VESICULAR ERUPTIONS OF THE ORAL MUCOUSA · Primary Herpetic Gingivostomatitis • Childhood, Teens...
Transcript of VESICULAR ERUPTIONS OF THE ORAL MUCOUSA · Primary Herpetic Gingivostomatitis • Childhood, Teens...
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VESICULAR ERUPTIONS OF THE
ORAL MUCOUSA
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Febrile Associated Vesicles
• Primary Herpetic Gingivostomatitis• Varicella-Zoster• Enterovirus stomatitis• Hand Foot and Mouth Disease• Herpangina
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Primary Herpetic Gingivostomatitis
• Childhood, Teens• 99% of population, subclinical• 1% of the population, Primary disease• The “tetralogy” of signs and symptoms
– Fever, lymphadenopathy, gingival lesions, movable mucosa lesions
• Infectious for 5 days, heal 7-8 days• Robust immune response• Establish latency in trigeminal ganglion
– Both primary and subclinical infections
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Primary Herpetic Gingivostomatitis
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Primary Herpetic Gingivostomatitis
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Primary Herpes
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Primary Herpetic Gingivostomatitis
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Primary Herpes CytologyBallooning Degeneration
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Primary Herpes, Viral Antigen
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Primary Herpes, Viral DNA
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Varicella Zoster• Primary Chicken Pox
– Cutaneous Vesicular Rash– Childhood Immunization
• Recurrent Shingles (Zoster)– Follow entire nerve distribution– Abrupt cessation at midline– May persist for three weeks– Recurrences– Post-herpetic Neuralgia,
Chronic
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Primary Varicella (Chichen Pox)
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Primary Varicella (Chichen Pox)
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Zoster, Ophthalmic Division
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Zoster, Maxillary Division
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Zoster, Mandibular Division
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Enteroviruses• Include ECHO and Coxsackies• No latency• Numbered genotypes and serotypes• Fever, Malaise and Diarrhea• Typing by Stool Culture• Paliative Treatment, 10 day course• Foor oral vesicular syndromes
– Nonspecific enterovirus vesicular stomatitis– Herpangina– Hand Foot and Mouth Disease– Acute Lymphonodular Pharyngitis
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The Enteroviruses
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Enterovirus Stomatitis
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Hand Foot and Mouth Disease
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Hand Foot and Mouth Disease
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Herpangina
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Herpangina
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NonFebrile Associated Vesicles
• Herpes Labialis• Intraoral Recurrent Herpes• Allergic Stomatitis
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Herpes Labialis
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Herpes Labialis, Crust
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Recurrent Intraoral Herpes
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Recurrent Intraoral Herpes
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Treatment for HSV and VZV
HSV Active Disease• Infectious for 5 days• Topicals not effective• Systemic effective
only if given first day of infection
VZV Active Disease• Systemic Antivirals
Prophylaxis• Systemic
administration• Rx prior to
precipitating events• Continue 7-10 days
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HSV,VZV Therapy
• Acyclovir• Side groups
– Alter Bioavailability– Alter Half Life
• Topicals• Oral Systemic
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Therapy
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Therapy
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Allergic Vesicular Stomatitis
• Immediate (IgE) hypersensitivity• Immune complex hypersensitivity• Diffuse oral vesiculoulcerative lesions• Afebrile• Painful• Antihistamine/Steroid Responsive
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Allergic Stomatitis (Shell Fish)
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DIAGNOSIS BY LOCATION• Primary Herpetic Gingivostomatitis
– Gingival, Movable mucosa• Herpes Labialis
– Clustered lip, ala of the nose• Recurrent Intraoral Herpes
– Clustered palatine, mental, long buccal
• Chichen pox– Diffuse over abdomen, oral
• Shingles– Follow entire nerve (dermatome)
• Hand Foot and Mouth Disease– Movable mucosa, hands, feet
• Herpangina– Soft Palate