VIRAL INFECTIONS

DR.LINDA MAHER

INFECTION AND INFLAMMATIONINFECTION Infection is disease caused by a specific

invading microorganism (virus, bacteria, , parasite, etc.).

INFLAMMATION Inflammation is the body's response to

an irritation which may be infection, chemical or autoimmune

DIAGNOSIS OF ORAL INFECTIONS1\clinical manifestations2\detailed history3\biopsy of the lesion and histopathological investigations

4\serological antibody test

VIRUSA virus is a small infectious agent  that

replicates only inside the living cells  of other organisms.

COMMON VIRUSES AFFECTING ORAL MUCOSA:

HIVHERPES SEMPLEX VIRUS(HSV)EPESTIN BARR VIRUS(EBV)HUMAN PAPILLOMA VIRUS(HPV)COXSACKIE VIRUSINFECTIOUS MONONUCLEOSIS

DIFFERENCE BETWEEN VIRUS AND BACTERIA

VIRUS BACTERIANon living organism which

needs a living host to survive

viral infections are systemic. This means they involve many different parts of the body or more than one body system at the same time.(mostly causes fever , malaise ,and fatigue)

more difficult to killCan not be treated with

antibiotics

Living microorganism

bacterial infection are localized (causes redness , heat, swelling and pain in specific part of the body)

Can be treated with antibiotics

MANAGEMENT OF VIRAL INFECTIONSTREATMENT OF VIRAL INFECTIONS

DEPENDS ON:

1\strength of the individual’s immune system

2\ their overall health status3\ age 4\the severity of the condition5\ type of viruses involved.

GENERAL RULES IN MANAGEMENT:1\viral infections usually only require

symptomatic treatment(analgesics to decrease pain-antipyretic for fever)

2\supportive therapy(to improve the overall body health and immunity)

-eating foods rich in vitamins -drinking plenty of fluids

-bed rest3\in severe cases antiviral drugs may be

indicated

1\HERPES SEMPLEX VIRUS(HSV)TRANSMISSION: By direct contactAfter treatment of primary infection the virus

become latent and can be activated again by certain triggering factors to cause secondary infection

PRIMARY INFECTION: Causes acute herpetic stomatitisSECONDARY INFECTION: Causes herpes labialis(cold sore or fever

blister)

1\PRIMARY ACUTE HERPETIC STOMATITIS;

CLINICAL FEATURES:Most of primary infections with HSV are subclinical(no clinical manifestations)

The lesions are vesicles which can affect any part of the oral mucosa but mostly the hard palate and the dorsum of the tongue.

The vesicles are 2-3 mm in diameter. they rupture leaving circular ,sharply defined ,shallow ulcers with yellowish or grayish floor and red margins

Ulcers are painful and may interfere with eating

Systemic manifestations:Regional lymph node enlargementFever, malaise and systemic upset

DIAGNOSIS:1\mainly clinical2\biopsy 3\antibody titer(level of antibodies against HSV in the

blood)

TREATMENT:Aciclovir(topical)Bed rest , fluid intake ,soft dietUSUALLY prolong herpetic ulcerations that persist for

more than a month not responding to acyclovir is an AIDS-defining illness

2\HERPES LABIALIS:

After the primary infection ,the latent virus can be reactivated in 20-30 % of patient to cause herpes labialis or cold sores(fever blisters)

TRIGGERING FACTORS: common cold - other febrile

infections emotional upset - strong sunshine menstruation -any local irritation

such as dental treatment

CLINICAL FEATURES:1\Prodromal paresthesia or burning

sensation in the lip2\then, erythema at the site of the attack3\vesicles form after an hour or two, usually

in clusters along the mucocutaneous junction of the lip , but can extend onto the adjacent skin.

4\the vesicles enlarge , coalesce and weep exudates. after two or three days they rupture and crust over.

The whole cycle may take up to 10 days

TREATMENT:Aciclovir creamPenciclovir 2hourly is more

effective.

2\VERICELLA ZOOSTER VIRUS(VSV)Can cause primary or secondary infectionAfter the primary exposure the virus

remains latent in nerve ganglion e.g. trigeminal ganglion

When reactivated , the secondary lesion well affect the dermatome corresponding to the affected ganglion

1\PRIMARY INFECTION: Causes chickenpox mainly in children2\SECONDARY REACTIVATION: Causes zoster mainly in elderly

1\chickenpox

2\RECURRENT HERPES ZOSTER(shingles):

CLINICAL FEATURE:1\pain and irritation in the dermatome

corresponding to the trigeminal ganglion(along the distribution of the trigeminal nerve)

2\then vesicles are formed on one side of the face and mouth up to the midline.

3\regional lymph nodes are enlarged and tender

4\fever and malaise5\the acute phase usually lasts about a

week.

MANAGEMENT:1\Aciclovir 800 mg 5 times per day for

7 days2\analgesics3\in very severe cases

prednisolone(steroid) may be indicated

3\COXSACKIE A VIRUSCAUSES HAND FOOT AND MOUTH

DISEASEThis is a common ,mild viral infection which

is highly infectious and often causes minor epidemics among school children.

CLINICAL FEATURES:IT is characterized by ulcerations in the

mouth and a vesicular rash in the extremities.1\ORALY: the small scattered oral ulcers

causes little pain –gingivitis is not a feature.

2\regional lymph nodes are not usually enlarged.

3\systemic upset is typically mild or absent.

4\the rash consist of vesicles mainly seen around the base of fingers or toes

TREATMENT:No specific treatment is needed and the

disease typically resolves within a week

4\EPSTEIN BARR VIRUSCAUSES INFECTIOUS MONO NUCLEOSISAcute ,self limited infectious disease primarily

affects young adolescents .CLINICAL FEATURES:1\fever ,malaise ,headache ,sore throat and fatigue2\The oral manifestations are early and common,

and consist of palatal petechiae, uvular edema, tonsillar exudates, gingivitis, and rarely ulcers

Generalized lymphadenopathy, hepatosplenomegaly,

maculopapular skin rash are common.

Palatal petechiae

TREATMENT:Symptomatic non specific treatment

Thank you.