Oral Pathology 1

Front 1

Herpes Simplex Overview

Back 1

- DNA virus of the human herpesvirus family
- 2 forms: HSV-1 (predominately oral) and HSV-2 (predominately genital)
- Initial contact w/ the virus produces primary infection
- HSV is neurotrophic=> will be transported via nerves to sensory ganglia

Front 2

Primary Herpes

Back 2

- Spread through saliva, usually early in childhood
- Fever, cervical lymphadenopathy, oral sores
- Oral lesions begin as vesicles that quickly rupture to form shallow ulcers
- Small ulcers often coalesce, resulting in larger ulcers having "serpentine" boarders.
- Assoc. w/ pain and discomfort

Front 3

Primary Herpes Diagnosis

Back 3

- Exfoliative cytology or rarely a biopsy- infected cells show multi nucleation and ballooning degeneration of nuclei
- Viral culture
- Sequential serum antibody titers
- Immunohistochemistry or sampled tissue

Front 4

Primary Herpes Tx and Prognosis

Back 4

- If identified w/in first 2-3 days, acyclovir or one of its analogues may be helpful
- Valacyclovir is absorbed better than acyclovir and is eventually metabolized to acyclovir
- Symptomatic care: analgesic, antipyretics
- Topical anesthetics so they can eat and drink: important to hydrate
- Generally good, only 1 episode lasts 10-14 days, even w/o Tx
- Approx. 25% chance of developing at least one episode of recurrent disease
- Care should be taken not to spread virus other to body sites or other people

Front 5

Recurrent Herpes Labialis

Back 5

- Triggered UV light exposure or trauma
- Affect vermillion zone or perioral skin
- Prodromal itching or tingling
- Erythema, followed by cluster of vesicles
- W/ no Tx, vesicles rupture, form a crust, and lesions heal in 7-10 days
- Tx: Avoid sun exposure and use sunblocks. Topical antivirals agents statistically decrease in healing time. Systemic valacyclovir have best results.

Front 6

Recurrent Intraoral Herpes

Back 6

- Seems to be relatively uncommon
- Usually few symptoms- irritated or rough feeling
- Cluster of shallow ulcers
- Confined to mucosa bound to periosteum
- Heal in 1 week w/ no Tx

Front 7

Herpes- Immunosuppressed

Back 7

- Patients who are immunocompromised are susceptible
- Most cases represent reactivated virus
- Any oral mucosal surface can be affected
- Large shallow ulcers w/ elevated, scalloped borders
- Tx is intravenous acyclovir for acute cases; maintenance w/ oral acyclovir may be necessary

Front 8

Herpetic Whitlow

Back 8

- One of the hazards assoc. with not wearing gloves
- Despite the host having antibodies to herpesvirus, infection can still be induced w/ a sufficient viral inoculum

Front 9

Varicella

Back 9

- Direct contact or air-borne droplets
- Cutaneous lesions: intense pruritic vesicles
- "Dew drops on rose petals"
- Fever and malaise present
- A few 1-2 mm shallow oral ulcers may develop at any intraoral site

Front 10

Varicella- Dx and Tx

Back 10

- Dx based on clinical signs
- Tx is usually supportive; acyclovir if detected w/in 1 day of onset
- Good prognosis
- Zoster may develop

Front 11

Herpes Zoster
(Shingles)

Back 11

- Reactivation of VZV in 10-20% of the pop.
- Increasing frequency w/ aging
- Painful erythema and vesicles, usually on trunk
- May occur in head and neck region that stop at midline
- Tx: Systemic acyclovir (5x dosage of HSV); good prognosis, lesions resolve in 2-3 weeks; post-herpetic neuralgia can develop

Front 12

Herpangina

Back 12

- Enterovirus infection caused by coxsachievirus A or B, or echovirus
- Children 1-4 yrs
- Acute onset of sore throat, fever and 1-2 mm oral ulcers localized to posterior soft palate/tonsillar pillar region
- Dx is based on clinical findings
- Self-limiting process resolves in 7-10 days
- Tx is supportive care w/ analgesics, antipyretics, and topical anesthetics

Front 13

Hand, Foot, and Mouth Disease

Back 13

- Enterovirus infection caused by coxsachievirus A or B, or echovirus 71
- Sore throat, fever
- Oral and hand lesions most common; 2-7 mm oral lesions
- Buccal/labial mucosa and tongue lesions most common
- Skin lesions consist of 1-3 erythematous macules that may develop a central vesicle
- Dx is based on clinical manifestations; supportive care is indicated
- Condition resolves w/in 7-10 days
- Good prognosis