VIRAL INFECTIONS HPV human papillomavirus causing subclinical infection

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. More than 65 HPV types associated with certain clinical lesions.

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

VERRUCA VULGARIS common warts Firm papules, 1 -10 mm, hyperkeratotic round, oval, polygonal, with vegetations. Skin colored or light brown Hands, fingers, knees, . . . Therapy: cryosurgery with liquid nitrogen, electrosurgery, loop excision, CO 2 Laser Th: topical 5 -fluorouracil (VERRUMAL liq), podophyllin (WARTEC), keratolytic agents (DUOFILM liq. ). . .

VERRUCA VULGARIS

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

CONDYLOMATA ACUMINATA

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

MOLLUSCUM CONTAGIOSUM Oval, round papules 1 to 5 mm 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

MOLLUSCUM CONTAGIOSUM

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 HSV 2 correlates with sexual behavior.

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

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 Trigger factors: emotional stress, illness, exposure to sun, trauma, menses, chapped lips, season of the year, UV, trigeminal nerve surgery, . .

HERPES OROFACIALIS

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

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.

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

HERPES GENITALIS - male

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

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

HERPES GENITALIS - cervix

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

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.

Neonatal herpes

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

Extragenital herpes

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“

VARICELLA - chickenpox

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.

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.

Pathogenesis of Herpes zoster

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

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!

HERPES ZOSTER

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

Visceral complications of HZ Pneumonitis Hepatitis Esophagitis Gastritis Pericarditis Cystitis Arthritis

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

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