Oral viral infections

Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections

Herpesviruses are medium-sized double-stranded DNA viruses. Of more than 80 herpesviruses identified, only 9 human herpesviruses have been found to cause infection in humans. These include herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cyto-megalovirus (HCMV), Epstein-Barr virus (EBV), and human herpesvirus (HHV-6A, HHV-6B, HHV-7, HHV-8). HSV-1, HSV-2, and VZV can be problematic given their characteristic neurotropism which is the ability to invade via fusion of its plasma membrane and reside within neural tissue. HSV and VZV primarily infect mucocutaneous surfaces and remain latent in the dorsal root ganglia for a host's entire life. Reactivation causes either asymptomatic shedding of virus or clinical manifestation of vesicular lesions. The clinical presentation is influenced by the portal of entry, the immune status of the host, and whether the infection is primary or recurrent. Affecting 60% to 95% of adults, herpesvirus-associated infections include gingivostomatitis, orofacial and genital herpes,and primary varicella and herpes zoster. Symptomatology, treatment, and potential complications vary based on primary and recurrent infections as well as the patient's immune status.

Expression of SARS-CoV-2 entry factors in human oral tissue

The distribution of cells expressing SARS‐CoV‐2 entry factor angiotensin‐converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) in human oral tissues were tested. The investigation was conducted with normal flesh tissue and paraffin‐embedded specimens. The ACE2 and TMPRSS2 expression was detected with all subjects in the normal mucosa of the keratinized stratified squamous epithelia of the tongue and non‐keratinized stratified squamous epithelia of the lip and cheek. It was found that ACE2 is expressed in the cytoplasm and on the cell membrane mainly in the stratum granulosum of the epithelia while the TMPRSS2 is strongly expressed on the cell membrane mainly in the stratum granulosum and stratum spinosum, but not in the stratum basale. Antibodies’ reactions for ACE2 and TMPRSS2 were not observed in the nuclei or keratin layer. The expression of ACE2 and TMPRSS2 in the oral epithelia appears to be general, and the expression was also observed in the mucous and serous acini of the labial glands. The SARS‐CoV‐2 may transiently attach to the oral mucosa and the minor salivary glands which are present under all of the oral mucosa. The oral cavity can be considered an important organ for SARS‐CoV‐2 attachment and may provide a preventive medical avenue to guard against COVID‐19 by preventing saliva from scattering.

Diagnostic methods and management strategies of herpes simplex and herpes zoster infections

Herpes infections are extremely prevalent in the adult population. Recognizing early signs and symptoms is essential to provide effective treatment. The immunocompromised population presents treatment challenges requiring prolonged antiviral therapy and more frequent recurrences. Viral culture is often considered the gold standard diagnostic technique; however, polymerase chain reaction (PCR) should be done in tandem with culture especially for varicella zoster virus infections. Antivirals can decrease viral shedding, recurrences of herpes simplex, and hasten healing of herpes zoster. Herpes virus can be a challenging entity to treat with significant morbidity (both physically and psychologically).

Usefulness of oral cytopathology in the diagnosis of infectious diseases

In recent years, the incidence of oral opportunistic infections has increased, partly due to the widespread implementation of organ and bone marrow transplantation and the increase in the prevalence of human immunodeficiency virus (HIV) infection. Cytology can be used as a rapid, inexpensive and simple routine procedure in diagnosing infectious diseases of the mouth. Moreover, ancillary methods can be applied to cytological samples, increasing the specificity and sensitivity for the diagnosis of infectious diseases. This review describes the cytopathological features of the main viral, fungal, bacterial and parasitic infections of the mouth. Cytological techniques of specimen collection, identification of infectious agents by cytomorphological approaches and ancillary methods, and diagnostic pitfalls will be discussed.

Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management

Eight of the more than 80 known herpesviruses are human pathogens. Human herpes simplex virus (HSV) is a contagious infection with a large reservoir in the general population. It has a potential for significant complications in the immunocompromised host. In addition, psychological distress caused by the negative stigma associated with genital herpes and visible facial lesions in those experiencing frequent outbreaks renders it a challenging clinical dilemma. This article reviews the epidemiology, pathogenesis, and diagnostic features of HSV infections, providing the clinician with an up-to-date understanding of the available management strategies for mucocutaneous HSV-induced disease.

Oral manifestations of sexually transmitted diseases

Sexually transmitted diseases frequently affect the mucous membranes producing characteristic and potentially diagnostic lesions on the oral mucosa. This article reviews the classic route of transmission and the corresponding clinical presentation of several of the sexually transmitted viruses, including herpes virus types I and II, Epstein Barr virus, cytomegalovirus, human papilloma virus, molluscum contagiosum, as well as the human immunodeficiency virus. Bacterial infections such as syphilis, gonorrhea, as well as the fungus candida are reviewed under the umbrella of STDs with potential oral involvement encountered in the sexually active patient.

HPV e carcinogênese oral: revisão bibliográfica

O Papilomavírus humano (HPV) é um vírus ubíquo de DNA, epiteliotrópico, que tem a pele e as mucosas como principais sítios de infecção. Ultimamente, a sua associação com neoplasias benignas e malignas da cavidade oral, principalmente o carcinoma epidermóide, tem sido mais evidente. O seu achado comum em epitélio de mucosa oral normal, amplamente divulgado na literatura, não permite inferências mais precisas quanto ao seu papel na carcinogênese (se agente etiológico principal, coadjuvante ou simples habitante do epitélio de revestimento da mucosa oral). São mais de 100 tipos já identificados, dos quais 24 já foram localizados na cavidade oral. Desses, 4 são particularmente importantes, os tipos 6 e 11 (que estão envolvidos nas lesões benignas do epitélio oral) e 16 e 18 (comprovadamente carcinogênicos e possivelmente envolvidos na etiologia de determinados carcinomas epidermóides orais). A ação desses dois últimos tipos está principalmente associada às oncoproteínas E6 e E7 produzidas pelos mesmos. A E6 liga-se, seqüestra e degrada a p53, importante proteína supressora de tumor. A segunda liga-se e seqüestra a pRb, também supressora de tumor, facilitando a liberação de E2F. Apesar do aprimoramento das técnicas de detecção do HPV nas lesões de mucosa oral, o seu envolvimento direto com os carcinomas orais não foi ainda devidamente comprovado, todavia a sua ação sinérgica com outros carcinógenos químicos e físicos, tais como o fumo e o álcool, em determinados carcinomas epidermóides nos parece o caminho mais correto para explicar a ação do papilomavírus humano na carcinogênese oral.

Acute oral ulcers

In general, a detailed history and examination of the patient provides sufficient information for diagnosis. The pattern, frequency, and natural history of ulcer episodes are helpful. The presence or absence of associated features and the site of oral involvement guides most physicians accurately in the diagnosis. Additional investigations, including blood tests, and occasionally the use of oral cultures or biopsy, are needed to make a definitive diagnosis. A multispecialty approach is often necessary to evaluate patients with other systemic features. Most acute oral ulcers heal spontaneously without specific therapy being necessary, but an understanding of the cause of the ulcer is reassuring to the patient and guides the clinician in management to prevent recurrent episodes of oral ulceration, or chronicity of ulcers.

Viral diseases of the oral mucosa

A wide variety of both DNA and RNA viruses affect the oral cavity. When considered in conjunction with cutaneous features, careful examination of the oral mucosa and oropharynx aids the clinician in making a diagnosis. Examination of the oral cavity should be incorporated as a regular component of the dermatologic examination because diagnostic clues are readily available to assist in the evaluation of infectious processes.