Diseases of the Mouth
A. Herpes simplex; Herpes labialis-(fever blisters and cold sores); primary herpes is a systemic
infection. Have fever, viremia, generalized lymphadenopathy, and goes away; it stays in the
sensory ganglia (dormant in the sensory ganglia) – every now and then it can come out with
stress, menses, whatever, and will form vesicles. Recurrent herpes is no longer systemic – there
is no more fever, and no more lymphadenopathy. Other virus that remain latent – herpes zoster
– remains latent in the sensory ganglia; can involve the skin, lips, dermatomes. So, primary
herpes is systemic, recurrent herpes is not. (No fever = no lymphadenopathy).If we enroot and
stain, will see inclusion in herpes – it is a multinucleated cell with internuclear inclusions. Biopsy
of a multinucleated cell from a pt with HIV, with multiple internuclear inclusions – herpes
B. Hairy Leukoplakia
This is not an AIDs defining lesion, but IS a preAIDs type of infection – as is thrush, shingles.
Located on the lateral boarder of the tongue. Has nothing to do with dysplasia (leukoplakia). It
is a result of an infection from EBV. So, do not get the idea that it is a preneoplastic lesion.
Start seeing this before the helper T cell count get to 200. Rx - Acyclovir
C. Thrush (oral candidiasis)
In an adult, therefore can assume that it is in an immunocompromised patient, where there is a
defect in cellular immunity. In kids (newborns), they can get it from the mom on the way out.
However, it is not a sign of immunocompromise.
So, adult = IC’d
D. Exudative tonsillitis
30% chance that it is group A beta hemolytic strep. 70% chance that it is a virus; adenovirus,
EBV. So, when you see exudative tonsillitis, cannot assume it is bacteria and immediately give
PCN. How do you prove it is group A strep? Latex agglutination test. So, most pus tonsils are
not bacteria. Example: It is group A strep, and 3 weeks later, has bilateral rales, pansystolic
murmur apex radiating into the axilla, polyarthritis – dx?