Viral Infections: Dent 452 Dr. Jumana Karasneh
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Viral Infections Dent 452 Lecture 5 Dr. Jumana Karasneh
Viruses 1.
Human Herpes Virus (HHV)
2.
Enteroviruses 1.
3.
Coxsackieviruses (CSV)
Paramyxovirus 1.
Mumps virus
2.
Morbillivirus
4.
Human papillomavirus (HPV)
5.
Human immunodificiency virus 2
Human Herpes Virus (HHV)
1.
Herpes simplex virus type 1 (HSV-1)
(HHV-1)
2.
Herpes simplex virus type 2 (HSV-2)
(HHV-2)
3.
Varicella-zoster virus (VZV)
(HHV-3)
4.
Epstein-Barr virus (EBV)
(HHV-4)
5.
Cytomegalovirus (CMG) Human Herpes Virus 6 Human Herpes Virus 7 Human Herpes Virus 8
(HHV-5) (HHV-6) (HHV-7) (HHV-8)
6. 7. 8.
3
Characteristics of HHV 1.
DNA virus
2.
Contracted in early life
3.
Transmitted in saliva
4.
Latency
5.
Reactivated by immunosuppression 4
HSV-1 (HHV-1) Primary Herpetic Gingivostomatitis Clinical Picture:
Children 6m-6y affected.
Systemic symptoms
Multiple vesicles anywhere intra orally, lips & circumoral skin
Recovery 10-14 days
Management
Should exclude leukaemia in children
Supportive & rehydration 5
HSV-1 (HHV-1)
Herpetic whitlow *Infection control procedure are always essential (mask, eye protection, gloves)
6
HSV-1 (HHV-1) Recurrent Herpes Clinical Picture:
Usually on lips / nose
Could occur intra-orally on keratinized fixed mucosa
Tingling sensation for 1-2 days
Crops of vesicles that crust later
Bell’s palsy if facial nerve is affected
Management
Supportive
Topical aciclovir 5 times/day 7
VZV(HHV-2) Chickenpox Definition:
Infection for 1st time causes Chickenpox
Stay latent in the sensory ganglia
Recurs causing 2° infection Herpes Zoster (shingles)
Diagnosis:
Clinical picture
Management
Supportive
8
VZV(HHV-2) Shingles
Clinical picture:
Unilateral
Most cases involve thoracic only 30% affect trigeminal
Affect older age group usually
Starts as severe pain then vesicles follow.
Complicated by post-herpetic neuralgia
Management
High doses of systemic aciclovir or famciclovir
Ophthalmic consultation if Ophthalmic branch is affected 9
EBV (HHV-3) Infectious mononucleosis Clinical picture:
Complications:
subclinical
Hairy Leukoplakia
Lymphadinopathy
Nasopharyngeal carcinoma
Sore throat
Burkett’s lymphoma
Fever & malaise
Rashes
Management
supportive
10
Enteroviruses
Coxsackieviruses (CSV)
No latent phase
Group A & B with subtypes
Transmitted by direct contact
Group A causes: Hand, foot & mouth disease Herpangina
Mild symptoms
Self-limiting condition 11
Paramyxoviruse
Mumps virus Clinical picture:
Mostly bilateral swelling of parotid gland
Unilateral / submandibular less frequently
Pain, fever & malaise
Xerostomia
Trismus
Complications:
Pancreatitis
Encephalitis
Orchitis / Oophoritis
Management 12
Paramyxoviruse
Morbillivirus Clinical picture: 1.
Febrile illness & nasal discharge
2.
Koplik’s spots
3.
Maculopapular rash
4.
Conjunctivitis
Complications:
Encephalitis
Pneumonia
Management
Symptomatic 13
Human papilloma virus (HPV)
Over 100 type all causing warty growths in skin & mucosa Most common is Verruca vulgaris causing common wart Focal epithelial hyperplasia (Heck’s disease)
Clinical Picture:
Diagnosis:
Treatment: 14
Retroviruses Human immunodeficiency virus (HIV) High Risk Group:
Homosexuals
History of previous blood transfusion.
Drug addicts.
Multiple partners
HIV attacks CD4+ T & brain glial cells
Tranmission via saliva is rare Secretory leukocyte protease 1 Peroxidase Thrombospondin-1
15
16
Retroviruses Human immunodeficiency virus (HIV)
Clinical features 1.
Acute HIV infection Rapid viral replication Mimicking glandular fever symptoms
1.
HIV infection Asymptomatic Last for years
1.
HIV disease ↓ CD4+ T cells Affected with Pneumonia, candida, bacterial, viral & malignancy
1.
AIDS CD4+ T cells > 200 cells/ml Severe symptoms 17
Retroviruses Human immunodeficiency virus (HIV)
Oral features
18
Retroviruses Human immunodeficiency virus (HIV)
Oral features
19
Retroviruses Human immunodeficiency virus (HIV)
Oral features
20
Retroviruses Human immunodeficiency virus (HIV)
Management
Aggressive treatment for infections
Antiretroviral therapy Azidothymidine (AZT), protease inhibitor Nucleoside reverse transcriptase inhibitor Non-nucleoside reverse transcriptase inhibitor
21
Viruses 1.
Human Herpes Virus (HHV)
2.
Enteroviruses 1.
3.
Coxsackieviruses (CSV)
Paramyxovirus 1.
Mumps virus
2.
Morbillivirus
4.
Human papillomavirus (HPV)
5.
Human immunodificiency virus 2
Human Herpes Virus (HHV)
1.
Herpes simplex virus type 1 (HSV-1)
(HHV-1)
2.
Herpes simplex virus type 2 (HSV-2)
(HHV-2)
3.
Varicella-zoster virus (VZV)
(HHV-3)
4.
Epstein-Barr virus (EBV)
(HHV-4)
5.
Cytomegalovirus (CMG) Human Herpes Virus 6 Human Herpes Virus 7 Human Herpes Virus 8
(HHV-5) (HHV-6) (HHV-7) (HHV-8)
6. 7. 8.
3
Characteristics of HHV 1.
DNA virus
2.
Contracted in early life
3.
Transmitted in saliva
4.
Latency
5.
Reactivated by immunosuppression 4
HSV-1 (HHV-1) Primary Herpetic Gingivostomatitis Clinical Picture:
Children 6m-6y affected.
Systemic symptoms
Multiple vesicles anywhere intra orally, lips & circumoral skin
Recovery 10-14 days
Management
Should exclude leukaemia in children
Supportive & rehydration 5
HSV-1 (HHV-1)
Herpetic whitlow *Infection control procedure are always essential (mask, eye protection, gloves)
6
HSV-1 (HHV-1) Recurrent Herpes Clinical Picture:
Usually on lips / nose
Could occur intra-orally on keratinized fixed mucosa
Tingling sensation for 1-2 days
Crops of vesicles that crust later
Bell’s palsy if facial nerve is affected
Management
Supportive
Topical aciclovir 5 times/day 7
VZV(HHV-2) Chickenpox Definition:
Infection for 1st time causes Chickenpox
Stay latent in the sensory ganglia
Recurs causing 2° infection Herpes Zoster (shingles)
Diagnosis:
Clinical picture
Management
Supportive
8
VZV(HHV-2) Shingles
Clinical picture:
Unilateral
Most cases involve thoracic only 30% affect trigeminal
Affect older age group usually
Starts as severe pain then vesicles follow.
Complicated by post-herpetic neuralgia
Management
High doses of systemic aciclovir or famciclovir
Ophthalmic consultation if Ophthalmic branch is affected 9
EBV (HHV-3) Infectious mononucleosis Clinical picture:
Complications:
subclinical
Hairy Leukoplakia
Lymphadinopathy
Nasopharyngeal carcinoma
Sore throat
Burkett’s lymphoma
Fever & malaise
Rashes
Management
supportive
10
Enteroviruses
Coxsackieviruses (CSV)
No latent phase
Group A & B with subtypes
Transmitted by direct contact
Group A causes: Hand, foot & mouth disease Herpangina
Mild symptoms
Self-limiting condition 11
Paramyxoviruse
Mumps virus Clinical picture:
Mostly bilateral swelling of parotid gland
Unilateral / submandibular less frequently
Pain, fever & malaise
Xerostomia
Trismus
Complications:
Pancreatitis
Encephalitis
Orchitis / Oophoritis
Management 12
Paramyxoviruse
Morbillivirus Clinical picture: 1.
Febrile illness & nasal discharge
2.
Koplik’s spots
3.
Maculopapular rash
4.
Conjunctivitis
Complications:
Encephalitis
Pneumonia
Management
Symptomatic 13
Human papilloma virus (HPV)
Over 100 type all causing warty growths in skin & mucosa Most common is Verruca vulgaris causing common wart Focal epithelial hyperplasia (Heck’s disease)
Clinical Picture:
Diagnosis:
Treatment: 14
Retroviruses Human immunodeficiency virus (HIV) High Risk Group:
Homosexuals
History of previous blood transfusion.
Drug addicts.
Multiple partners
HIV attacks CD4+ T & brain glial cells
Tranmission via saliva is rare Secretory leukocyte protease 1 Peroxidase Thrombospondin-1
15
16
Retroviruses Human immunodeficiency virus (HIV)
Clinical features 1.
Acute HIV infection Rapid viral replication Mimicking glandular fever symptoms
1.
HIV infection Asymptomatic Last for years
1.
HIV disease ↓ CD4+ T cells Affected with Pneumonia, candida, bacterial, viral & malignancy
1.
AIDS CD4+ T cells > 200 cells/ml Severe symptoms 17
Retroviruses Human immunodeficiency virus (HIV)
Oral features
18
Retroviruses Human immunodeficiency virus (HIV)
Oral features
19
Retroviruses Human immunodeficiency virus (HIV)
Oral features
20
Retroviruses Human immunodeficiency virus (HIV)
Management
Aggressive treatment for infections
Antiretroviral therapy Azidothymidine (AZT), protease inhibitor Nucleoside reverse transcriptase inhibitor Non-nucleoside reverse transcriptase inhibitor
21
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