Viral Infections

Presented by:
Fatimah Zahraa Ahmed
Supervised by :
Dr.Rafil
introduction
A viral disease of the oral cavity is the infectious type of pathology
affecting oral tissues. Viral diseases may either occur due to cellular
destruction or consequence of immune reaction following viral
proteins. Viral infections typically present with abrupt onset and
association of solitary or multiple blister or ulcerations.
Concomitant general symptoms such as fever, malaise, and
lymphadenopathy are observed in a few viral conditions. Viral
infections are also linked to the development and progression of
periodontal diseases. A viral disease of oral tissues is often
encountered in dental practice, however, limited attention is given
in diagnosis and management due to diagnostic challenges. Certain
viral infections are associated with tumor formation and, hence,
early reporting and referral to oral disease management are
essential in dental practice.
HERPES VIRUSES
The herpes family of viruses consists of the following:
Herpes simplex virus 1 (HSV-1)
Herpes simplex virus 2 (HSV-2)
Varicella-zoster virus (VZV)
Epstein-Barr virus (EBV)
Cytomegalovirus (CMV)
Other human herpesvirus (HHV-6, HHV-7, HHV-8)
HHV 1 HSV) 1
When HHV 1 infection occur, it has different and
distinct oral and perioral presentations of primary
herpetic gingivostomatitis
primary herpetic gingivostomatitis usually occurs in
children or adolescents who have not been
previously exposed to the virus. Many primary
infections are asymptomatic
Symptomatic primary infection, with multiple,
small, clustered vesicles in numerous locations,
can occur anywhere in the oral cavity, on the
perioral skin, or on the pharynx.
Recurrent HHV 1 infections typically occur
throughout
life and are particularly triggered by stress, illness,
immune compromise, or other factors
Signs and Symptoms
1-Headache
2-fever
3-painful lymphadenopathy
4-malaise
PRIMARY HERPES CAN AFFECT THE LIPS, AND THE
RUPTURED VESICLES MAY APPEAR AS BLEEDING OF THE
LIPS
DIAGNOSIS AND MANAGEMENT
The differential
diagnosis of primary herpetic gingivostomatitis
includes recurrent aphthous ulceration , which
forms ulcers on non keratinized oral mucosa
without a vesicle phase.
Acyclovir is a potent drug and may be life saving for
HHV 1 infection and other disseminated infections,
especially in those individuals who are
immunocompromised
Bed rest, fluids and a soft diet, with antipyretics for
fever are recommended.
HHV 2 SECONDARY HERPES LABIALIS
HSV) 2
Oral Manifestation
HHV-2 infection is less common in the oral cavity than HHV-1
infection, its oral manifestations are clinically indistinguishable
from HHV-1 infection.
Around 15 to 30% of the community is affected by episodes of
secondary herpes simplex lesions (herpes labialis) that
predispose the patient to recurrent infection,
as these cause reactivation of the virus, which subsequently
migrates along one of the sensory divisions of the trigeminal
nerve. The lesions are most often seen at the mucocutaneous
junction of the lip or perioral skin.
Trigger factors
1 Common colds
2 influenza
3 fever
4 emotional up set
5 stress and anxiety.
6-menstruation
7-UV light,trauma
Symptoms:burning sensation,erythema at the site of
attack,vesicle formation at mucocutaneous junction of lip
and extending skin,crust formation after 2-3 days
VARICELLA ZOSTER VIRUS ( VZV)
Herpes zoster usually affects patients older than 40 years,
Clinical features
Headache, photophobia, malaise, fever, abnormal skin sensations,
pain
Rash:
 Vesicular eruption follows the distribution of sensory
nerves, being segmental and unilateral.
Thoracic , cervical, ophthalmic involvement most common 
Initially erythematous, maculopapular
 Vesicles form over several days, then crust over
comlications
Postherpetic Neuralgia (PHN)
Herpes Zoster Ophthalmicus
DIAGNOSIS AND MANAGEMENT
Herpes zoster may be confused with recurrent Herpes
simplex virus infection. Herpes zoster has a longer duration
,it’s unilateral vesicles and ulceration, with abrupt ending
at the midline and post-herpetic neuralgia.
The treatment is supportive with topical or systemic
antipruritics and analgesics that do not contain aspirin. A
high dose of oral acyclovir (800 mg five times daily for
seven days) is recommended for treating both primary and
recurrent infections in immunocompromised patients.
Primary varicella(Chicken pox)
age: Children ,Dermal vesicular exanthem and incubation period lasts 2 to
3 weeks
 Early onset of vesicles that rapidly rupture & leave erosions with a
surface pseudomembrane
lesions located on the trunk and face, are vesicular with an erythematous
boundary, and are extremely pruritic.
 Fever, malaise , mild generalized lymphadenopathy
 lesions resolve within 5 to 8 days.
Superficial intraepithelial vesicle formation.
 vesicular contents contain eosinophilic exudate, inflammatory cells
and epithelial cells.
EPSTEIN BARR VIRUS ( EBV)
The virus ( usually acquired from infected saliva)
replicates in the cells of the mucosa and salivary
glands and spreads to the blood stream.
If the patient is immunocompetent , cytotoxic T
cells
become activated and a characteristic
lymphadenopathy notably involving the posterior
cervical nodes) accompanies tonsillitis and
Hepatosplenomegaly
Signs and Symptoms
1 headache
2 fever
3 malaise
4 myalgia
5 fatigue
6 Severe abdominal pain may indicate splenic
rupture.
infectious Mononucleosis

Aka Glandular Fever & Kissing Disease because adult contract the virus through direct
salivary transfer like straws or kissing
7-10 days incubation period.
 Acute self-limiting infection
 Clinical Features
 Age : Young Adults ,
symptoms
Petechiae on hard palate  Lymphadenopathy, Pharyngitis, Tonsillitis.  Sore throat,
fever, rash
 Malaise, lethargy, extreme tiredness
 Liver and spleen involvement and enlargement
 Hematology: High WBC, over 20% atypical reactive lymphocytes also known as
Downey cells.
 T/t
 Supportive  Bed rest and high liquid intake.  Mild analgesic and antipyretic
CYTOMEGALOVIRUS ( CMV)
The virus is shed by glandular secretions , including
saliva .
Primary CMV infection can be asymptomatic, but it
can also mimic mononucleosis.
Latent CMV infection may cause esophagitis , which
is occasionally accompanied by oral ulcerations or
erythema
The oral ulcerations are clinically nonspecific, and
a biopsy is required for definitive diagnosis.
Treatment:
The infection resolve spontaneously
Gancyclovir in immunocompromised patients
HHV 6
The virus is spread through saliva and possibly by genital
secretions.
The childwith HHV-6 usually does not appear seriously
ill during this disease.
HHV-6 infection is much more serious in adults and can lead to
organ involvement
No prophylaxis or treatment for infection with HHV-6 presently
exists. The great majority of HHV-6 infections are silent or
appear as a general mild febrile illness.
HHV 7
HHV 7 has been identified in the saliva of adults,
and this is most likely where the virus persists
Chronically
HHV 8
initially, the lesion may appear as a red, purple, or
dusky patch that enlarges into a plaque and later
progresses into a tumorous mass.
HUMAN PAPILLOMA VIRUS LESIONS
(WARTS)
In the oral cavity, they tend to be somewhat flatter than the type
occurring on hands, but if they are dried with air, the tiny
projections characteristic of regular warts become evident.
There are about 200 different strains of HPV, it’s seem to account
for the serious rise in the incidence of oral cancers in younger
people, many of whom do not smoke or drink regularly.
Most strains are relatively harmless
They may be removed using
lasers, cautery or cold steel blades.
COXSACKIE VIRUS HERPANGINA
Herpangina affects children, mainly during summer, Patients
present with vesicles, ulcerations and diffuse erythema on the
soft palate and tonsillar areas.
Herpanginais characterised by a sudden onset of:
1-Malaise
2-fever
3-sore throat.
The systemic symptoms settle in two to three days and the
ulcers heal in 7 to 10 days.
DIAGNOSIS AND TREATMENT
The clinical features of Coxsackie virus are distinctive.
The distribution of the lesions of herpangina differentiates
it from primary herpetic gingivostomatitis, which affects
the gingivae whereas herpanginais an oropharyngitis.
Herpanginais self-limiting disese and need no treatment
Treatment is indicated in very painful cases of
herpangina, in which case antipyretics and topical
anaesthetic scan be used.
HAND, FOOT AND MOUTH DISEASE
Hand, foot and mouth disease is most commonly seen amongst
children aged 1 to 5 years.
Oral Manifestation
In 75% of cases presents with an eruption of vesicles on the
palms of the hands and on the feet. Occasional vesicles may also
be found on the proximal extremities and buttocks.
There are also vesicles in the anterior part of the mouth.

An associated low-grade fever and malaise are usually present.

foot and mouth disease are self-limiting, of short
duration and need no treatment
references
1- Oral & maxillofacial pathology: Neville, 3rd edition.
2- Text book of oral medicine: Burkitts, 11th edition.
3- Shafer’s text book of oral pathology, 6th edition