Transcript herpes virus 8 - Semmelweis Egyetem

Oral infections 1.
Dr Bródy Andrea
Semmelweis Egyetem Orális
Diagnosztikai Tanszék
The significance of infectious diseases
Same pathogenic – different consequences
• In the 1960s we were convinced that the
final victory over infectious diseases was
only a matter of time
- antibacterial, antifungal, anti-parasite medicines
- vaccinations
The significance of infectious diseases
Fought diseases rise again – causes
• Most people die of infectious diseases in the world
• More relations are discovered between infectious and
other diseases (Chlamydias – atherosclerosis,
Helycobacter pylori – ulcus, etc.)
• New and altered pathogenics appear (Zika virus, Lyme
disease, Legionellosis, TBC, malaria, HIV, heartworm)
• Anti-vaccination movements, wars – the danger of
endemics is increasing again
• Appearence of the pathogenics in new places
• Change of sexual habits
The significance of infectious diseases
causes
Fought diseases rise again
• Fast and cheap travel opportunities – importing new diseases
 Not diagnosed properly
 Wrong treatment
• Not enough responsible drug therapy
• Agressive therapy for severe diseases
 Survival rate increases
 Nosocomialis infections
 Therapeutical side effects
• Average age rise
• Environmental changes
Factors determining the formation of
infections
Same pathogenic – different consequences
Virulence of the
microorganism
Size of inoculum
infection
Immunity of the host body
Grouping of pathogenics
Three main groups
• Obligate
Causes infection in responsive person
• Facultative
Causes disease under only certain circumstances
• Opportunistic
Causes infection only in case of altered immunity
•
•
nosocomialis infections
sexually transmitted infections
Nosocomialis infections
• Growing proportion among all infectious
diseases
• Patients from infectious departments are
out to the general departments
• Pathogenics are different from the
„street” versions - resistance
• Treatment is becoming more challenging
Pathogenics and the host body
• In the body, special microflora is found in
each place
• Substances produced by microbes:
 Making it possible to bond to the tissue (adhesion)
 Blocking the adhesion of other microbes, so the colonised
microflores create a defensive ring towards the outside
(colonisation resistance, immunity)
 Unnecessary antibiotic use destroys this
defensive function!!!
Infection or colonisation?
• Microorganisms settle in the tissues in both
 If there’s no response: colonisation
 In case of response: infection (may be
with or without symptoms)
• An important question is whether the
isolated microbe is a part of the flora or is an
infectious agent?
(e.g. Candida detection)
Factors determining the outcome of
the infection
• The virulence, quantity, drug sensitivity of
the the pathogenic
• Place of infection
• Immunity
• Quality of the applied treatment
Systematic relations of oral cavity
infections
Systematic infections often
cause symptoms in the oral
cavity
Primary oral cavity infections also cause
systematic consequences every time.
Oral cavity viral
infections
Dicovery of the viruses
BEIJERINCK
Infected healthy plants with the filtrate of mosaic viruses (1898)
„contagium vivum fluidum”
It occured in 1903 already that viruses may cause tumors.
The viruses
• They consist of genetic substances (DNA, RNA) and protein
• Their size range is between 20 nm to 300 nm
• They multiple by getting into and using living cells – they reprogram the host cells
infectious genetic information
• The virus out of the cells is the virion
• The virion consists of the DNA (or RNA) and a protein shell (capsid).
In some cases an additional lipoprotein shell, the peplon is found.
• Special viruses:
• Bacteriophages
• Retroviruses
• Viral infections cause symptoms in the oral cavity in a
significant number of the infections, furthermore, often
they appear only there or they appear there for the first
time. However, infection always a systematic problem.
• Detection is important for the following reasons:
• Early treatment,
• To prevent further spreading
• Diagnosis: clinical symptoms, serology, DNA (RNA)
examination
• Most viral infections are spread by saliva or other
body fluids. They are found in big numbers mostly
where close body or body fluid contact occurs.
Children are particularly sensitive.
• In developed countries childhood infections are
frequently skipped, therefore adult primer infections
are more often detected.
The effect of viruses on the
human body
• Immediate, possibly life threatening disease (Grippe,
Ebola)
• Slowly developing disease, e.g. tumor (HPV, hepatitis
B,C, TBC), slow viruses (sclerosis multiplex, kuru)
• Destruction of the immune system (HIV)
• Stimulation of the immune system
Enteroviruses (Picornaviruses)
• They spread enterally in the mucosa of the intestines
mostly causing a mild infection faecal-oral way
• They leave life-long immunity behind
• Frequent diseases: Herpangina, Poliomyelitis,
Hand, foot, and mouth diseases
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Herpangina
• In the back region of the oral cavity – only on the
soft palate and the uvula – small ulcers develop.
• Diagnosis: based on clinical symptoms (especially
children)
• Treatment: symptomatic
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Hand, foot, and
mouth disease
• Mostly caused by
Coxsackie A or B virus
• Beyond vesicular skin
symptoms it may cause
enchephalomyelitis as
well
• Mostly mild disease, it
heals by itself within
approximately a week
• Slight fever, red throat
• Vesiculas surrounded by
inflamed frame
Differential diagnosis: varicella,
impetigo, aphta, Kawasaki
disease, herpangina
Herpes viruses
They belong to the
DNA viruses. Their
typical attribute is
that they are capable
of hiding for a long
time in the human
body by evading the
immune system and
cause diseases that
flare up from time to
time.
Type
Name
1
Herpes simplex 1 (HSV-1)
2
Herpes simplex 2 (HSV-2)
3
Herpes varicella-zoster (VZV)
4
Epstein-Barr (EBV)
5
Cytomegalovirus (CMV)
6
Human herpes virus 6
7
Human herpes virus 7
8
Human herpes virus 8 (Kaposi
sarcoma)
•
Herpes simplex viruses
1. HSV-1
Primarily causes oral cavity infections
however it tends to play a role more
and more often in anogenital
infections.
•
It multiplies in the skin or mucosa
and then reaches the sensing
ganglions, where it’s persisted
•
Upon the first encounter, especially in
children it usually causes acute
gingivostomatitis herpetica
Unpleasent breath, fever, bad
general feeling, vesiculas and
ulcers, plaque, pain
• Treatment: accurate mouth
hygiene, painkillers, antiseptic
rinsing, spice free diet, fluids,
antiviral drugs (e.g. Aciclovir)
Differential
diagnosis:
Herpangina, aphta,
Hand, foot and
mouth disease
Herpes simplex 1
Herpes labialis,
herpes intraoralis
• The persisting virus is
activated by different
stimuli or the declining of
the immune system.
• Primarily lip, face and oral
cavity
Differential
diagnosis:
Herpangina, aphtas,
Hand, foot and
mouth disease,
impetigo
Herpes simplex viruses
2. HSV-2
• One fifth of the American adult population is infected with
HSV-2
• Primarily causes anogenital infection
• Infection during pregnancy may lead to the death of the
foetus
Differential diagnosis: Herpangina, aphta, Hand,
foot and mouth disease
3. Varicella
• First encounter – chickenpox
• Mostly mild disease, extraordinarily contagious Spreads by droplet infection
• Infection during pregnancy may lead to the death of both the foetus and the
mother
•
•
•
•
•
Foetus: severe malformations
Mother: fulminans varicella pneumonia
Endangered as well:
Smokers!
People with weakened immune system
Small vesiculas may appear in the mouth as well – e.g. on the hard palate
After the elapse of the disease the virus may persist in the ganglions
Reactivated - herpes zoster
Treatment: symptomatic. (Reye!) Using antiviral drugs may be effective.
Prevention: vaccination within 3 days upon exposion
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3. Herpes Zoster
• The extraordinarily painful and itchy vesiculas appear by the nerve
paths – in case of trigeminus affection e.g. on the face and cornea
– urgent consultation with an oculist is advised
• The vesiculas appear on only one side of the oral cavity too and
they follow the path of the nerves – may imitate tooth pain or may
cause facialis paresis
• It is life threatening for immune deficient people
• Treatment: antiviral drugs orally or IV
• Postherpeticus pain
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4. Epstein-Barr
Mononucleosis infectiosa, Burkitt lymphoma,
B cell lymphomas, nasopharyngealis carcinoma,
inflammation of the salivary glands, hairy
leukoplakia in immune deficient people
In a significant number of people the virus persists without symptoms
during their whole lifetime.
The decline of the immune system may lead to the activation of the
virus and the development of different tumors (e.g. Non-Hodgkin
lymphomas, nasopharynx- and stomach carcinoma).
4. Epstein-Barr
• Mononucleosis infectiosa: It may be detected during the disease and for a few
months afterwards from the saliva – it is spread by saliva but its infectious
capacity is low
• Symptoms: Throat pain, swollen lymphatic nodes, low fever, general bad feeling,
swollen upper eyelid
• Angina type – ulcers in the pharynx and the tonsils, possibly oedema too,
sore throat
• Glandular type (Pfeiffer glandular fever) – enlarged lymphatic nodes and
swollen liver and splenes
• Differential diagnosis – serology
•
Atypical mononuclear cells
• Treatment: Symptomic
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4. Epstein-Barr Burkitt lymphoma
• Non-Hodgkin lymphoma
• The endemic form appears in malaria infected
territories in young children.
• The sporadic form worldwide – mostly abdominal Bcell origin lymphoma
• Not too malignant – 3 year survive is around 80%
4. Epstein-Barr Hairy leukoplakia
• In people with immunodeficiency– often in HIV infected
people
• No malignant
• In the background some immundeficiency is existing
4. Epstein-Barr Malignus tumors
• Carcinoma: EBV transformer effect + weak immune system +
enviromental factors
• Malignus lymphomas – in transplanteted person and patients with AIDS –
polyclonal B lymphocyta proliferation– the weakened cellular immunity
system cannot react properly
In 95% of the people the virus persists without any
symptoms through their whole lifetime.
5. Cytomegalovirus
• Only the human
cytomegalovirus causes human
infection
• 50-80% of people go through it
by the time of reaching
adulthood, and the virus may
persist
• Symptoms only develop in 1%
of the cases, they resemble
mononucleosis.
• Infection in the uterus causes
serious malformations
• Swollen saliva glands
• Often causes the death of AIDS
patients
cytomegalic inclusion disease
Exanthema subitum – Herpes virus 6, 7
•
•
•
•
Mild rash disease
May activate the HIV virus
By the age of 2-3 practically everybody gets over it
There are no typical oral symptoms
Kaposi sarcoma - herpes virus 8
(KSHV)
• This virus plays a role in the development of more than
one type of tumors
• The Kaposi sarcoma is an endotelial, vascular originated
tumor – angiogenetic tumor
• It is transmitted sexually, nosocomial infection is not
known
• Often occurs in AIDS patients
Mumps virus
Parotitis epidemica
• Childhood disease. One or two
side swelling of the parotis
appears (other big salivary
glands may be affected too)
• May be spread by droplet
infection
• Diagnosis: clinical symptoms –
swelling, erythema and
oedema of the ductus Stenon,
pain (eating, opening)
• Complications often occur
Differential diagnosis: stone, other salivary gland inflammation,
enlarging lymphatic nodes, tooth originated inflammation
Morbilli
• Dangerous childhood disease. Main characteristics are
maculo-papulosus rash, fever, respiratory symptoms and
often severe complications (pneumonia, enchephalitis,
stomatitis gangraenosa)
• It is spread by droplet infection
• Differential diagnosis: herpes, herpangina
• The virus has an immunstimulate effect
Morbilli - Koplik spot
• Simultaneously with the appearance of the
catarrhal symptoms, first erythematosus then
red sided white spots show up and disappear
within 1-2 days.
Papilloma (HPV) virus
• The human papilloma virus infects the cells of the epithelium
and the mucosa
• HPV 1-4 – warts appear on the skin, but occasionally on the
gingiva and the hard palate as well.
• Condyloma acuminatum: HPV6, HPV 11
• Infection: with close contact, in dressing rooms, passing
newborn through the vagina, sexual transmission
• Certain strains are oncogens – e.g. cervix carcinoma, pharinx
carcinoma
(HPV 16,18,33)
• Prevention: vaccination, sexual habits
Pox viruses – molluscum
contagiosum
• Large viruses that may be seen with light microscop too
• Wart-like, beningnant deformations in the skin and/or
the mucosa
• Transmission via direct contact
• Spontaneously heals after a few months
• Treatment: removal or freezing or waiting
HIV, AIDS
Due to the suppression of the immune system a
wide range of diseases threaten the patient
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•
•
•
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Candidiasis
Linearis gingiva erythema
Herpes simplex infections
Kaposi sarcoma, hairy leukoplakia, lymphoma
Necrotising gingivitis
Necrotising parodontitis
Tumor viruses
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•
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More strains of the human papilloma
Epstein-Barr
Human herpes virus 8
Molluscum contagiosum
Hepatitis B, C
Other viral infections with dental
significance
• Hepatitis B, C
• Influenza
• And the latest threat: Ebola
Treatment of infectious patients
• In case of an acute infection, if possible, the treatment has to be
delayed or a conservative solution is advised to be chosen
Exception: pulpitis, periapicalis abcessus
• In case of a chronical infection, providing treatment may not be
denied!
• In most cases, exposion with the blood or body fluid of a HBV, HCV or
HIV infected person does not lead to infection.
• For HIV, probability of infection after exposion is 0,3%
• For HBV and sensitive persons is 6-30%, for HCV it is 1,8%,
• Contact of small quantity of blood with intact skin does not hold any risk.
Prevention of the spread of
infection
• Should be called in to consultation as the last patient
• Mouth hygiene has emphasized significance, chlorine
hexidine rinsing
• Wearing protective gear is especially important - mask,
glasses, plexiglass, gloves
• The use of turbine and depurator should be avoided
• Sterilization must be carried out as normally!!
Thank you for your
attention!