VIRAL INFECTIONS

Name of Lesion Cause Usual Location Usual Age & Sex Distinct Clinical Features Treatment1. Herpes Simplex(Acute Herpetic Gingivostomatitis; Herpes Labialis; Fever Blister; Cold Sores)

Herpes simplex virus Lips, mouth, gums - By age 20- Female

1. Ulceration on the lip.

A. Primary Herpetic Stomatitis

-Caused by the Herpes Simplex Virus (HSV) I or II-10% of people exposed to HSV develop primary herpetic gingivostomatitis

1. Lips (usually)2. Tongue3. Buccal mucosa4. Palate5. Pharynx6. Tonsils

Can occur at any age, but it is most frequently seen in children and young adults.

1. Primary attack and characterized by the development of fever, irritability, pain upon swallowing, headache and regional lymphadenopathy.2. Mouth becomes painful in few days.3. Gingiva is intensely inflamed.4. Development of yellowish fluid-filled vesicles and these will rupture and will form shallow, ragged, extremely painful ulcers covered by a gray membrane and surrounded by an erythematous halo.

-Antibiotic therapy is of considerable aid in prevention of secondary infection.-Topical Acyclovir can be prescribed.

B. Secondary or Recurrent Herpetic Labialis and Stomatitis

-Precipitating factor such as fever, cold, upper respiratory infection, exposure to the sun or cold air, fatigue and psychic stress may reactivate the virus.-Diminished host resistance is the common precipitating factor for the reactivation of HSV.

1. Lips2. Intraoral (most commonly the hard palate, attached gingival or alveolar ridge.

Adults 1. Burning or tingling sensation2. Feeling of tautness3. Swelling or slight soreness at the location in which the vesicles subsequently develop.4. Small red ulceration due to ruptured gray or white vesicles. 5. Sometimes with erythematous halo.6. On lips, the ruptured vesicle is covered by a brownish crust.7. Degree of pain is quite variable.

1. Antiviral chemotherapeutic agents such as acyclovir, vidarabine and idoxuridine. (Must only be used according to prescribed indications and do not represent curative drugs for this disease.

2. Herpes Zoster (Shingles; Zona)

1. Caused by reactivation of the latent Varicella-Zoster virus which had been acquired during a previous attack of chickenpox.2. Trauma

Buccal mucosa, soft palate and tongue

- Most common in adult life and affects males and females. - Although rare, it does occur in children.

1. Patient exhibits fever2. General malaise3. Pain with development of clusters of vesicles over the skin and oral mucosa.4. Tenderness along the coarse of the involved sensory nerves, usually unilaterally.5. Often, trunk is affected.6. Facial paralysis7. Pain of the external auditory meatus and pinna of the ear.

Antiviral drugs are now under intensive clinical testing for potential effectiveness in treatment of herpes zoster. The preliminary results appear very promising.

3. Chickenpox (Varicella)

1. The varicella-zoster virus may be spread through the air or by direct contact

1. Tongue2. Buccal Mucosa3. Gingival

Usually occurring in children and on rare occasions,

1. The disease begins with fever, headache, nausea, vomiting, myalgia, sore throat, malaise, lung congestion and headache, etc.

- Only palliative treatment is given, which includes antibiotics, antipyretics and

with the blisters (lesions) of someone infected with chickenpox or shingles.2. Immunosuppression such as cytotoxic drug, radiation, internal malignancies, malnutrition, old age, and alcohol and substance abuse.

4. Palate5. Oropharynx

nonimmune adults.

2. These are followed by a popular rash first appearing over the trunk and then rapidly spreading to face and limbs.3. After 3 to 4 days, unusual sequences of macules, vesicles, ulcerations and scabbing of the skin and oral mucosa are seen.4. The individual vesicle and ulcerations appears as “dew drop” on rose petals and is often surrounded by a zone of erythema at the periphery.5. Secondary infection of the vesicles results in formation of pustules which may leave small pitting scars upon healing.6. Small blister-like7. Not particularly painful

vitamins, etc.

4. Measles (Rubeola; Morbilli)

1. Direct contact with an affected person.2. By droplet of infection, the portal of entry being the respiratory tract.

Buccal Mucosa Primarily affecting children

1. Onset of fever2. Malaise3. Cough4. Conjunctivitis5. Photophobia6. Lacrimation7. Eruptive lesion of the skin which begin on the face, in the hair line and behind the ears, and spread to the neck, chest, back and extremities. It would appear as tiny red papules or macules.8. Eruptive lesion of the oral mucosa would appear small, irregularly shaped flecks which appears bluish, white specks surrounded by a bright red margin.9. Palatal and pharyngeal petechiae as well as generalized inflammation, congestion and swelling.10. Focal ulceration of the gingival, palate and throat may also occur.

No specific treatment

5. Mumps (Epidemic Parotitis)

-Caused by Paramyxovirus-2-3 weeks incubation period-Saliva is the mode of transmission

Side of the face under the ears (the parotid glands).

Usually a disease of childhood but may also affect adults.

1. Headache2. Chills3. Moderate fever4. Vomiting5. Pain below the ear6. Firm, somewhat rubbery or elastic swelling of the salivary glands, frequently elevating the ear.7. Pain upon mastication

-Symptomatic supportive therapy, including bed rest.-Analgesics may be utilized to moderate pain.

8. “Hamster face” appearance6. Herpangina (Aphthous Pharyngitis; Vesicular Pharyngitis)

Coxsackie group A viruses Commonly present in the posterior hard and soft palate (bilateral)

Young chidren, older children and adults.

1. Mild and of short duration.2. Begins with a sore throat, low grade fever, headache, sometimes vomiting, prostration and abdominal pain.3. Soon will be small ulcers, each showing a gray base and an inflamed periphery on the anterior faucial pillars and sometimes on the hard palates and soft tissues, posterior pharyngeal wall, buccal mucosa and tongue.4. Ulcers are not extremely painful, although dysphagia may occur.

No treatment is necessary, since the disease appears to be self-limiting and presents few complications.

7. Infectious Mononucleosis (Glandular Fever)

-Caused by the Epstein B Virus (EBV)-Saliva transfer is the mode of transmission-EBV associated with cases of hairy leukoplakia, Burkitt’s lymphoma & nasopharyngeal carcinoma

-Occurs chiefly in children and young adults (15-20 years old)-No sex or seasonal predilection.

1. Characterized by fever, sore throat, headache, chills, cough, nausea or vomiting, lymphadenopathy, pharyngitis and tonsillitis.2. Prodromal fatigue, anorexia and malaise usually presents 10-14 days prior to the onset of fever.3. Fever usually lasts up to 14 days.4. Bilateral lymphadenopathy and oropharyngeal tonsillar enlargements are common signs.

-No specific treatment.-NSAIDs and non-aspirin containing anti-inflammatory medications may be used for common symptoms.-Acyclovir has not been proven to be clinically effective to this disease.

8. Cytomegalic Inclusion Disease (Salivary Gland Virus Disease)

Caused by intrauterine or early post natal infection by CMV (Cytomegalovirus).

Salivary gland tissue

Majority are under two years of age/infants and few adults.

1. During initial period it produces fever, malaise, pharyngitis, myalgia and lymphadenopathy, etc.2. Retardation of mental and motor development.3. Superficial ulcerations or fissures of oral area; aphthous-like ulcers.4. Later on there is formation of multiple, small, fragile vesicles.5. Soon the fragile vesicles rupture and leave shallow, pinpoint ulcers.6. The ulcer often resemble herpetic infections and each ulcer is surrounded by a zone of intense erythema (halo)

- Only palliative treatment is done.- Antiherpetic agents: acyclovir, foscarnet, gancyclovir, cidofovir