Transcript 03. Viral disease and their symptomatic manifestation in oral cavity

Viral diseases and their symptomatic
manifestations in oral cavity.
AIDS, influenza, foot and mouth
disease, mononucleosis.
Etiology, clinics and diagnostics.
Lecturer: Matsko N.V.
Department of therapeutic Dentistry, TSMU
Viral diseases are extremely widespread
infections caused by viruses, a type of
microorganism
There are many types of viruses that cause a wide variety
of viral diseases:
•
•
•
•
•
•
•
•
•
•
•
•
Chickenpox
Flu (influenza)
Herpes
Human immunodeficiency virus (HIV/AIDS)
Human papillomavirus (HPV)
Infectious mononucleosis
Mumps, measles and rubella
Shingles
Viral gastroenteritis (stomach flu)
Viral hepatitis
Viral meningitis
Viral pneumonia
Viral diseases are contagious and
spread from person to person when a
virus enters the body and begins to
multiply
Viral diseases can occur in any age group or population.
Common ways that viruses spread from person to person
include:
1. Breathing in air-borne droplets contaminated with a virus
2. Eating food or drinking water contaminated with a virus
3. Having sexual contact with a person who is infected with a sexually
transmitted virus
4. Indirect transmission from person to person by a virus host, such
as a mosquito, tick, or field mouse
5. Touching surfaces or body fluids contaminated with a virus
Oral mucous membranes may be infected by one
of several different viruses
Virus family:
1. Herpesviruses
HSV1
HSV2
Varicella-zoster
Epstein-Barr
Cytomegalovirus
HHV6
HHV8
2. Papillomaviruses
3. Coxackieviruses
4. Measles virus
5. Mumps virus
Disease:
Primary herpes gingivostomatitis
Secondary herpes infections
Genital herpes
Varicella(chickenpox),
zoster(shingles)
Mononucleosis
Hairy leukoplakia
Burkitt’s lymphoma
Salivary gland inclusion disease
Roseola infantum
Kaposi’s sarcoma
Oral papillomas/warts, condyloma
Herpangina, hand-foot-mouth disease
Measles
Mumps parotitis
What are the symptoms of viral
diseases?
Symptoms of viral diseases vary depending on the specific type of virus causing infection,
the area of the body that is infected, the age and health history of the patient, and
other factors. The symptoms of viral diseases can affect almost any area of the body
or body system.
Symptoms of viral diseases can include:
• Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)
• Gastrointestinal disturbances, such as diarrhea, nausea and vomiting
• Irritability
• Malaise (general ill feeling)
• Rash
• Sneezing
• Stuffy nose, nasal congestion, runny nose, or postnasal drip
• Swollen lymph nodes
• Swollen tonsils
• Unexplained weight loss
Herpes Simplex Infections
• Herpes Simplex virus (HSV) infections are common
vesicular eruptions of the skin and mucosa.
They occur in two forms: -systemic;
- primary.
They may be: - localized ;
- secondary in nature.
Both form are self-limited, but recurrences of the
secondary forms are common because the virus can be
sequestered within ganglionic tissue in a latent state.
HSV
Primary Herpes Simplex
Clinical features:
• Most infections occur during childhood and subclinically;
• Multiple painful oral ulcers preceded by vesicles;
• May have similar perioral and skin lesions;
• Systemic signs/symptoms (fever, malaise);
• Self-limited;
• Symptomatic care;
• Immunocompromised have more severe disease.
Treatment:
• Acyclovir and analogs may control virus;
• Must use early to be effective
HSV
Secondary herpes simplex
Etiology:
• Reactivation of latent virus, commonly precipitated by stress,
sunlight, cold temperature, low resistance, and immunodeficiency.
Clinical featured:
• Affected usually adults and young adults, prodromal symptoms-tingling and
•
•
burning;
Affects perioral skin, lips, gingiva, palate-multiple small ulcers preceded by
vesicles;
Self- limited.
Treatment:
• Possible control with acyclovir and analogs;
• Must administer early;
• Systemic treatment
Primary herpetic infection
Varicella-Zoster
• Primary disease (Varicella, Chickenpox):
• Self-limited;
• Common in children
• Vesicular eruption of trunk and head, neck occuring in crops, few
oral lesions
• Systemic signs/symptoms-fever, melaise…
• Symptomatic treatment
• Secondary disease (zoster, shingles):
•
•
•
•
Self-limited;
Adults;
Rash, vesicles, ulcers unilateral along dermqatom, rare intraorally;
Post herpetic pain can be severe immunompromised and lymphoma
patients at risk;
• Treated with acyclovir and analogs
Varicella
Zoster
Complications of Herpes Zoster
• Postherpetic Neuralgia
• Herpes Zoster Ophthalmicus
• VZV viremia
• Dermatologic complications
Enteroviruses
• Genus of the picornavirus family which replicate
mainly in the gut
• Single stranded RNA virus
• Divided into 5 groups:
- Polioviruses
- Coxsackie A, B viruses
- Enteroviruses
- Herpanginia, hand-food-and-mouth disease,
acute lymphonodular pharyngitis
Hand-foot-and-mouth disease
Clinical features:
• Painful ulcers preceded by vesicles on hands,
•
•
•
feet, and oral mucosa (buccal, labial mucosa and
tongue most affected)
After a short incubation period, vesicles with an
erythematous halo appear in the oral cavity, on
the hands, on the feet
Affects usually children
Treatment is symptomatic
Hand-foot-mouth disease
Herpangina
Clinical features:
• Endemic, seasonal occurrence;
• Children most commonly affected;
• Multiple painful ulcers in posterior oral cavity and
•
pharynx, lesions preceded by vesicles, diffuse
erythematous pharyngitis is also present;
Systemic symptoms (malaise, fever, dysphagia)
• Treatment:
• Self-limited (short, mild duration);
• Not required
Herpangina
Measles (Rubeola)
Etiology:
• Measles virus(DNA virus) is spread by airbone droplets
through the respiratory tract.
Clinical Features:
• Disease of children;
• Seasonally appearing;
• Prodromal symptoms: fever, malaise, conjunctivitis,
photophobia, and cough develop;
• Koplik’s spots precede maculopapular skin rash in the
buccal mucosa.
• There is no specific treatment (bed rest, adequate diet,
fluids, analgesics)
Measles
Influenza
• Influenza, commonly called "the flu," is caused by viruses that infect
•
•
•
•
the respiratory tract.
Influenza viruses are divided into three types, designated A, B, and
C, with A types usually causing the most problems in humans.
Most people who get the conventional or seasonal flu recover
completely in one to two weeks, but some people develop serious
and potentially life-threatening medical complications, such as
pneumonia.
Much of the illness and death caused by conventional or seasonal
influenza can be prevented by annual influenza vaccination.
Influenza A undergoes frequent antigenic changes that require new
vaccines to be developed and people to obtain a new vaccination
every year. New vaccine technology is being developed.
Influenza
RNA viruses
Illness caused by RNA viruses that infect the respiratory
tract of many animals, birds, and humans.
Symptoms:
• Fever,cough, headache, malaise(tired, no energy), sore
throat, nausea, vomiting, diarrhea. The majority of
individuals has symptoms for about one to two weeks
and then recovers with no problems.
Treatment:
• Symptomatics;
• Prevention by vaccination
Human immundeficiency virus (HIV)
• The human immunodeficiency virus (HIV) is a type of virus called a
retrovirus, which infects humans when it comes in contact with tissues such
as those that line the vagina, anal area, mouth, or eyes, or through a break
in the skin (sexual transmission, blood or blood products, maternal-fetal
transmission, infected needles).
• HIV infection is generally a slowly progressive disease in which the virus is
present throughout the body at all stages of the disease.
Three stages of HIV infection have been described.
• The initial stage of infection (primary infection), which occurs within weeks
of acquiring the virus, and often is characterized by a flu- or mono-like
illness that generally resolves within weeks.
• The stage of chronic asymptomatic infection (meaning a long duration of
infection without symptoms) lasts an average of eight to 10 years.
• The stage of symptomatic infection, in which the body's immune (or
defense) system has been suppressed and complications have developed, is
called the acquired immunodeficiency syndrome (AIDS). The symptoms are
caused by the complications of AIDS, which include one or more unusual
infections or cancers, severe loss of weight, and intellectual deterioration
(called dementia).
ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS)
• HIV infection is associated with different lesions in the
oral cavity
– Candidiasis
– Herpetic vesicles
– Other oppurtunistic infections
– Kaposi’s sarcoma: multifocal vascular tumor, present
in 25% of AIDS patients; HSV8
– Hairy leukoplakia: white patches with hairy surface:
• caused by EBV
• rare, but seen mainly in AIDS
• histology shows acanthosis, hyperkeratosis
WHO Clinical Staging of HIV/AIDS
for Adults and Adolescents
Primary HIV Infection
Asymptomatic
Acute retroviral syndrome
Clinical Stage 1
•
Asymptomatic
•
Persistent generalized lymphadenopathy
Clinical Stage 2
•
Moderate unexplained weight loss (<10% of presumed or measured body weight)
•
Recurrent respiratory infections (sinusitis, tonsillitis, otitis media, and pharyngitis)
•
Herpes zoster
•
Angular cheilitis
•
Recurrent oral ulceration
•
Papular pruritic eruptions
•
Seborrheic dermatitis
•
Fungal nail infections
Clinical Stage 3
•
Unexplained severe weight loss (>10% of presumed or measured body weight)
•
Unexplained chronic diarrhea for >1 month
•
Unexplained persistent fever for >1 month (>37.6ºC, intermittent or constant)
•
Persistent oral candidiasis (thrush)
•
Oral hairy leukoplakia
•
Pulmonary tuberculosis (current)
•
Severe presumed bacterial infections (e.g., pneumonia, empyema, pyomyositis, bone or joint infection, meningitis, bacteremia)
•
Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
•
Unexplained anemia (hemoglobin <8 g/dL)
•
Neutropenia (neutrophils <500 cells/µL)
•
Chronic thrombocytopenia (platelets <50,000 cells/µL)
•
•
WHO Clinical Staging of HIV/AIDS
for Adults and Adolescents
Clinical Stage 4
HIV wasting syndrome, as defined by the CDC (see Table 1, above)
Pneumocystis pneumonia
Recurrent severe bacterial pneumonia
Chronic herpes simplex infection (orolabial, genital, or anorectal site for >1 month or visceral herpes at any site)
Esophageal candidiasis (or candidiasis of trachea, bronchi, or lungs)
Extrapulmonary tuberculosis
Kaposi sarcoma
Cytomegalovirus infection (retinitis or infection of other organs)
Central nervous system toxoplasmosis
HIV encephalopathy
Cryptococcosis, extrapulmonary (including meningitis)
Disseminated nontuberculosis mycobacteria infection
Progressive multifocal leukoencephalopathy
Candida of the trachea, bronchi, or lungs
Chronic cryptosporidiosis (with diarrhea)
Chronic isosporiasis
Disseminated mycosis (e.g., histoplasmosis, coccidioidomycosis, penicilliosis)
Recurrent nontyphoidal Salmonella bacteremia
Lymphoma (cerebral or B-cell non-Hodgkin)
Invasive cervical carcinoma
Atypical disseminated leishmaniasis
Symptomatic HIV-associated nephropathy
Symptomatic HIV-associated cardiomyopathy
Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Oral manifestation of HIV infection can be divided
into three categories:
• Group 1 lesions are strongly associated with HIV
•
•
infection ( oral candidosis, linear gingival
erythema, necrotizing gingivatis, necrotizing
periodontitis);
Group 2 lesions are less commonly associated
with HIV infection (necrotizing stomatitis,
melanotic hyperpigmentation, thrombocytopenic
purpura, bacterial, viral infection);
Group 3 lesions are seen in HIV infection ( oral
infection with actinomyces israelii, escherichia
coli, klebsiella pneumoniae)
Epstein-Barr virus infection or
mononucleosis
• member of the herpesvirus family of viruses (B•
•
•
lymphotropic gamma-herpesvirus).
causes infectious mononucleosis and oral hairy
leukoplakia, and is associated with various types of
lymphoid and epithelial malignancies (Burkitt's
lymphoma, nasopharyngeal carcinoma)
is very contagious and spreads from person to person
through intimate contact with the saliva of a person who
has the Epstein-Barr virus. causes infectious
mononucleosis and oral hairy leukoplakia, and is
associated with various types of lymphoid and epithelial
malignancies
General symptoms of an EpsteinBarr virus infection
• Symptoms of an Epstein-Barr virus infection are often mild, vague,
•
•
•
•
•
•
•
•
•
•
and similar to symptoms of a cold or the flu or there may be no
symptoms of infection. Symptoms include:
Body aches
Cough
Fatigue
Headache
Low-grade fever
Malaise
Runny or stuffy nose or nasal congestion
Sneezing
Sore throat
Swollen tonsils
As mononucleosis progresses,
symptoms become more severe
and can include:
As mononucleosis progresses, symptoms
become more severe and can include:
- Extreme fatigue
- Painful swollen glands (lymph nodes) in
the neck, armpits or groin
- Rash
Thank you for your attention