May of 2024/ Viral Infection Dr. Darya K.

Mahmood

Herpes Virus Infections:

(Primary Herpetic gingivostomatitis)
 (HSV-I) incubation period 3-7 days.
 It occurs predominantly in young children (6 month-5 years) and the majority of cases are
subclinical.
 Multiple painful, shallow vesicular eruptions, located on attached gingiva, movable
mucosa, lip, palate, pharynx, and tonsils.
 Vesicles are dome-shaped 2-3mm diameter when vesicles rupture shallow, painful ulcer
appears with a gray cover and erythematous hallo, self-limited heal in 7-14 days.
 Gingiva with diffuse erythema, edema. Cervical lymphadenopathy, fever, malaise,
irritability & anorexia.
 Circum-oral crusting lesions on the lips may be seen.
 Common in children (poor areas).
 Virus does not remain in its original site but undergoes latency in the trigeminal ganglion.
Pathology: Viral infection of epithelial cell produces intraepithelial vesicles. HSV-infected
epithelial cells exhibit acantholysis, and nuclear enlargement (termed ballooning degeneration).
The acantholytic cells called Tzanck cells (this term referred to free-floating epithelial cells in
any intraepithelial vesicle and is non-specific for herpes). Epithelial giant cells are formed by
fusion between adjacent cells.
Treatment: soft diet, fluid intake, analgesics, chlorhexidine mouth wash. Acyclovir suspension
used as a rinse and then swallowed during the first 3 symptomatic days.
Herpes labialis (secondary or recurrent HSV) (fever blisters=cold sore)
 Reactivation of latent HSV in ganglion; through stress stimuli such as UV light, fever,
hormonal changes, surgical trauma to the neuron, or unknown cause.
 Prodromal symptoms include tingling, burning or pain at site where lesion appear mostly
lip (skin or mucocutaneous junction) then vesicles appear & heal without scar within 7-
10d, recurrence may be once / year, or once / month.
 If recurrence is intraorally, it’s on hard palate and gingiva.
Herpetic Whitlow
Cross infection due to direct contact with active lesion affect fingers (in dentists & health
care workers). May be primary or secondary type (both contagious), Pain, redness and swelling
of the finger skin, vesicles rupture and become ulcers, heal within 4-6 weeks. Recurrence on the
digit may occur and result in paresthesia and permanent scarring.

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May of 2024/ Viral Infection Dr. Darya K. Mahmood

Varicella-Zoster virus VZV (chicken pox)

 Acute highly contagious childhood illness (Most cases 5-9 year) with fever, skin rash,
 Epidemically occurs in spring and winter,
 Oral eruptions quickly progress to an ulcer, patient should not scratch to avoid scar, resolve
within 3-8 days, incubation period is 2 weeks.
 The rash begins on the face and trunk, followed by involvement of the extremities.
 Each lesion progresses through a stage of erythema, vesicle, pustule and hardened crust.
In contrast to herpes simplex the lesions typically continue to erupt for 4 days. Old crusted
lesion intermixed with newly formed and intact vesicles.
 Oral lesions are fairly common and may precede the skin lesions.
Herpes zoster secondary (shingles)
 Reactivation of sequestered virus of chicken pox.
 Unilateral erythematous maculopapular lesion. Which evolve into vesicles, within 2wks
crustation take place, resolution takes place within 4-6 wks.
 Tzanck test is positive.
 Acute pain along the division of nerve affecting old people usually on face and trunk, hard
palate.
 May be complicated into chronic pain which is post herpetic neuralgia.
Treatment: Antiviral, antipyretics, anti-infective, analgesics.
**Reactivation of VZV in the geniculate ganglion may cause Ramsay Hunt syndrome, which
is characterized by cutaneous lesions of external auditory canal and involvement of the ipsilateral
facial and auditory nerves leading to facial paralysis, hearing defects, and in some patient loss of
taste in anterior 2/3 of the tongue.
Epstein Bar Virus EBV {infectious mononucleosis}
 A debilitating infection persists 4-6 wk.
 Sore throat, tonsillar faucial swelling, ulceration with creamy exudates, palatal petechiae,
mouth ulcers, lymph node enlargement, fever, anorexia.
 Adolescents predominantly.
 EBV is transmitted by saliva; it’s the cause of kissing disease, ANUG, nasopharyngeal
carcinoma, Burkitt's lymphoma & associated with oral hairy leukoplakia in AIDS patients.
Treatment: NSAIDs, corticosteroid, and antiviral.

Cytomegalovirus CMV
 Infects major salivary glands & causes xerostomia.
 Common in general population with 60% being seropositive & asymptomatic.
 Fever, myalgia, malaise (in adults).
 Severe infection can cause hepatitis & encephalitis

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May of 2024/ Viral Infection Dr. Darya K. Mahmood

Coxsackie's viral infections

Herpangina
 Acute viral infection caused by Coxsackie A Virus.
 Transmitted by contaminated saliva & occasionally feces.
 Affect school children (endemic) in summer.
 There is prodromal period of fever, ill feeling then followed by vesicles and ulcer (24mm)
appearance mainly on posterior mouth (soft palate, tonsillar pillars) (oropharyngitis).
 Patient complains of dysphasia, sore throat, fever, self-limiting in 7-10 days.
 Symptomatic treatment.
Hand Foot & Mouth disease
 Epidemic infection in children less than 5 years age.
 Short incubation period, resolves in 1-2 weeks.
 Fever, lymphadenopathy, sore-throat, pain in lesions. Vesicles rupture leaving ulcers
covered by yellow fibrinous membrane, surrounded by erythematous halo may appear on
any site of the mouth (mostly buccal, labial surface, and tongue), which may precede the
development of cutaneous lesions.
 Maculopapular lesions on feet, toes, hands & fingers.
 Vesicles are found within epithelium.
 Symptomatic treatment.
Measles (Rubeola) Not vesiculo-ulcerative but viral
 A highly contagious viral infection caused by paramyxovirus, spread by airborne droplets
through respiratory tract. Its disease of children.
 Oral manifestations: lesions known as Koplik spots which are small erythematous
macules with white necrotic centers on buccal mucosa that precedes skin rash 1-2 days.
 Systematically there are prodromal symptoms: fever, malaise, conjunctivitis, and
photophobia, cough & skin rash.
 Treatment: supportive, bed rest, fluid, soft diet.
 Note: differentiate this infection from Rubella infection (German measles!!!!!!!!!)