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Oral Path Exam 2 > 5: Bacterial Infections > Flashcards

5: Bacterial Infections Flashcards

1
Q

Two types of impetigo and tx for each?

A
  1. Non-bullous: topical mupirocin

2: Bullous: systemic antibiotics for one week

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2
Q

What are the two types of bacteria that may cause impetigo?

A

S. aureus and strep pyogenes (group A)

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3
Q

Which type of impetigo is more common?

A

Non-bullous (impetigo contagiosa)

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4
Q

Where is impetigo usually located?

A

Legs

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5
Q

How can you visually tell non-bullous from bullous?

A

Thick vs. thin yellow crusts, respectively

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6
Q

What age and during what time of the year is impetigo more common?

A

2-6 years of age during summer or early fall

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7
Q

What is the most common transmission? What helps prevent?

A

Direct contact with nasal carriers (only to non-intact skin), scratching aka pruritis spreads, and good hygiene helps prevent.

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8
Q

What is impetigo’s incubation period and what is non-bullous’ course?

A

1-3 days: Red macules/papules, fragile vesicles, then form thick amber crust (“cornflakes glued to the surface”)

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9
Q

What is a tonsillar plug?

A

Food/debris stuck in tonsillar crypts–> foul-smelling tonsillar concretions

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10
Q

What bacteria usually colonizes tonsillar plugs?

A

Actinomyces

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11
Q

Tonsillar concretions that undergo dystrophic calcification form…

A

Tonsilloliths

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12
Q

Treatment of tonsilloliths

A

Suction, local excision, or if common occurrence, removal of tonsils

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13
Q

What causes syphillis?

A

Treponema pallidum (spirochete)

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14
Q

What are the stages of syphillis and which are contagious?

A

Primary, secondary, latent and tertiary (only infectious during stage 1 and 2 and EARLY latent ); also may have congenital

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15
Q

Describe primary syphilis symptoms and its timeline.

A

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).

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16
Q

Describe secondary syphilis symptoms and its timeline.

A

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)

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17
Q

What are signs/symptoms of latent Syphilis?

A

There are none: use serologic proof.

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18
Q

How do you treat early vs. late latent syphilis?

A

Early (<2 years): Single IM injection of penicillin

Late: 3 weekly injections

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19
Q

What is the sequelae of tertiary syphilis?

A

Cardiovascular, Gumma, Leutic glossitis ad interstitial glossitis

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20
Q

What is gumma?

A

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)

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21
Q

What is leutic glossitis?

A

Diffuse atrophy and loss of dorsal tongue papillae

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22
Q

What is interstitial glossitis?

A

Lobulated pattern of gumma involvement with the tongue

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23
Q

What are six neurologic issues with syphilis?

A

Insanity caused by late stage, personality and emotional changes, hyperactive reflexes, tubes dorsalis (locomotive ataxia–> e.g. shuffling gate), neurosyphilis (Co-infection with HIV)

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24
Q

What is a diagnostic sign of tertiary syphilis? Primary syphiliis?

A
  1. Argyll-Roberson Pupil: thin irregular pupil will constrict to focus but does not accommodate with light
  2. Chancre
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25
Q

What are the two main modes of syphilis transmission and why?

A

Sexual contact and mother to child; T. palladium is susceptible to drying.

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26
Q

What type of syphilis is passed from mother to child? When must this be treated?

A

Congenital; tx within 5-6 months of becoming pregnant

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27
Q

What is the most common site for oral syphilitic chancre and its characteristic?

A

Lip most common, painless, clean-based ulceration with regional lymphadenopathy

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28
Q

What is the secondary syphilitic rash known as and describe its appearance?

A

Condyloma lata: when syphilitic rash becomes flat broad white papules in moist areas of body

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29
Q

What is the main difference between primary and secondary chancres?

A

Singular vs. multiple lesions

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30
Q

Which stage of syphilis is the most serious?

A

Tertiary

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31
Q

When will tertiary syphilis show up?

A

1-10 years after initial infection

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32
Q

What are the three general systems tertiary syphilis affects?

A

Cardiovascular, CNS, and sight

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33
Q

What are the characteristic inflammation of tertiary syphilis?

A

Focal granulomatous

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34
Q

What is the shuffling gate of tertiary syphilis due to neurological involvement called?

A

Tubes dorsalis aka locomotive ataxia

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35
Q

What are three cardiovascular effects from tertiary syphilis?

A

Syphilitic aneurysm, aortic aneurysm or aortic regurgitation

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36
Q

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?

A

Primary or secondary

Secondary

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37
Q

3 pathognomonic diagnostic features of Hutchinson’s triad for Congenital syphilis

A

Hutchinson’s teeth, Ocular interstitial keratitis, 8th Nerve deafness

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38
Q

5 physical characteristics of person living with congenital syphilis (look likewhat cartoon character)?

A

Frontal Bossing, Short maxilla, High-Arched palate, Saddle Nose, Rhagades

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39
Q

T/F. Sores on infected babies are not contagious.

A

F. They are contagious.

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40
Q

What are five other problems associated with babies born with syphilis?

A

Rash, fever, swollen liver/spleen, anemia and jaundice

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41
Q

What are rhagades?

A

Furrows around mouth giving an older than age appearance.

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42
Q

When will interstitial keratitis appear and how will it look?

A

Between 5 and 25, opacified corneal surface with resultant loss of vision

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43
Q

What are two specific tests of syphilis?

A

Treponema pallidum hemagluttination test (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS)

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44
Q

T/F. Most newborns are asymptomatic.

A

T. Only ID’ed on routine screening.

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45
Q
  1. What happened in Tuskegee?

2. End result?

A
  1. 600 black sharecroppers were in a 40-year study and not given meds to stop syphilis.
  2. National Research Act requires government to review and approve all studies on human subjects
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46
Q

How does Tuskegee differ from Guatemala incident?

A

Guatemalan docs infected soldiers, prisoners, etc. vs. Tuskegee where they just observed their decline.

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47
Q

What is the most common reportable bacterial infection in the U.S.?

A

Gonorrhea

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48
Q

Bacteria that causes gonorrhea?

A

Neisseria gonorrhea

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49
Q

What protects against gonorrhea without sexual contact?

A

Intact stratified squamous epithelium

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50
Q

Most important female complication and what can it lead to long-term?

A

Pelvic inflammatory disease; ectopic pregnancies and infertility

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51
Q

Gram stain and shape?

A

Gram neg diplococci

52
Q

What STD is also co-treated for if one has gonorrhea?

A

Chlamydia

53
Q

What antibiotics are used to tree gonorrhea?

A

Ceftriaxone and doxycycline

54
Q

What is the gonorrhea transmitted to newborn’s eyes from an infected mother? How tx?

A

Gonococcal Opthalmia Neonatum; Opthalmic erythromycin, tetracycline or silver nitrate

55
Q

What is the most common site of oropharyngeal gonorrhea and its symptoms?

A

Pharynx, tonsils, uvula (may also be seen on tongue). Asymptomatic or mild/moderate sore throat and oropharyngeal erythmea

56
Q

What can oral gonorrhea mimic? Differentiating trait?

A

NUG; no fetor oris in gonorrhea

57
Q

What bacteria causes tuberculosis?

A

Mycobacterium tuberculosis

58
Q

What is the most important factor concerning TB testing?

A

Distinguish between latent infection and exposure.

59
Q

T/F. TB only infects the lungs.

A

F. Lungs most common, but may also attack CNS, lymphatics, circulatory system, bones, joints, skin, etc.

60
Q

What fraction of the world’s population has TB? What country has the most infections?

A

1/3; India

61
Q

What are two types of tuberculosis?

A

Primary and secondary

62
Q
  1. What TB version occurs in previously unexposed people and almost always involves the lungs?
  2. Common mode of transmission?
A
  1. Primary
  2. Airborne droplets from someone with active disease and is the result of direct person-to-person spread (poor ventilation and crowding facilitates spread)
63
Q

Can you get oral TB only?

A

No, aways second to pulmonary and is extremely rare

64
Q

What does Primary TB infection results in what and where?

A

Localized fibrocalcified nodule at initial site of involvement

65
Q

What is the key to getting tuberculosis

A

Long-term exposure to large number of respiratory droplets from a person with active TB

66
Q

How does one typically get secondary tuberculosis and in what type of patient?

A

Active disease later in life from reactivation of someone that was previously infected (typically also now has a compromised immunity)

67
Q

What’s another name for secondary tuberculosis?

A

Miliary tuberculosis: describes the diffuse granulomas

68
Q

Four synonyms for tuberculosis?

A

Consumption, lupus vulgaris, miliary, scrofula

69
Q

What is the skin involvement of TB called?

A

lupus vulgaris

70
Q

Oral lesions associated with TB have what characteristics?

A

Painful, non-descript ulcers (always secondary to pulmonary diagnosis)

71
Q

What TB infection is characterized by enlargement of oropharyngeal lymphoid tissue and cervical lymph nodes? How transmitted?

A

Scrofula; drinking contaminated milk

72
Q

4 ways to diagnose TB?

A

Mantous or PPD skin test, chest x-ray, culture of sputum for gram neg diplococci, mycobacterial stains

73
Q

What is the cause of the formation of granulomas which are a classic histologic presentation of TB?

A

Cell-mediated hypersensitivity

74
Q

What vaccine cause a false positive for TB?

A

BCG

75
Q
  1. How does TB infection vs. active disease differ (6)?

2. Similarities?

A
  1. Infection: no symptoms, Normal chest x-ray, No AFB in sputum, not contagious, no isolation needed, active TB can be prevented
  2. +PPD
76
Q

How do you treat active disease?

A

Tx w/ multiple drugs and keep person isolated until 3 AFB-neg sputum tests

77
Q

How does HIV + vs. HIV- patients affect TB tx?

A

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

78
Q

What can scrofula be misdiagnosed as?

A

Sialoliths

79
Q

What type of necrosis is TB associated with?

A

Caseating

80
Q

What is gangrenous disease leading to tissue destruction of the face?

A

Noma

81
Q

What causes Noma?

A

Opportunistic infection caused by components of normal flora that become pathologic during periods of compromised immunity

82
Q

What are seven predisposing factors of Noma?

A

Immunodeficiency, Malignancy, Recent Illness, Malnutrition, Dehydration, Poor sanitation or poor oral hygiene

83
Q

What specific illness usually precedes Noma?

A

Measles (or TB)

84
Q

What are three other names for Noma?

A

Necrotizing stomatitis, gangrenous stomatitis or cancrum oris

85
Q

What age group does Noma usually affect?

A

Children between 2-6 yo

86
Q

T/F. Noma has a low morbidity and mortality.

A

F. Around 80% die.

87
Q

How do you treat (2), prevent (5) and repair (1) Noma?

A

Tx: Antibiotics (penicillin or metrinizadole)
Prevent: OHI, better nutrition/hydration, breastfeeding 3-6mo and childhood vaccinations
Repair: Plastic surgery

88
Q

What is actinomycosis?

A

Infectino of filamentous, branching gram pos anaerobic bac (not fungal)

89
Q

What species causes actinomycosis?

A

Bac: actinomycose israelii

90
Q

Where is actinomycosis commonly found?

A

Cervicofacial area (area over the angle of the mandible)

91
Q

What are three clinical features of actinomycosis infection?

A

Acute deep suppurative abscess, multiple draining tracts, and yellow sulfur granules

92
Q

What are three types of treatment for actinomycosis?

A

Sx drainage/debridement, aerate the area and high daily dosage of ab

93
Q

Most common cause of regional lymphadenopathy in children?

A

Cat Scratch disease

94
Q

What organism causes cat scratch disease?

A

Bartonella henselae; rod-shaped gram neg bacteria

95
Q

What are three clinical features of cat scratch disease?

A

Tender regional lymphadenopathy; sterile suppurative papules at scratch site within 1-2 weeks; similar to Lyme disease (headache, fever, chills)

96
Q

How long can regional lymphadenopathy remain in cat scratch disease?

A

3 weeks to several months post scratch

97
Q

What may make cat scratch disease hard to diagnose?

A

Primary site of inoculation has healed before lymphadenopathy presents

98
Q

Which is more likely to carry CSD: kittens or cats?

2. What other organism may carry it?

A

Kittens: more likely to carry in blood and transmit it then adults.
2. Ticks can also be vectors.

99
Q

What are four ways to test?

A

Warthin-Starry method, indirect fluorescent Ab assay for Bh, ELISA for IgM ab or PCR

100
Q

What is cat scratch disease tx?

A

Self limiting w/ or w/o tx in 1-2mo. Can give analgesics for pain, aspirate nodule and local heat. Ab not always required.

101
Q

What is the disease ass’d with cat scratch bacilli and AIDS patients?

A

Bacillary angiomatosis

102
Q

What is bacillary angiomatosis and how do you tx?

A

Subcutaneous vascular proliferation seen in AIDS pts and responds to erythromycin

103
Q

What is one of the most common health complaints in U.S.?

A

Sinusitis

104
Q

What are the four bilateral sinuses of the adult? What do they drain through?

A
  1. Frontal, Sphenoid, Maxillary: Middle Meatus
  2. Ethmoid: ostia
  3. Mastoid?
105
Q

What is the key to sinus disease?

A

Osteomeatal complex has a narrow opening that can trap inspired foreign matter. This disrupts normal drainage, decreases ventilation, and causes disease

106
Q

What are the characteristics of reparatory epithelium?

A

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

107
Q

3 requirements for normal function of the paranasal sinuses?

A

Patency of ostial openings, proper function of ciliary apparatus, and quality of nasal secretions. Upset balance, you get sinusitis.

108
Q

If maxillary sinusitis has an odontogenic origin, how do you treat the sinusitis?

A

Treat odontogenic pathosis

109
Q

2 most common predisposing factors for acute sinusitis?

A

Recent Upper Respiratory Tract Infection (usually viral origin) or secondary fungal invasion

110
Q
  1. How does virus cause acute sinusitis?

2. Most common organisms responsible for acute sinusitis?

A
  1. Damaged surface mucosa colonized by the virus

2. H. influenza, S. pneumonia or S. aureus, or Moraxella cutarrhalis

111
Q

What is the major issue with Type I diabetes and fungal invasions?

A

Ketoacidosis causes sinusitis by mucormycosis (life threatening)

112
Q

What is mucormycosis?

A

Secondary fungal infection of sinuses, brain or lung in immunocompromised

113
Q

What are symptoms of acute sinusitis? Chronic sinusitis?

A
  1. Headache, fever, congestion, pain over sinus
  2. Acute symptoms + thick green/yellow discharge, halitosis, blurred vision, feeling of facial fullness worsens when bending over
114
Q

What are the diagnostic requirements of chronic sinusitis?

A

Reoccurring episodes of acute sinusitis or symptomatic sinus disease lasting > three months

115
Q

What are three causes of chronic sinusitis?

A

Allergy, environmental factors (e.g. fungus), non-allergic such as abnormal narrow sinus passages (small # from dental infections)

116
Q

Although rare, what can sinus infections cause?

A

Anosmia: Inability to smell

117
Q

How do you tell the difference between sinusitis and migraine?

A

Sinusitis: dull, constant aching pain over affected sinus and possible discharge
Migraine: unilateral headache and often vomiting and visual disturbances

118
Q

3 different sinusitis based on duration of symptoms?

A

Acute: 12 weeks

119
Q

In chronic sinusitis, what can develop in the sinus that can be viewed radiographically?

A

Antrolith: Area of dystrophic calcification

120
Q

What organism is commonly found in antral calcifications?

A

Aspergillus fumigatus

121
Q

T/F. Prescribe an antibiotic and decongestant to better relieve patient’s pain.

A

F. Topical decongestant shrinks nasal membranes to improve osteal drainage but also decreases mucosal bloodflow required for antibiotic delivery

122
Q

Do you have to prescribe ab for acute sinusitis?

A

No, b/c usually self-limiting but amoxicillin can be given to healthy pt

123
Q

What can be done if sinusitis does not respond to medical managements (2)?

A

Surgery (or nasal endoscopy)

124
Q

Is sinusitis a primary infection or disease of infection?

A

Disease of obstruction w/ secondary inflammation developing?

125
Q

What must be a differential diagnosis when patient present with maxillary tooth ache?

A

Sinusitis

126
Q

What are other symptoms of maxillary sinusitis?

A

Pain over cheekbone, toothache, periorbital pain or temporal headache; also increased pain when head is upright and less discomfort supine

Oral Path Exam 2 (8 decks)

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