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...