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Questions and Answers
Which type of herpes virus is typically associated with oral-facial lesions?
Which type of herpes virus is typically associated with oral-facial lesions?
How is HSV2 infection usually transmitted?
How is HSV2 infection usually transmitted?
HSV1 infection may provide some protection against HSV2 infection due to antibody cross-reactivity.
HSV1 infection may provide some protection against HSV2 infection due to antibody cross-reactivity.
True
What is the latent site for the HSV1 virus after the primary infection?
What is the latent site for the HSV1 virus after the primary infection?
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Asymptomatic shedding of intact HSV particles in saliva can be identified in approximately 2% to 10% of healthy adults in the absence of __________ disease.
Asymptomatic shedding of intact HSV particles in saliva can be identified in approximately 2% to 10% of healthy adults in the absence of __________ disease.
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What virus causes Herpangina?
What virus causes Herpangina?
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Which group of viruses is Coxsackie virus a part of?
Which group of viruses is Coxsackie virus a part of?
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Varicella is most commonly confused with Hand-Foot-and-Mouth Disease (HFM).
Varicella is most commonly confused with Hand-Foot-and-Mouth Disease (HFM).
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The virus responsible for typical Herpangina may sometimes cause _____ symptoms without evidence of pharyngeal lesions.
The virus responsible for typical Herpangina may sometimes cause _____ symptoms without evidence of pharyngeal lesions.
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What is the primary disease caused by herpes simplex infections usually seen in?
What is the primary disease caused by herpes simplex infections usually seen in?
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What are some common systemic signs/symptoms that accompany primary herpes simplex infection?
What are some common systemic signs/symptoms that accompany primary herpes simplex infection?
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Recurrent herpes lesions typically heal with scarring.
Recurrent herpes lesions typically heal with scarring.
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Herpetic whitlow is a primary or secondary HSV infection involving the __________.
Herpetic whitlow is a primary or secondary HSV infection involving the __________.
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Match the following herpes simplex infection descriptions:
Match the following herpes simplex infection descriptions:
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What is the etiology of measles?
What is the etiology of measles?
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How is measles virus primarily spread?
How is measles virus primarily spread?
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Measles virus is structurally and biologically related to mumps and rubella viruses.
Measles virus is structurally and biologically related to mumps and rubella viruses.
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Measles rash typically consists of early pinpoint elevations over the soft palate that coalesce with ultimate involvement of the ______.
Measles rash typically consists of early pinpoint elevations over the soft palate that coalesce with ultimate involvement of the ______.
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What is the primary mechanism of action of acyclovir in herpes-infected cells?
What is the primary mechanism of action of acyclovir in herpes-infected cells?
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Which antiviral agents are effective for controlling primary genital herpes?
Which antiviral agents are effective for controlling primary genital herpes?
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Topical acyclovir is effective in preventing the recurrence of secondary or recurrent herpes.
Topical acyclovir is effective in preventing the recurrence of secondary or recurrent herpes.
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Varicella-zoster infection in seronegative individuals is known as ________.
Varicella-zoster infection in seronegative individuals is known as ________.
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Match the following clinical features with the respective infection: 1. Unilateral painful vesicular eruption along dermatome, 2. Rash involving primarily the trunk, head, and neck
Match the following clinical features with the respective infection: 1. Unilateral painful vesicular eruption along dermatome, 2. Rash involving primarily the trunk, head, and neck
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What is the primary factor determining the prognosis of epidermolysis bullosa?
What is the primary factor determining the prognosis of epidermolysis bullosa?
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In which form of epidermolysis bullosa is the behavior most commonly life-threatening?
In which form of epidermolysis bullosa is the behavior most commonly life-threatening?
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What side effects are associated with the use of systemic corticosteroids?
What side effects are associated with the use of systemic corticosteroids?
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How are gingival lesions often presented with oral mucous membrane pemphigoid?
How are gingival lesions often presented with oral mucous membrane pemphigoid?
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Systemic corticosteroids are typically resistant to systemic therapy in treating mucous membrane pemphigoid.
Systemic corticosteroids are typically resistant to systemic therapy in treating mucous membrane pemphigoid.
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To prevent corneal damage, many patients with ocular pemphigoid have their eyelashes permanently removed by ________________.
To prevent corneal damage, many patients with ocular pemphigoid have their eyelashes permanently removed by ________________.
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What is the major bullous pemphigoid antigen?
What is the major bullous pemphigoid antigen?
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Linear IgA bullous disease is associated with gluten-sensitive enteropathy.
Linear IgA bullous disease is associated with gluten-sensitive enteropathy.
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What is the specific immunologic finding in dermatitis herpetiformis?
What is the specific immunologic finding in dermatitis herpetiformis?
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Linear IgA bullous disease is principally a chronic autoimmune disease of the skin that commonly affects ______ membranes.
Linear IgA bullous disease is principally a chronic autoimmune disease of the skin that commonly affects ______ membranes.
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Match the following terms with their descriptions:
Match the following terms with their descriptions:
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What type of testing can be used for confirmation of pemphigus vulgaris besides standard biopsy?
What type of testing can be used for confirmation of pemphigus vulgaris besides standard biopsy?
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Which autoantibodies are almost always demonstrated in pemphigus vulgaris with Direct immunofluorescence (DIF) testing?
Which autoantibodies are almost always demonstrated in pemphigus vulgaris with Direct immunofluorescence (DIF) testing?
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Patients with mucous membrane pemphigoid are typically children.
Patients with mucous membrane pemphigoid are typically children.
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Mucous membrane pemphigoid is an autoimmune process with deposits of immunoglobulins and complement components within the ______ zone.
Mucous membrane pemphigoid is an autoimmune process with deposits of immunoglobulins and complement components within the ______ zone.
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Study Notes
Vesiculobullous Diseases
-
Etiology and Pathogenesis
- Vesiculobullous diseases can be caused by viral, immunologic, and hereditary factors
- Viral diseases include herpes simplex, varicella-zoster, and hand-foot-and-mouth disease
- Immunologic diseases include pemphigus vulgaris, mucous membrane pemphigoid, and dermatitis herpetiformis
- Hereditary diseases include epidermolysis bullosa
Herpes Simplex Infection
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Etiology and Pathogenesis
- Herpes simplex virus (HSV) is a common cause of vesiculobullous diseases
- HSV is transmitted through direct contact with an infected individual
- The virus infects epithelial cells and causes the formation of vesicles and ulcers
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Primary Herpes Simplex Infection
- Occurs in individuals who have not been previously exposed to the virus
- Characterized by a vesiculoulcerative eruption in the oral and perioral tissues
- May be accompanied by systemic signs and symptoms such as fever, malaise, and cervical lymphadenopathy
- Lesions heal without scarring in 7-10 days
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Secondary Herpes Simplex Infection
- Occurs in individuals who have been previously infected with the virus
- Characterized by a recurrence of lesions at or near the same site as the primary infection
- Lesions are typically confined to the lips, hard palate, and gingiva
- May be accompanied by prodromal symptoms such as tingling, burning, or pain
- Lesions heal without scarring in 1-2 weeks
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Herpetic Whitlow
- A primary or secondary HSV infection involving the finger(s)
- Typically occurs in individuals who have been in physical contact with an infected individual
- Characterized by pain, redness, and swelling, with vesicles or pustules that eventually break and become ulcers
Histopathology
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Microscopic Features
- Intraepithelial vesicles containing exudate, inflammatory cells, and characteristic virus-infected epithelial cells
- Virus-infected keratinocytes contain one or more homogeneous, glassy nuclear inclusions### Herpes Simplex Virus (HSV)
- HSV1 and HSV2 have identical microscopic appearances and cannot be differentiated microscopically
- After several days, herpes-infected keratinocytes cannot be demonstrated in biopsy or cytologic preparations
- Differential diagnosis of HSV infection includes aphthous stomatitis, streptococcal pharyngitis, erythema multiforme, and acute necrotizing ulcerative gingivitis (ANUG)
- Tzanck smear or preparation is helpful in diagnosing HSV infection only if it is positive
Treatment of HSV Infection
- Systemic antiviral agents, including acyclovir and valacyclovir, are effective in controlling primary genital herpes and primary oral herpetic gingivostomatitis
- Supportive therapy is an essential component of any primary herpes simplex regimen
- Topical acyclovir has been advocated for the treatment of secondary or recurrent herpes, but its effectiveness is limited
- Topical n-docosanol (10%) has been used effectively, but randomized clinical trials are lacking
Varicella-Zoster Virus (VZV) Infection
- Primary VZV infection is known as varicella or chickenpox, while secondary or reactivated disease is known as herpes zoster or shingles
- VZV is structurally similar to HSV, with a DNA core, protein capsid, and lipid envelope
- Microscopically, VZV and HSV infections show similar characteristics, including a cutaneous or mucosal vesiculo-ulcerative eruption
Pathogenesis of VZV Infection
- Varicella is believed to be transmitted predominantly through direct contact by contaminated droplets from skin lesions or by the inhalation of aerosolized virus
- The condition is very contagious and is known to spread readily from person to person
- After a 2-week incubation period, virus proliferates within macrophages, with subsequent viremia and dissemination to the skin and other organs
Clinical Features of VZV Infection
- Varicella is characterized by a rash that involves primarily the trunk, head, and neck, and becomes vesicular and ulcerative
- Fever, chills, malaise, and headache may accompany the rash
- Oral mucous membranes may be involved, showing multiple shallow ulcers that are preceded by evanescent vesicles
Herpes Zoster (Shingles)
- Herpes zoster is essentially a condition of the older adult population and of individuals who have compromised immune responses
- The incidence of herpes zoster infection increases with age, reaching approximately 10 cases per 100,000 patient-years by age 80
- The sensory nerves of the trunk and head and neck are commonly affected, resulting in a unilateral maculopapular rash that becomes vesicular and ulcerative
Hand-Foot-and-Mouth Disease (HFM)
- HFM disease is a common, moderately contagious viral infection that usually is caused by Coxsackie type A16 or enterovirus 71
- The virus is transferred from one individual to another through direct contact with nasal secretions, saliva, blister fluid, or via fecal-oral contamination
- The virus exhibits a predilection for mucous membranes of the mouth and cutaneous regions of the hands and feet, as well as the buttocks
- Clinical features of HFM disease include low-grade fever, malaise, lymphadenopathy, and sore mouth, with multiple maculopapular lesions on the feet, toes, hands, and fingers### Vesiculobullous Diseases
Hand-Foot-and-Mouth Disease
- Caused by Coxsackie virus A1-6, A8, A10, A22, B3, and possibly others
- Transmitted through contaminated saliva and occasionally through contaminated feces
- Symptoms: malaise, fever, dysphagia, and sore throat
- Intraorally, a vesicular eruption appears on the soft palate, faucial pillars, and tonsils
- Duration: 4 to 6 days
- Differential diagnosis: primary herpetic gingivostomatitis, varicella, and streptococcal pharyngitis
Herpangina
- Caused by Coxsackie virus A1-6, A8, A10, A22, B3, and possibly others
- Symptoms: malaise, fever, dysphagia, and sore throat
- Intraorally, a vesicular eruption appears on the soft palate, faucial pillars, and tonsils
- Duration: 4 to 6 days
- Differential diagnosis: primary herpetic gingivostomatitis, varicella, and streptococcal pharyngitis
Measles (Rubeola)
- Caused by measles virus (RNA-enveloped virus, member of the paramyxovirus family)
- Spread through airborne droplets
- Incubation period: 7-21 days
- Contagious: 4 days before until 4 days after the onset of the body rash
- Symptoms: fever, malaise, coryza, conjunctivitis, photophobia, and cough
- Pathognomonic Koplik's spots appear on the buccal mucosa (small, erythematous macules with white necrotic centers)
- Rash: maculopapular, initially affects the head and neck, followed by the trunk and extremities
- Complications: encephalitis and thrombocytopenic purpura
German Measles (Rubella)
- Caused by an unrelated virus of the togavirus family
- Shares some clinical features with measles, but with milder symptoms
- Can cause congenital defects in a developing fetus
- Vaccine: MMR vaccine (live attenuated viruses of measles, mumps, and rubella)
Pemphigus Vulgaris
- Autoimmune mucocutaneous disease characterized by intraepithelial blister formation
- Results from a breakdown or loss of intercellular keratinocyte adhesion
- Causes: circulating autoantibodies of the IgG type that are reactive against desmoglein 3
- Symptoms: painful ulcers, preceded by flaccid and short-lived intraoral vesicles and bullae
- First signs of the disease appear in the oral mucosa in approximately 70% of cases
- Ulcers range in appearance from small aphthous-like lesions to large, irregular map-like lesions
- Treatment: immunosuppressives, biologic agents, and IVIg
- High mortality when untreated
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Description
This quiz covers the etiology and pathogenesis of vesiculobullous diseases, including viral diseases such as Herpes Simplex Infection and Varicella-Zoster Infection. It's suitable for medical students and healthcare professionals.
