1. بسم الله الرحمن الرحيم

2. VIRAL INFECTIONS

3. Herpes simplex.
Herpes zoster.
Warts.
Molluscum contagiosum.
Small pox / Chicken pox.
Measles / German measles.
AIDS / Infectious mononucleosis.
Roseola infantum / Kaposi sarcoma.
Hand, foot & mouth disease.
Herpangina / Erythema Infectiosum (5th disease).
Orf / Burkitt’s lymphoma.

4. Herpes Simplex (HS) Cause: HSV. Types: I & II. Incidence: Commonest.
Sites: Skin & mucous membranes.
Transmission: Skin-to-skin or skin-to-MM.
IP: 3-5 days.

5. Predisposing factors:
Pathogenesis:
Invades mucosal surface or traumatized skin
Replication Primary infection Neural tissue
(Dorsal root ganglia) Reactivation
Recurrence
Predisposing factors:
Fever / Fatigue / Food.
Trauma / UV /Stress .
Menstruation / Altered immune state.

6. Oral mucosa: 1ry Herpetic gingivostomatitis
Age: 1-5 years.
Subclinical: 90 %.
Clinically apparent: Tongue, pharynx, palate, buccal
mucosa & surrounding skin.
Accompanied by: Fever, sore throat, malaise, loss of
appetite and lymphadenopathy Fever subsides after
3-5 days Recovery after 2 weeks.
Recurrence: Lips or face / Oral mucosa.

7. The lips: Recurrence of primary
Age: Over 5 years.
C/P: Unilateral or bilateral and symmetrical One week No scarring if secondary infection does not occur.
Regional LNs: Enlarged if secondary infection.
The face: Recurrence of primary
C/P: Around orifices & on cheeks.

8. The genitals: Sex: Both sexes. Common cause of: Genital ulceration.
Males: Glans & shaft of penis + Urethritis.
Females: Labia, vulva, vagina, perineum & cervix.
C/P: Local or radiating pain may precede the lesions by 24 hours Intact vesicles Recurrent, irregular, superficial, grouped, soft ulcers Lymphadenopathy.
Recurrent infection: Less severe.

9. Complications:
Serious neonatal infection.
*Neonatal herpes simplex:
Passage of fetus through birth canal
Infection Fatal CS.

10. Diagnosis: Complications: C/P. Tzanck smear. Viral culture.
Serological test.
PCR.
Complications:
Impetigo.
Eczema herpeticum.
EM.
Keratitis and corneal ulcers.
Encephalitis & meningitis.

11. Treatment: Avoid precipitating factors if possible
I) Local ttt: Mild cases
a) Drying, soothing antiseptic lotions:
Boric acid lotion / KMNO4 / Aluminum acetate lotion 10 %.
b) Topical antivirals: Acyclovir cream / Pencyclovir cream.
c) Topical antibiotics.
d) Idoxuridine (IDU).
II) Systemic ttt: Severe cases
a) Acyclovir. b) Valacyclovir. c) Famcyclovir.

12. Herpes Zoster (HZ) Cause: VZV. Sex: Both sexes.
Age: Any age, more in adults.

13. Pathogenesis: Recurrence
1ry is chickenpox Virus in dorsal nerve roots &
dorsal root ganglia Reactivation Nerves
Recurrence.
Predisposing factors:
Trauma.
Drugs.
Diseases of the spine.
Malignant diseases.

14. C/P: Pain Chest: 50 %. Face: Eye involvement.
Unilateral grouped vesicles on erythematous base
along distribution of a sensory nerve Local lymph
nodes Vesicles dry up Recovery after 2-4
weeks May leave scars Permanent immunity

15. Clinical types: Complications: Ordinary vesicular type. Bullous type.
Haemorrhagic type.
Gangrenous type.
Abortive type.
Generalized type.
Complications:
Secondary infections.
Post-herpetic neuralgia.
Nervous system
Eye: HZ ophthalmicus.

16. Treatment: General ttt: Bed rest. Ophthalmology consultation.
Local ttt:
Antiseptic drying lotions: In vesicular stage.
Topical antibiotic ointments: In healing stage.
Systemic ttt:
Analgesics.
Antibiotics.
Systemic acyclovir.

17. Warts (Verrucae) Cause: HPV. Types: 50. Age: Children & young adults.
Sex: Both sexes.
Transmission: Direct / Indirect / Autoinoculation.
IP: 1-6 months.
Involution: 2/3 of lesions within 2 years.

18. Types: Common warts (Verruca Vulgaris): Plane warts (Verruca Plana):
Hands & fingers.
Asymptomatic / Skin-colored or darker / Firm / Rough hyperkeratotic mamillated surface.
Spread.
Plane warts (Verruca Plana):
Face, neck, forearms & hands.
Asymptomatic / Skin-colored or darker / Flat-topped / Smooth & slightly elevated.
Koebner’s phenomenon.
Filliform warts (Verruca Filiformis):
Sides of the neck and eyelids.
Long, thin thread-like skin growths.
Finger-like processes (Digitate warts).

19. Plantar warts (Verruca Plantaris):
Soles of the feet.
Painful & tender / Black / Thick / Flattened & deeply embedded.
Against pressure points.
Venereal warts (Condyloma Accuminata):
Skin and mucous membranes of genital organs of males & females.
Painless / Pinkish / Soft / Moist, foul-smelling & bleed easily.
Differentiated from Condyloma lata.

20. Complications: Spread: To same patient or to others.
Malignancy: HPV 6, 16 and 18.

21. Treatment: Electric cautery. Cryocautery. Chemical cautery:
Carbolic acid / Glacial acetic acid / TCA /
Salicylic acid / Cantharidin
Podophyllin resin: 25 % in alcohol or paraffin.
Autosuggestion & hypnosis.
Surgical excision.

22. Molluscum Contagiosum
Cause: Pox virus.
Transmission: Direct & indirect.
IP: 2-6 weeks.
C/P: Shiny, pearly white, dome-shaped, sessile papules with a smooth surface and central umbilication.
*Squeezing the lesion White cheesy material.
Sites:
Face & neck: In children and young adults.
Genitals, lower abdomen & thighs: STD.

23. Treatment: Electric cautery. Cryocautery. Chemical cautery.
Laser treatment.

24. THANK YOU