Histopathology of Viral Skin Infections

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Questions and Answers

What is the characteristic histopathological feature of herpes simplex?

Multinucleate giant cells

Eosinophilic nuclear inclusions

Keratinocyte showing ballooning degeneration

All of the above (correct)

Which of the following viruses causes herpangina?

Coxsackie Virus (correct)

Herpes Simplex Virus

Human Papilloma Virus

Ebola Virus

What is the primary route of transmission for Coxsackie virus?

Skin-to-skin contact

Vector-borne transmission

Fecal-oral route (correct)

Airborne transmission

What is the typical duration of herpangina?

7-10 days Signup and view all the answers

Which of the following is a characteristic feature of hand-foot-and-mouth disease?

Skin rash on palms and soles Signup and view all the answers

What is the primary treatment for herpes simplex?

Antiviral medications Signup and view all the answers

What is the etiological agent of human papilloma virus infection?

Human Papilloma Virus (HPV) Signup and view all the answers

What is the typical age range for herpangina?

Children and young adults Signup and view all the answers

What is the type of DNA found in Herpes Simplex Virus?

Double stranded Signup and view all the answers

Which of the following is NOT a characteristic of viruses?

Can replicate outside host cells Signup and view all the answers

What is the name of the disease caused by Coxsackie Virus?

Herpangina Signup and view all the answers

What is the incubation period of Primary Herpes?

3-8 days Signup and view all the answers

What is the name of the virus family that causes warts?

Papovavirus Signup and view all the answers

What is the name of the disease caused by Herpes Simplex Virus?

Acute herpetic gingivostomatitis Signup and view all the answers

What is the percentage of Primary Herpes cases that are sub-clinical in childhood?

99% Signup and view all the answers

What is the name of the disease caused by Coxsackie Virus in addition to Herpangina?

Hand-foot-and-mouth Disease Signup and view all the answers

What is the characteristic of nodules in Herpangina?

Hyperplastic lymphoid aggregates Signup and view all the answers

What is the mode of transmission of HIV in haemophiliacs?

Infected blood transfusions Signup and view all the answers

What is the association of Kaposi's sarcoma with?

HHV 8 Signup and view all the answers

What is the characteristic of AIDS periodontitis?

Rapidly progressive Signup and view all the answers

What is the treatment for AIDS?

HAART - Highly Active Antiretroviral Therapy Signup and view all the answers

What is the characteristic of oral hairy leukoplakia?

Occurrence on the lateral borders of the tongue Signup and view all the answers

What is the association of Lymphoma with?

Epstein Barr virus Signup and view all the answers

What is the characteristic of Necrotizing ulcerative gingivitis in HIV disease?

Rapidly progressive Signup and view all the answers

Study Notes

Histopathology of Viral Infections

Keratinocytes show "ballooning degeneration" with margination of chromatin, eosinophilic nuclear inclusions, and multinucleate giant cells.
Vesicles rupture and become erosions.

Human Herpes Virus (HHV)

Double-stranded DNA virus with two types: HSV-1 and HSV-2.
Lytic to human epithelial cells and latent in neural tissue.
Clinical features:
- May penetrate intact mucous membrane, but requires breaks in skin.
- Infects peripheral nerve, migrates to regional ganglion.
- Primary infection, latency, and recurrence occur.
- 99% of cases are sub-clinical in childhood.

Primary Herpes: Acute Herpetic Gingivostomatitis

1% of cases; severe symptoms in children (1-3 years) and occasionally in adults.
Incubation period: 3-8 days.
Numerous small vesicles in various sites in mouth; vesicles rupture to form multiple small shallow punctate ulcers with red halo.
Child is ill with fever, general malaise, myalgia, headache, regional lymphadenopathy, excessive salivation, and halitosis.
Self-limiting; heals in 2 weeks.

Secondary Herpes: Recurrent Oral Herpes Simplex

Presents as:
- Herpes labialis (cold sores) or
- Recurrent intra-oral herpes – palate or gingiva.
Seen in adults (approx 30%).
Predisposing factors: sunlight, fever, allergy, trauma, menstruation, and immunosuppression.
Herpes labialis:
- Prodrome of burning and tenderness.
- Intraepithelial blisters which burst, crust, and heal in 10-12 days.
Recurrent intra-oral herpes (uncommon):
- Vesicles rupture early, form ulcers with red or white bases.
- Heal in 10-12 days.

Human Papilloma Virus (HPV)

Benign proliferation of stratified squamous epithelium resulting in a papillary or verruciform mass.
Etiology: Human papilloma virus (HPV).
Clinical features:
- M=F; 30-50 years.
- Site: Tongue; Lips; Soft palate (common); any oral surface.
- Soft, painless, pedunculated, exophytic nodule with surface finger-like projections (cauliflower-like).
- Normal color.
- Solitary, 0.5mm; occasionally multiple lesions occur.

RNA Viruses: Picorna Virus (Coxsackie)

Coxsackie A viruses cause:
- Herpangina
- Hand, foot, and mouth disease
- Acute lymphonodular pharyngitis
Most cases arise in summer/early fall.
Spread: fecal-oral route.

Herpangina

Multiple Coxsackie subtypes.
Sore throat, dysphagia, fever.
Occasional cough, rhinorrhea, anorexia, vomiting, headache, and myalgia.
Oral lesions, confined to posterior sites: soft palate, tonsil; begin as red macules and petechiae, form vesicles and ulcerate (2-4mm).
Heals within 7-10 days.

Hand, Foot, and Mouth Disease

Coxsackie subtypes A9 and A16.
Sore throat, dysphagia, fever.
Occasional cough, rhinorrhea, anorexia, vomiting, headache, and myalgia.
Skin rash on palms and soles.
Oral and hand lesions almost always present; other sites variable.
Oral lesions similar to herpangina but not confined to posterior mouth.

Acute Lymphonodular Pharyngitis

Yellow to dark pink nodules develop on soft palate and/or tonsillar pillars.
Nodules are hyperplastic lymphoid aggregates.
Resolves within 7-10 days.

Acquired Immune Deficiency Syndrome (AIDS)

A human immunodeficiency state caused by the human immunodeficiency virus (HIV) and associated with several life-threatening opportunistic infections and malignant neoplasms.
Etiology:
- Human immunodeficiency virus (HIV)
Susceptible individuals and predisposing factors:
- Homosexual/bisexual men (sexual intercourse)
- Intravenous drug users (contaminated needles)
- Haemophiliacs (via infected blood transfusions)
- Heterosexual contacts (sexual intercourse)
- Vertical transmission – mother to child (in-utero)
Clinical features:
- Fever, generalized malaise, unexplained weight loss, night sweats, lymphadenopathy (persistent cervical, axillary, and inguinal), diarrhea, and persistent cough.
Associated infections:
- Pneumocystis carinii (pneumocystis pneumonia)
- Candidiasis (oral and genital)
- Herpes (oral, genital, ocular, encephalitis)
- Cytomegalovirus (CMV) in kidney, lung, and brain
- Mycobacterium avium intracellulare
Associated malignant neoplasms:
- Kaposi's sarcoma (hard palate, gingiva, skin)
- Lymphoma
- Squamous cell carcinoma of the oral cavity
Oral findings:
- Hairy leukoplakia on lateral borders of tongue
- Candidiasis
- Recurrent herpes simplex infections
- Kaposi's sarcoma – association with HHV 8
- Lymphoma (hard palate; tonsils; intra-bony in mandible and maxilla) – some associated with Epstein Barr virus
- Salivary gland cystic lymphoepithelial lesion
- AIDS periodontitis (rapidly progressive); necrotizing ulcerative gingivitis
- Aphthous-like ulcers
Treatment:
- HAART – highly active antiretroviral therapy

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Description

Identify the characteristics of viral skin infections, including histopathological features and diagnosis methods. Understand the treatment options for these infections.