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Oral Path Exam 5 Objectives > 20. Infectious Stomatitis > Flashcards

20. Infectious Stomatitis Flashcards

1
Q

Impetigo: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)?

A
  • 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.
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2
Q

Scarlet fever: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis often associated with tonsilitis and pharyngitis)

A
  • 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”
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3
Q

Rheumatic fever: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis often associated with tonsilitis and pharyngitis)

A
  • 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.
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4
Q

Syphilis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)

A
  • 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.
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5
Q

What are the characteristics of congenital syphilis?

A
  • FUSH
    • Frontal bossing
    • Underdeveloped Mx
    • Saddle nose deformity
    • High arched palate
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6
Q

What makes up the Hutchinson’s triad?

A
  1. Intersitial keratitis of cornea
  2. 8th nerve deafness
  3. Dental abnormalities:
    1. Hutchinson’s Incisors (screwdriver-shaped),
    2. Mulberry molars
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7
Q

Tuberculosis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)

A
  • 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
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8
Q

Actinomycosis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)

A
  • 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.
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9
Q

Necrotizing ulcerative gingivitis: Characteristics, typical population and presentation, etiology and treatment (bacterial stomatitis)

A
  • 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.
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10
Q

Pseudomembranous candisosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)

A
  • 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.
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11
Q

Erythematous candidosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)

A
  • “Acute Atrophic” candidosis
  • Painful burning sensation, often associated with antibiotics: “antibiotic sore mouth,” usually affects gingiva, loss of filiform papillae on tongue.
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12
Q

Chronic atrophic candidosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)

A
  • “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.
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13
Q

Chronic hyperplastic candisosis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)

A
  • “Candidal Leukoplakia,”
  • Indistinguishable from leukoplakia.
  • White lesion that does not wipe off, biopsy if no resolution with antifungal therapy.
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14
Q

Angular cheilitis: Characteristics, typical population and presentation, etiology and treatment (fungal stomatitis)

A
  • 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.
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15
Q

What are the different deep fungal infections?

A
  • Histoplasmosis
  • Coccidiomycosis
  • Blastomycosis
  • Cryptococcis
  • Aspergillosis
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16
Q

What is the subcutaneous fungal infection?

A

Sporotrichosis

17
Q

What are the opportunistic fungal infections?

A
  • Zygomycosis (mucormycosis)
    • Often in immunosuppressed/diabetics, biopsy with tissue staining and culture, systemic antifungal medications
18
Q

Histoplasmosis: Characteristics, typical population and presentation, etiology and treatment (deep fungal stomatitis)

A
  • 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.
19
Q

What are the characteristics of Human papilloma virus (HPV)?

A
  • 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
20
Q

Papilloma: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)

A
  • 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
21
Q

Verruca vulgaris: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)

A
  • 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
22
Q

Condyloma acuminatum: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)

A
  • 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
23
Q

Focal epithelial hyperplasia: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human papilloma viruses)

A
  • 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.
24
Q

Herpes simplex viruses: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • 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
25
Q

What do 5-30% of patients have in their saliva?

A

They will asymptomatically excrete and will have HSV DNA in their saliva.

26
Q

Varicella-zoster virus: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • HHV-3.
  • Chickenpox - 1˚ infection usually in children 5-9 years, 10-21 incubation period, erythema - vesicle - pustule - hardened crust on skin and mucous membranes, recovery in 2-3 weeks, VZV vaccine.
  • Herpes Zoster “shingles” - reactivation of VZV, usually in adults, prodromal phase - intense pain, fever malaise, headache, unilateral eruption of vesicles along the distribution of a sensory nerve classically stops at midline,
  • POSTHERPETIC NEURALGIA - may take months to resolve. “Ramsay Hunt Syndrome” - infection of external auditory canal with involvement of the ipsilateral facial and auditory nerves producing facial paralysis, hearing deficits and vertigo.
27
Q

Epstein-barr virus: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • Infectious Mononucleosis “kissing disease” - close contact or saliva transmission, sore throat, fever, lymphadenopathy, tonsilitis, fatigue, enlarged spleen,
  • Petechiae on hard/soft palate as prodome, presence of heterophil antibody and elevated white blood cell count. Self-limiting in 4-6 weeks,
  • Tx is symptomatic.
28
Q

Hairy Leukoplakia: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • White lesion, usually on lateral border of tongue
  • Ccannot be wiped off, often associated with candidal infection, EBV can be identified in situ hybridization, PCR, immunohistochemistry and is the cause.
  • Most commony occurs in HIV+ patients.
29
Q

Cytomegalovirus: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • HHV-5
  • Usually affects newborns, common in AIDS patients
  • Bodily fluid transmission, 90% of infections are asymptomatic but can produce a mono-like illness.
  • Can cause serious complications leading to organ failure, blindness, and severe mental and motor retardation.
  • Oral lesions: chronic ulceration, affects endothelial cells and blood flow, can reside latently in salivary gland cells, cells show “owl eye” appearance.
30
Q

HHV-8: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-human herpes viruses)

A
  • Causative virus in Kaposi’s Sarcoma.
  • Reddish-purple flat or raised lesions.
  • Orally most commonly on palate, gingiva and tongue.
  • Before advent of AIDS, this was rare and usually seen in men over 60 years. No most cases are associated with AIDS.
31
Q

Coxsackie A virus Characteristics, typical population and presentation, etiology and treatment:

A
  • Viral stomatitis -
  • Herpangina, Hand-foot-mouth disease, acute lymphonodular pharyngitis.
  • Usually kids under 5 in epidemics, fecal-oral route, painful vesicles and ulcers intraorally, Herpangina - hyperplastic lymphoid tissue on soft palate and tonsils in acute lymphonodular pharyngitis.
  • Papules on skin of feet/toes, hands, and fingers. Usually resolves in 7-10 days.
32
Q

Measles: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-Paramyxoviruses)

A
  • Rubeola - childhood, highly contagious, skin rash,
  • “Koplik’s spots” may be an early intraoral manifestiation - small red patches with white, necrotic centers,
  • MMR vaccine.
33
Q

Mumps: Characteristics, typical population and presentation, etiology and treatment (viral stomatitis-Paramyxoviruses)

A

See salivary gland pathology.

Oral Path Exam 5 Objectives (3 decks)

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