bacterial infections Flashcards
what is actinomycosis?
a rare, chronic suppurative granulomatous disease
what bacteria is associated with actinomycosis?
- filamentous anaerobic gram postive bacilli
- human commensal flora protect us against it
what is the age and sex demographic of actinomycosis
- m = f
- 30-60 years old
what are the predisposing factors of actinomycosis?
- Poor oral hygiene
- Trauma
- Poorly controlled diabetes mellitus
- Immunosuppressed
- Alcoholism
- Malnutrition
what is the clinical appearance of actinomycosis?
> Cervicofacial commonest clinical presentation
> Submandibular region
> Slow growing painless, indurated swelling
> Abscesses with sinus discharge to oral mucosa or skin
> Discharge contains visible granules “sulphur like”
> Pain and trismus in advanced stages
(50% Affect mandible, cheek 15%, chin 15%, angle, submaxillary ramus 10%
Rarely see tongue, paranasal air sinuses middle ear, larynx, thyroid)
what is the diagnosis pathways for actinomycosis?
> imaging
aspiration and culture
histopathology
what is the management of actinomycosis?
> Removal of dental focus
Antimicrobials
Surgical debridement
what is cat scratch disease?
- Regional lymphadenopathy and fever resulting from the scratch or bite of an infected cat (in particular kittens)
what bacteria cause cat scratch disease?
- Bartonella henselae – gram negative bacilli
what is the age and sex demographic of cat scratch disease?
- M>F
- mean age of 33 years
what is the clinical presentation of cat scratch disease?
> Benign self-limiting illness
> Papule/pustule at site of inoculation (3-30 days)
> Regional lymphadenopathy
> Surrounding tissue changes
> Suppuration
> Atypical presentation in immunocompromised
what is the diagnosis of cat scratch disease?
- History of flea or cat bite
- Exclusion of other causes
- PCR positivity for Bartonella DNA
- ELISA positive for B. henselae
- Tissue biopsy
what is the management of cat scratch disease?
- avoidance
- self limiting
- antimicrobial therapy
what is impetigo?
common contagious superficial bacterial skin infection
> face and personal region
who does impetigo commonly effect?
> usually affects children 3-5 years old
> summer / early autumn time
> trauma creates a portal of entry
what bacteria cause impetigo ?
staphylococcus aureus and streptococcus pyogenes
what is more common - non bullous or bullous impetigo?
- non bullous
what is the clinical appearance/ features of non bullous impetigo ?
> Erythematous macule, papule
> Ruptures
> “Honey-coloured” yellow crust on skin
> Lesions expand and coalesce
> Pruritis, pain, lymphadenopathy
what is the clinical appearance/ features of bullous impetigo?
( New born and infants)
> Vesicles or bullae
> S. aureus
> Blister formation
> Rupture and shed to produce an erythematous moist base that oozes serum
> Systemic symptoms
how do you diagnosis of impetigo?
- gram stain and culture of pus
- histopathology
what is the management of impetigo?
> spontaneous resolution
> antimicrobial agents
what is Lyme disease?
multisystem bacterial infection
natural hosts include most animals, so forest and farm workers at great risk
endemic in certain countries
what bacteria causes Lyme disease?
Borrelia burgdorferi
what are the stage 1 symptoms for Lyme disease?
- Spreading annular rash 14-30 days following tick bite
- Affects 80%
what are the stage 2 symptoms of Lyme disease?
- Weeks-months
Cardiac, neurological abnormalities, musculoskeletal symptoms
what is the stage 3 symptoms of Lyme disease?
- months years
- chronic skin, CNS or joint abnormalities
what are erythema migrans ?
> Rash pathognomonic of Lyme disease
> Red rash, increases in size
May have a central clearing
Presents at site of bite
Days to months
how do you diagnose Lyme disease?
> clinical diagnosis
> antibody test - repeat testing
what is the management of Lyme disease?
> antibiotic depending on symptoms
> Jarisch-Herxheimer reaction can occur
what is syphilis?
common sexually transmitted infection with 4 main clinical stages
what is the bacteria that causes syphilis?
> Treponema pallidum - anerobic filamentous spirochete
how is syphilis transmitted?
> sexual contact - 50%
> vertical
> indirect routes eg. blood transfusions
describe primary syphilis - 5 points
> Chancre
> Develops at site of inoculation
> Usually solitary lesion
> Lymphadenopathy
> Healing within 8 weeks
describe secondary syphilis - 4 points
> Two to twelve weeks after first contact
> Two months after healing of primary syphilis
> Due to haematogenous dissemination
> Constitutional and mucocutaneous manifestations
what is constitutional symptoms? 6 points
> “Flu-like”
> Fever
> Headache
> Weight loss
> Malaise
> General aches and pains
what is mucocuntaneous symptoms ? 5 points
> Skin rash – non pruritic
> Symmetrical pink/red macules, papules, pustules
> Arms, palms, flanks, soles
> Heal within weeks +/- hypo/hyper pigmentation
> Scalp
what are some key features of secondary syphilis patients may suffer from?
> 33% have mucous patches
> 50% generalised lymphadenopathy
> Condyloma latum
> Ocular involvement
> Joint involvement
> Glomerulonephritis
> Neurological involvement
what is latent syphilis?
> shows no signs of disease
> however positive serological testing
what are the key features of tertiary syphilis?
> Hard palate
- Small pale raised area- ulcer- area of necrosis
- Bone exposure
- Perforate into nasal canal
- Painless
> Osteomyelitis
Glossitis
Leukoplakia
Salivary glands
what are the complication of tertiary syphilis?
> Cardiovascular syphilis
- Aneurysms of ascending aorta
- Left ventricular hypertrophy
- Congestive heart failure
> Neurosyphilis
- Tabes dorsalis
- Psychosis
- Dementia
what is argyll Robertson pupils?
> caused by neurosyphilis
> Bilateral, asymmetrical small irregular pupils
> Constricts with accommodation
> No reaction to light
what causes congenital syphilis?
> T.pallidum can cross placental barrier
> Mother in primary or secondary stage of infection
> Second or third trimester
> can lead to Undesirable outcomes
what are the early manifestations of congenital syphilis?
> Periostitis
> Diffuse maculopapular rash
> Rhinitis
what are late manifestations of congenital syphilis?
> Dental anomalies (mulberry molars, hutchinsons incisors, open bite)
> Sensorineural hearing loss
> Interstitial keratitis of the cornea
> saddle nose, frontal bossing
how do you diagnose syphilis?
> History and clinical examination
> Dark field microscopy
> Serological tests
what is the management of syphilis?
> Benzyl penicillin
Erythromycin
Tetracycline
> Follow up for two years
> Contact tracing
what is tuberculosis?
> chronic communicable infectious disease
lung the main organ effected
extra pulmonary infections
what bacteria causes tuberculosis?
mycobacterium tuberculosis
how is tuberculosis transmitted?
> via droplet spread
what are the predisposing factors of tuberculosis?
> Over crowding
Poor health and hygiene
Poverty
Drug abuse
Immunosuppression, AIDS
> Local factors
- Poor oral hygiene
- Local trauma/irritation
what are the oral manifestations of tuberculosis/
> Oral manifestations are uncommon (0.1-5.0%)
> mainly Young adults
> Tongue
> Painful ulcers
> Lymphadenopathy
how do you diagnosis tuberculosis?
> history
> clinical examination
> special investigations
