BDS IV Viral Diseases PDF

BDS IV VIRAL DISEASES Prof. Mohamed Al Ismaili BDS, MSc., FDSRCPS, FFDRCSI, FCGDent Head of Oral Surgery M. Al Ismaili Learning Objectives: list the viral diseases which affect the oral mucosa and face and d...

BDS IV VIRAL DISEASES Prof. Mohamed Al Ismaili BDS, MSc., FDSRCPS, FFDRCSI, FCGDent Head of Oral Surgery M. Al Ismaili Learning Objectives: list the viral diseases which affect the oral mucosa and face and describe their presentation. differentiate these diseases on the basis of history, examination and special investigations. prescribe appropriate treatment and follow up and identify cases requiring referral. M. Al Ismaili  Viruses and Oral Disease Herpes Viruses Paramyxoviruses ▪ Herpes Simplex Viruses ▪ Measles ▪ Varicella Zoster Viruses ▪ Mumps ▪ Ebstein – Barr Viruses ▪ Cytomegaloviruses Papilloma Viruses ▪ Squamous Cell Papilloma Coxsackie A Viruses ▪ Veruca Vulgaris ▪ Herpangia ▪ Heck’s Disease ▪ Hand, Foot and Mouth Disease Human Immunodeficiency Virus (Another Lecture) M. Al Ismaili  VIRAL DISEASES Common oral manifestations: Ulcers Salivary gland swellings Epithelial hyperplasia M. Al Ismaili  VIRAL DISEASES Herpes Viruses: Herpes Simplex I & II Varicella Zoster Epstein-Barr Cytomegalovirus M. Al Ismaili  VIRAL DISEASES Herpes Simplex: Type I responsible for primary herpetic gingivo- stomatitis Type II in genital lesions, increasingly in oral infections Endemic – 40% of 12 year olds and 90% elderly in UK have antibodies to HSV M. Al Ismaili  VIRAL DISEASES Primary Herpes: Primary infection occurs in early childhood Minimal symptoms ( teething) or significant symptoms Primary infection in adults is more severe M. Al Ismaili  VIRAL DISEASES Primary Herpes: (Primary herpetic gingivo-stomatitis) May cause significant symptoms Blood crusted lips Widespread oral ulcerations Lymphadenopathy Pyrexia Malaise M. Al Ismaili  VIRAL DISEASES Primary Herpes: (Primary herpetic gingivostomatitis) M. Al Ismaili  VIRAL DISEASES Primary Herpes: Diagnosis Clinical appearance Contact history Confirmation: Direct smear (direct immunofluorescence) Viral culture Antibody titres >4 x rise between symptomatic and convalescent sera M. Al Ismaili  VIRAL DISEASES Antibody Titre: 10ml venous sample – clotted Acute and Convalescent serum >Four fold rise in antibody titre M. Al Ismaili  VIRAL DISEASES HSV Treatment: Rehydration Depends on severity and stage of presentation Early presentation of extensive mucosal involvement, use systemic acyclovir Antiseptic m/w to prevent secondary bacterial infection Relief of pain and fever Self limiting 10 -14 days M. Al Ismaili  VIRAL DISEASES Antivirals: Use in primary HSV Early treatment Depends on severity of lesions Depends on state of patient Systemic acyclovir suspension / dispersible In adults 200mg five times a day for five days M. Al Ismaili  VIRAL DISEASES Acyclovir: Analogue of 2 –deoxyguanosine Action: Terminates viral DNA duplication M. Al Ismaili  VIRAL DISEASES  Zovirax  Penciclovir  Vectavir cream M. Al Ismaili  VIRAL DISEASES Primary Infection Asymptomatic Latency Clinical Symptoms (neural tissue ) M. Al Ismaili  VIRAL DISEASES Trigger factors Latent HSV Reactivation Secondary Infection Asymptomatic shedding in saliva Recurrent Herpes Herpes Labialis M. Al Ismaili  VIRAL DISEASES Recurrent Herpes: 30% of patients who have HSV Herpes labialis (cold sore) Intra-oral lesions are rare Viral reactivation: trauma, exposure to sunlight, menstruation, systemic upset Prickling/burning sensation followed by vesicles which rupture leaving painful erosions Lesion lasts 7 to 10 days Highly infectious during ulcer phase Recurrent episodes M. Al Ismaili  VIRAL DISEASES Herpes Labialis Herpetic whitlow M. Al Ismaili  VIRAL DISEASES Varicella Zoster: Primary infection is chickenpox Affects 90% of children Itchy maculopapular lesions on the back, chest and face M. Al Ismaili  VIRAL DISEASES Herpes Zoster: Reactivation of VZV (shingles) Adults and elderly May involve trigeminal nerve Tooth ache for several days prior to cutaneous lesions if VII and VIII are affected Unilateral ulcerations or skin lesions limited to the dermatome underlying systemic disease? Systemic acyclovir 800 mg five times a day for 10 days M. Al Ismaili  VIRAL DISEASES Herpes Zoster M. Al Ismaili  VIRAL DISEASES Ebstein-Barr Virus: Infectious mononucleosis (glandular fever/kissing disease) Burkitt’s lymphoma Naso-pharyngeal carcinoma Hairy leukoplakia M. Al Ismaili  VIRAL DISEASES Infectious mononucleosis (glandular fever) Lymph node enlargement Fever Pharyngeal inflammation Early adolescents ( kissing disease) Oral involvement in – 30% patients – Palatal petichae and ulcers M. Al Ismaili  VIRAL DISEASES Infectious mononucleosis (glandular fever) M. Al Ismaili  VIRAL DISEASES Infectious Mononucleosis Diagnosis: IgM Abs to EBV Monospot or Paul-Bunnel test – Lymphocytosis – Atypical mononuclear cells Ampicillin causes skin rash M. Al Ismaili  VIRAL DISEASES Cytomegalovirus: Salivary gland inclusion disease Uncommon Relatively harmless Sialadenitis with salivary gland swelling Limited to newborn and immunosuppressed M. Al Ismaili  VIRAL DISEASES Coxsackie A Viruses: Herpangina Children Pyrexia, sore throat Multiple palatal and faucial vesicles Salivary glands pain and swelling Diagnosis: Isolation of virus / antibodies M. Al Ismaili  VIRAL DISEASES Coxsackie A Viruses: Hand, Foot and Mouth disease Usually in childhood Multiple oral ulcers Erythematous macules on hands and feet Diagnosis: Isolation of virus / antibodies M. Al Ismaili  VIRAL DISEASES Paramyxoviruses: Measles – Koplik’s spots – yellow white papules with dark red surround on buccal mucosa Mumps – Common – Usually in children – Community outbreaks – Salivary glands swelling usually parotid – Pyrexia, sore throat and pain on eating – Risk of complications in adults – orchitis, oopheritis M. Al Ismaili  VIRAL DISEASES Measles Mumps M. Al Ismaili  VIRAL DISEASES Human Pappiloma Virus: More than 100 HPV Warty lesions Oral pre-malignancy? Squamous cell papilloma Condyloma acuminatum Verruca vulgaris ( HPV 2 and 4) Focal epithelial hyperplasia (Heck’s disease HPV 13 and 32) Genital lesions (HPV 6, 11 and 16) M. Al Ismaili  VIRAL DISEASES Squamous cell papilloma: Incidental Exophytic lesion with multiple projections Simple excision M. Al Ismaili  VIRAL DISEASES Condyloma acuminatum: Clusters of sessile papillomatous lesions Oro-genital region (oral sex) In children and teenagers ? Sexual abuse M. Al Ismaili  VIRAL DISEASES Verruca vulgaris ( HPV 2 and 4) Common Children Usually skin Perioral and intraoral lesions Excision or cryosurgery M. Al Ismaili  VIRAL DISEASES Focal epithelial hyperplasia (Heck’s disease): HPV 13 and 32 Rare Eskimos, North American Indians Multiple papillomatous lesions No active treatment M. Al Ismaili  IMMUNIZATION IN OMAN The Expanded Program of Immunization (EPI) protects children against 10 of the most dangerous diseases of childhood. Measles is an important cause of malnutrition, poor mental growth and blindness. It can be fatal. A non-immunized child will almost certainly be infected with the poliovirus. And for every 200 children, who are infected, one will be crippled for life. Tetanus germs grow in dirty cuts and kill most of the people who become infected - if they are not immunized. Breastfeeding (colostrum) is a kind of natural immunization (passive) against several diseases. But this immunity is not permanent, so immunization is a must. Hepatitis B can lead to liver failure and liver cancer See pink chart for immunization schedule in Oman M. Al Ismaili Poll M. Al Ismaili