oral infections

1. Oral Viral Infections
HUMAN HERPES VIRUSES
The most wellknown,herpes simplex virus (HSV), exists in 2 types: HSV-1
and HSV-2. The remaining types in the Herpetoviridae family include
varicella zoster virus (VZV), Epstein-Barr virus (EBV), CMV, HHV-6, HHV-7,
and HHV-8.
Herpes Simplex Virus Type 1
usually acquired
during childhood. Its primary mode of transmission is via infected saliva
or direct contact of mucocutaneous lesions.
In primary infection, the virus migrates to the sensory or autonomic
ganglia (trigeminal ganglia) where it remains dormant until reactivation
(secondary or recurrent form).
Reactivation occurs during stress induced states (ie, fever, anxiety,
immune compromised states). Incubation period ranges from several
days to 2 weeks.
Herpes Simplex Virus Type 2
has a predilection for genital mucosa lesions.
Transmission occurs from oral to genital contact
Becomes latent in the autonomic ganglia (lumbosacral region).
Also capable of causing ocular lesions in newborns. from infected
mothers during the peripartum period owing to disrupted membranes
and/or with direct contact with the infected mother’s vaginal secretions

2. Clinical features
Primary herpeticgingivostomatitis is an acute onsetof the primary form
of HSV-1 that occurs between the ages of 6 months and 5 years.
Primary herpetic gingivostomatitis commonly presents with flulike
symptoms (fever,chills, and cervical lymphadenopathy), intraoral mucosal
lesions (usually 2–3 mm in size) and skin lesions. Lesions usually take
about 7 to 10 days to resolve and heal without scar formation.
The main features of clinical primary disease are:
A. The mouth or oropharynx is sore
B. A single episode of oral vesicles which may be widespread, and break
down to leave oral ulcers. These are initially pin point but fuse to
produce irregular painful ulcers
C. Acute generalised marginal gingivitis
D. Cervical lymph nodes may be enlarged & tender.
Herpes labialis is secondary or recrudescent herpes
occurring around the perioral region, characterized by a burning and
itching sensation before the appearance of vesicles.
They can also appear in keratinized tissue of the hard palate and gingival
tissues owing to the reactivation of the latent virus during conditions of
stress or immunocompromised states
recurrent oral herpes infection consists of small ulcers usually localized
on palatal mucosa , lesions are observed on the attached gingiva
surrounding the teeth and on the palate. Recurrent intraoral herpes
appears to be an infrequent problem.

3. The lesions of intra oral herpes may persist and be very serious in patients
with a compromised immune system. While the virus may regress, it does
not disappear
Herpetic whitlow
Herpetic whitlow occurs when the virulent orofacial lesions come in
direct contact with fingers
Treatment and prevention
Supportive therapy is indicated (analgesics, nonsteroidal
antiinflammatory drugs, lavage, hydration).
When symptoms arise, a 5% topical acyclovir ointment applied 5 times a
day decreases the duration of herpes labialis.
200 to 400 mg acyclovir 5 times a day in adut patients
Prophylactic treatment with acyclovir
400 mg twice a day, valacyclovir 1 g daily, or famciclovir 250 mg twice
daily reduces the prevalence and severity of recurrence
VARICELLA
The VZV is a highly contagious member of the herpes virus family
its effects on children is more commonly known as chickenpox
it can reactivate in adults as shingles
Spreading in droplet form,
recover in a 2- to 3-week span. Children, older
adults, and immunocompromised patients face a greater threat

4. Clinical Features
common in children 6 to 11 years of age
the virus remains latent at the dorsal root and trigeminal ganglia
Primary symptoms include low-grade fever, pruritis,
malaise, and rash. Subsequently, vesicles develop. Initial lesions begins on
the trunk and face and spread to the extremities
Skin lesions are preceded typically by oral lesions, which tend to be
painless.
HERPES ZOSTER
Latent VZV is reactivated
Typically, it affects the sensory nerves of the trunk, head, and neck,
resulting in symptoms of pain or paresthesia in those dermatomes.
Vesicular primary lesions ulcerate and heal over
in 1 to 2 weeks
Clinical Features
Vesicular development is distributed in a unilateral and linear distribution
The involvement of the geniculate ganglion is a rare but reported
complication, also known as Ramsay Hunt syndrome
Treatment for Varicella Zoster Virus and Herpes Zoster Infections
Primary VZV infections are treated
with a high dose of oral acyclovir, 800 mg 5 times daily for 7 days.
Treatment should
begin within hours of disease onset to reduce the risk of postherpetic
neuralgia.

5. INFECTIOUS MONONUCLEOSIS (ALSO KNOWN AS “MONO” OR “KISSING
DISEASE”)
Mono is a disease of young adults, also known as kissing disease owing to
its nature of transmission.
It is primarily transmitted owing to close contact (sharing of straws,
kissing, and other forms of saliva exchange).
EBV and HHV-8 are the causal agents
Clinical Features
children affected are asymptomatic
young adults symptoms like fever, lymphadenopathy, pharyngitis, and
tonsillitis are noted.
Prodromal symptoms like
malaise, fatigue precede 2 weeks before the development of fever, which
can last 2 to
14 days in classic infectious mononucleosis cases.
oral lesions are similar to
petechiae on the soft and hard palates; necrotizing ulcerative gingivitis is
also fairly common in infected patients
Treatment
resolves spontaneously within 4 to 6 weeks and only require treatment of
clinical symptoms.
Nonsteroidal antiinflammatory drugs are used for fever reduction
and bed rest is advised for malaise and fatigue

6. CYTOMEGALOVIRUS
CMV establishes latency after initial infection in the salivary glandular
cells, endothelium, macrophages, and lymphocytes.
The virus can cross the placenta, causing congenital disease or infect
newborns during delivery.
Transmission can also occur by exchange of bodily fluids and blood
transfusions.
Clinical Features
Most infections are asymptomatic
less than 10% can present with flulike symptoms.
In rare cases, other signs like hepatomegaly, splenomegaly, jaundice, and
central nervous system involvement can occur
Oral lesions presenting with chronic
mucosal ulcerations can present with coinfections of HSV
Neonatal CMV infections can produce
dental disorders exhibiting diffuse enamel hypoplasia, enamel
hypomaturation, attrition, or discoloration of dentin
Diagnosis
Diagnosis is based on a combination of clinical features and other testing
procedures, such as polymerase chain reaction or immunoassays
serologic testing

7. Treatment
Intravenous ganciclovir is recommended for treatment of CMV infections,
although most resolve spontaneously
ENTEROVIRUSES
classified into echoviruses, polioviruses, enterovirus 17 and
coxsackieviruses A and B
HERPANGINA
The name, herpangina, is derived from herpes, which involves vesicular
eruption and angina, which means inflammation. COXSACKIEVIRUS A
(CVA) serotypes 1 to 10, 16, and 22 are the most common viruses isolated
with this condition.
Herpangina is transmitted
by contaminated saliva or through contaminated feces. Outbreaks are
very common in summer or early autumn
Clinical Features
Sore throat, fever, rhinorrhea, myalgia, and dysphagia are commonly seen
with herpangina.
Most cases are mild and symptoms last for 3 days.
oral lesions
appear in the posterior areas of the mouth, usually the tonsillar pillars or
soft palate.
Small vesicles form but rapidly break down to 2- to 4-mm ulcers

8. Treatment
Supportive therapy is recommended.
Contact with infected individual should be avoided to prevent spread of
disease
ACUTE LYMPHONODULAR PHARYNGITIS
Acute lymphonodular pharyngitis is a variant of herpangina that is
associated with CVA 10
Clinical Features
Sore throat, headache, and a fever, which may last up to 10 days, are
prominent features.
Patients will develop diffuse small yellow to dark-pink nodules in the area
of Oropharynx
Treatment
No treatment is necessary; the condition is self-limiting.
HAND, FOOT, AND MOUTH SYNDROME
This most common enterovirus condition mostly affects children younger
than 5 yearsold,
is highly contagious (seasonal mostly summer), and transmits through
airborne spread or fecal–oral contamination
Coxsackie type A16 or enterovirus 71 viruses
were linked to these infections.

9. Clinical Features
Skin rash and oral lesions are associated with flulike symptoms,
accompanied by cough, rhinorrhea, diarrhea, and headaches
Oral lesions
precede skin lesions, first
presenting as vesicles that rupture and become ulcers. Intraorally, these
lesions
tend to disseminate anywhere in the mouth although the palate, tongue,
and buccal
mucosa are favored sites.
Cutaneous lesions primarily affect ventral surfaces and
sides of the fingers and toes, borders of the palms, and soles of the feet.
The legs
genitals are rarely affected.
Skin lesions start as erythematous macules that
develop central vesicles and heal without crusting
Management of hand, foot, and mouth disease is mainly
supportive.
Signs and symptoms usually clear up in 7 to 10 days.
Over-the-counter pain medications
RUBEOLA (MEASLES)
belongs to the family paramyxovirus, an RNA enveloped virus that is
highly contagious.
Rubeola is spread via airborne droplets

10. Clinical Features
commonly seen in unvaccinated individuals.
The incubation period lasts from 10 to
12 days with the prodromal period lasting 1 to 7 days
The first stage
(runny nose), cough, and conjunctivitis.
Oral manifestations, known as Koplik’s spots, precede cutaneous
lesions by 1 to 2 days.
Koplik’s spots are characterized as red macular lesions
with a blue white center
The second stage
consists of erythematous maculopapular
rashes that starts from the face and spreadsdowntoward the extremities,
along with a continuing fever.
The third stage
is when the fever resolves and the rashes began
to subside.
Treatment and Prevention
Supportive therapy includes adequate rest, fluids, and antipyretic and
analgesics medications.
The best therapy is prevention through vaccination

11. MUMPS
Belonging to the Paramyxoviridea
virus family, the mumps virus primarily infects via salivary secretions or
respiratory droplets
nonspecific symptoms
such as fever, malaise, myalgia, and headache.
The incubation period usually
ranges from 2 to 4 weeks, with the patient at risk of spreading the virus 1
day
before clinical symptoms to 2 weeks after resolution.
parotid gland involvement
is the most commonly affected salivary gland; however, the sublingual
and submandibular glands can also be involved.
Swelling and pain begin from the ears and extend down to the mandible
posteriorly and inferiorly, with pain during mastication
Diagnosis
is easily made clinically with serologic confirmation of rising titers of
mumps, specifically immunoglobulin (Ig)G and IgM during the infectious
stages.
Treatment and Prevention
palliative care with nonsteroidal antiinflammatory
drugs as analgesics, antipyretics, and bed rest. Hydration and diet
precautions are recommended.
Prevention is through prior MMR vaccinations

12. HUMAN PAPILLOMAVIRUS
at least 25 strains of HPV have been associated with oral lesions.
The most frequent lesions include: verruca vulgaris (common wart) and
oral squamous papilloma.
ORAL SQUAMOUS PAPILLOMA
small, white, isolated, exophytic, and pedunculated growths.
Exaggerated growth of normal squamous epithelium.
With fingerlike extensions of the epithelium supported by connective
tissue.
This pattern resembles cutaneous warts
found on the hard and soft palate, uvula, and vermillion of the lips.
COMMON WART (VERRUCA VULGARIS)
found commonly on the skin and are caused by the cutaneous HPV
subtypes 2 and 57.
These warts are similar in appearance to squamous papillomas and
tend to involve the lips, gingivae, and hard palate
locally excising these lesions with laser or electrocautery
CONDYLOMA ACUMINATUM
another condition resulting froma virus-induced proliferation
of stratified squamous epithelium of the genitalia, perianal region, mouth,
and larynx.

13. HPV types 6 and 11 are usually detected in these lesions
regarded as a sexually transmitted disease with an incubation period of 1
to 2 months from the time
of contact.
Intraorally,
these lesions commonly present as a group of multiple pink nodules on
the labial mucosa, soft palate, and lingual frenum
Surgical excision with cryosurgery, scalpel excision, or laser ablation is the
ultimate
approach to manage these condition
Recurrences are common
HECK’S DISEASE (ALSO KNOWN AS FOCAL EPITHELIAL
HYPERPLASIA/MULTIFOCAL
EPITHELIAL HYPERPLASIA
multiple asymptomatic well-circumscribed,
smooth papules on the tongue and labial mucosa of children.
These lesions are
frequently seen in children but they can often be seen in older adults as
well
HPV
types 13 and 32 are detected in 75% to 100% of these lesions.