Viral Infections Dent 451 Lecture 5 Dr. Jumana Karasneh

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Viral Infections

• Dent 451
• Lecture 5
• Dr. Jumana Karasneh

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Viruses

• Human Herpes Virus (HHV)
• Enteroviruses
• Coxsackieviruses (CSV)
• Paramyxovirus
• Mumps virus
• Morbillivirus
• Human papillomavirus (HPV)
• Human immunodificiency virus

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Human Herpes Virus (HHV)

• Herpes simplex virus type 1 (HSV-1) (HHV-1)
• Herpes simplex virus type 2 (HSV-2) (HHV-2)
• Varicella-zoster virus (VZV) (HHV-3)
• Epstein-Barr virus (EBV) (HHV-4)
• Cytomegalovirus (CMG) (HHV-5)
• Human Herpes Virus 6 (HHV-6)
• Human Herpes Virus 7 (HHV-7)
• Human Herpes Virus 8 (HHV-8)

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Characteristics of HHV

• DNA virus
• Contracted in early life
• Transmitted in saliva
• Latency
• Reactivated by immunosuppression

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HSV-1 (HHV-1)Primary Herpetic Gingivostomatitis

• Clinical Picture
• Two groups are mainly affected
• Children 6m-6y affected
• Young adults
• Systemic symptoms
• Multiple vesicles anywhere intra orally, lips
  circumoral skin
• Recovery 10-14 days
• Management
• Should exclude leukaemia in children
• Supportive rehydration
• Analgesics (systemic / topical)

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HSV-1 (HHV-1)Herpetic whitlow

• Infection control procedure are always essential
  (mask, eye protection, gloves)

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Acyclovir

• Systemic antiviral is essential if the patient is
  immunocompromised to prevent general
  dissemination
• If 1? infection fail to improve after 14 days,
  referral further investigation should be
  conducted

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HSV-1 (HHV-1) Recurrent Herpes

• Clinical Picture
• Provoked by UV, common cold, stress mechanical
  trauma
• Usually on lips / nose
• Could occur intra-orally on keratinized fixed
  mucosa
• Tingling sensation for 1-2 days
• Crops of vesicles that crust later
• Bells palsy if facial nerve is affected
• Management
• Supportive
• Topical aciclovir 5 times/day

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VZV(HHV-3)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

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VZV(HHV-3)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
• Ramsy Hunt Syndrome
• Management
• High doses of systemic aciclovir or famciclovir
• Ophthalmic consultation if Ophthalmic branch is
  affected

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EBV (HHV-4)Infectious mononucleosis

• Clinical picture
• subclinical
• Lymphadinopathy
• Sore throat
• Fever malaise
• Rashes
• Management
• supportive

• Complications
• Hairy Leukoplakia
• Nasopharyngeal carcinoma
• Burketts lymphoma

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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

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ParamyxoviruseMumps virus

• Clinical picture
• Mostly bilateral swelling of parotid gland
• Unilateral / submandibular less frequently
• Tender salivary glands, fever malaise
• Xerostomia
• Trismus
• Complications
• In older age group
• Pancreatitis
• Encephalitis
• Orchitis / Oophoritis
• Management

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ParamyxoviruseMorbillivirus

• Clinical picture
• Febrile illness nasal discharge
• Kopliks spots
• Maculopapular rash
• Conjunctivitis
• Complications
• Encephalitis
• Pneumonia
• Management
• Symptomatic

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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 (Hecks disease)
• Clinical Picture
• Diagnosis
• Should be differentiated from squamous cell
  papilloma
• Treatment

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RetrovirusesHuman 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

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RetrovirusesHuman immunodeficiency virus
(HIV)Clinical features

• Acute HIV infection
• Rapid viral replication
• Mimicking glandular fever symptoms
• HIV infection
• Asymptomatic
• Last for years
• HIV disease
• ? CD4 T cells
• Affected with Pneumonia, candida, bacterial,
  viral malignancy
• AIDS
• CD4 T cells lt 200 cells/ml
• Severe symptoms

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RetrovirusesHuman immunodeficiency virus
(HIV)Oral features
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RetrovirusesHuman immunodeficiency virus
(HIV)Oral features
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RetrovirusesHuman immunodeficiency virus
(HIV)Oral features
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RetrovirusesHuman immunodeficiency virus
(HIV)Management

• Aggressive treatment for infections
• Antiretroviral therapy
• Azidothymidine (AZT), protease inhibitor
• Nucleoside reverse transcriptase inhibitor
• Non-nucleoside reverse transcriptase inhibitor