Ch 5 Bacteria - NOMA thru Sinusitis Flashcards
What are the 4 alternate names for NOMA? What does NOMA stand for?
1.Cancrum oris 2.Orofacial gangrene 3. Gangrenous stomatitis 4. necrotizing stomatits…noma comes from “devour” in greek
NOMA is polymicrobial, but what are two key players?
Fusobacterium necrophorum and Prevotella intermedia
What infection most frequently sets the stage for noma?
MEASLES (HSV, Varicella, Scarlet fever, malaria, TB, etc)
Some believe that noma is an extension of what process?
NUG (necrotizing ulcerative gingivitis)
What are three situations that can yield noma in the developed world?
HIV, severe combined immunodeficiency syndrome, intense immunosuppressive therapy
What age range is most likely to present with noma?
1-10 years of age
Noma begins as NUG, and extends to form areas called: ?
necrotizing ulcerative mucositis (NUM)
What makes the spread of noma different from other infections??
it does not respect or follow tissue planes (spreads through normal anatomic borders like muscle)
Are most noma lesions uni or bilateral?
unilateral
What are the two first line abx for necrotizing stomatitis?
penicillin and metronidazole
Name 2 of the most common organisms found actinomycosis? What type are they?
Actinomyces isaelii and a. viscous….Filamentous, branching, gram positive ANAEROBIC bacteria
In most cases of actinomycosis, what other two bacterial types are commonly found alongside of the culprits?
Streptococci and staphylococci
What is the term for large yellow flecks representing colonies of bacteria in actinomycosis? What other infection can mimic these???
sulfur granules…BOTRYOMYCOSIS (unrelated to actino, but can produce sulfur granules)
What is botryomycosis an unusual host reaction to? What can be produced in this disease process that mimics actinomycosis?
S. Aureus, sulfur granules
What is the classic clinical description of actino?
“wooden” induration of fibrosis with a softer, central area of abscess
What is the MOST FREQUENTLY AFFECTED site for an actinomycosis infection?
angle of the mandible
Actino histo: “____“-shaped filaments that form a radiating “______” pattern
club-shaped…rosette pattern
What can you stain actino with to see the organisms?
methiamine silver
What can be used to diagnose actino on the sulfur granules?
fluorescein-conjugated antiserum
What is the first line treatment for actinomycosis? What is an alternative if there is an allergy? How long?
Its a debate between penicillin and amoxicillin. But use lots of it. Tetracycline if allergic..5-6 weeks UP TO 12 months (holy shit)
Cat-scratch disease is an infectious disorder that begins in the _____ but classically spreads to the adjacent ______.
skin, lymph nodes
What infection is the most common cause of CHRONIC REGIONAL lymphadenopathy in children?
Cat-scratch disease
What is the causative agent in CAT SCRATCH DISEASE?
Barton-ella HENSEL-ae (formerly roch-al-imea henselae)
How does bartonella henselae transmit from cat to cat?
CAT FLEAS (gross)
What are the two ways bartonella henseale is transmitted from cat to human?
saliva or scratch
Besides cats, what are 4 other documented routes of infection for bartonella henselae?
dogs, monkeys, porcupine quills, and thorns
What age range is most likely for cat scratch disease?
YOUNG. 80% of pts under 21
Besides the papule and LAD associated with cat scratch disease, what two systemic manifestations occur?
prolonged fever, hepatosplenic disease
What two vasoproliferative disorders can be found in immonocompromised pt’s with cat scratch disease?
- bacillary angiomatosis 2. bacillary PELIOSIS HEPATIS (specific form of hepatosplenic Bartonella disease)
Which lesion associated with cat scratch disease in AIDS patients can resemble Kaposi Sarcoma?
bacillary angiomatosis
What are two stains that can show cat scratch bacilli?
Warthin-starry or Brown-Hopps method of Gram stain
Cat scratch disease is SELF LIMITING. How long does this take? IF a pt is immunocompromized what are three abx that work against Bartonella?
4 months….azithromycin, erythromycin, doxycycline
Normal sinuses are lined by __________
pseudostratified columnar epithelium with cilia
Most acute sinusitis cases are ______ in origin and most chronic cases are _______ in origin
acute = viral, chronic = bacterial
What are the 3 most common bacteria cultured in acute sinusitis? (even though acute is viral lol)
1.Strept penumoniae, Haemophilus influenzae, and Moraxella catarrhalis
Chronic sinusitis is defined as recurring acute sinusitis or symptomatic sinus disease lasting longer than _____
3 months
What are the 3 most common bacteria cultured in chronic sinusitis?
Strept, Bacteriodies, or veilonella (anaerobes)
Occasionally in chronic sinusitis, what radiographic dystrophic calcification can arise?
antrolith
A sinus that is unresponsive to therapy and exhibits
focal antrolith formation within a diffuse soft tissue opacification is highly suggestive of _________
noninvasive aspergillosis.
Focal antral calcification also has been seen in sinuses filled with a fungal ball of ________ (noninvasive mycetoma)
Aspergillus fumigatus
What is the first line abx for sinusitis? Secondary?(if allergic)
amoxicillin…doxycycline or clarithromycin alternatively
