Schubert M M
Department of Oral Medicine, School of Dentistry, University of Washington, Seattle.
Curr Opin Dent. 1991 Aug;1(4):384-97.
Viral infections are a significant cause of morbidity and mortality in immunosuppressed patients. It is clear that diseases or medical treatments that have cytostatic or cytotoxic effects on lymphocytes and disrupt cytokine production or activity increase the risk of viral infections. While the rate of viral infection varies with the nature and degree of immunosuppression, it is clear that reactivation of latent virus is the most important determinant of the types of viral infections most frequently noted in immunosuppressed patients result from the reactivation of latent virus. Herpesviruses account for the majority of oral viral infections. Herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus infections nearly always result from reactivation of latent virus, while cytomegalovirus infections, besides presenting as reactivated disease, are almost as likely to present as a primary infection in susceptible hosts. Other viral pathogens potentially of concern in immunocompromised patients are enteric viruses (adenoviruses and coxsackieviruses), human papillomaviruses, and possibly the recently identified human herpesvirus type 6. Ninety-eight percent of herpes simplex virus lesions are caused by reactivated disease and tend to be characterized by large, very painful ulcerative lesions throughout the mouth. Varicella-zoster virus is also rarely seen as primary infection, and the herpes zoster lesions involving cranial nerves can cause significant morbidity, including postherpetic neuralgia, corneal scarring, cranial nerve palsies, and deafness. Distinct oral ulcerative lesions caused by Epstein-Barr virus and cytomegalovirus have only recently been described in detail and are usually associated with disseminated disease. Oral human papillomavirus lesions are noted as warts and condylomas. The contribution of enteric viruses and human herpesvirus type 6 to oral disease in immunosuppressed patients is yet to be determined.
病毒感染是免疫抑制患者发病和死亡的重要原因。显然，对淋巴细胞具有细胞抑制或细胞毒性作用并干扰细胞因子产生或活性的疾病或医学治疗会增加病毒感染的风险。虽然病毒感染率因免疫抑制的性质和程度而异，但很明显，潜伏病毒的重新激活是免疫抑制患者中最常出现的病毒感染类型的最重要决定因素，这些感染是由潜伏病毒的重新激活引起的。疱疹病毒占口腔病毒感染的大多数。单纯疱疹病毒、水痘-带状疱疹病毒和爱泼斯坦-巴尔病毒感染几乎总是由潜伏病毒的重新激活引起的，而巨细胞病毒感染，除了表现为重新激活的疾病外，在易感宿主中几乎同样可能表现为原发性感染。免疫功能低下患者中其他可能令人担忧的病毒病原体是肠道病毒（腺病毒和柯萨奇病毒）、人乳头瘤病毒，以及可能最近发现的人类疱疹病毒6型。98%的单纯疱疹病毒病变是由重新激活的疾病引起的，往往表现为口腔内遍布大的、非常疼痛的溃疡性病变。水痘-带状疱疹病毒也很少见原发性感染，累及颅神经的带状疱疹病变可导致严重的发病率，包括疱疹后神经痛、角膜瘢痕、颅神经麻痹和耳聋。由爱泼斯坦-巴尔病毒和巨细胞病毒引起的独特口腔溃疡性病变直到最近才得到详细描述，通常与播散性疾病有关。口腔人乳头瘤病毒病变表现为疣和湿疣。肠道病毒和人类疱疹病毒6型对免疫抑制患者口腔疾病的影响尚待确定。
