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Viral Infections...
Dr Ravikumar V,
JR II, Dept Of Oral Path,
GDC, Kottayam
Intro
ï‚— What is a Virus..?
ï‚— Basic structure
ï‚— Sequlae of infection
ï‚— Classification
Herpes Simplex
ï‚— HSV I and II
ï‚— Skin, mucosa, eye and CNS
Viral infections of Oral Cavity
Viral infections of Oral Cavity
ï‚— Herpes genitalis
ï‚— Herpes meningoencephalitis
ï‚— Herpetic conjunctivitis
ï‚— Herpetic eczema
ï‚— Disseminated HS of newborn
ï‚— Herpetic whitlow
ï‚— Herpes gladiatorum
Primary Herpetic Stomatitis
ï‚— Infancy and adult
 Spread – droplets, contact
ï‚— Fever, irritation, headache, pain on
swallowing, regional lymphadenopathy
ï‚— Yellow fluid filled vesicles which
rupture to form characteristic ulcers
Vesicles
Erythematous halo
Shallow
Ulcer with
Gray
membrane
ï‚— HSV culture from sites
ï‚— HSV DNA demonstration in lumbar and
trigeminal ganglia
 Histology – ballooning degeneration
- Lip schutz bodies
Diagnosis – clinical, stains, cytology, DNA,
PCR
Treatment – Antiviral drugs, NSAID
Reccurent Herpes Labialis /
Stomatitis
ï‚— Attenuated form of primary disease
 Reactivation – ganglion trigger, skin
trigger, emotional theory
ï‚— The viruses spread through nerves
and act on epithelial cells and cause
inflammation
ï‚— Lesions may recur at any interval
ï‚— May occur on lips, intraoral, or along
area of distribution of nerve
ï‚— Preceded by tingling or burning
sensation
ï‚— Vesicles less than a mm appear as
clusters which coalasce
ï‚— Associated pain
ï‚— Lesions heal by a week
Diagnosis
ï‚— Histology
ï‚— Viral identification and isolation
ï‚— Immunofluorescent tests
ï‚— Immunoperoxide test
ï‚— RIA and ELISA
ï‚— Treatment
Herpangina
ï‚— Coxsakie group A virus
ï‚— Ingestion, contact, droplet
ï‚— Seen in summer, in young
 Symptoms – sore throat, cough,
rhinorhea, fever, vomiting and even
abdominal pain
ï‚— Vesicles which rupture to form ulcers
ï‚— All of these heal by 7 days
ï‚— No treatment needed as it is self
limiting
Hand Foot and Mouth
Disease
ï‚— Coxsakie and entero virus
ï‚— Multiple ulcers with dysphagia
ï‚— Intracytoplasmic viral inclusions, high
antibody titer to Coxsakie
ï‚— Self limiting
RUBEOLA (MEASLES)
ï‚— produced by a paramyxovirus
ï‚— Affected individuals are infectious from
2 days before becoming symptomatic
until 4 days after appearance of the
rash
ï‚— Incubation period of 8 to 12 days
ï‚— Pre erutive, eruptive and post eruptive
stage
ï‚— Small red macules or papules appear
which enlarge and coalesce to form
irregular lesions which blanch on
pressure and gradually fade in 4 or 5
days.
 Koplik’s Spots
ï‚— Warthin Finkeldey giant cells
Viral infections of Oral Cavity
RUBELLA (GERMAN
MEASLES)
ï‚— capacity to induce birth defects
ï‚— Forchheimer spots- small discrete
dark-red papules that develop on the
soft palate and may extend onto the
hard palate
ï‚— The classic triad of CRS consists of
deafness, heart disease, and
cataracts
Molluscum Contagiosum
ï‚— Caused by virus of pox group
ï‚— Considered tumor like
ï‚— Occur as single or multiple discrete
elevated nodules with central
crustation
ï‚— Cowdry A inclusion bodies
ï‚— Henderson Paterson inclusions
Viral infections of Oral Cavity
Varicella
ï‚— Oral lesions
Herpes Zoster
 James Ramsay Hunt’s syndrome
ï‚— Tzank smear
Mumps
Non Specific Mumps
ï‚— C/c Non Specific Sialadenitis
ï‚— Acute Post operative Parotitis
ï‚— Nutritional Mumps
ï‚— Chemical Mumps
ï‚— Miscellaneous
ï‚— Human Immuno Deficiency Virus
ï‚— Etiologic agent of Acquired
Immunodeficiency Syndrome (AIDS).
ï‚— Characterized by severe depletion of CD4
cells.
Viral infections of Oral Cavity
MODES OF TRANSMISSION
ï‚— Sexual transmission
ï‚— Blood or blood products
ï‚— Maternal-fetal
ï‚— Infected needles
ï‚— Transmission routes
ï‚—
CLASSIFICATION OF CLINICAL
MANIFESTATIONS
ï‚— Group I : Acute Infection
ï‚— Group II : Chronic Asymptomatic
Infections
ï‚— Group III : Persistent Generalized
Lymphadenopathy
ï‚— Group IV : Aids Related Complex
Viral infections of Oral Cavity
CHRONIC ASYMPTOMATIC
INFECTIONS
ï‚— Most dangerous group
ï‚— Seropositive pt who is apparently healthy
capable of infection
ï‚— Enlarged axillary glands
ï‚— Hematological & immunological
abnormalities
PERSISTENT GENERALISED
LYMPHADENOPATHY
ï‚— LYMPHADENOPATHY in 2 or more
extrainguinal sites persisting for more than
3 months
AIDS RELATED COMPLEX
ï‚— OPPORTUNISTIC INFECTIONS
-Pneumonia, Cryptococcosis,
Viral Infections, Toxoplasmosis, TB etc.
ï‚— NEOPLASMS
- KS, Lymphoma, SCC
ï‚— NEUROLOGIC DISEASES
- Meningocephalitis
ï‚— OTHERS
- Encephalopathy, Purpura,
Thrombocytopenia
Viral infections of Oral Cavity
ï‚— Oral lesions in HIV...
Candidiasis
PSEUDOMEMBRANOUS ERYTHEMATOUS
ANGULAR CHEILITIS
HISTOPLASMOSIS
ï‚— Histoplasma capsulatum
Nodules over the mucosa which undergoes ulceration
Gingiva, tongue, palate, buccal mucosa
LINEAR GINGIVAL ERYTHMA
Very fine red band along gingival margin and attached gingiva with profuse bleedin
NECROTIZING ULCERATIVE
PERIODONTITIS
Advanced destruction of peridontium, rapid bone loss, loss of PDL
Oral Hairy Leukoplakia
Viral infections of Oral Cavity
WART (HPV)1
Painless papule or nodule with papillary projections or rough surface
Pedunculated or Sessile
APHTHOUS ULCER (MINOR)
Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded b
Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
APHTHOUS ULCER (MAJOR)
KAPOSI’S SARCOMA
ï‚— Predominantly in homosexuals.
ï‚— lesions are vascular, angiomatous
neoplasms that begin as red macule &
progress to large tumefactive red & purple
lesions.
ï‚— Oral lesions: multifocal & typically seen on
palate & gingiva
LYMPHOMA
ï‚— Most are of B cell origin and Epstein-Barr virus occurs
in cells from several cases.
ï‚— Lymphoma can occur anywhere in the oral cavity &
there may be soft tissue involvement with or without
involvement of underlying bone.
Diagnosis of HIV
ï‚— Viral Culture
ï‚— PCR
ï‚— P24 antigen detection
ï‚— ELISA
ï‚— Western Blot
Treatment - HAART
TREATMENT
ï‚— Haart - zidovudine, stavudine, lamivudine,
didanosine
ï‚— Symptomatic treatment
ï‚— Precautions
Thank u...

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