20. Infectious Stomatitis Flashcards
Impetigo: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)?
- Skin infection caused by Strept. pyogenes & Staph. aureus
- Young children face and extremities, facial lesions usually develop around the nose and mouth, poor hygiene, crowded living conditions, hot & humid climate, Previous trauma, abrasions, insect bites, dermatitis, spread by skin contact
- Vesicles that rupture leave light brown “amber” colored crusts “cornflakes glued to surface,” Unlike HSV lesions persist until treated
- Topical or systemic antibiotics - Mupirocin topica, Cephalexin, dicloxacillin.
Scarlet fever: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis often associated with tonsilitis and pharyngitis)
- A complication of Strep-Throat - _Group A, beta-hemolytic streptococc_i
- Children aged 3-12 years, organisms elaborate an erythrogenic toxin that attacks blood vessels, skin rash, fever, palatal petechiae
- “strawberry tongue”
Rheumatic fever: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis often associated with tonsilitis and pharyngitis)
- A complication of Strep-Throat - affects heart, joints, central nervous system, and damages heart valves.
- Children 5-15. Bacterial or viral in origin: group A, beta-hemolytic streptococci.
- Tx: Penicillin, amoxicillin, cephalosporin.
Syphilis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)
- Treponema pallidum.
- Highly infectious. Direct contact with mucosal surfaces. Increased in African Americans, prostitutes and drug abusers. 50-100x higher in US.
- 1˚ - chancre (painless ulcer at site of inoculation), regional lymphadenopathy.
- 2˚ - 4-10 weeks later, mucous patches & “snail track” ulcers, Condyloma Lata - maculopapular rash.
- 3˚ - Gumma - unique necrosis, can be intraorally, glossitis, leukoplakia.
What are the characteristics of congenital syphilis?
- FUSH
- Frontal bossing
- Underdeveloped Mx
- Saddle nose deformity
- High arched palate
What makes up the Hutchinson’s triad?
- Intersitial keratitis of cornea
- 8th nerve deafness
- Dental abnormalities:
- Hutchinson’s Incisors (screwdriver-shaped),
- Mulberry molars
Tuberculosis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)
-
Mycobacterium tuberculosis.
- Acid fast bacillus.
- Primary infection of lungs. Immunodeficiency contributes to spread. Fever, night sweats, fatigue, weight loss, productive cough, hemoptysis.
- “Scrofula” - lymph node invovlement. Oral: chronic painless ulceration usually involving tongue or palate, atypical periodontal disease. Biopsy- show granulomas with central areas of necrosis.
- Tx: Isoniazid & Rifampin
Actinomycosis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)
- Bacterial infection. Actinomyces israelli
- Normal saprophytic anaerobic inhabitant of oral cavity. History of surgery or trauma. 55% of cases occur in cervicofacial areas. Injury, perio pocket, nonvital tooth, extraction socket, infected tonsil. Abscesses and draining sinus tracts.
- Colonies of yellow “sulfur granules.”
- Localized acute infections may be treated more conservatively -removal of infected tissue is sufficient.
Necrotizing ulcerative gingivitis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)
- NUG, ANUG, “trench mouth,”
- Bacillus fusiformis and Borrelia vincetti
- High stress, immunodeficiency or malnourished. Young - middle aged, interdental papilla highly inflammed and hemorrhagic, papilla are blunted with “punched out” necrosis that is covered with gray pseudomembrane. Fetid odor & intense pain.
- Tx: Debridement by scaling or curretage, CHX rinses, antibiotics if fever or lmyphadenopathy is present.
Pseudomembranous candisosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)
- Candidiasis - white material that can be wiped off, tangled hyphae, yeasts, dead epithelial cells & debris.
- Normal or erythematous mucosa underneath, symptomatic, burning sensation to pain. Metallic taste.
Erythematous candidosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)
- “Acute Atrophic” candidosis
- Painful burning sensation, often associated with antibiotics: “antibiotic sore mouth,” usually affects gingiva, loss of filiform papillae on tongue.
Chronic atrophic candidosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)
- “Denture stomatitis, Denture sore mouth,”
- Change limited by mucosa covered by denture and confined to denture bearing tissues.
- Only Mx and in patients who wear dentures 24hrs/day, asymptomatic to symptoms.
Chronic hyperplastic candisosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)
- “Candidal Leukoplakia,”
- Indistinguishable from leukoplakia.
- White lesion that does not wipe off, biopsy if no resolution with antifungal therapy.
Angular cheilitis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)
- Candida about 90%, rest caused by Strep or Staph.
- Erythema or fissuring at labial commissures, Uilat or Bilat.
- Predisposing factors: reduced vertical dimension and accentuated folds at the corners of the mouth.
What are the different deep fungal infections?
- Histoplasmosis
- Coccidiomycosis
- Blastomycosis
- Cryptococcis
- Aspergillosis
What is the subcutaneous fungal infection?
Sporotrichosis
What are the opportunistic fungal infections?
-
Zygomycosis (mucormycosis)
- Often in immunosuppressed/diabetics, biopsy with tissue staining and culture, systemic antifungal medications
Histoplasmosis: Characteristics, typical population and presentation, etiology and treatment (deep fungal stomatitis)
- Most cause primary lung invovlement, somer are more common in certain parts of the US,
- Chronic non-healing intraoral ulcers which can mimic squamous cell carcinoma.
What are the characteristics of Human papilloma virus (HPV)?
- DNA viruses,
- Over 100 types, most adults have buccal epithelial cells containing at least one type, tends to clear in health patients.
- Can be difficult to distinguish between the various lesions of HPV
Papilloma: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)
- Usually HPV subtypes 6 and 11.
- Virus-induced benign proliferation of stratified squamous epithelium.
- Ages 30-50 years. Tongue, lips and soft palate.
- White/red/normal color “cauliflower” shaped exophytic nodule, sessile or pedunculated. Usually small but can be as large as 3cm
Verruca vulgaris: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)
- HPV subtypes 2,4,6,40.
- “Common wart” children, usually on skin of hands, oral mucosa: vermillion border, labial mucosa, anterior tongue.
- Pink/white nodule with rough, pebbly surface, usually less than 5mm
Condyloma acuminatum: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)
- HPV subtypes 2, 6, 11, 53, 54, 16, 18.
- Teenagers and adults. Oral mucosa, larynx, genitalia, soft palate, lingual frenum. Sexual transmission or self-inoculation. Incubation 1-3 months.
- Anogenital condyloma infected with HPV-16 and 18 are associated with increased risk of malignant transformation. Pink to white exophytic mass with short, blunted surface projections. 1-1.5cm as large as 3cm.
- Often occur in clusters
Focal epithelial hyperplasia: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)
- HPV subtypes 13 & 32.
- “Heck’s Disease”
- Multiple soft, flattened papules clustered together.
- Most common in children often malnourished and in poor living conditions.
- 1st described in Native Americans and Eskimos. Labial, buccal and lingual mucosa. Koilocytes and mitosoid cells.
Herpes simplex viruses: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)
- HSV-1 - oral infections
- HSV-2 - genital infections/20% crossover.
- More than 90% of 1˚ infections are asymptomatic.
-
Acute herpetic gingivostomatitis
- Very acute in onset, FEVER, painful gingiva, coalescing vesicles progress to widespread, lesions heal in 1-2 weeks.
- Recurrent Herpes Simples Infection - Occurs in 15-45% of US population, from latency in trigeminal ganglion, stimuli include: old age, UV light, stress, pregnancy, allergy, trauma, illness, dental therap, herpes labialis “cold sore”.
- Prodromal symptoms of pain, burning and tingling. Herpetic witlow (fingers).
- Tx: Acyclovir, Famcyclovir, Valacyclovir
