5: Bacterial Infections Flashcards
Two types of impetigo and tx for each?
- Non-bullous: topical mupirocin
2: Bullous: systemic antibiotics for one week
What are the two types of bacteria that may cause impetigo?
S. aureus and strep pyogenes (group A)
Which type of impetigo is more common?
Non-bullous (impetigo contagiosa)
Where is impetigo usually located?
Legs
How can you visually tell non-bullous from bullous?
Thick vs. thin yellow crusts, respectively
What age and during what time of the year is impetigo more common?
2-6 years of age during summer or early fall
What is the most common transmission? What helps prevent?
Direct contact with nasal carriers (only to non-intact skin), scratching aka pruritis spreads, and good hygiene helps prevent.
What is impetigo’s incubation period and what is non-bullous’ course?
1-3 days: Red macules/papules, fragile vesicles, then form thick amber crust (“cornflakes glued to the surface”)
What is a tonsillar plug?
Food/debris stuck in tonsillar crypts–> foul-smelling tonsillar concretions
What bacteria usually colonizes tonsillar plugs?
Actinomyces
Tonsillar concretions that undergo dystrophic calcification form…
Tonsilloliths
Treatment of tonsilloliths
Suction, local excision, or if common occurrence, removal of tonsils
What causes syphillis?
Treponema pallidum (spirochete)
What are the stages of syphillis and which are contagious?
Primary, secondary, latent and tertiary (only infectious during stage 1 and 2 and EARLY latent ); also may have congenital
Describe primary syphilis symptoms and its timeline.
Chancre, firm painless skin ulceration, regional lymphadenopathy, oral cavity is most common extragenital site, initial exposure to bac and can last 10-90 days (may persist 4-6 weeks).
Describe secondary syphilis symptoms and its timeline.
Flu-like symptoms, symmetrical reddish-pink maculopapular, non-itchy skin rash (systemic syphilis) and oral lesions are mucous patches.
Timeline: 1-6 months after primary (commonly 6-8 weeks)
What are signs/symptoms of latent Syphilis?
There are none: use serologic proof.
How do you treat early vs. late latent syphilis?
Early (<2 years): Single IM injection of penicillin
Late: 3 weekly injections
What is the sequelae of tertiary syphilis?
Cardiovascular, Gumma, Leutic glossitis ad interstitial glossitis
What is gumma?
Soft tumor-like balls of inflammation due to body’s inability to clear infection (intraoral lesions affect palate or tongue and perforate through nasal cavity)
What is leutic glossitis?
Diffuse atrophy and loss of dorsal tongue papillae
What is interstitial glossitis?
Lobulated pattern of gumma involvement with the tongue
What are six neurologic issues with syphilis?
Insanity caused by late stage, personality and emotional changes, hyperactive reflexes, tubes dorsalis (locomotive ataxia–> e.g. shuffling gate), neurosyphilis (Co-infection with HIV)
What is a diagnostic sign of tertiary syphilis? Primary syphiliis?
- Argyll-Roberson Pupil: thin irregular pupil will constrict to focus but does not accommodate with light
- Chancre
What are the two main modes of syphilis transmission and why?
Sexual contact and mother to child; T. palladium is susceptible to drying.
What type of syphilis is passed from mother to child? When must this be treated?
Congenital; tx within 5-6 months of becoming pregnant
What is the most common site for oral syphilitic chancre and its characteristic?
Lip most common, painless, clean-based ulceration with regional lymphadenopathy
What is the secondary syphilitic rash known as and describe its appearance?
Condyloma lata: when syphilitic rash becomes flat broad white papules in moist areas of body
What is the main difference between primary and secondary chancres?
Singular vs. multiple lesions
Which stage of syphilis is the most serious?
Tertiary
When will tertiary syphilis show up?
1-10 years after initial infection
What are the three general systems tertiary syphilis affects?
Cardiovascular, CNS, and sight
What are the characteristic inflammation of tertiary syphilis?
Focal granulomatous
What is the shuffling gate of tertiary syphilis due to neurological involvement called?
Tubes dorsalis aka locomotive ataxia
What are three cardiovascular effects from tertiary syphilis?
Syphilitic aneurysm, aortic aneurysm or aortic regurgitation
What are the two stages of syphilis a mother must be in to pass it to her children? If a baby gets it and survives, what stage will they automatically be in?
Primary or secondary
Secondary
3 pathognomonic diagnostic features of Hutchinson’s triad for Congenital syphilis
Hutchinson’s teeth, Ocular interstitial keratitis, 8th Nerve deafness
5 physical characteristics of person living with congenital syphilis (look likewhat cartoon character)?
Frontal Bossing, Short maxilla, High-Arched palate, Saddle Nose, Rhagades
T/F. Sores on infected babies are not contagious.
F. They are contagious.
What are five other problems associated with babies born with syphilis?
Rash, fever, swollen liver/spleen, anemia and jaundice
What are rhagades?
Furrows around mouth giving an older than age appearance.
When will interstitial keratitis appear and how will it look?
Between 5 and 25, opacified corneal surface with resultant loss of vision
What are two specific tests of syphilis?
Treponema pallidum hemagluttination test (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS)
T/F. Most newborns are asymptomatic.
T. Only ID’ed on routine screening.
- What happened in Tuskegee?
2. End result?
- 600 black sharecroppers were in a 40-year study and not given meds to stop syphilis.
- National Research Act requires government to review and approve all studies on human subjects
How does Tuskegee differ from Guatemala incident?
Guatemalan docs infected soldiers, prisoners, etc. vs. Tuskegee where they just observed their decline.
What is the most common reportable bacterial infection in the U.S.?
Gonorrhea
Bacteria that causes gonorrhea?
Neisseria gonorrhea
What protects against gonorrhea without sexual contact?
Intact stratified squamous epithelium
Most important female complication and what can it lead to long-term?
Pelvic inflammatory disease; ectopic pregnancies and infertility
Gram stain and shape?
Gram neg diplococci
What STD is also co-treated for if one has gonorrhea?
Chlamydia
What antibiotics are used to tree gonorrhea?
Ceftriaxone and doxycycline
What is the gonorrhea transmitted to newborn’s eyes from an infected mother? How tx?
Gonococcal Opthalmia Neonatum; Opthalmic erythromycin, tetracycline or silver nitrate
What is the most common site of oropharyngeal gonorrhea and its symptoms?
Pharynx, tonsils, uvula (may also be seen on tongue). Asymptomatic or mild/moderate sore throat and oropharyngeal erythmea
What can oral gonorrhea mimic? Differentiating trait?
NUG; no fetor oris in gonorrhea
What bacteria causes tuberculosis?
Mycobacterium tuberculosis
What is the most important factor concerning TB testing?
Distinguish between latent infection and exposure.
T/F. TB only infects the lungs.
F. Lungs most common, but may also attack CNS, lymphatics, circulatory system, bones, joints, skin, etc.
What fraction of the world’s population has TB? What country has the most infections?
1/3; India
What are two types of tuberculosis?
Primary and secondary
- What TB version occurs in previously unexposed people and almost always involves the lungs?
- Common mode of transmission?
- Primary
- Airborne droplets from someone with active disease and is the result of direct person-to-person spread (poor ventilation and crowding facilitates spread)
Can you get oral TB only?
No, aways second to pulmonary and is extremely rare
What does Primary TB infection results in what and where?
Localized fibrocalcified nodule at initial site of involvement
What is the key to getting tuberculosis
Long-term exposure to large number of respiratory droplets from a person with active TB
How does one typically get secondary tuberculosis and in what type of patient?
Active disease later in life from reactivation of someone that was previously infected (typically also now has a compromised immunity)
What’s another name for secondary tuberculosis?
Miliary tuberculosis: describes the diffuse granulomas
Four synonyms for tuberculosis?
Consumption, lupus vulgaris, miliary, scrofula
What is the skin involvement of TB called?
lupus vulgaris
Oral lesions associated with TB have what characteristics?
Painful, non-descript ulcers (always secondary to pulmonary diagnosis)
What TB infection is characterized by enlargement of oropharyngeal lymphoid tissue and cervical lymph nodes? How transmitted?
Scrofula; drinking contaminated milk
4 ways to diagnose TB?
Mantous or PPD skin test, chest x-ray, culture of sputum for gram neg diplococci, mycobacterial stains
What is the cause of the formation of granulomas which are a classic histologic presentation of TB?
Cell-mediated hypersensitivity
What vaccine cause a false positive for TB?
BCG
- How does TB infection vs. active disease differ (6)?
2. Similarities?
- Infection: no symptoms, Normal chest x-ray, No AFB in sputum, not contagious, no isolation needed, active TB can be prevented
- +PPD
How do you treat active disease?
Tx w/ multiple drugs and keep person isolated until 3 AFB-neg sputum tests
How does HIV + vs. HIV- patients affect TB tx?
HIV-: 6 months daily of INH (Rifampin, pyrzinamide daily for two months then twice weekly for 2-3 months
HIV+: 12 months daily INH or 2/week
What can scrofula be misdiagnosed as?
Sialoliths
What type of necrosis is TB associated with?
Caseating
What is gangrenous disease leading to tissue destruction of the face?
Noma
What causes Noma?
Opportunistic infection caused by components of normal flora that become pathologic during periods of compromised immunity
What are seven predisposing factors of Noma?
Immunodeficiency, Malignancy, Recent Illness, Malnutrition, Dehydration, Poor sanitation or poor oral hygiene
What specific illness usually precedes Noma?
Measles (or TB)
What are three other names for Noma?
Necrotizing stomatitis, gangrenous stomatitis or cancrum oris
What age group does Noma usually affect?
Children between 2-6 yo
T/F. Noma has a low morbidity and mortality.
F. Around 80% die.
How do you treat (2), prevent (5) and repair (1) Noma?
Tx: Antibiotics (penicillin or metrinizadole)
Prevent: OHI, better nutrition/hydration, breastfeeding 3-6mo and childhood vaccinations
Repair: Plastic surgery
What is actinomycosis?
Infectino of filamentous, branching gram pos anaerobic bac (not fungal)
What species causes actinomycosis?
Bac: actinomycose israelii
Where is actinomycosis commonly found?
Cervicofacial area (area over the angle of the mandible)
What are three clinical features of actinomycosis infection?
Acute deep suppurative abscess, multiple draining tracts, and yellow sulfur granules
What are three types of treatment for actinomycosis?
Sx drainage/debridement, aerate the area and high daily dosage of ab
Most common cause of regional lymphadenopathy in children?
Cat Scratch disease
What organism causes cat scratch disease?
Bartonella henselae; rod-shaped gram neg bacteria
What are three clinical features of cat scratch disease?
Tender regional lymphadenopathy; sterile suppurative papules at scratch site within 1-2 weeks; similar to Lyme disease (headache, fever, chills)
How long can regional lymphadenopathy remain in cat scratch disease?
3 weeks to several months post scratch
What may make cat scratch disease hard to diagnose?
Primary site of inoculation has healed before lymphadenopathy presents
Which is more likely to carry CSD: kittens or cats?
2. What other organism may carry it?
Kittens: more likely to carry in blood and transmit it then adults.
2. Ticks can also be vectors.
What are four ways to test?
Warthin-Starry method, indirect fluorescent Ab assay for Bh, ELISA for IgM ab or PCR
What is cat scratch disease tx?
Self limiting w/ or w/o tx in 1-2mo. Can give analgesics for pain, aspirate nodule and local heat. Ab not always required.
What is the disease ass’d with cat scratch bacilli and AIDS patients?
Bacillary angiomatosis
What is bacillary angiomatosis and how do you tx?
Subcutaneous vascular proliferation seen in AIDS pts and responds to erythromycin
What is one of the most common health complaints in U.S.?
Sinusitis
What are the four bilateral sinuses of the adult? What do they drain through?
- Frontal, Sphenoid, Maxillary: Middle Meatus
- Ethmoid: ostia
- Mastoid?
What is the key to sinus disease?
Osteomeatal complex has a narrow opening that can trap inspired foreign matter. This disrupts normal drainage, decreases ventilation, and causes disease
What are the characteristics of reparatory epithelium?
Pseudostratified columnar epithelium with cilia (mvmt via help of gravity). This is the most mature epithelium, so it easiest to degrade. Once degraded, ciliary mvmt lost
3 requirements for normal function of the paranasal sinuses?
Patency of ostial openings, proper function of ciliary apparatus, and quality of nasal secretions. Upset balance, you get sinusitis.
If maxillary sinusitis has an odontogenic origin, how do you treat the sinusitis?
Treat odontogenic pathosis
2 most common predisposing factors for acute sinusitis?
Recent Upper Respiratory Tract Infection (usually viral origin) or secondary fungal invasion
- How does virus cause acute sinusitis?
2. Most common organisms responsible for acute sinusitis?
- Damaged surface mucosa colonized by the virus
2. H. influenza, S. pneumonia or S. aureus, or Moraxella cutarrhalis
What is the major issue with Type I diabetes and fungal invasions?
Ketoacidosis causes sinusitis by mucormycosis (life threatening)
What is mucormycosis?
Secondary fungal infection of sinuses, brain or lung in immunocompromised
What are symptoms of acute sinusitis? Chronic sinusitis?
- Headache, fever, congestion, pain over sinus
- Acute symptoms + thick green/yellow discharge, halitosis, blurred vision, feeling of facial fullness worsens when bending over
What are the diagnostic requirements of chronic sinusitis?
Reoccurring episodes of acute sinusitis or symptomatic sinus disease lasting > three months
What are three causes of chronic sinusitis?
Allergy, environmental factors (e.g. fungus), non-allergic such as abnormal narrow sinus passages (small # from dental infections)
Although rare, what can sinus infections cause?
Anosmia: Inability to smell
How do you tell the difference between sinusitis and migraine?
Sinusitis: dull, constant aching pain over affected sinus and possible discharge
Migraine: unilateral headache and often vomiting and visual disturbances
3 different sinusitis based on duration of symptoms?
Acute: 12 weeks
In chronic sinusitis, what can develop in the sinus that can be viewed radiographically?
Antrolith: Area of dystrophic calcification
What organism is commonly found in antral calcifications?
Aspergillus fumigatus
T/F. Prescribe an antibiotic and decongestant to better relieve patient’s pain.
F. Topical decongestant shrinks nasal membranes to improve osteal drainage but also decreases mucosal bloodflow required for antibiotic delivery
Do you have to prescribe ab for acute sinusitis?
No, b/c usually self-limiting but amoxicillin can be given to healthy pt
What can be done if sinusitis does not respond to medical managements (2)?
Surgery (or nasal endoscopy)
Is sinusitis a primary infection or disease of infection?
Disease of obstruction w/ secondary inflammation developing?
What must be a differential diagnosis when patient present with maxillary tooth ache?
Sinusitis
What are other symptoms of maxillary sinusitis?
Pain over cheekbone, toothache, periorbital pain or temporal headache; also increased pain when head is upright and less discomfort supine
