
  2. Benign
  3. Not pre-malingnant
  4. Oral clinical features
    1. Spiky exophytic growths or cauliflower-like
    2. Pedunculated
    3. Sites
      1. Most common = lip
      2. Palate
      3. Labial & buccal mucosa
      4. Gingiva
    4. White or Pink
  5. Management = surgical exicision
  6. If multiple -> may be immunocompromised
3. Condyloma acuminatum
  1. = genital warts
  2. Sessile
  3. Broad, cauliflower-like
  4. Sexually transmitted
Cocksackie
1. Hand, foot & mouth disease
  1. Cocksakie A
  2. Small epidemics in children
  3. Clinical features
    1. Rash on palms & soles
      1. Red papules -> vesicles
    2. Oral lesions similar to herpetic stomatitis
      1. No gingivitis
    3. Fever, malaise, poor appetite
2. Herpangina
  1. Cocksakie A or B
  2. Uncommon
  3. Small children
  4. Clinical features
    1. Pharyngeal ulcers
    2. Fever, malaise, poor appetite
    3. Vomiting

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Oral Viral conditions

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