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Viral Infections
Diagnostic Tests
Clinical Diagnosis,
remember that the diagnosis of most viral infections is primarily made on
clinical grounds.
Cytology
it is direct & rapid test that can be used in the clinic or at least can be used in
the lab probably, you will have the results within 12 hours if you have a lab close
to your clinic.
Molecular techniques,
which look at the DNA of each virus, and in some cases it is the only technique
that distinguish between HSV type 1 and HSV type 2 and Varicella zoster virus.
1.Herpes Simplex
Type 1 : Oral mucosa, pharynx, skin, Bells palsy.
The most common disease with type 1 HSV is primary herpetic
gingivostomatitis can affect the skin and cause recurrent infection.
Primary Herpetic
Gingivostomatitis
Complications
Encephalitis (inflammation of the brain, caused by
infection or an allergic reaction.)
Eating is extremely painful in those patients, and you have to advice your
patient how to maintain their nutrition. It can cause dehydration in infants and
children, and have consequences.
Management
Supportive
Antiseptic mouthwashes
Antipyretics,
patients who have fever can be given paracetamol or
Acetomeniphen. However this is debatable
Foscarnet
is prescribed for patients with resistance cases to Acyclovir
Valacyclovir, famciclovir
Recurrent Herpes
HSV-1 remains latent thereafter in the
trigeminal ganglion but can be reactivated.
Occurs in 20-40% of patients: reactivation of
latent herpes virus
(recurrent attack -> resolve -> attack again)
Most commonly seen on keratinized mucosa: lips,
palate, gingivae, skin
Prodromal symptoms include itching, burning
before vesicular eruptions
We use topical acyclovir
Recurrent lesion are localized
Triggers
What reactivates HSV?
Sunlight
Mechanical trauma
Common cold (avoid contact with people
who have cold)
Emotional factors
triggering factor)
Menstruation
Clinical Manifestation
Prodromal Stage: burning, itching, irritation
Vesicle stage (highly infectious)
remember that when you educate your patient
about his disease, that although it doesnt
have severe complications but it can have
serious implications on other family members
who are immune-suppressed.
Healing without scarring in 10 days
Lesions tend to involve the same area in
successive episodes
Although these lesions heal within 14 days, large
chronic lesions are seen in
immunocompromised patients that lasts for
2 months or more than that.
Clinical Manifestation
The prodromal symptoms are more severe in
primary herpetic gingivostomatitis than in
recurrent herpes.
Primary herpetic gingivostomatitis ->
fever, malaise,fatigue,lymph node
enlargement
Recurrent herpes ->
itching&burning sensation at the site where
herpetic lesion will appear (there are no
systemic manifestation) its localized
Diagnosis and
Management
Diagnosis: Cytology, viral cultures, clinical(most
common)
Management: Avoidance of triggers, sunblock,
acyclovir, penciclovir cream
Acyclovir 400mg twice daily for frequent deforming
lesions
is recommended but not all patients. Specially for famous people (e.g. Nancy
Ajram :P) or whose work requires good appearance can take prophylactically
treatment.
That will not treat the disease but Acyclovir will prevent virus replication, so
those patients will still develop latencies but the periodicity of those latencies
is reduced.
Diagnosis and
Management
Patients especially infants or
nurses can develop herpetic
lesions of the fingers that get
in contact with a fresh viral
lesion, and these lesions are
called herpetic whitlow.
May be transmitted from the
mouth / genitalia
Contagious and very painful
2. Varicella Zoster
Infections
Chicken pox is the primary infection with VZ, while the latent
condition is called Shingles
Clinical manifestation
Prodromal sever pain for 2-3 days precede
vesicular eruptions.
Vesicular eruptions in the area of distribution of a
sensory nerve
15% affect the trigeminal nerve (ophthalmic
division in most cases)
Oral lesions in some cases resemble herpetic
lesions
Recovery in 2-4 weeks
Complications: corneal ulceration, post herpetic
neuralgia
The lesions are unilateral, in most doesnt cross the
midline, and it follows the sensory distribution of
Treatment of Varicella
Zoster
If you were late in introducing the medication, dont start the patient on these
medications
*Post herpetic neuralgia is difficult to treat and the symptoms are usually sever,
and it is caused by scarring of the nerve, through which the virus was
reactivated, and therefore controlling their symptoms should include tricyclic
antidepressant
*Bells palsy is caused by HSV-1 and Varicella zoster both viruses are implicated
in the etiology.
*If a patient has ear rashes and vesicles without facial nerve
involvement the diagnosis will be shingles not Ramsay Hunt syndrome.
a. Infectious
mononucleosis
Synonyms: glandular fever, kissing disease
Affects young adults and they presents with
Febrile illness
Sore throat, tonsillitis
Oral ulcerations
Petechiae on the palate
They may develop generalized lymphadenopathy, similar to that
in lymphoma.
b. Burkitts lymphoma
Is a malignant tumor
Affects African children
It is also caused by EBV
c. Hairy leukoplakia
Usually at the lateral borders of
the tongue
In most cases it is bilateral white
lesion
It is seen in patients with
immune-suppression (HIV or
organ transplant or those on
corticosteroids systemic therapy)
*If you are dealing with bilateral
lesion of the tongue then you are
likely to diagnose it as hairy
leukoplakia.
*one of the most common oral
disorders in persons infected with
HIV, occurring in approximately
15 to 20% ofpatients.
4. Coxsakievirus
infections
Group A: 24 types: causes hand,
foot and mouth disease, herpangina,
acute lymphonodular pharyngitis
Group B: 6 types: hepatitis,
meningitis, myocarditis, pericarditis
and acute respiratory disease
*These lesion looks like the herpetic lesion but there will be
vesicles,macules,papules on the hands&feets
*there is no available antiviral medication to treat coxsakie lesion.
Acyclovir is a antiviral medication only to herpetic lesion.
b. Herpangina
Coxsakie A1 to
A10, A16 to A22
Occurs in
epidemics
more common in
children
patients may be
affected more
than once
Clinical Manifestations
5. Paramyxovirus
Infections
Measles
Caused by morbilli virus
Nasal discharge, kopliks spots intraorally (that is very
similar to fordyces granules) and conjunctivitis, skin
rash
Complications: encephalitis, pneumonia
Treatment: supportive
*Patient will be severely ill
*Those patients develop oral kopliks spots before skin rash, so if you have
a patient with conjunctivitis, cough and sever fever with Fordyces
granules like on the buccal mucosa you can make a diagnosis of measles.
*But there is a difference between Fordyces granules and Kopliks spots
which is the erythematous base is associated with kopliks spots.
Mumps
Viral infection affecting the
salivary glands.
Incubation 14-21 days
Bilateral parotid
enlargement, trismus, dry
mouth,fever, headache.
not always bilateral, some
patients develop
unilateral enlargements.
Diagnosis: clinical, serum
amylase levels, serology
Complications: deafness,
orchitis (inflammation of the testes),
myocarditis and oophoritis
(inflammation of the ovaries), encephalitis
Treatment: symptomatic
(verruca vulgaris)
Condyloma acuminatum
(its significance, if you see it in children that means the child may be
sexually abused)
Candidosis,
hairy leukoplakia,
periodontal disease,
kaposis sarcoma,
lymphoma,
mycobacterial infection,
Melanotic pigmentation,
salivary gland disease,
purpura,