19- Infections Flashcards
What are the 3 types of infectious diseases that exist?
1.) Bacterial infections
2.) Fungal infections
3.) Viral infections
What is impetigo?
It is a type of bacterial infection which affects the superficial surface of the skin.
Arises in areas of damaged skin.
What are the causes of impetigo?
1.) Streptococcus pyogenes
2.) Staphylococcus aureus (infections from open wounds)
What are some characteristics of impetigo?
1.) More common in children
2.) Very contagious
3.) It is preceded by a herpes simplex infection (cold sores)
4.) Can appear to look similar to herpes infections
What does impetigo usually present it self like?
Usually like a blister or yellow adherent yellow crust
What are the treatment options for impetigo?
- Antibiotics (cloxacillin or clindamycin) oinment like treatment.
What is streptococcal pharyngitis?
Also known as a sore throat but is caused by streptococcus bacteria and is more serious
* It is mostly viral and self-limiting
What are the clinical findings of streptococcal pharyngitis?
1.) Fever, headache, malaise
2.) Dysphagia (pain upon swallowing)
3.) Erythema of the pharynx (redness of pharynx)
4.) Lymphadenopathy (swelling of lymph nodes)
**Possible side effect is Scarlet Fever
What is the result of Scarlet Fever?
It comes from group A streptococcus infection
How does Scarlett Fever present itself?
Initially as a white strawberry tongue. White colour will disappear in a few days and will exhibit a strawberry tongue
How can streptococcal pharyngitis be diagnosed?
Through a throat swab.
What can untreated streptococcal pharyngitis lead to ?
It can lead to rheumatic fever. A cross reactivity reaction. Which is type II hypersensitivity
How is Streptococcal Pharyngitis treated?
It is treated through a Penicilin, which targets the bacteria
What is Syphilis?
It is an STI infection (bacterial) which is caused by spirochetes (worm-like bacteria)
What is the spirochete bacteria called that causes Syphilis?
Treponema pallidum
How many stages of Syphilis exist?
3 stages + congenital syphilis
What is the first presentation of syphilis? (primary syphilis)
1.) It exhibits as chancre, which is a painless, indurated ulcer commonly found on the genitals but can arise on the oral mucosa
2.) Can exhibit a painless regional lymphaedenopathy (hardening of the lymph nodes)
3.) Very contagious
4.) Spontaneously resolves in 3-12 weeks
How can the causative spirochetes of syphilis be seen?
In a dark-field microscopy on a smear.
- Also with a VDRL (Venereal disease Research Laboratory) test
*Warthin-Starry stain
What occurs in the secondary presentation of syphilis?
1.) Flu-like symptoms
2.) Mucous path involving the oral mucosa
3.) Maculopapular rash on the body (flat lesion & bump like appearance)
4.) Very contagious (like primary)
What occurs in the tertiary stage of syphilis?
1.) Not very contagious
2.) Can occur years after the second stage
3.)Can pose serious concerns including neurological involvement & cardiovascular manifestations
What are the oral manifestations of tertiary syphilis?
1.) Syphilllitic glossitis: a thickened white plaque on the tongue dorsum
2.) Gumma: a destructive granuloma that usually involves skin but can involve oral mucosa. It most commonly involves the palate. Can be destructive
What occurs in Congenital Syphilis?
1.) The spirochete treponema pallidum can cross the placenta and infect the fetus in the 3rd trimester
2.) Leads to a symptom known as Classic Hutchinson’s Triad
What are the 3 pre-disposing symptoms of Classic Hutchinson’s Triad
1.) Interstitial keratitis (eye inflammation)
2.) 8th nerve deafness
3.) Mulberry molars and Hutchinson’s Incisors (dental anomalies & nothing of the incisors)
What causes Tuberculosis?
It is due to mycobacterium tuberculosis. It occurs prior to the pasteurization of milk, and oral lesions secondary to bovine TB were common.
How is Tuberculosis spread nowadays?
Either from blood or from direction implantation from infected sputum
What are the 2 main forms of TB?
1.) Primary infection
2.) Secondary infection
How does primary infection of TB typically occur?
Occurs in previously unexposed people. It primarily affects the lungs.
How does secondary infection of TB typically occur?
Occurs in 5-10% of patients due to immunosuppression.
What are the common oral sites in which Tuberculosis can affect?
1.) The palate and gingiva
2.) Lymph nodes often involved
What are the clinical presentations of tuberculosis?
1.) Chronic, painless ulcer or nodule
2.) Can look similar to OSCC
In Tuberculosis if there is oral involvement, there is also _____ involvement
Lung involvement
What are the diagnostic methods of Tuberculosis?
1.) If it stains positive with a Ziehl-Nielsen stain (will be able to pick up TB)
2.) Identification of an acid-fast bacili
What are the treatment options for Tuberculosis?
Antibiotics for a very strict and long regimen.
What is the etiology of Actinomyocosis?
1.) It is a filmentaous, gram-positive branching of anaerobic bacteria (bacteria that does not want exposure to oxygen)
What is the bacteria of Actinomyocosis known as?
It is known as Actinomyces israelii
How does Actinomycosis present itself?
It presents itself as a draining facial fistula (Starts in the mouth and drains into the skin)
How long does an Actionmycosis last?
It may last weeks or months, especially if we don’t get the root cause
What kind of bacteria is an actinomycosis?
It is a normal oral, commensal bacteria that can be found in necrotic pulp canals (meaning it can become pathologic - dead teeth can arbour this infection)
How does actionmycosis often spread?
It is often spread from necrotic tooth after trauma or a difficult dental extraction
What are the small yellow substances expelling from the pus draining from an actinomycosis lesion?
Sulphur granules
What is the treatment of actinomycosis?
surgical debridement + high dose antibiotics
What is zygomycosis?
It is a type of fungal infection in which fungus grows in decaying organic materials
What class of fungus does the zygomycosis infections come from?
The zyogmycetes class of fungus
In what kind of people does zygomycosis exacerbate?
1.) In uncontrolled diabetics
2.) In immunocompromised patients
What are indication of zygomycosis histologically?
large, non-septate fungal hyphae
What occurs if zygomycosis is left untreated?
1.) Involvement of orbit and loss of vision (spread through the eyes = loss in vision)
2.) Possible intracranial spread
What treatments are used in zygomycosis?
1.) Surgical debridement
2.) IV antifungal medications
- Needs to be treated early and aggressive
What is oral candidiasis?
It is a fungal infection caused by Candida Albicans
What are the two forms of candidiasis?
1.) Yeast form
2.) Hyphal form
What is the non-pathologic form of candidiasis?
Yeast form
- normal in 50% of people
- not pathologic
What is the pathologic form of candidiasis?
Hyphal form
- Disease form
- Invades tissues
What is the most common clinical presentation of candidiasis?
Erythematous (atrophic) = most common and classic presentation of candida.
What does pseudomembranous mean in candidiasis?
Has a white plaque appearance (thrush)
What are the causes of Pseudomembranous Candidiasis?
1.) Antibiotic use
2.) Immunosuppression (leukemia, AIDS, uncontrolled diabetics etc)
3.) Xerostomia
4.) Corticosteroid use (inhaler)
5.) Poor denture hygiene
What is erythematous (atrophic) candidiasis?
When the tissue has a burning or tender appearance to it. The tissue is erythematous. It is the most common form of candidiasis.
What is angular cheilitis?
A form of perioral candidiasis (meaning it is around the mouth/corner of the mouth)
What are the clinical presentations of Angular Cheilitis?
1.) It is cracking at lip commissures
2.) Often tender/painful
3.) Where patients have intraoral candida as well
For diagnosis of Candidiasis, why is a cytology smear more efficient than a culture?
Because a culture can identify candida that is NOT pathologic, leading to a high false positive rate
What are the treatments used for candidiasis?
1.) Antifungal medications
2.) Nystatin, Fluconazole - most common used for oral infections.
What is Herpes Simplex Virus?
It is a viral virus due to the HSV-1 & HSV-2.
Which herpes virus variant is more associated with oral lesions?
HSV-1
Which herpes virus variant is more associated with genital herpes?
HSV-2
What are the 2 main presentations of the Herpes Simplex Virus?
1.) Acute herpetic gingivostomatitis
2.) Recurrent herpes infections
What is the more common presentation of the Herpes Simplex Virus?
Recurrent herpes infections
Which presentation of Herpes Simplex Virus is more apparent in kids?
Acute herpetic gingivostomatitis. Minority of patients actually exhibit this full blown response.
Which presentation of Herpes Simplex Virus is more apparent in adults?
Recurrent herpes infections
How is HSV-1 spread?
It is spread through saliva and vesicles (acute herpetic gingivostomatitis). It represents first contact with HSV virus.
What is the incubation range for acute herpetic gingivostomatitis?
Days to 2 weeks.
What is prodrome?
It is a fever, headache and lymphadenopathy which come from Acute Herpetic Gingivostomatitis.
Acute Herpetic Gingivostomatitis involves ____ and _____ mucosa as well as _______ skin
Unattached, attached & perioral
What do patients exhibit in acute herpetic gingivostomatitis?
Bright red gingival erythema & vesicles which subsequently ulcerate
How many days does it take for the primary infection to self-limit and resolve itself?
7-10 days
*Antivirals can used if within the first 3 days
* Pain control to help patients as it resolves on it own
Where does the HSV virus migrate to? (hint: it remains latent in this ganglion)
In the trigeminal nerve. This is why we have recurrences throughout our lives, the virus is with you for life.
What is the most common form of recurrent infection?
A recurrent herpes labialis (RHL), involving lip vermilion.
What are the triggers of recurrent herpes simplex?
Sunlight, stress, certain foods.
*May trigger erythema multiforme.
What are the treatments used for recurrent herpes simplex?
1.) Antivirals
2.) Acyclovir or valacyclovir (Valtrex)
Where does recurrent intraoral herpes occur?
in the mouth from HSV-1.
Where is the most common area of recurrent intraoral herpes?
The palate or gingiva. The lesion is involved with the attached mucosa (keratinized mucosa)
What are the treatments used for recurrent intraoral herpes?
Antiviral medications
What are the diagnosis methods for Herpes Simplex Virus?
1.) Viral culture
2.) Cytology
3.) Biopsy
What is Varicella Zoster Virus? (HHV-3 OR VZV)
It is the virus responsible for chickenpox (varicella) and for shingles (zoster)
What is the initial symptoms of varicella-zoster virus?
Fever, malaise, headache, and vesiculopustular rash
What occurs after chickenpox is resolved?
The virus remains dormant in the sensory nerve ganglia.
What do shingles represent?
It is a recurrence of the virus which increases with age.
What are unique features of shingles?
1.) It has a dermatomal distribution, which means it will be strictly limited to one side of the body.
2.) It follows a 1 attack rule (has multiple recurrences)
What can trigger Shingles?
1.) Chemotherapy
2.) Malignancy
3.) Immunosuppression
4.) Old age
What are the oral manifestation of shingles?
1.) Multiple vesicles noted on attached mucosa
2.) Stops at the midline
What are the possible long-term side effects of shingles?
1.) Postherpetic neuralgia: chronic neuropathic pain
2.) Ramsay Hunt Syndrome: Facial paralysis (7th nerve drop), vertigo
What are the treatments used for varicella zoster virus?
1.) Antivirals medications
- Only effective if used early in the infection.
What is Epstein Barr Virus? (EBV OR HHV-4)
It is known as the infectious mononucleosis “kissing disease”
What are the other EBV diseases?
1.) Oral hairy leukoplakia
2.) Lymphoma
3.) Nasopharyngeal carcinoma
What is cytomegalovirus? (CMV or HHV-5)
- It is an oral lesion which can proliferate into oral ulcers in immunocompromised patients
- Xerostomia
- Sialadenitis
What is Coxsackie virus?
It is a viral virus responsible for
1.) Hand-Foot-Mouth disease
2.) Herpangina
3.) Acute lymphonodular pharyngitis
Who and where are the Coxsackie virus more prevalent in?
1.) In children.
2.) Oral lesions anterior to first molars.
3.) lesions involving feet and hands.
What is the treatment needed for Coxsackie Virus
There is no treatment used for Coxsackie Virus.
What is HIV?
It is known to be as the Human Immunodeficiency Virus, which is an RNA retrovirus.
What determines the severity of the HIV virus?
The CD4 count. The lower the CD4 count, the worst you are off
What is the last stage of HIV infection?
AIDS (acquired immunodeficiency syndrome)
How many attack of varicella zoster virus can you have?
1 is the rule, unless you have recurrences
