CYTOMEGALOVIRUS ULCERSHAND-FOOT-AND-MOUTH DISEASEHERPANGINAMEASLESANDCHICKEN POX
PAGES 240-242CYTOMEGALOVIRUS ULCERS
The main interest in cytomegalovirus ulceration of the oral mucosa is in immunodeficiency, particularly in HIV infection. These ulcers show no specific clinical features but are usually large and shallow and solitary. In the immunosuppressed they heal slowly, and biopsy is usually undertaken to identify a cause. The virally infected cells have typical inclusions in their nuclei and can be identified on immunohistochemistry (see Fig.).Cytomegalovirus infection is treated with the acyclovir analogue ganciclovir or related drugs.
HAND-FOOT-AND-MOUTH DISEASE
The disease is highly infectious and often causes minor epidemics among school children and an occasional parent or teacher. Often in the autumn.(WHY???)The incubation period is probably between 3 and 10 days.
The disease is unrelated to foot-and-mouth disease of cattle.
Hand-foot-and-mouth disease: key features
• Caused mainly by enteric viruses.
• Highly infectious.
• School children predominantly affected.• Typically mild vesiculating stomatitis.
• Vesicles and erythema on palms and soles of feet.• Rarely severe enough for dental opinion to be sought.
• No specific treatment available or needed.• Herpangina is similar but with no rash and fewer ulcers.
HERPANGINA & MEASLES
The presentation is a similar mild viral disease with a cluster of a few larger ulcers usually limited to the soft palate, tonsils or posterior mouth but no rash.As after hand, foot and mouth disease, occasional complications can occur.
In the prodromal stage of measles, toward the end of a 14-day incubation period, Koplik’s spots form on the buccal mucosa and soft palate. These are characteristic pinpoint foci of epithelial necrosis on a red background .
Classically, while these break down into ulcers, the patient develops the typical fever and rash starting on the face.
However, the spots are very variable, have been reported to be absent in vaccinated children and also to occur late in the disease. Recognising Koplik’s spots is therefore very helpful, but the oral lesions require no treatment.
Koplik’s spots in measles(Why is it named Koplik’s?????)
White pinpoint spots on anerythematous background, likened to the appearance of grains of sailt.
Located on the buccal mucosa.
CHICKEN POX
After a 2-week incubation period, there is malaise, nausea, fever, sore throat and the rash appears on the face and trunkproducing intensely itchy blisters that break down into ulcers. The oral lesions are identical and usually appear before the rash and appear like herpes simplex vesicles and ulcers except that they tend to occur on the buccal mucosa& palate.
There are normally only a few lesions,
and