- Viruses exist on the border line between living and non-living entities.
- They are the smallest obligate intracellular infective agents.
- Viruses lack metabolic activity outside living cells and do not contain cellular organelles.
- Different prokaryotes lack a cell wall, ribosomes, cellular enzymes, binary fission, growth on inanimate objects, sensitivity to antibacterial antibiotics, and nucleic acids DNA and RNA.
- Morphologically, viruses range in size from 20 to 300 nm in diameter, with the smallest being parvoviruses and the largest being smallpox.
- The structure of viruses includes a nucleic acid core (genome), a capsid that envelops the nucleic acid, and an envelope derived from the host cell containing lipoprotein-lipid and virus-coded proteins.
- Viruses can have various shapes, including brick-shaped (poxvirus) and bullet-shaped (rabies).
- Viruses exhibit physical and chemical properties such as heat lability at various temperatures, lipid solubility in substances like chloroform and detergents, and susceptibility to disinfectants and radiation.
- The replication of viruses involves adsorption, penetration, uncoating, biosynthesis, maturation, and release.
- Cultivation methods for viruses include animal inoculation, embryonated egg inoculation, and tissue culture.
- Laboratory investigations to detect viruses include direct demonstration using electron microscopy, immuno-electron microscopy, viral antigen detection using ELISA and RIA, nucleic acid probes, PCR, and antibody detection tests.
- Taxonomy of viruses categorizes them into DNA viruses (such as Poxviridae, Herpesviridae, Adenoviridae) and RNA viruses (such as Orthomyxoviridae, Paramyxovirus, Picornaviridae).
- Routes of virus transmission include the respiratory tract, skin, alimentary and genital tracts, and conjunctiva.
- Viroids are short, circular, single-stranded RNA pathogens found in plants, like those causing Hepatitis D in humans.
- Prions are abnormal protein molecules that reproduce by changing the structure of normal cellular proteins, leading to neurodegenerative conditions like Creutzfeldt-Jakob disease and mad cow disease.- The virus affecting the GI tract causes common cold, pharyngitis, severe acute respiratory syndrome (SARS), and respiratory syndrome.
- The Lab diagnosis for this virus is usually practical since it can be diagnosed clinically.
- The virus can also be found in urine, sweat, and feces, in addition to respiratory droplets.
- Symptoms of this virus may include sneezing, rhinorrhea, mild sore throat, and can peak between 3-4 days and last up to 10 days.
- The RNA virus causing SARS is known to also cause fever, common cold, running nose, malaise, headache, and myalgias.
- Lab diagnosis for SARS involves tests like ELISA, immunofluorescence assays, RT-PCR, and culture using Vero E6 tissue culture.
- Paramyxovirus, known for being highly contagious, typically affects young children aged 3-6 years and can lead to symptoms like coryza, conjunctivitis, and cutaneous rashes, along with oral cavity lesions.
- The Paramyxovirus causing mumps can lead to complications like orchitis, encephalitis, aseptic meningitis, residual deafness, and sudden sensorineural hearing loss. Increased serum amylase is a common lab finding.
- The Paramyxoviridae family, which includes various types of viruses, is associated with diseases like croup, bronchiolitis, and pneumonia, with transmission occurring through person-to-person contact.
- Another RNA virus known for causing various respiratory illnesses, including pneumonia, URTI, bronchiolitis, and tracheobronchitis, can lead to symptoms such as characteristic "seal bark" cough, stridor, and respiratory distress.
- The influenza virus is known for its different subtypes, with important respiratory pathogen being predominant in infants and causing common cold, pneumonia, and other respiratory illnesses.
- The virus causing "avian influenza" has a high mortality rate, primarily transmitted through infected birds' secretions and can lead to symptoms like fever, cough, muscle aches, pneumonia.
- HIV, a retrovirus, uses reverse transcriptase to convert single-stranded RNA into double-stranded DNA.
- HIV infection can cause various symptoms ranging from mucocutaneous ulceration and maculopapular rash in acute illness to opportunistic infections and various ENT manifestations in later stages.
- Hearing loss manifestations in HIV patients can include external ear issues like seborrheic dermatitis and inner ear problems related to CMV, HSV, and HZV infections.
- Different viral infections like Rubella, Mumps, Measles, CMV, and Influenza can lead to sensorineural hearing loss.
- HIV-positive patients with hearing loss can have various middle and inner ear issues like serous otitis media, mastoiditis, and SNHL, which may require high-dose penicillin or other treatments.
- Oral manifestations like oral aphthous ulcers and oral candidiasis are common in HIV patients, requiring specific treatments like topical anaesthetics, antifungals, and steroids.- Plaque: erythematous surface indicating a possible dermatological condition
- Scapping lesion +/-: may require further evaluation for scraping or biopsy to confirm diagnosis
- Rx – systemic ketoconazole, fluconazole: treatment options including systemic antifungal medications
- Hairy leukoplakia: unique to HIV-positive individuals, presenting as white, raised, and corrugated lesions on the tongue and other oral mucosa
- Oral herpes simplex: common manifestation in HIV patients, characterized by fever, blisters, and cold sores, treated with oral acyclovir
- Gingivitis: inflammation of the gum line with potential progression to necrotizing gingivitis/periodontal disease, managed with topical irrigation and antibiotics
- HPV: verrucous flat spiky lesions in the oral cavity, may require surgical excision to prevent recurrence
- Xerostomia: chronic inflammation of salivary glands leading to dry mouth, managed with symptomatic relief and oral care measures
- Kaposi Sarcoma: the most common oral malignancy in HIV patients, often affecting the palate and treated with various approaches including surgery and radiation
- NHL: a poor prognostic indicator with ulcerative lesions in the oral cavity, often requiring chemotherapy or radiation with high recurrence rates
- Laryngeal candidiasis: associated with hoarseness and shortness of breath, diagnosed through various tests like barium swallow and treated with antifungal medications
- Oesophagus: potential sites of HIV-related inflammatory lesions and infections like candidiasis, CMV, and HSV, managed accordingly with antifungal or antiviral treatments
- Salivary glands: implications of xerostomia and potential lymph node involvement, diagnosed with FNAC and CT, managed with radiotherapy or surgery
- Neck masses: common in HIV patients with differential diagnoses including neoplasms like Kaposi's sarcoma or NHL, requiring diagnostic procedures like biopsy and imaging
- Hepatitis viruses: B, C, D, E pose serious health risks and need to be screened and managed with universal precautions
- Viruses and malignancy: viruses like EBV and HPV can lead to different cancers by disrupting normal cell function and growth
COMMON VIRUSES OF ENT & HEAD NECK REGION
VIRUS
Border line b/w living and non living.
Smallest obligate intracellular infective agents .
No metabolic activity outside living cell.
Lacks cellular organelles
Different from prokaryotes-
Lacks – cell wall , ribosomes and cellular enzymes,
no binary fission , no growth on inanimate object ,
no sensitivity to antibacterial antibiotics, lacks nucleic acid – DNA & RNA
Possess – sensitivity to interferon ,
Morphology :
Size : (20 – 300 nm in diameter )
Smallest - parvovirus
Largest – small pox
Structure :
Nucleic acid core (genome)
Capsid : envelops nucleic acid
Envelop : aquired from progeny virus- host cell
lipoprotein- lipid :host cell
protein :virus coded
Shape : brick shaped ( pox )
bullet shaped ( rabies)
Physical and chemical property:
Temperature : Heat labile – 56o C - within secs
37o C - minutes
4o C - days
Lipid solubility : chloroform , ether , detergents (enveloped)
Disinfectant : destroys -
H2O2 , hypochlorite, iodine , formaldehyde
Radiation - sunlight , UV , ionising radiations
Replication : Adsorption (ligand –receptor) -> Penetration( viropexis ) -> Uncoating (lysosomal action) ->Biosynthesis (transcription,translation) ->Maturation -> Release
Cultivation :
a) Animal inoculation – intracerebral, intranasal
b)Embryonated egg inoculation – Chorioallantoic membrane-CAM(pox), amniotic sac, yolk sac, allantoic (inf vaccine prod )
c)Tissue culture – organ (tracheal ring- RSV, corona)
explant
cell culture
Lab investigation :
- Direct demonstration-
Electron microscopy, Immuno-electron microscopy &
Fluoresecent electron microscopy –
paramyxo, orthomyxo, adeno
- Viral antigens- ELISA , RIA , Latex agglutination test
- Nucleic acid probes – enzyme labeled ,radiolabeled
- PCR – HIV 1, HIV 2 , HPV , HSV
- Detection of specific Ab- rise in titre- neutralisation test
complement fixation test
latex agglutination
TAXONOMY OF VIRUSES :
DNA VIRUSES :
Poxviridae (FAMILY ) – variola,vaccinia,cowpox,molluscum , tana ,yata viruses
Herpesviridae – herpes simplex virus –I,II ;varicella zoser virus,cytomegalovirus,epstein barr virus
Adenoviridae – adenovirus
Papovaviridae- Papiploma virus
Hepadnoviridae- hepatitis virus
Parvoviridae – adeno associated virus , parvovirus B – 19
RNA VIRUSES :
Orthomyxoviridae : inf a , b , c virus
Paramyxovirus : parainfluenza 1,3, type 2, 4a ,4b mumps,measles , respiratory syncitial virus
Picornaviridae : polio, echo,coxsackie, hep a , rhinovirus
Rhabdoviridae : VSV , rabies virus
Togaviridae : chikungunya , rubella
Coronaviridae : coronavirus
Retroviridae : HTLV -1, 2 ; HIV 1,2 ;HEP – D
ROUTES OF TRANSMISSION :
Respiratory tract : Inf A,B,C ; parainf , RSV, measles, mumps, rubella, rhinovirus adenovirus,coronavirus,coxsackievirus,VZV,CMV,EBV
2)Skin : herpes simplex, papilloma virus, mulluscum contagiosum ,rabies, arbovirus, HIV and HTLV
3)Alimentary tract
4)Genital tract
5)Conjunctiva – adenovirus
VIROIDS - plant pathogens- consist short stretch of highly complementary, circular, single-stranded RNA without protein coat typical for viruses
IN HUMANS-Hepatitis-D
PRIONS- Abnormal protein molecules
-Reproduce by changing structure normal cellular protein counterparts.
- Neurodegenerative conditions- Creutzfeldt-Jakob disease, Gerstmann-Straüssler disease, kuru, and human bovine spongiform encephalopathy(mad cow disease)
Disease of ENT caused by DNAvirus
Herpes Simplex virus
DNA virus
2 types
Type I – isolates - facial or oropharyngeal lesion.
latent- in trigeminal ganglia & spiral ganglia
Type II – present in genital area,
latency in sacral and lumbar ganglia
Clinical Features:
Gingivostomatitis- Superficial ulcers in gingiva.
Pharynx and tonsils - shallow ulcers.
Cervical LN enlarged
Encephalitis - result in B/L SNHL (permanent).
Diagnosis:
PCR- detect HSV-DNA
ELISA
Treatment:
Symptomatic
Local antiviral cream
Acyclovir, vancyclovir, famicyclovir
Acyclovir- 800mg P/O TDS.
Famicyclovir 500mg P/O TDS.
Varicella Zoster Virus(VZV)
Herpesviridae family
Transmission via respiratory droplets
Diseases
Chickenpox
Shingles
Chickenpox
Common in children.
Clinical features-
Mild fever,
vesicular lesions,
oropharyngitis,
Laryngitis
conductive hearing loss( due to secondary viral /bacterial otitis media)
Treatment
Symptomatic
Antivirals- Acyclovir
Prevention
Live attenuted vaccine
Herpes zoster (Shingles)
Reactivation of Varicella –Zoster virus
Predisposing factor: Immunocompromised status
One dermatome affected
Unilateral
Ulcers in the distribution of dermatome
Mandibular nerve: ulceration of one side of tongue, floor of the mouth, lower labial & buccal mucosa
Maxillary nerve: one side of palate, the upper gingiva, buccal sulcus
Lesions persists for 2-3 wks
Herpes Zoster Oticus (Ramsay Hunt Syndrome)- facial Facial nerve inv- rash on TM / EAC + facial palsy
Ophthalmic Herpes Zoster
Post Herpetic Neuralgia
Diagnosis: clinically
Treatment:
Analgesics,
Antivirals(within 72 hrs of onset of the lesions):acyclovir, famciclovir, valacyclovir, & gabapentin
Epstein Barr Virus(EBV)
Herpesviradae
Transmission – saliva
Diseases:
Infectious mononucleosis (Glandular fever).
Malignancies-
Burkitts lymphoma
Nasopharyngeal carcinoma
NHL
Infectious mononucleosis
Peak age – 15 to 19 years.
Symptoms and signs-
- Fever, malaise, headache, sore throat in 80 %.
- Pharyngitis , ulcers in pharynx.
- Tonsillitis, tonsilar hypertrophy.
-epiglottis.
- Lymphadenopathy (cervical) common
- Skin rashes
- Periorbital edema in 30%.
- Enlarged spleen in 50%, hepatomegaly in 15%.
- Secondary bacterial infection in 30% -GABHS Pharyngitis, meningitis.
Diagnosis:
Peripheral blood smear- lymphocytosis , neutropenia, thrombocytopenia.
Paul Bunnel test +ve 70% to 90%. (heterophilic monospot test). 50% can be negative in children < 4 yrs
EBV specific antibody test- produce antibody against viral capsid antigen (VCA).
Treatment
Most cases are self limiting
For secondary bacterial infection (30%)- antibiotics
Steroid if upper airway infection
Burkitts lymphoma
High grade NHL, arises from B cell Lymphocytes.
Involve childrens & young adults, involve LNs & abdominal organs.
Diagnosis :
Biopsy of tissue.
Treatment:
Chemotherapy (cytorabine/ doxorubicine / cyclophosphamide / vincristine)
Cure rate 80% in localized disease,60% in disseminated disease
Nasopharyngeal carcinoma
South China , Indonesia , Vietnam
Clinical feature:
hoarseness ,dysphonia , rarely air obstruction
- type 6/11 – invasive ca
Treatment:
- Radiotherapy- definitive treatment as tumors are radiosensitive and surgical approach is relatively in accessible location.
- Chemotherapy +radiotherapy for locally advanced disease and recurrent disease.
- Surgery- limited role.
Cytomegalovirus (CMV)
Relatively rare
Herpesviridae
Transmission-saliva,sexual,parental,in utero
HIV infection and immunocompromised
Clinical features: asymptomatic
Oral lesions -nonspecific painful ulcerations- gingiva & tongue
-Enlargement of parotid & submandibular glands, dry mouth, fever, malaise, myalgia, headache
Laboratory tests:
HPE/Immunochemistry
Treatment:
-Resolve spontaneously
-Ganciclovir (Persistent case)
Adenovirus
Double stranded DNA virus- adenoid tissue
45 serotypes
Transmission-aerosol,fecal and oral spread
C/f -Pharyngo conjuctival fever
- b/l conjuctivitis,fever,rhinits,sore throat
-Cervical lymphadenopathy
-Exudative tonsillitis
-Pharyngitits & Pneumonia.
Lab diagnosis- immunofluorescence or ELISA
Rx -Ribavarin.
Disease of ENT caused by RNA virus
Coxsackie virus
Picornaviridae
Two types
Coxsackie virus A
Coxsackie virus B
Diseases caused by Coxsackie virus A
Herpangina
Hand, Foot and Mouth Disease
Herpangina
Common in children
Transmission-fecal-oral
Coxsackie virus group A,
Self limiting vesicular eruptions in the oropharynx
Similar to herpes simplex except the lesions more commonly in oropharynx rather than oral cavity
Diagnosis: Clinically
Treatment: Supportive
Hand, Foot and Mouth Disease
Group A coxsackie
Transmission –Fecal-oral
Epidemics among school children
Vesicles on hands, feet and occ. Buttocks together with intra-oral vesicles and later ulcers
Fever/malaise
Lasts for 1 week
Diagnosis: clinically
Treatment: supportive
Rhinovirus
Picornaviridae
Leading cause – URI
Serotypes – 102
Transmission : aerosol, direct contact
Unable to replicate in GI tract.
Clinical feature:
sneezing ,rhinorhoea,mild sore throat
Peaks – ( 3- 4 days ) – 10 days
Diagnosis: clinical
Rx –symptomatic.
Corona Virus
Large(80-120nm),enveloped, RNA.
3 types.-Group 1,2,3
Causes -
Common cold, Pharyngitis, severe acute respiratory syndrome (SARS),
Lab diagnosis not practical.
Rx –symptomatic.
SARS
SARS-CoV
Transmission-Respiratory droplets
Virus also found in urine,sweat and feces
Clinical feature:
fever,common cold-running nose, malaise, headache, and myalgias followed by in 1–2 days by a nonproductive cough and dyspnea.
Lab-lymphopenia, thrombocytopenia
Diagnosis-ELISA or immunofluorescence assays or
RT-PCR, culture-Vero E6 tissue culture
Rx –ribavarin & supportive care.
Measles (Rubeola)
Paramyxovirus
Highly contagious
Incubation period-14days
Age – 3 – 6 yrs
Coryza, conjunctivitis & generalised cutaneous erythematous rashes
Oral cavity lesions: Pharyngotonsillitis
Koplik’s spot: small, spotty, exanthematous lesions on buccal mucosa
Complications– croup ,otitis media ,SSPE
Vaccination program
Mumps virus
Highly infectious –RNA virus
Paramyxovirus
IP – 2 – 3 wks
Transmission-droplet, closecontact
Onset – fever,malaise parotid enlargment (1-2 d) swelling subsides transient facial nerve palsy
Complications- orchitis, encephalitis , aseptic meningitis,residual deafness , sudden SNHL
Lab diagnosis– increased serum amylase
Rx – vaccination –live attenuated vaccine –MMR dramatic reduction
Parainfluenza virus
Paramyxoviridae
Primary cause – croup , bronchiolitis , pneumonia
Transmission- – Person – Person transfer
Diseases:
children – croup , URTI, bronchiolitis
adults – URTI / pneumonia
Symptom :
“Seal Bark ” cough – harsh cough
-insp stridor, resp distress ,low fever,rhinorrhoea,
Diagnosis:PCR
Treatment
supportive
Respiratory syncitial virus
RNA virus - serotype A /B
Important respiratory pathogen –infancy
Common Diseases –
URTI ,
Bronchiolitis
Pneumonia
Tracheobronchitis
Uncommon – otitis media
Transmission – droplet
contact –respiratory secretions, fomites
Age group : 6 wks – 2 yrs (peak - 6 wks – 6 months)
Clinical features:
low grade fever,
Clear rhinorrhoea,
Tachypnoea
Cough
Expiratory wheeze / hypoxemia
Pneumonia – resp distress ,fever , diffuse intestitial infiltrates
Treatment:
– symptomatic , preventive measures, vaccine - undertrial ,
- Use of steroids / Ribavirin as prophylaxis – (controversial)
Rubella virus (German Measles)
Enveloped RNA virus.
Togaviridae
Transmission-Spread by droplets.
Clinical feature:
Lymphadenopathy, generalized rashes
maternal infection during pregnancy - permanent hearing loss, microcephaly, mental defects, PDA, septal defect in heart,cataract.
Diagnosis:Serology,Antirubella specific IgM
Prevention:MMR
Influenza virus
RNA , Orthomyxovirus
Antigenic Shift / Drift .
Transmission : Droplet ,contact –respiratory secretions
Incubation Period - ( 1- 3 ) days ; peaks 4 weeks ; lasts -10 wks
Clinical features –
fever ,chills, myalgia , headache , sore throat , non productive cough
Children - otitis media , croup , bronchiolitis ,febrile convulsion
Lab Diagnosis: leukocytosis ; viral culture ,rapid Ag detection , serology , immunofluoroscence
Imaging : chest x ray – infiltrate
Treatment:
Adamantines – amantadine ,rimanadine
Neuraminadase inhibitor – zanamivir,oseltamivir
Prevention & Control :
Intranasal sprays(LAV)
Recomendeted for children >5yrs
Bird flu- A(H5N1)
“Avian influenza”
Mortality rate 60%
Transmission-Infected birds -saliva, nasalsecretions, feces and blood
replicate - lower respiratory tract,viral pneumonia
Clinical feature:
fever, cough, sore throat, muscle aches, conjunctivitis, pneumonia
Lab Diagnosis- RT-PCR
Rx- oseltamivir
Swine flu- SIV
influenza A virus subtypes
- H1N1, H3N2 and H1N2 –
Transmission-
Aerosols,droplet infection
Clinical feature: influenza-like illness
fever, cough, sore throat, bodyahes, headache, chills and fatigue.
causes of death -respiratory failure, pneumonia, high fever, dehydration-vomitting & diarrhoea and electrolyte imbalance.
Lab Diagnosis- RT-PCR
Rx- oseltamivir or zanamivir
Vaccine-H1N1/09- nasal mist
Viruses Causing URTI
Common cold
Rhinovirus (1/3rd)
coronavirus
Adenovirus
Influenza A/B
Parainfluenza-type 4
RSV
Pharyngitis : (majority bacterial )
Adenovirus
Enterovirus
Rhinovirus
influenza a/b
parainfuenza
RSV
EBV
HIV
HSV
coxsackie
Acute laryngitis
RSV
Adenovirus
rhinovirus
Influenza
parainfluenza
Acute Rhinosinusitis
Rhinovirus
Adenovirus
Influenza
CMV
Virus causing Sensorineural Hearing Loss
Rubella
Mumps
Measles
HZV
CMV
Influenza
HIV and Ear,Nose,Throat &Head-Neck Diseases
HIV - Retrovirus – RNA based
Uses reverse transcriptase –convert-
( ss RNA – double stranded DNA )
Envelop – gp 120 / gp41 ; gp 120 – CD4 - host cell
Initial infection - -> clinical latency - asymptomatic
50 – 70 % - Ac illness (2-6wks ) – fever, mucocutaneous ulcerationmaculopapular rash ,pharyngitis
6 months – most seropositive fever ,night sweats,chills , diarrhoea wt loss CD4 count decreases opportunistic infection various ENT – Head neck manifestations / Neoplasms (oncogenic viruses )
Otologic manifestations
External ear –
seborrhoeic dermatitis
kaposi’s sarcoma
Seborrhoeic dermatitis :
periauricular / EAC / face/ scalp
Rx : wash with coal tar ,selenium sulphide , ketoconazole, 1 % hydrocortisone lotion
Kaposi’s sarcoma :
Higher incidence in AIDS population
Pinna , EAC +/- conductive loss
Any subcutenous cyst / polyp ( AIDS population) biopsied
Middle Ear :
Serous & Recurrent otitis media infection
Organism – S. pneumonia/ H influenza /M catarrhalis
Nasopharyngeal neoplasms- u/l otitis media
Mastoiditis – S.pneumonia
Inner Ear :
Aural fullness,vertigo,tinnitus, SNHL ( CNS / CN VIII )
SNHL – CMV (congenital deafness ) , HSV , HZV
Otosyphilis – any stage of HIV
Diagnosis - clinical history / aural fullness +/- ; low frequency hearing loss, labyrinthine symptom
Serology : fluoroscent treponemal Antibody absorption test
Treatment:high dose penicillin +/- steroids
Work Up - HIV + with Hearing loss :
1) Detailed history
2) Audiogram
3) Auditory brain stem response
4) Serological treponemal test
5) Imaging: CT
Ramsay hunt syndrome :
- More prevalent – HIV pt & caused-VZV
- Peripheral F .N palsy ,herpetic vesicles ( 7th nerve dermatome ), severe herpetic pain
Diagnosis – clinical + audiogram +electrophysiological test
Treatment – high dose acyclovir / steroids
Exclude Bell’s palsy
Nose and Paranasal sinuses
30 – 68 % HIV population – nasal and sinus manifestations
–(Tami et al ,1992 )
Non paediatric patient + Adenoid hyper – Test for HIV .
Kaposi sarcoma / NonHodgkins Lymphoma nasal obstruction
Kaposi Sarcoma – nasal septum
NHL – sinuses
Sinusitis : similar symptomatology – depends on CD4 count - 1) CD4< 50 /microL Aspergillus
2) Chronic sinusitis – ( CD 4 < 200/microL)
P.aeuroginosa ,S.aureus , Anaerobes
Broad spectrum antibiotics -6wks / cult
Other pathogens isolated – CMV , Microsporidium
Oral Cavity
Oral manifestations : 100 % -HIV patients
1)Oral apthous ulcer :
- (1mm-4cm) solitary/multiple – well circumscribed,+/-exudate erythematous halo
- odynophagia , dysphagia
Treatment– Topical anaesthetics /steroids
- Mile’s mixture (liquid tetracycline, hydrocortisone, viscous lidocaine in orabase with nystatin )
- Topical tetracycline /systemic clindamycin
- Intralesional triamcinolone acetonide (24-48 hrs )
2) Oral candidiasis :
- tender white plaque erythematous surface
- Scrapping of lesion +/-
- Rx – systemic ketoconazole , fluconazole
- topical – nystatin solution
3)Hairy leukoplakia : Unique for HIV +
- Lat border of tongue –white ,raised,corrugated
- Dorsal tongue,buccal,labial mucosa /soft palate
- Rx – no treatment /usually asymptomatic
4)Oral herpes simplex : Herpes labialis – most common
manifestation seen in HIV pt
- fever , blisters , cold sores
- painful bullae ulceration
- Rx – oral acyclovir
5) Gingivitis : -
- erythema – gum line + inflamm & interdental
soft tissue oedema
- easily progress necrotising gingivitis/periodontal disease
- common presentation – bleeding gums .
- Rx – topical irrigation – chlorhexidine gluconate
antibiotic – anaerobic org
6)HPV :
- verrucuos flat spiky lesion–oral cavity
- Often solitary /widespread
- Rx : surgical excision /reoccurrence
7)Xerostomia : Secondary to chronic inflammation of major /minor
salivary glands.
- Coexistent ; dental carries , periodontal disease
-Rx – symptomatic relief ,oral irrigation, saline rinses ,salivary
substitutes , sialogogues
8) Kaposi Sarcoma – Most common HIV-oral malignancy
- majority – palate / (also gingival ,oropharynx )
- Diagnosis – excisional / punch biopsy - Rx – intralesional vinblastine
- sodium tetradecyl sulphate – effective
- Responds well – radiations
- surgical debulking- laser
9) NHL : poor prognostic indicator – disease progression
- ulcerative lesion – red /exophytic
- Involves – gingiva alveolar ridge
- chemo / radiation recurrence common
Pharynx and larynx
Odynophagia ,dysphagia ,chest pain ,retrosternal pain
Laryngeal candidiasis : hoarseness ,shortness of breath
- barium swallow / oesophageoscopy
- biopsy / fibreoptic layngoscopy
-Rx – Amphotericin B or Fluconazole.
Oesophagus : advanced HIV inflammatory lesions
- Organism : candidiasis ,herpetic oesophagitis,
CMV, apthous ulcers
-Oesophageal candidiasis – Rx- fluconazole(2wks)
-CMV -distal part,raised indurated border– necrotic base
- HSV – 5 % cases – Rx- iv acyclovir
Salivary glands :
- Xerostomia
- Parotid gland – Intraglandular lymph node involvment
- nontender swelling u/l ; b/l
- Diagnosis – FNAC + CT
- Rx – Radiotherapy / superficial parotidectomy
NECK :
Majority –HIV – neck mass
-D/d – Neoplasm , Infectious ,HIV lyphadenopathy ,Parotid disease
- Neoplasm- kaposi’s sarcoma , NHL, Sq cell ca
Kaposi’s sarcoma – Defines AIDS ;CD4 <100/micrL
NHL – 2nd most common neoplasm – HIV
- rapidly enlarging non tender neck mass
- fever , night sweats , weight loss
Diagnosis – open biopsy + immunohistochemical staining
Hepatitis Viruses
Many virus causes hepatitis
EBV,CMV,hepatitis A,B,C,D,E
Hepatitis viruses B,C,D can be patently transmitted
Can have serious sequale
Great concern to medical practitioners
Every patient should be screened for Hepatitis B,C
Should follow universal precaution for infected patient
Oncogenic virus
Viruses and malignancy :
Interferes normal cell function & growth - viral DNA incorporates host genome disruption of tumor suppressor gene malignant host cell
Epstein Barr Virus
Nasopharyngeal Ca.
Burkett's lymphoma
B- cell lymphoma
Hairy oral leukoplakia
Human papilloma virus:
Recurrent respiratory papilloma
Condylomata.
