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Micro Lesson 6- viruses in the dental enviro

Micro Lesson 6- viruses in the dental enviro - Introduction...

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Unformatted text preview: Introduction to Microbiology Lesson 6 Differences between viruses and bacteria As a review, a virus is a small non­living organism that consists of a small segment of nucleic acid and possibly some enzymes that assist it in replication. There are a few main differences between a bacterium and a virus. • Bacteria contain both DNA and RNA as their nucleic acids, a virus has either RNA or DNA, never both. Differences between viruses and bacteria Differences (continued): (continued): Bacteria reproduce by binary fission, viruses replicate by taking over the machinery of the host cell and directing the formation of new viral capsids. Bacteria can be grown on an artificial culture media whereas viruses need a living host cell in order to be grown. Bacteria have a cell wall and are susceptible to antibiotics, and viruses have neither. Viruses have a protein coat that surrounds the enclosed nucleic acid, and because they live inside of the host cell, they are not susceptible to antibiotics. This diagram shows the difference in sizes of some common viruses. • Not only do they have various sizes, but viruses come in different shapes, based on how they were originally formed and how they need to be shaped in order to penetrate the host cell and incorporate their nucleic acid into the host chromosome. Viral structure •The basic structure of a virus is very simple, a small piece of nucleic acid surrounded by a protein coat is called a capsid. DNA capsid protein fiber capsomere • The virus may contain some other enzymes used for entry into the cell and for basic replication functions. capsid core protein Once inside the cell, the viral genome begins to direct the cell metabolism. The cell becomes a factory that produces the pieces necessary to build a new virus. • Once the pieces are synthesized, then they are assembled into a functional virus, ready to infect a new cell. • As the cell builds the new viruses, they are released into the surrounding intracellular space in one of 2 ways: 1. As the number of viruses inside the cell increases, the cell will either allow the viruses to transport through the cell membrane, just like they entered, so that they acquire a cell membrane envelope so they’ll be recognized by the next host cell. (That’s one way they can be released) 2. The second is through cell lysis. As the number of viruses builds inside the cell, eventually the cell cytoplasm gets full and the expanding pressure causes the cell to explode, releasing all the newly formed viral particles. The Essentials on Viral The Hepatitis A Hepatitis Overview What Is Hepatitis A? What Causes Hepatitis A? How Could I Get Hepatitis A? Who Can Get Hepatitis A? What Are the Symptoms? How Is Hepatitis A Treated? How Can I Protect Myself? Hepatitis A (HAV) Hepatitis A is caused by a small single-stranded RNA virus that has no envelope. It is inactivated by ultraviolet light, exposure to water at 100°C for 5 minutes and by exposure to 2% glutaraldehyde for 15 minutes. This is an electron micrograph of HAV that causes hepatitis A. HEPATITIS A VIRUS TRANSMISSION Close personal contact (e.g., household contact, sex contact, child day­care centers) Contaminated food, water (e.g., infected food handlers) Blood exposure (rare) (e.g., injection drug use, rarely by transfusion) low risk associated with transfusion. Transmission of HAVgenerally occurs when susceptible persons put anything in their mouths that has been contaminated with the feces of an infected person. Close personal contact is the most common mode of HAV transmission, as demonstrated by infections among household and sex contacts of persons with hepatitis A and among children in day­care center outbreaks. Contaminated food and water can also serve as vehicles of HAV transmission. HAV transmission can occur when an infected food handler directly handles uncooked or cooked foods. Outbreaks have also been reported in association with foods contaminated before wholesale distribution, such as fresh vegetables contaminated at the time of harvesting or processing. HAV transmission can occur as a result of blood exposure or blood transfusion because viremia can occur prior to the onset of illness in infected persons. HEPATITIS A - CLINICAL FEATURES Jaundice by age group: <6 yrs 10% 6­14 yrs 40 ­50% >14 yrs 70%­80% Rare complications: Fulminant hepatitis Cholestatic hepatitis Relapsing hepatitis Incubation period: Average 30 days Range 15­50 days Chronic sequelae: None The average incubation period The for hepatitis A is 30 days, with a range of 15 to 50 days. Patients characteristically have Patients abrupt onset of symptoms which can include fever, fever malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice (yellowish jaundice discolor of skin) discolor The severity of clinical disease The associated with HAV infection increases with increasing age increases HEPATITIS A - CLINICAL FEATURES Man with jaundice (yellowing of skin and eyes) Courtesy of Centers for Disease Control and Prevention Complications of Hepatitis A include: Fulminant hepatitis, in which the case fatality rate can be greater than 50% despite medical interventions such as liver transplantation; Cholestatic hepatitis, with very high bilirubin levels that can persist for months; and relapsing hepatitis, in which exacerbations can occur weeks to months after apparent recovery. Chronic infection does not occur following HAV infection. The infection is self-limiting and resolves in about 4 months. PREVENTING HEPATITIS A Hygiene (e.g., hand washing) Sanitation (e.g., clean water sources) Hepatitis A vaccine Immune globulin (pre­ and post­exposure) Hepatitis B Virus Hepatitis B is caused by a virus that has a double-stranded DNA, a DNA polymerase and an outer coat. The virus can survive 60o C for 4-10 hours, cannot survive 98o C for any more than a minute, but is stable down to -20o C for years Hepatitis B - Clinical Features • Incubation period: days Average 60-90 Range 45-180 days • Clinical illness (jaundice): <5 yrs, <10% ≥ 5 yrs, 30%50% • Acute case-fatality rate: 0.5%-1% • Chronic infection: <5 yrs, 30%90% ≥ 5 yrs, 2%-10% Geographic Distribution of Chronic HBV I nfection HBsAg Prevalence ≥ 8% - High 2-7% - Intermediate <2% - Low Concentration of Hepatitis B Virus in Various Body Fluids High Moderate blood semen serum vaginal fluid wound exudates saliva Low/Not Detectable urine feces sweat tears breast milk The greatest concentration of HBV is at the gingival sulcus as a result of the continuous serum exudate, which is small in health but greatly increased in diseased states H epatitis B Virus M odes of Transmission • Permucosal – thru sex • Parenteral – thru broken skin • Perinatal – thru childbirth In the United States, the most important route of HBV transmission is by sex contact, either heterosexual or homosexual, with an infected person. Direct parenteral inoculation of HBV by needles during injecting drug use is also an important mode of transmission. Transmission of HBV may also occur by other percutaneous exposures, including tattooing, ear piercing, and acupuncture, and by needle sticks or other injuries from sharp instruments sustained by medical personnel; however, these exposures account for only a small proportion of reported cases in the United States. In addition, transmission can occur perinatally from a chronically infected mother to her infant, most commonly by contact of maternal blood to the infant’s mucous membranes at the time of delivery Hepatitis B surface antigen (HbsAg) indicates the person is a carrier and potentially infective About 2­10% of patients become chronic carriers and are infectious long after the acute illness. Hepatitis B Chronic carriers of Hepatitis can be classified into 2 main groups: 1. Chronic persistent hepatitis 2. Chronic active hepatitis Risk Factors for Acute Hepatitis B United States, 1992-1993 Heterosexual* (41%) Injecting Drug Use (15%) Homosexual Activity (9%) Household Contact (2%) Health Care Employment (1%) Unknown (31%) Other (1%) * Includes sexual contact with acute cases, carriers, and multiple partners. Source: CDC Sentinel Counties Study of Viral Hepatitis Hepatitis B SIGNS & SYMPTOMS: About 30% of persons have no signs or symptoms. Signs and symptoms are less common in children than adults. jaundice fatigue abdominal pain loss of appetite nausea, vomiting joint pain Hepatitis B Vaccine: Fact Sheet First Anti­cancer Vaccine: Hepatitis B vaccine prevents hepatitis B disease and its serious consequences like hepatocellular carcinoma (liver cancer). Therefore, this is the first anti­cancer vaccine. Safe and Effective: Medical, scientific and public health communities strongly endorse using hepatitis B vaccine as a safe and effective way to prevent disease and death. Scientific data show that hepatitis B vaccines are very safe for infants, children, and adults. There is no confirmed evidence which indicates that hepatitis B vaccine can cause chronic illnesses. Post-vaccination Testing After routine vaccination of infants, children, adolescents, or adults post­ After routine vaccination of infants, children, adolescents, or adults post­ vaccination testing for adequate antibody response is not necessary. Post­vaccination testing IS recommended for persons whose medical management will depend on knowledge of their immune status. This includes persons who: are immunocompromised (e.g., hemodialysis patients) received the vaccine in the buttock are infants born to HBsAg (hepatitis B surface antigen)­positive mothers are healthcare workers who have contact with blood are sex partners of persons with chronic hepatitis B virus infection Post­vaccination testing should be completed 1­2 months after the third vaccine dose for results to be meaningful. A protective antibody response is 10 or more milliinternational units (>=10mIU/mL). Hepatitis C Hepatitis C (HCV) is a disease of the liver caused by an enveloped RNA enveloped virus related to the flaviviruses. •It’s transmitted parenterally usually through blood transfusions and contaminated blood. •The incubation period is 2-26 weeks and presents with a mild illness. •Infected persons are HCV seropositive within 6 months of infection. Because of this delay in antibody response donated blood may not be screened effectively. HCV Approximately 30% of patients develop jaundice. It can progress on to cirrhosis and liver failure. Although its mortality rate and symptoms are much lower and less severe than HBV, HCV is just as infectious as HBV and any patient should be treated with caution. Patients at risk for hepatitis C include: blood from a donor who later tested positive for hepatitis C. injected illegal drugs received a blood transfusion or solid organ transplant before July, 1992 recipient of clotting factor(s) made before 1987 long­term kidney dialysis evidence of liver disease (e.g., persistently abnormal ALT levels) Treatment of HCV HCV can be managed with the use of Interferon, Alfa, Aciclovir and Tribavirin. At present, there is no active immunization program for HCV infection. Oral Manifestations of HCV: Possible oral manifestations of HCV infection include: Lichen planus,(LP) oral malignancy and salivary gland disease. LP may be found with other diseases of altered immunity; these conditions include ulcerative colitis, alopecia areata, vitiligo, dermatomyositis, morphea, lichen sclerosis, and myasthenia gravis. Lichen planus on the oral mucosa with ulceration in the center of the lesion appears with whitish papules and plaques in the periphery. An association is noted between LP and hepatitis C infection, chronic active hepatitis, and primary biliary cirrhosis. Oral lesions may be asymptomatic or have a burning sensation, or they may even be painful if erosions are present. Oral ulcerations have the potential to become malignant. Malignant transformation has been reported in ulcerative oral lesions in men. Hepatitis D Hepatitis D is the small delta virus that rides piggy­back on the HBV virus. It is caused by a “defective” RNA virus which coexists with HBV. By itself, it is not infectious and it normally doesn’t travel alone. Hepatitis D virus infection is often severe if it occurs in someone who already has chronic hepatitis B. This acute fulminant form of hepatitis involves severe liver cell destruction and loss of liver function. It can be fatal. Symptoms include: ∙ an enlarged, painful liver ∙ enlarged spleen ∙ severe jaundice ∙ susceptibility to bleeding ∙ encephalopathy, a disorder in the functioning of the brain ∙ aplastic anemia in rare cases. Aplastic anemia is a condition in which the bone marrow cannot make enough red and white blood cells. Chronic liver disease, which may occur with hepatitis D, often has minimal symptoms. At times there may be mild flare­ups with jaundice, nausea, fatigue, and weight loss. Hepatitis D Virus Modes of Hepatitis Transmission Transmission Percutanous exposures • injecting drug use Permucosal exposures sex contact Notes: The modes of HDV transmission are similar to those for HBV, with percutaneous exposures the most efficient. Sexual transmission of HDV is less efficient than for HBV. Perinatal HDV transmission is rare. Incubation period of HDV infection ranges from 2 weeks to 12 – weeks and most infections lead to jaundice. What can be done to prevent the What Hepatitis D infection? Hepatitis Right now, there is no vaccine for Hepatitis D. The best way to prevent the D virus is to prevent hepatitis B. This can be done by getting the hepatitis B vaccine, avoiding unsterile needles, and following safer sex guidelines. Hepatitis E Hepatitis E is a European form of hepatitis that has not traveled to the Americas yet. It is a relatively newly described RNA virus. It’s an infectious form similar to HAV inoculated through an enteric route. Serologic tests are available to detect specific type of Hepatitis including A,B,C,D and E antibodies Hepatitis E Notes: The incubation period following exposure to HEV ranges from 15 to 60 days (mean, 40 days). Typical clinical signs and symptoms of acute Hepatitis E are similar to those of other types of viral hepatitis and include abdominal pain anorexia, dark urine, fever, hepatomegaly, jaundice, malaise, nausea, and vomiting. Other less common symptoms include arthralgia, diarrhea, pruritus, and urticarial rash. The period of infectivity following acute infection has not been determined but virus excretion in stools has been demonstrated up to 14 days after illness onset. No evidence of chronic infection has been detected in long­term follow­up of patients with hepatitis E. Hepatitis caused by HEV is clinically indistinguishable from hepatitis A disease HEV is transmitted primarily by the fecal­oral route and fecally contaminated drinking water is the most commonly documented vehicle of transmission. Virtually all cases of acute hepatitis E in the United States have been reported among travelers returning from high HEV­endemic areas. Diagnosis of HEV is based on serological tests. Prevention and Control Measures for Prevention Travelers to HEV-Endemic Regions Travelers Avoid drinking water (and beverages with ice) of unknown purity, uncooked shellfish, and uncooked fruit/vegetables not peeled or prepared by traveler Hepatitis E usually resolves on its own over several weeks to months. Hepatitis F Hepatitis F was named when several isolated cases of hepatitis were non-parenterally acquired in stool samples of patients in western Europe, India and the United States. It’s a double stranded DNA virus that can cause acute (short term) hepatitis. Hepatitis G Hepatitis G was discovered in 1995 in a serum sample of a 34­year old surgeon. It had genomic sequences that were related to but distinct from HCV. Hepatitis G virus RNA is present in whole saliva of infected individuals, but transmission through this route has not been determined. It was given the name Hep­GB after the initials of the surgeon but it was later shortened to Hepatitis­G. It is not known if HGV can cause clinically significant cases of acute or chronic hepatitis. No vaccine at this time. Measles - Rubeola •Measles is mainly a childhood disease, the most prominent signs being a macular rash and characteristic Koplik’s spots, small red ulcers that appear intraorally at the beginning if the infectious stage of the disease. •It’s usually spread by aerosol into the respiratory tract. •The most infectious stage is associated with coughing and sneezing. The incubation period is 10­12 days. • On the onset of the prodromal stage, the virus is shed in nasal secretions, throat and urine. •The patient will have malaise, fever, copious nasal discharge, cough and conjunctivitis associated with photophobia. •If a woman gets measles while she is pregnant, the risk of miscarriage or premature birth is increased. However, measles infection does not cause birth defects Treatment Overview - Rubeola Rubeola • In cases without complications, measles is treated with bed rest and care at home. Medications that relieve pain and decrease fever, such as nonsteroidal anti-inflammatory medications (Advil, Motrin, naproxen) and acetaminophen (Tylenol, paracetamol), increase comfort A vaccine - combined MMR (measles, mumps and rubella) vaccine can impart immunity for life. Koplik’s spots The white necrotic lesions are Koplik's spots. They resemble small grains of salt. Appear on the oral membranes and mucosal surfaces at the end of the prodromal stage. Koplik’s spots - blue-white spots on the inside Koplik’s of the mouth that occur 24-48 hours before the before rash stage rash Courtesy of Centers for Disease Control and Prevention Measles (Rubeola) pharyngitis in an adult showing striking inflammation Copyright American Academy of Pediatric German measles (Rubella) •German measles is often characterized by mild symptoms and a generalized rash. •It usually occurs in 5­9 year olds and is transmitted through close person to person contact. • The virus is excreted in oropharyngeal secretions and spread by the respiratory tract. •The virus is communicable for 5­7 days before and 3­5 days after clinical signs appear. •The incubation period is 12­21 days. • There’s a non­tender lymphadenopathy that precedes the macular rash that begins on the face and spreads downward. The rash turns reddish­ blue and disappears after 3­4 days. •Treatment is palliative (treat the symptoms to soothe or relieve) with no cure. Rubella is caused by a different virus from the one that causes regular measles (rubeola). Immunity to rubella does not protect a person from measles, or vice versa. The infection frequently causes miscarriage and stillbirth. About 25 percent of babies whose mothers contract rubella during the first trimester of pregnancy are born with one or more birth defects which, together, are referred to as congenital rubella syndrome. Many children with congenital rubella syndrome are slow in learning to walk and to do simple tasks, though some eventually catch up and do well. The March of Dimes recommends that all women be tested for immunity to rubella before they become pregnant, and that they consider being vaccinated at that time if they are not immune. Herpes Simplex The herpes infection is caused by the Herpes simplex virus (HSV). There are two types of HSV: There HSV type 1 most commonly causes sores on the HSV lips, which are known as cold sores or fever blisters. HSV type 2 most often causes genital sores, but HSV both can infect either the mouth or genitals. both Both HSV 1and 2 can produce sores in the genital Both area, around the anal area, on the buttocks and thighs, or where broken skin has come into contact with the virus. HSV remains in certain nerve cells in the body for HSV life, which can case periodic symptoms or outbreaks in some people. Symptoms vary widely. Most people who are infected with either HSV 1 or Most 2 never develop symptoms. never The primary outbreak is usually the most painful. The Symptoms generally appear within 2 - 10 days of 10 exposure and last two to three weeks. Lesions appear after the initial symptoms at the site of infection. These lesions develop into blisters or painful open sores. The lesions then crust over and heal. With a primary episode fever, headache, muscle aches, and dysuria (difficult or painful difficult muscle discharge of urine). discharge Recurrent HSV episodes are usually milder than the primary outbreak. The frequency and severity of recurrent episodes vary greatly. One person may experience only one or two episodes in a lifetime, while another may have several outbreaks a year. While it is not known what causes the reoccurrences, it is thought that stress, illness, menstruation, and sunlight may be precipitating factors. Visual inspection is a very common diagnostic tool used to diagnose HSV. Other tests include viral culture, and an antibody blood test. Since HSV is a viral infection there are no treatments to eradicate the virus. However, there are some antiviral that can be given early during an outbreak that will ease the severity of symptoms. Acyclovir is very widely used and fairly inexpensive. It must be taken five times a day and has some problems being absorbed in the body. Valtrex and Famcyclovir are two newer antivirals. Herpes Simplex – on the hands and fingers called (herpetic whitlow). Herpetic whitlow most commonly affects health care workers. Plastic or rubber gloves can prevent its spread. The herpes simplex virus is also an extremely contagious The extremely microorganism. microorganism. Any part of the body can be infected and the outbreak will look very similar to the picture below. look Herpes Labialis Typical appearance of ruptured vesicles and scabs. Chickenpox Chickenpox (varicella) is a Chickenpox common contagious illness caused by a type of herpes herpes virus. virus. Chickenpox is most Chickenpox common in children and is usually not serious. In teenagers, adults, pregnant women, and people who have impaired immune systems, chickenpox can be more serious. more Chicken pox Chickenpox is transmitted through direct contact and respiratory droplets. Incubation period is usually 7­21 days. • Patient is infectious from 2 days before the rash appears until the vesicles have dried. •Signs and symptoms include a short prodromal period with fever and headache with a red rash appearing. Copyright American Academy of Pediatrics Chicken pox continued: Lesions appear on the trunk, scalp, face, arms and legs over a period of 3 days. Symptoms last about 3­5 days and fever stays in the range of 101oF to 103oF. Usually the disease imparts lifelong immunity, but adults can have a recurrent outbreak of skin eruptions later in life called shingles. Treatment involves relieving the itching, usually by some type of creme or lotion and warm baths Chicken pox Oral lesions of chickenpox are often isolated vesicles that appear on the palate then rupture and leave a painful ulcer with a inflammatory halo. Common cold Common Rhinovirus or Adenovirus Rhinovirus •There are over 110 different varieties of the common cold. •It’s most prevalent in the fall season, usually associated with school openings and in the spring. •It involves all ages and it’s spread by close contact, direct and indirect contact, and is highly communicable. •The incubation period is 1­4 days and the virus is detectable in nasal secretions. Common cold: Common •The disease is characterized by prominent sneezing, nasal obstruction with discharge and headache. •Other mild signs and symptoms include malaise, myalgia, sore throat, hoarseness and cough. •Therapy is directed at relieving signs and symptoms. •No antivirals or vaccines are available. In diseases like chickenpox, measles and german measles, these patients should not be seen in the office until their acute infectious stages have passed. Since these diseases are transmitted indirectly through aerosolized particles, any patient in the office at the time of treatment is susceptible to the virus. Herpes simplex in either form, these patients should not be treated until after the vesicles have crusted and healed. These ulcers are very fragile and easily ruptured, and aerosolizing the viral particles can put everybody in the office at risk. Protect yourself and your patients Protect With the different forms of hepatitis, HAV, HEV, and HFV, there is no chronic carrier state so once the disease has resolved, the patient is no longer infectious. With HBV, HCV, HDV and HGV, since there is a chronic carrier state, infectious patients should not be treated for routine elective dental treatment. Any patient showing suspicious signs of hepatitis or with a prior history of hepatitis should be referred for evaluation. Basic universal standards should be taken, and with infectious patients, care should be taken not to aerosolize any blood or secretions. Use of air syringes, ultrasonic scalers, and handpieces should be avoided. Any staff personnel that has patient contact should be immunized against hep­B and have their serum titre checked on a regular basis. AIDS (Autoimmune Deficiency) Two of the most popular infectious diseases we need to be aware of in dentistry are hepatitis and the virus that causes AIDS, HIV. HIV stands for Human Immunodeficiency Virus and since it was first discovered in the 1980s, it has become one of the scariest stigmas associated with relationships in history. The HIV virus is an enveloped retrovirus with an RNA strand and a reverse transcriptase. The virus attacks T­helper cells and macrophages which eventually shuts down the immune system and makes the patient subject to a number of opportunistic infections. T­helper cells stimulate B lymphocytes as well as other T cells and macrophages, so the overall effect is a dampening of the immune response that leads to an increased susceptibility of AIDS patients to many opportunistic infections. After a period of inoculation, the virus can eventually be found in every cell of the body, but it has a propensity for the cells of the liver. The patient will develop signs and symptoms such as low-grade fever, swollen lymph nodes, night sweats and general malaise. The disease goes through a latency period of 10-14 years before the patient shows major signs and symptoms. The virus is transmitted through blood and blood products, direct mucous membrane contact, genital discharges and congenitally from mother to fetus. There are some antiviral medications that can slow the progression of the disease and inhibit replication of the virus, but the only cure for AIDS before infection is abstinence before marriage and a monogamous relationship by both man and woman after marriage. If an infected person continues with sexual activity using latex condoms, transmission of the virus can be halted by the prophylactic but remember that condoms fail 16% of the time. That's only 1 time in 6. A final diagnosis of AIDS is made when the blood shows presence of the HIV antibody, the T­helper cell count drops below 200 cells/mm3 or signs of one of 37 life­threatening opportunistic infections appears. HIV to AIDS When a patient is infected with HIV, their body begins to lose the ability to defend itself against infection. The virus infects certain white blood cells of the immune system called T-helper cells. These cells are in charge of regulating the immune system and when they don't function properly, the immune system cannot defend itself against many infections. Because a patient is infectious with HIV from the moment they are exposed to the virus, we need a way to know how sick a person is with HIV. We measure their health in 2 ways, by measuring the number of T-helper cells the patient has in their blood, or by evaluating the number and types of opportunistic infections the patient gets. Once the T-helper cell count drops below 200 cells per cc of blood, or if the patient shows certain infections such as candida inside the esophagus or specific pneumonia strains, then the patient is diagnosed with AIDS Virus Replication Between the time the patient is infected with the virus until they are diagnosed with full­blown AIDS, they are referred to as patients with AIDS­ Related Complex, or ARC. These patients exhibit various clinical and laboratory manifestations of HIV infection and are as infectious as the day they were first inoculated with the virus. They exhibit persistent, generalized lymphadenopathy associated with fever, fatigue and weight loss. This is a prodrome to the development of the opportunistic infections and neoplasms that characterize AIDS. Dental management of patients with AIDS As far as we're concerned in the dental office, handling AIDS is easier than hepatitis. HIV is not a virulent as hepatitis, and is easier to kill on dry counter tops and surfaces. Most hospital grade disinfectants will kill HIV without complications, but HBV has to be sterilized to be destroyed. HIV needs a moist environment to be able to survive, so once a counter top or chair has been wiped down with a disinfectant and allowed to dry, the possibility of transmission of HIV no longer exists. HBV has a much longer life span and is much harder to destroy, so with HBV, the best treatment is prevention. Legislature states we cannot refuse to work on a patient infected with HIV using only his HIV­antibody as a reason, so if we find ourselves with an HIV­infected patient is our chair, it's up to us to provide the protection we need to break the spread of the virus from the patient to others. Proper universal precautions and PPE are required, and meticulous review of the medical history is a must. Consultation with the patient's medical physician should be sought, if the patient is under medical care, else the patient may need referral to an appropriate health care provider for diagnostic work­up. It's important for us to know the status of the patient and the meds they may be taking. Most patients that are HIV+ know their current status, and can probably even tell us their CD4 count and viral load. HIV status is a confidential matter and sharing it with anybody, not just a staff member, who doesn't need to know is a breech of the doctor­ patient confidentiality rule and against the law. Oral complications of AIDS As a disease, it's important for us to recognize some of the oral pathology we may encounter in an infected patient, or in a patient who is undiagnosed. Overgrowth of resident fungal infections are a primary sign of a compromised immune system. Candidiasis overgrowth in the posterior pharynx is a diagnostic indicator of full­blown AIDS. Kaposi's sarcoma which is a malignant tumor of connective tissue has become almost pathognomonic of a patient having AIDS. Recurrent herpes, warts or aphthous ulcers can be a tip­off of a compromised immune system, as can aggressive periodontal disease (ANUG) or idiopathic xerostomia. Oral Manifestations of AIDS Candidiasis Human Papillomavirus (HPV) Ulcerative disease (apthous ulcer) Kaposi’s sarcoma Hairy leukoplakia Progressive periodontal disease ­ ANUG Xerostomia (dry mouth) without reason Candidiasis Esophageal candidiasis Human Papillomavirus (HPV) Virus Hairy leukoplakia Hairy Leukoplakia HIV – Apthous ulcer Acute Necrotizing Ulcerative Gingivitis – Acute ANUG - HIV ANUG Acute necrotizing ulcerative gingivitis - ANUG 10 days of Metronidazole with 10 Amoxicillin and Chlorhexadine Amoxicillin Kaposi’s sarcoma Kaposi’s sarcoma Recurrent herpes Since AIDS is not a disease that can be cured, then the progression of the disease must be slowed. Promiscuous unprotected sexual encounters are a prime method by which the virus is spread. Although the disease originally began in the homosexual population, it has become a disease more of heterosexual adults. Over the past 20 years since AIDS was discovered, the emphasis has moved from the male­male relationship and it's become more of male­female disease. The disease is not specific for who it infects and in the end, it is always fatal. Nobody dies of AIDS, they die from the opportunistic infections that result from having AIDS. Protection from the virus involves not coming in contact with a surface that harbors the virus, like mucous membranes or blood from an individual at high risk of having the virus. Since you can't tell by just looking at someone if they have AIDS, then discretion is the better part of valor. Protect yourself and your patients: Protect Practice…. Practice…. Universal standards Hospital grade disinfectants Proper disposal of biohazardous wastes and sharps Proper patient barriers Disposables as much as possible Vocabulary review: Percutanous ­ effected through the skin. Permucosal – effected through the mucous membrane lining all body cavities or passages that communicate with the exterior Perinatal ­ the period around childbirth, especially the five months before and one month after birth Enteric - passed from one person to another through food, water, or objects that are contaminated with stool from an infected person. Congenitally – existing at birth Reading Assignment: Microbiology for the Health Sciences Chapter 17 Major Viral, Bacterial and Fungal Diseases of Humans pp. 447­516 ...
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