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Oral Pathology Exam 2 > 4 Bacterial Infection > Flashcards

4 Bacterial Infection Flashcards

1
Q

a superficial skin infection with Stapylococcus aureus alone or in combination with Streptococcus pyogenes

A

impetigo

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2
Q

two subtypes of impetigo

A

non-bullous (70%) and bullous

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3
Q

occurs most often in school-aged children

A

impetigo

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4
Q

time of the year impetigo peaks

A

summer or early fall (especially in warm, humid climates)

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5
Q

Impetigo is (common/uncommon).

A

common

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6
Q

very contagious, spreads easily, intact epidermis is usually protective

A

impetigo

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7
Q

Most cases of impetigo arise how?

A

damaged skin—cuts and abrasions, insect bites, preexisting dermatitis

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8
Q

affects extremities (legs especially) and face (facial lesions develop around the nose or mouth

A

non-bullous impetigo

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9
Q

lesions are pruritic (itchy), scratching causes the lesions to spread

A

non-bullous impetigo

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10
Q

disease course of non-bullous impetigo

A

red macules or papules that subsequently develop into fragile vesicles —> vesicles rupture and become covered by a thick, honey-colored crust

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11
Q

dx of impetigo

A

clinical presentation

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12
Q

tx of impetigo (localized/mild cases vs extensive/severe involvement)

A

Localized/mild cases
• topical mupirocin (Bactroban)
• remove crusts with a cloth soaked in warm, soapy water before applying medication

Extensive/severe involvement
• refer to pediatrician or dermatologist
• systemic antibiotics
• lesions are superficial and typically heal without scarring

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13
Q

Most cases of pharyngitis are caused by ________.

A

viruses

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14
Q

Tonsillitis and pharyngitis:

organism that causes 15-30% of cases in children and 5-15% of cases in adults

A

streptococcal bacteria (Group A, beta-hemolytic streptococci)

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15
Q

How is streptococcal tonsillitis and pharyngitis spread?

A

infectious respiratory droplets or saliva

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16
Q

most common age range of streptococcal tonsillitis and pharyngitis

A

5-15 yo

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17
Q

Clinical features:
• sudden onset of sore throat and dysphasia
• fever 101-104*F
• enlarged tonsils with a yellowish exudate
• erythema of the oropharynx
• cervical lymphadenopathy
• swollen uvula

A

streptococcal tonsillitis and pharyngitis

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18
Q

Young children with streptococcal tonsillitis and pharyngitis may develop:

A
  • headache
  • malaise and anorexia
  • abdominal pain and vomiting
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19
Q

NOT COMMON with streptococcal tonsillitis and pharyngitis

A

runny nose, cough, hoarseness (suggests viral infection)

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20
Q

dx of streptococcal tonsillitis and pharyngitis

A
  • rapid antigen detection—quick results, sensitive and specific
  • throat culture
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21
Q

Tx of streptococcal tonsillitis and pharyngitis is usually recommended to reduce severity and prevent complications:

A
  • peritonsillar abscess
  • acute rheumatic fever
  • acute post-streptococcal glomerulonephritis
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22
Q

infection usually resolves spontaneously in 3-4 days (with no tx)

A

streptococcal tonsillitis and pharyngitis

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23
Q

tx of streptococcal tonsillitis and pharyngitis

A

systemic antibiotics—penicillin or amoxicillin (erythromycin or azithromycin for penicillin allergy)

*pts are considered non-contagious 24 hours after initiating antibiotic therapy

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24
Q

Don’t confuse streptococcal tonsillitis and pharyngitis with:

A
  • normal, large tonsils

* tonsillar concretions

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25
Q

Tonsillar concretions may calcify to form ______, which may show up as calcifications superimposed on the ramus in panoramic images.

A

tonsilloliths

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26
Q

a systemic infection that begins as a streptococcal tonsillitis/pharyngitis

A

scarlet fever

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27
Q

organism that causes scarlet fever

A

group A, beta-hemolytic streptococci

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28
Q

How does group A, beta-hemolytic streptococci cause scarlet fever?

A

produces a toxin that attacks blood vessels and causes the characteristic skin rash

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29
Q

occurs in susceptible pts who don’t have antibodies to the toxin

A

scarlet fever

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30
Q

most common in children ages 3-12

A

scarlet fever

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31
Q

Clinical features:
• fever
• skin rash that looks like a “sunburn with goosebumps”

A

scarlet fever

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32
Q

Describe the rash characteristic of scarlet fever:

  • appearance?
  • time frame in which it develops?
  • texture?
  • more intense in areas?
  • uncommon where?
A
  • looks like a “sunburn with goosebumps”
  • develops 12-48 hours after onset of fever
  • sandpaper texture
  • more intense in areas of pressure and skin folds
  • uncommon on the face
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33
Q

Oral manifestations:
• oropharynx—red, swollen uvula and tonsils with yellowish exudate
• white strawberry tongue (first few days)
• red strawberry tongue (by day 4 or 5)

A

scarlet fever

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34
Q

White/red strawberry tongue associated with scarlet fever:

A

White strawberry tongue
• first few days
• dorsal surface develops a white-coating through which only the fungiform papillae can be seen

Red strawberry tongue
• by day 4 or 5
• white coating desquamates
• dorsal tongue is erythematous with hyperplastic fungiform papillae

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35
Q

dx of scarlet fever

A

refer to a physician, rapid antigen detection or throat culture

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36
Q

tx of scarlet fever

A

penicillin V or amoxicillin

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37
Q

Tx of scarlet fever is indicated to prevent potential complications:

A

peritonsillar abscess, sinusitis, pneumonia

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38
Q

scarlet fever rash lasts how long?

A

rash resolves in 1 week, skin begins to desquamate which can continue for up to 6 weeks

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39
Q

organism that causes syphilis and shape

A

Treponema pallidum, a spirochete bacterium

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40
Q

modes of transmission of syphilis

A
  • sexual contact (vaginal, anal, oral)

- mother to fetus

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41
Q

Infection of syphilis classically proceeds through 3 stages:

Which stages are pts highly contagious?

A

1) primary
2) secondary
* LATENT PHASE*
3) tertiary

Patients are highly contagious during the first two stages.

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42
Q

After penicillin was invented in the 1940s, incidence of this disease in the US declined until being on the verge of elimination in 2000.

A

syphilis

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43
Q

After penicillin was invented in the 1940s, incidence of syphilis in the US declined until being on the verge of elimination in 2000.

Syphilis since 2000:

A

Since 2000, the rate of primary and secondary syphilis has increased almost every year.

  • 14% increase from 2017-2018
  • MSM accounted for 64% of new cases in 2018, high rates of HIV co-infection
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44
Q

characterized by a chancre (painless, deep ulcer) that develops at the site of inoculation

A

primary syphilis

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45
Q

During a primary syphilis infection, a chancre occurs anytime between _____ days after exposure. What is the average time? Accompanied by? Healing time?

A
  • occurs anytime between 3-90 days after exposure
  • average time = 21 days
  • accompanied by regional lymphadenopathy
  • heals in 3-8 weeks without tx
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46
Q

Common locations of a chancre (primary syphilis infection):

A

external genitalia (85%)
anus (10%)
oral cavity, especially the lip (4%)

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47
Q

How long does it take for the secondary stage of syphilis to develop? Resolution time?

A

develops 4-10 weeks after the initial infection (sometimes before chancre has resolved), resolves on its own over several weeks

48
Q

Clinical features:

  • diffuse, widespread maculopapular skin rash (red/brown/purple)
  • mucous patches of the oral cavity
  • fatigue, headache, muscle aches, fever
A

secondary syphilis

49
Q

affects 30% of patients with secondary syphilis

A

mucous patches of the oral cavity

50
Q

Mucous patches of the oral cavity (secondary syphilis):

  • affects what % of pts with secondary syphilis?
  • appearance?
  • common locations?
A
  • affects 30% of pts with secondary syphilis
  • focal areas of sensitive, whitish mucosa
  • tongue, lip, buccal mucosa, palate
51
Q

After the second stage of syphilis, patients enter an asymptomatic and lesion-free period called ______ syphilis. How long can it last?

A

latent / 1-30 years

52
Q

most serious stage of syphilis

A

tertiary

53
Q

stage of syphilis that develops in about 30% of untreated patients

A

tertiary

54
Q

the vascular and nervous systems are often affected significantly with this stage of syphilis

A

tertiary

55
Q

The ______ and ______ systems are often affected significantly with tertiary syphilis.

A

vascular and nervous systems

56
Q

Clinical features:

  • foci of granulomatous inflammation (“gumma”) –> can affect any tissue type and cause extensive destruction
  • cardiovascular –> aortic aneurysm, congestive heart failure
  • neurologic –> paralysis, numbness, psychosis, dementia
A

tertiary syphilis

57
Q

often affects the palate and causes perforation into the nasal cavity

A

tertiary syphilis (foci of granulomatous inflammation, or “gumma”)

58
Q

transplacental infection, about half of all babies infected in utero die before or shortly after birth

A

congenital syphilis

59
Q

congenital syphilis in newborns vs children

A

Newborns- failure to thrive, jaundice, anemia, fever, rash

Children- abnormalities of the bones, teeth, eyes, ears, and brain

60
Q

rates have increased in parallel with primary and secondary syphilis among women from 2013-2017

A

congenital syphilis

61
Q

What is Hutchinson’s triad associated with? What is it?

A

congenital syphilis

Hutchinson’s triad:

  • Hutchinson’s teeth (Hutchinson’s incisors 63%, mulberry molars 65%)
  • ocular interstitial keratitis (9%)
  • 8th cranial nerve deafness (3%)

*Very few patients exhibit all three pathognomic features

62
Q

Two variations of Hutchinson’s teeth and descriptions:

A

Hutchinson’s incisors:

  • greatest mesiodistal width occurs in the middle 1/3 of the crown
  • notching of incisal edges
  • teeth resemble the head of a straight-edged screwdriver

Mulberry molars:

  • crown tapers towards the occlusal surface
  • abnormal occlusal anatomy with globular projections of enamel
63
Q

dx of syphilis

A
  • screening tests (one of these two is performed twice during a woman’s pregnancy –> VDRL and RPR)
  • specific and sensitive serologic test (positive for life, performed after a positive screening test result, FTA-ABS)
64
Q

screening tests done during pregnancy for syphilis (2)

A

VDRL (Venereal Disease Research Lab)

RPR (Rapid plasma reagin)

65
Q

specific and sensitive serologic test done to dx syphilis, positive for life

A

FTA-ABS (fluorescent treponemal antibody absorption)

66
Q

tx for syphilis

A

penicillin G IV or IM administration depending on stage, doxycycline for penicillin allergy

67
Q

stages of syphilis that resolve with or without therapy

A

primary and secondary

68
Q

neurosyphilis

A

when syphilis infection gets into the CNS

69
Q

T or F: The cardiovascular and neurologic effects of tertiary syphilis are reversible.

A

F (not reversible!!)

70
Q

organism that causes TB

A

Mycobacterium tuberculosis

71
Q

mode of transmission of TB

A

airborne droplets from a patient with active disease

72
Q

T or F: Infection with TB means you have an active disease.

A

False!! 1/4 of the world’s population is infected

73
Q

1/4 of the world’s population is infected (infection does not mean active disease)

A

TB

74
Q

Overall incidence of TB in the US is declining, but disproportionally high rates (70%) are observed among…?

A

foreign-born persons (Asians = racial/ethnic group with the most cases)

75
Q

racial/ethnic group with the most cases of TB

A

Asians

76
Q

people previously unexposed to M. tuberculosis, inhalation of airborne droplets from someone with TB disease

A

latent TB infection

77
Q

asymptomatic form of TB, initiates a chronic inflammatory response that results in a localized, fibrocalcified nodule in the lung

A

latent TB infection

78
Q

signs of a latent TB infection

A
  • localized, fibrocalcified nodule in the lung

- viable organisms remain in the nodule and can become reactivated later in life

79
Q

PPD skin test will be positive, NOT CONTAGIOUS

A

latent TB infection

80
Q

develops in about 5-10% of pts infected with TB, usually occurs later in life due to reactivation of organisms

A

TB disease

81
Q

TB disease is associated with…

A

compromised immune status (AIDS, immunosuppressive drugs, diabetes, old age)

82
Q

leading killer of HIV-infected people

A

TB disease

83
Q

Clinical features:

  • low grade fever, night sweats
  • malaise, anorexia, weight loss
  • persistent, productive cough (chest pain, hemoptysis)
  • extrapulmonary lesions present in over 50% of AIDS pts with an active infection, can involve any organ system
A

TB disease

84
Q

present in over 50% of AIDS patients with an active TB infection

A

extrapulmonary lesions (can involve any organ system)

85
Q

____ and ____ involvement can occur with TB disease. Most commonly affected area?

A

Head and neck / cervical lymph nodes

86
Q

calcified lymph nodes may be visible on panoramic radiographs

A

TB disease with head/neck involvement

87
Q

intraoral lesions are uncommon, but presents as a chronic painless ulcer or granular tissue proliferation (tongue, mandible, gingiva, lip)

A

TB disease

88
Q

dx of TB

A
  • PPD skin test will be positive 2-4 weeks after initial exposure (5-10% of US population is +), does not distinguish between latent and active TB disease (follow by chest x-ray if positive)
  • culture of infected sputum
  • biopsy: granulamatous inflammation (special stains reveal mycobacteria)
89
Q

tx of latent TB vs TB disease

A

Latent TB- chemoprophylaxis, various protocols, drugs utilized: isoniazid, rifampin, rifapentine (3-9 months of therapy)

TB disease- multi-agent drug therapy, various protocols, drugs utilized: isoniazid, rifampin, pyrazinamide, ethambutol (6-9 months of therapy)

90
Q

organism that causes actinomycosis

A

Actinomyces israelii or Actinomyces viscosus

91
Q

Actinomyces species are normal components of the oral flora:

A

tonsillar crypts, periodontal pockets, dental plaque and calculus, carious dentin

92
Q

55% of cases are diagnosed in the cervicofacial region

A

actinomycosis

93
Q

How does an actinomycosis infection start? How does it spread?

A

organism infects tissue through an area of prior trauma (injury, extraction socket, perio pocket, etc) –> infection spreads by direct extension through soft and hard tissue (not the usual lymphatic and vascular spread)

94
Q

most common location of actinomycosis infection

A

soft tissue overlying the angle of the mandible

95
Q

Clinical features:

  • slow progression and minimal pain
  • begins as a “wooden” indurated area, eventually forms a soft abscess
  • may discharge yellowish flecks called sulfur granules (colonies of the bacteria)
A

actinomycosis

96
Q

Dx:

  • characteristic colonies can be seen in biopsy specimens
  • culture has low sensitivity (positive in less than 50% of cases)
  • clincian’s surgical findings and description can be helpful (sulfur granules)
A

actinomycosis

97
Q

may discharge yellowish flecks called SULFUR GRANULES

A

actinomycosis

98
Q

tx of actinomycosis

A
  • surgical drainage of abscess
  • 5-6 week course of high-dose penicillin or amoxicillin
  • pts with a deep-seated infection may require longer duration of therapy
  • fibrotic nature of lesion makes it difficult for antibiotics to penetrate
99
Q

organism that causes cat-scratch disease

A

Bartonella henselae

100
Q

spread of cat-scratch disease

A
  • begins in the skin –> characteristically spreads to adjacent lymph nodes
  • no person-to-person transmission
  • arises after contact with a cat
101
Q

the most common cause of regional lymphadenopathy in children, majority of cases (80%) occur in patients under 21 yo

A

cat-scratch disease

102
Q

Clinical features:

  • a papule or pustule develops in 3-14 days within the area of the scratch/exposure, resolves in 1-3 weeks
  • lymphadenopathy takes 3 weeks to develop, may be accompanied by fever and malaise
  • evidence of the primary trauma may have completely resolved by this time
A

cat-scratch disease

103
Q

a single lymph node is involved in about half of all cases (head and neck, axillary, groin)

A

cat-scratch disease

104
Q

Cat-scratch disease: scratches on the face usually lead to ________ lymphadenopathy

A

submandibular

105
Q

this dx should always be suspected in cases of unexplained lymphadenopathy

A

cat-scratch disease

106
Q

tx of cat-scratch disease

A
  • analgesics
  • lymph node aspiration
  • self-limiting, resolves within 4 months
  • antibiotics are used only for severe cases or immunocompromised pts
107
Q

one of the most common health complaints in the US

A

sinusitis

108
Q

Usually the result of a disruption in the normal balance/function of the paranasal sinuses:

  • patency of ostial openings (through which the contents of sinus cavities drain into the nose)
  • function of the cilia
  • quality of nasal secretions
A

sinusitis

109
Q

most sinus disease begins due to…

A

blockage of the sinus ostia, which prevents normal drainage

110
Q

bacteria are inherently present in the sinuses, so even a light thickening of the lining can lead to blockage and infection

A

sinusitis

111
Q

Organisms often responsible for acute cases of sinusitis (4):

A
  • viruses
  • Streptococcus pneumoniae
  • Haemophilus influenzae
  • Moraxella catarrhalis
112
Q

Most common predisposing factors of sinusitis:

A
  • recent upper respiratory viral infection

- allergic rhinitis

113
Q

up to 30% of cases of ______ sinusitis are the result of an odontogenic problem

A

maxillary (infection of maxillary teeth, extractions of maxillary teeth, placement of implants)

114
Q

Clinical features:

  • headache
  • fever
  • facial pain in the area involved
  • anterior nasal or posterior pharyngeal discharge (can be thick, thin, clear, mucoid, purulent)
A

acute sinusitis

115
Q

REMEMBER: this can present as a toothache

A

acute maxillary sinusitis

116
Q
  • recurring episodes of acute sinusitis or symptomatic sinus disease lasting > 3 months
  • facial pressure, headache, obstructed sensation
  • less diagnostic than the acute form (involved sinus shows cloudy increased density on panoramic films, endoscopy, CT)
A

chronic sinusitis

117
Q

tx of acute vs chronic sinusitis

A

Acute- the infection is self-limiting, but antibiotics are usually prescribed (amoxicillin)

Chronic- rule out odontogenic infection, refer to ENT specialist, often corrected with endoscopic sinus surgery (enlarges ostial openings and corrects blockages)

Oral Pathology Exam 2 (8 decks)

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