Viral Infections

Dent 452
Lecture 5
Dr. Jumana Karasneh
Viruses
1. Human Herpes Virus (HHV)
2. Enteroviruses
1. Coxsackieviruses (CSV)

3. Paramyxovirus
1. Mumps virus
2. Morbillivirus

4. Human papillomavirus (HPV)

5. Human immunodificiency virus
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 Human Herpes
Virus (HHV)

1. Herpes simplex virus type 1 (HSV-1) (HHV-1)

2. Herpes simplex virus type 2 (HSV-2) (HHV-2)
3. Varicella-zoster virus (VZV) (HHV-3)
4. Epstein-Barr virus (EBV) (HHV-4)
5. Cytomegalovirus (CMG) (HHV-5)
6. Human Herpes Virus 6 (HHV-6)
7. Human Herpes Virus 7 (HHV-7)
8. Human Herpes Virus 8 (HHV-8)
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 Characteristics of HHV

1. DNA virus
2. Contracted in early life
3. Transmitted in saliva
4. Latency
5. Reactivated by
immunosuppression

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 HSV-1 (HHV-1)
Primary Herpetic Gingivostomatitis
Clinical Picture:
 Children 6m-6y affected.
 Systemic symptoms
 Multiple vesicles anywhere intra
orally, lips & circumoral skin
 Recovery 10-14 days

Management
 Should exclude leukaemia in children
 Supportive & rehydration

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 HSV-1 (HHV-1)
Herpetic whitlow

*Infection control procedure are

always essential (mask, eye
protection, gloves)

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 HSV-1 (HHV-1)
Recurrent Herpes
Clinical Picture:
 Usually on lips / nose
 Could occur intra-orally on keratinized
fixed mucosa
 Tingling sensation for 1-2 days
 Crops of vesicles that crust later
 Bell’s palsy if facial nerve is affected
Management
 Supportive
 Topical aciclovir 5 times/day
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 VZV(HHV-2)
Chickenpox
Definition:
 Infection for 1st time causes Chickenpox
 Stay latent in the sensory ganglia
 Recurs causing 2 infection Herpes Zoster (shingles)

Diagnosis:
 Clinical picture

Management
 Supportive
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 VZV(HHV-2)
Shingles
Clinical picture:
 Unilateral
 Most cases involve thoracic only 30%
affect trigeminal
 Affect older age group usually
 Starts as severe pain then vesicles follow.
 Complicated by post-herpetic neuralgia
Management
 High doses of systemic aciclovir or
famciclovir
 Ophthalmic consultation if Ophthalmic
branch is affected
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 EBV (HHV-3)
Infectious mononucleosis

Clinical picture: Complications:

 subclinical  Hairy Leukoplakia
 Lymphadinopathy  Nasopharyngeal carcinoma
 Sore throat  Burkett’s lymphoma
 Fever & malaise
 Rashes
Management
 supportive 10
Enteroviruses
Coxsackieviruses (CSV)

 No latent phase
 Group A & B with subtypes
 Transmitted by direct contact
 Group A causes:
 Hand, foot & mouth disease
 Herpangina

 Mild symptoms
 Self-limiting condition

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Paramyxoviruse
Mumps virus
Clinical picture:
 Mostly bilateral swelling of parotid gland
 Unilateral / submandibular less frequently
 Pain, fever & malaise
 Xerostomia
 Trismus
Complications:
 Pancreatitis
 Encephalitis
 Orchitis / Oophoritis
Management
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Paramyxoviruse
Morbillivirus
Clinical picture:
1. Febrile illness & nasal discharge
2. Koplik’s spots
3. Maculopapular rash
4. Conjunctivitis
Complications:
 Encephalitis
 Pneumonia
Management
 Symptomatic

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 Human papilloma virus (HPV)
 Over 100 type all causing warty growths in skin &
mucosa
 Most common is Verruca vulgaris causing common wart

 Focal epithelial hyperplasia (Heck’s disease)

Clinical Picture:

Diagnosis:

Treatment:
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Retroviruses
Human immunodeficiency virus (HIV)

High Risk Group:

 HIV attacks CD4+ T & brain
 Homosexuals glial cells
 History of previous  Tranmission via saliva is
blood transfusion. rare
 Secretory leukocyte protease 1
 Drug addicts.
 Peroxidase
 Multiple partners
 Thrombospondin-1

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Retroviruses
Human immunodeficiency virus (HIV)
Clinical features
1. Acute HIV infection
 Rapid viral replication
 Mimicking glandular fever symptoms

2. HIV infection
 Asymptomatic
 Last for years

3. HIV disease
  CD4+ T cells
 Affected with Pneumonia, candida, bacterial, viral & malignancy

4. AIDS
 CD4+ T cells > 200 cells/ml
 Severe symptoms

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Retroviruses
Human immunodeficiency virus (HIV)
Oral features

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Retroviruses
Human immunodeficiency virus (HIV)
Oral features

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Retroviruses
Human immunodeficiency virus (HIV)
Oral features

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Retroviruses
Human immunodeficiency virus (HIV)

Management

 Aggressive treatment for infections

 Antiretroviral therapy
 Azidothymidine (AZT), protease inhibitor
 Nucleoside reverse transcriptase inhibitor
 Non-nucleoside reverse transcriptase inhibitor

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