Pathology -Virus

- A oobligate parasite because it has to enter a host before it can replicate

- Herpes Simplex Virus 1
-Herpes Simplex Virus 2
-Varicella-Zoster Virus
-Epstein-Bar Virus
-Cytomegalovirus

-Lytic to epithelial cells
-Latent in neural tissue
-Enters the body through breaks in the skin, but can penetrate intact mucous membranes
-HSV1 above the waist
-HSV2 below the waist

-1% of initial oral infections with HSV1 & 2 have symptomatic primary infection
- Usually occur in young children
- Multiple small, punctate, shallow ulcers involving the gingiva, lips, perioralskin and/or nasopharynx
- Severe forms have large, diffuse, white ulcers that have scalloped borders and erythematoushalos
- May experience muscle soreness(myalgia) and inability to masticate and swallow food - Immunocompromisedpatients may have prolonged form with larger and deeper lesions

-Labialis
-Intraoral
-Both are associated with recent dental treatment

-Most common form of recurrent HSV infections - “Cold sore” because it often occurs after an UR infection - Reactivation sunlight, trauma and manipulations of the lips, fever, immunosuppression, menstruation and stress/anxiety - Cover with ointment to prevent further spreading and secondary bacterial infection

- Uncommon and often occurs post dental treatment or injections - Most common site is the hard palate over the greater palatine foramen

- Most frequent in infant born during primary HSV infection - Commonly involve the skin, eyes and mouth - Caesarean sections recommended with clincialevidence of active herpes lesions on the cervix or vulva

- Herpes simplex infection on the hand acquired by direct contact with an active lesion - Throbbing pain, high fever, and regional lymphandenopathyof the arm - Systems may incapacitate the patient for 1 or more weeks - Very contagious

-Primary infection- varicella(chicken pox) -Secondary infection- shingles -Herpes virus -Fluid filled vesicles on the skin or mucosa -Mode of contact- inhalation of droplets

- Primary infection of VZV usually acquired in childhood -2 week incubation - Hemorrhagic maculopapularrash with malaise and low grade fever - Lesion progress to pustules and vesicles that rupture and become crusted - If acquired during adulthood cases can be severe and progress into interstitial pneumonia

-Recurrent form of Varicella-Zoster virus - 10-20% of population, more common in elderly and immunocompromised - Trigeminal nerve involvement unilateral face and oral lesions may develop along the opthalmic, maxillary and mandibulardivision of the nerve - Intraoral lesions are sharply unilateral and are fragile vesicle that rupture easily lasting 2-3 weeks - Pains, paresthesia, dyesthesia - Pain may persist for 1+ months after lesions have healed (burning & severe pain) and remain hypersensitive for years and can be highly debilitating - Ramsey-Hunt syndrome- involves 3 conditions of ipsilateralfacial palsy, external auditory canal lesions and loss of taste in the anterior 2/3 of the tongue - Antiviral meds are most effective when started within 72 hours after the onset of the rash

- Herpes virus know to cause infectious mononucleosis, Burkittlymphoma and nasopharyngeal carcinoma - Virus found in HPV in the nose, in AIDS patients in the hairy leukoplakiaof the tongue and lymphomas - Transmitted through saliva - 90% of population carry