3. HERPES SIMPLEX VIRUS
Members of the Herpes Virus Family which are some of the
most common human viruses
The Type 1 virus causes cold sores. Most people get Type 1
infections during infancy or childhood.
The Type 2 virus causes genital sores. Most people get Type
2 infections following sexual contact with an infected
person.
4. Acute Herpetic Gingivostomatitis
6 mon – 5 yrs (peak 2-3 yrs)
before 6 months rare because of protection by
maternal anti- HSV antibodies.
Onset is abrupt & accompanied
by anterior cervical
lymphadenopathy, chills,
fever ( 103 to 105 F).
5. Pharyngotonsillitis
Sore throat, Fever, Malaise & Headache.
Numerous vesicles develops
on the tonsils & posterior
pharynx.
Vesicles ruptures to form
ulcers which coalsce.
6. Herpes Labialis
"labia" = "lip”
Age: Adults
Sex: No predilection
Most common recurrent site for HSV-1 is vermilion
border & adjacent skin of lip.
7. In some pt UV light & trauma trigger recurrence.
Pain, Burning, Itching, tingling, Localized
warmth, erythema of involved epithelium.
Multiple small, erythematous
papules develop & form clusters
of fluid filled vesicles.
Persistent herpes labialis is indicative of
immunocompromised status, including HIV infection.
9. HERPETIC WHITLOW
A/k/a herpetic paronychia
Medical & Dental personnel infect their digits by
contact with infected patients.
Can cause permanent scarring
10. Herpes gladiaotorum
a/k/a scrumpox
Ocular involvement may occur
d/t self inoculation
Pt with diffuse chronic skin disease, such as
eczema, pemphigus and Darier’s disease may develop
life threatening HSV infection ka ECZEMA
HERPETICUM (KAPOSI’s VARICELLIFORM
ERUPTION).
12. Keratoconjunctivitis-- Infection of the eye
Pneumonia
Infection of the trachea
Keratitis-- Corneal infection, irritations, and
inflammations
13. H/P
Infected epithelial cells exhibit acantholysis, nuclear
clearing, nuclear enlargement which has been termed
ballooning degeneration.
Tzanck cells (multinucleated giant
cells) Multinucleated, infected
epithelial cells, infected cells are
formed when fusion occurs between
adjacent cells.
17. VARICELLA
VZV or HHV – 3
DNA virus
Two clinically distinct syndromes
Chickenpox
Shingles.
Acquired by inhalation or contact, with primary
infection of conjunctiva or upper airway mucosa
18.
19. Primary Varicella (Chicken Pox)
Age: Children
Sex: No predilection
Dermal vesicular exanthem
incubation period lasts 2 to 3 weeks
20. Early onset of vesicles that rapidly rupture & leave
erosions with a surface pseudomembrane
lesions located on the trunk and face, are vesicular
with an erythematous boundary, and are extremely
pruritic.
Fever, malaise
mild generalized lymphadenopathy
lesions resolve within 5 to 8 days.
25. Rash:
Vesicular eruption follows the
distribution of sensory nerves,
being segmental and unilateral.
Thoracic , cervical, ophthalmic involvement most common
Initially erythematous, maculopapular
Vesicles form over several days, then crust over
Full resolution in 2-4 weeks
27. Histopathologic Features
Same as HSV
Treatment and prevention
Vaccination
Acyclovir
VZIG as post-exposure prophylaxis in individuals at high
risk
Exclude kids from school until sixth day of rash
28. Infectious Mononucleosis
Aka Glandular Fever & Kissing Disease because adult
contract the virus through direct salivary transfer like
straws or kissing
7-10 days incubation period.
Acute self-limiting infection
Epstein-Barr Virus
29. Clinical Features
Age : Young Adults
Sex : no prediliction
Petechiae on hard palate
Lymphadenopathy, Pharyngitis, Tonsillitis.
Sore throat, fever, rash
30. NUG is common.
Malaise, lethargy, extreme tiredness
Liver and spleen involvement and enlargement
Hematology: High WBC, over 20% atypical reactive
lymphocytes also known as Downey cells.
33. Cytomegalovirus
HHV-5
Transmission occurs from person to person.
Close intimate contact
Sexual contact
During delivery
Breast milk
Organ transplant
Blood transfusion
34. Clinical features
Symptoms resemble IM
In babies may cause life threatening illness
Patients with deficient immune systems
AIDS patients
Transplant patients
Common in AIDS pt.
35. 90 % of CMV are infections are assymptomatic
Typical Features
Hepatosplenomegaly
Thrombocytopenia
• Fever
• Malaise
• Myalgia
36. H/P
Scattered infected cells are extremely
swollen, showing both intracytoplasmic and
intranuclear inclusions and prominent nuclioli - Owl
Eye
37. Diagnosis
Clinical Features
Viral Antigen
Treatment
CMV infection resolve spontaneously
Gancyclovir in immunocompromised patient
38. Enteroviruses
Genus of the picornavirus family which replicate
mainly in the gut.
Single stranded RNA virus
39. Divided into 5 groups
Polioviruses
Coxsackie A viruses & Coxsackie B viruses
Echoviruses
Enteroviruses
Herpanginia, Hand-foot-and-mouth
disease, Acute lymphonodular pharyngiitis
40. Herpangina
Caused by Coxakievirus A 1 to 6, 8, 10, 22 Coxakievirus
A7, 9 or 16; Coxakievirus B 2 to 6; Echovirus 9,16,17;
enetrovirus 71.
Age: Children
Sex: No predilection
41. Most cases arise in summer with crowding & poor oral
hygiene.
Fecal-oral route : major path of transmission
43. Vomiting, diarrhea and headache.
Mostly soft palate or tonsillar pillars involved
affected areas begin as red macules which form fragile
vesicles that rapidly ulcerate.
46. Like herpangina skin rash & oral lesions with flu like
symptoms like fever, dysphagia, sore throat associated
with cough, anorexia, vomiting, diarrhea, headache.
Without prodomal symptoms
47. Buccal mucosa, labial mucosa and tongue most
affected.
after a short incubation period, vesicles with an
erythematous halo appear in the oral cavity, on the
hands, and on the feet
48. H/P
Intraepithelial vesicles – early stages with intra-
cytoplasmic eosinophilic inclusion bodies.
Later stages - shallow ulcerations and erosions with
regeneration of the marginal epithelium.
Superficial inflammatory cell
infiltrate in submucosa.
50. Acute Lymphonodular pharyngitis
Clinical Features
Coxsakievirus A 10
Sore throat, fever, mild headache
Yellow to dark pink nodules
on soft palate and tonsillar
pillars
51. H/P
Affected epithelium exhibit intracellular &
intercellular edema leads to intraepithelial vesicle.
Vesicle enlarges and ruptures through the epithelial
basal cell layer which leads to subepithelial vesicle.
Diagnosis
Virus Isolation
Serology
53. Rubeola (Measles)
Paramyxo RNA virus
Highly contagious
Primarily respiratory infection
Incubation approximately 10
days, ranges from 8-13.
Rash appears at about day 14.
54. Prodromal Symptoms
irritability,
runny nose,
eyes that are red and sensitive to light,
cough, and
high fever
Koplik’s spot- small, red, irregular with blue white
centres on mouth and conjunctiva
Rash on forhead, face, neck, limbs
57. Rubella (Germen Measles)
RNA virus – Toga virus
Incubation 2- 3 weeks
Highly contagious, spread
through respiratory tract.
Rubella vaccine has resulted in 99% decline in
infections.
58. Mumps(Endemic Parotitis)
Age: Children
Sex: No predilection
Single stranded RNA virus.
Mumps is transmitted by direct contact with saliva and
discharges from the nose and throat
incubation 16-18 days.
59. Virus can infect many parts of body, especially parotid
salivary glands & Submandibular also common.
Glands usually become increasingly swollen & painful
over a period of 1 to 3 days
Pain is moderate to severe
Both left & right parotid glands may
affected
60. DIFFERENTIAL DIAGNOSIS
Bacterial or occlusive salivary inflammatory disease
Sjögren’s syndrome
Complications
Inflammation and swelling of the brain
Orchitis
Oophoritis
Infection in pregnant women may result in increased risk
for fetal death
62. T/t
MMR vaccine
No specific therapy exists for mumps.
Warm or cold packs for the parotid gland tenderness
and swelling is helpful.
Pain relievers acetaminophen
, ibuprofen are also helpful.
63.
64. Introduction
Human Immuno Deficiency Virus
Etiologic agent of Acquired Immunodeficiency
Syndrome (AIDS).
Characterized by severe depletion of CD4 cells.
65. MODES OF TRANSMISSION
SEXUAL TRANSMISSION
BLOOD OR BLOOD PRODUCTS
MATERNAL-FETAL TRANSMISSION
INFECTED NEEDLES
66. CDC CLASSIFICATION FOR HIV
INFECTED PATIENTS
CD4 Cell
Clinical Categories
Categories
A B C
Asymptomatic, Acute HIV, or Symptomatic Conditions, AIDS-Indicator
PGL not A or C Conditions
≥500 cells/µL A1 B1 C1
200-499 A2 B2 C2
cells/µL
<200 cells/µL A3 B3 C3
67. CLASSIFICATION OF CLINICAL
MANIFESTATIONS
GROUP I : ACUTE INFECTION
GROUP II : CHRONIC ASYMPTOMATIC
INFECTIONS
GROUP III : PERSISTENT GENERALIZED
LYMPHADENOPATHY
GROUP IV : AIDS RELATED COMPLEX
81. WART (HPV)
Painless papule or nodule with papillary projections or rough surface
Pedunculated or Sessile
82. APHTHOUS ULCER (MINOR)
Single or multiple recurrent ulcers with whitish pseudomembrane & surrounded by
Erythamatous halo mostly seen on cheek, tongue, soft palate, tonsils.
84. KAPOSI’S SARCOMA
Predominantly in homosexuals.
lesions are vascular, angiomatous neoplasms that begin
as red macule & progress to large tumefactive red &
purple lesions.
Oral lesions: multifocal &
typically seen on palate & gingiva
85. LYMPHOMA
Most are of B cell origin and Epstein-Barr virus occurs in
cells from several cases.
Lymphoma can occur anywhere in the oral cavity & there
may be soft tissue involvement with or without
involvement of underlying bone.