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VIRAL INFECTIONS

VIRAL INFECTIONS. HPV – human papillomavirus. - causing subclinical infection or a benign clinical lesions on skin and mucous membranes - have a role in the oncogenesis of cutaneous and mucosal premalignancies and malignancies .

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VIRAL INFECTIONS

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  1. VIRAL INFECTIONS

  2. HPV – human papillomavirus • - causing subclinical infection or a benign clinical lesions on skin and mucous membranes • - have a role in the oncogenesis of cutaneous and mucosal premalignancies and malignancies. • More than 65 HPV types associated with certain clinical lesions.

  3. Clinical manifestations • Incubation period: 2-6 months or more • Warts: skin and mucosal • Three major lesional types: • acuminate (pointed) • papular (sessile) • flat (macular) warts • Transmission: skin-to skin contact

  4. VERRUCA VULGARIS common warts • Firm papules, 1-10mm, hyperkeratotic round, oval, polygonal, with vegetations. • Skin colored or light brown • Hands, fingers, knees,... • Therapy: cryosurgery with liquid nitrogen, electrosurgery, loop excision, CO2 Laser • Th: topical 5-fluorouracil (VERRUMAL liq), podophyllin (WARTEC), keratolytic agents (DUOFILM liq.)...

  5. VERRUCA VULGARIS

  6. CONDYLOMATA ACUMINATA • HPV types 6,11, aslo 16,18,31,33. • Nonsexually and sexually transmitted • Prevalence of HPV inf. in women: 3-28% • Soft pinhead papules to cauliflower-like lesions, skin-colored, pink, red • M: frenulum, glans, prepuce, shaft, scrotum • F: labia, clitoris, perineum, vagina, cervix

  7. CONDYLOMATA ACUMINATA

  8. Pox virus • MOLLUSCUM CONTAGIOSUM - cause by Molluscum Contagiosum Virus MCV -1 and MCV-2 types • is a self-limited epidermal viral infection • Children, sexually active adults • Skin-to-skin contact • Resolve spontaneously

  9. MOLLUSCUM CONTAGIOSUM • Oval, round papules 1 to 5mm with central dimple (umbilication) • Pearly white or skin-colored • Face, eyelids, neck, trunk, anogenital area. • Gentle pressure on a molluscum causes the central plug to be extruded. • Therapy: curettage + iodine!, cryosurgery

  10. MOLLUSCUM CONTAGIOSUM

  11. HSV- herpes simplex virus • HSV 1 and 2 are members of the Herpesviridae family • HSV type 1 - associated with orofacial disease. 30-60% of children are exposed to the virus. • HSV type 2 - associated with perigenital infection. Acquisition of HSV2 correlates with sexual behavior.

  12. HSV type 1 • Cold sores • Gingivostomatitis • Keratoconjunctivitis • Eczema herpeticatum • Whitlow • Disseminated illnesses • About 20% of primary genital infections

  13. Orofacial manifestations • Perioral facial area – lips, nose, chin, cheek • Herpetic gingivostomatitis and pharyngitis • Symptoms: fever, malaise, myalgias, pain on swallowing, irritability, cervical adenopathy. • Erythema, vesicles  erosions  crust, heal without scars • Resolve within 5 to 15 days • Triggerfactors: emotional stress, illness, exposure to sun, trauma, menses, chapped lips, season of the year, UV, trigeminal nerve surgery,....

  14. HERPES OROFACIALIS

  15. Genital herpetic infections • HSV 2 infection, but it may also result from HSV 1 in 10 – 40 % of the cases • Localisation - genital or non-genital areas

  16. Infectivity • Genital herpes spread through sexual intercourse with a partner who has active sores (or cold sore) at the time. • To autoinoculate the virus from one anatomical site to another. • The virus does not survive for any length of time outside the body and transmission via towels or toilet seats is highly unlikely.

  17. Clinical manifestations • Prodromal symptoms – flu-like, fever, myalgia, headache, • Vulval or inguinal pain, dysuria, vaginal discharge, • Erythematous lesions with vesicles  erosions or ulcers.

  18. HERPES GENITALIS - male

  19. HERPES GENITALIS - female diffuse, bilateral confluent erosions and/or ulceration, heal without crusting

  20. Herpetic cervicitis • 80% women • Diffuse involvement of the cervix • May be multiple discrete ulcers • May be necrotic looking

  21. HERPES GENITALIS - cervix

  22. Complications • Viral meningitis • Urinary retention: • voluntary – due to pain on micturation • lumbo-sacral radiculomyelopathy

  23. Congenital and neonatal infections • By transplacental spread is an extremely rare condition  result in foetal death rather than birth defects. • At the time of delivery • After delivery, either from the mother or from infected medical or nursing personnel.

  24. Neonatal herpes

  25. Extragenital herpes • The spread of vesicles to the fingers, mouth and other areas of the body often occurs during the 2nd week of the infection. • These vesicles probably result from autoinoculation.

  26. Extragenital herpes

  27. VZV – varicella-zoster virus • Varicella – an acute, highly contagious inf. • Incubation period – 14 days (10 to 23 days) • In childhood • Systemic symptoms are usually mild • The rash begins on the face and scalp and spread rapidly to the trunk • „dewdrop on a rose petal“

  28. VARICELLA - chickenpox

  29. HERPES ZOSTER • Prodrome: pain and paresthesia in the involved dermatome – may simulate myocardial infarction, duodenal ulcer, cholecystitis, biliary or renal colic,... • Unilateral eruption –does not cross the midline (limited to the area of skin innervated by a single sensory ganglion.

  30. Pathogenesis of Herpes zoster • During the course of varicella, VZV passes from lesions in the skin into ending of sensory nerves and in transported to the sensory ganglia. In the ganglia, the virus establishes a latent infection that persist for life. • When immunity ebbs, viral replication within the ganglia occurs. The virus then travels down the sensory nerve, resulting in initial dermatomal pain followed by painful skin lesions.

  31. Pathogenesis of Herpes zoster

  32. HERPES ZOSTER • Papules  vesicles, bullae  pustules crusts. • Necrotic and gangrenous lesions sometimes occur • Herpetiform clusters of lesions • Erytematous, edematous base

  33. HERPES ZOSTER • Unilateral, dermatomal. Two or more contiguous dermatomes may be involved. - Thoracis : more than 50% - Trigeminal : 10 to 20% - Lumbosacral and cervical 10 to 20% • Disseminated type (varicella-like) – paraneoplastic condition!

  34. HERPES ZOSTER

  35. Cutaneous complications of HZ • bacterial superinfection • scarring • zoster gangrenosum • cutaneous dissemination – paraneoplastic condition

  36. Visceral complications of HZ • Pneumonitis • Hepatitis • Esophagitis • Gastritis • Pericarditis • Cystitis • Arthritis

  37. Neurological complications of HZ • Postherpetic neuralgia • Meningoencephalitis • Sensory loss • Deafness • Ocular complications • Peripheral nerve palsies

  38. Therapy • Acyclovir 800mg tbl 5x day – 5-7 days or 10mg/kg i.v 3x day – 7 do 10 days • or Valaciclovir, Famiciclovir • Analgesisc, antibiotic • Topical therapy –cool compresses, liquid powder, topical antibacterial agents,...

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