Ch 5 Bacterial infections Flashcards
Superficial skin infection caused by Strep pyogenes and Staph aureus
Impetigo (Bullous and Non-bullous forms)
Which age group is most commonly affected by Bullous impetigo
infants and newborns
Bullous impetigo usually caused by which bacteria: Strep pyogenes or Staph aureus
Staph aureus
What is protective against impetigo transmission
Intacts skin and good hygeine
How will bullous impetigo normally progress
fragile vesicles that rupture and form thin brown crusts
treatment options for bullous impetigo
1 week systemic antibiotics: cephalexin, fluclaxacillin, amoxicillin-cluvanic aci
Treatment of non-bullous impetigo
topical mupirocin
Found when tonsillar crypts fill w/ desquamated keratin and foreign material, then become secondarily colonized w/ bacteria, usually Actinomyeces, which become a form of foul-smelling material
Tonsilar concretions
Tonsillar concretions that undergo dystrophic calcification form
Tonsilloliths
Treatment of tonsilloliths
Suctions, local excision, or removal of tonsils are recurrence is common
What is the bacteria that causes Syphillis
Treponema pallidum
2 main modes of syphilis transmission and why
Sexual contact Mother to child
Treponema pallidum is very vulnerable to drying
What is a rare way to get syphilis currently due to better screening procedures
blood transmission/exposure to infected blood
Is Syphillis curable, and if so how
Curable via IM antibiotic benzathine penicillin
4 types/stages of syphilis
Primary Secondary
Tertiary
Congenital
Which stages of syphilis are most infectious
Primary and Secondary
When must syphilis be treated to avoid transmission during pregnancy
within 5-6 months of getting pregnant
What characterizes primary syphilis
Chancre
Where does a chancre first appear and in what time period
At point of initial exposure w/in 3-90 days after exposure and lasting 4-6 weeks
Most common site for oral syphilitic chancre and its characteristic
lip most common, painless, clean based ulceration with regional lymphadenopathy
What can a syphilitic chancre on the lip be mistaken for
Cancer
When does Secondary Syphillis start
4-10 weeks after initial infection
What are the clinical symptoms of Secondary syphilis
Flu like symptoms, symmetrical, reddish pink maculopapular non-itchy skin rash
The zones of intense exocytosis and spongiosis of the oral mucosa with zones of sensitive whitish mucosa during secondary syphilis are called
mucous patches
What are condyloma lata
rash becomes flat broad whitish papules in moist areas of body
What is the difference in chancres in primary versus secondary syphilis
Secondary has multiple lesions
When will secondary syphilis resolve
w/in 3-12 weeks, but can relapse into secondary during the next year
The period after secondary syphilis that a person is free of lesions and symptoms
latent syphilis
When is a patient with latent syphilis more contagious, early or late
early
How treat a patient with early latent syphilis
single IM injection of long acting penicillin
How treat a patient with late latent syphilis
3 weekly injections
When will tertiary syphilis show up
1-10 years after initial infection
Which stage of syphilis is the most serious
Tertiary
What systems will tertiary syphilis affect
Cardiovascular, CNS, sight
What is the character of the inflammation associated with tertiary syphilis
granulomatous that is focal
The active site of granulomatous inflammation that is indurated, nodular, or ulcerated in tertiary syphilis
gumma
Gummas of tertiary syphilis are most common where orally
palate and tongue, palate commonly perforates into sinus
Diffuse atrophy and loss of the dorsal tongue papillae produce what condition in tertiary syphilis
Leutic glossitis, was thought previously to be cancerous, but is not
What is Argyll-Robertson pupil-diagnostic sign for the neurological diagnosis of tertiary syphilis
thin and irregular pupils constrict for focusing but not in response to light
Shuffling gate of tertiary syphilis due to neurological involvement called
Tubes dorsalis (locomotive ataxia)
3 things tertiary syphilis can cause cardiovascularly
syphilitic aneurysm Aortic aneurysm
Aortic regurgitation
This syphilis present in utero and at birth when child is born to mother with primary or secondary syphilis
Congenital syphilis
What stage will a baby that survives birth with congenital syphilis go directly to
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
[looks a bit like Mr. Magoo]
What are rhagades
furrows around mouth giving appearance of premature aging
What other names for Hutchinson’s teeth as part of the triad for congenital syphilis
Hutchinson’s incisors
Mulberry molar, Fournier’s molars, Moon’s molars
Hutchinson’s incisors resemble what
Flat head screwdriver with a central hypoplastic notch
When will interstitial keratitis in congenital syphilis appear and how will it look
between 5 and 25, opacified corneal surface with resultant loss of vision
Can there be false positives for syphilis by using spiral shaped bacteria in oral smears
yes, because there are other treponemes in the mouth
2 specific tests for syphilis
Treponema pallidum hemagglutination test (TPHA) Fluorescent Treponemal Antibodgy Absorption (FTA-ABS)
What is the only good thing that came out of the Tuskegee Syphillis study
National Research Act requiring government to review and approve all studies on human subjects
Most common reportable bacterial infection in the United States
Gonorrhea
Bacteria that causes Gonorrhea
Neisseria gonorrhea
What is protective against gonorrhea inoculation without sexual contact
intact stratified squamous epithelium
Most important female complication of gonorrhea
Pelvic inflammatory disease (PID)
Neisseria gonorrhea Gram stain and shape
Gram negative diplococcic
If you have gonorrhea what other STD are you treated for concurrently
Chlamydia
Antibiotics used to treat gonorrhea and Chlamydia
Ceftriaxone and doxycycline
Most common site of oropharyngeal gonorrhea and its symptoms
pharynx, tonsils, uvula. Asymptomatic or mild- moderate sore throat and diffuse oropharyngeal erythmea
Oral gonorrhea can mimic what other pathology, but what is absent in oral gonorrhea
Necrotizing Ulcerative Gingivitis but without the fetor oris
What is the gonorrhea transmitted to newborn’s eyes from an infected mother
Gonococcal Opthalmia Neonatum
3 drugs used for prophylaxis against gonococcla ophthalmia neonatorum
Opthalmic erythromycin Tetracycline
Silver nitrate
What is the clinical symptom for men with gonorrhea infection
pain on urination with urethral discharge
Chronic infectious disease caused by Mycobacterium tuberculosis
Tuberculosis (TB)
What is key for testing tuberculosis
distinguish infection from active disease
2 types of tuberculosis
Primary and Secondary
Tuberculosis that occurs in previously unexposed people and almost always involves the lungs, commonly the result of direct person-to-person spread through airborne droplets from someone with active disease
Primary tuberculosis
Can you get oral Tuberculosis only
No, it is always secondary to pulmonary and is rare
Primary Tb infection results in what and where
localized fibrocalcified nodule at the initial site of involvement
What is key to getting tuberculosis
long term exposure to large number of respiratory droplets from a person with active tuberculosis
What is the test for the tuberculosis exposure
Purified protein derivative (PPD)
Secondary tuberculosis normally occurs how and in what type of patient
active disease later in life from a reactivation in a person previously infected and associated with compromised immunity
Synonymn for secondary tuberculosis describing its diffuse granulomas
Miliary Tuberculosis
4 synonymns for Tuberculosis
Consumption Lupus vulgaris
Miliary
Scrofula
Skin involvement of tuberculosis. A diffuse unremitting skin infection
Lupus vulgaris
Oral lesions associated with tuberculosis have what character
hronic, painless ulcer
This tuberculosis infection characterized by enlargement of the oropharyngeal lymphoid tissues and cervical lymph nodes and transmitted by drinking contaminated milk
Scrofula
4 ways to diagnose Tuberculosis
Mantous or PPD skintest Chest X-ray
Culture of sputum for Gram Neg diplococcic
Mycobacterial stains
What is the cause of the formation of granulomas, called tubercles, which are a classic histologic presentation of Tb
Cell-mediated hypersensitivity reaction
Gangrenous disease leading to tissue destruction of face
noma
What causes Noma
pportunistic infection caused by components of normal oral flora that become pathologic during periods of compromised immunity
Predisposing factors for Noma
Malnutrition Dehydration Poor oral hygiene Poor sanitation Recent illness (e.g. Tuberculosis, measles) Malignancy Immunodeficiency (e.g. AIDS)
What illness normally precedes Noma
Measels
What age group does Noma mostly affect
children 2-6 years old
How treat Noma
Antibiotics (penicillin or metronidazole) along with wound care, OHI, better nutrition and hydration. Prevent w/ vaccinations from childhood illness. Repair with plastic sugery
Actinomycosis is
infection of filamentous, branching, Gram positive anaerobic bacteria. Not fungal
Causitive bacteria of actinomycosis
Actinomyces israelii
Where is actinomycosis likely to sequester
deep, e.g. fractures, gunshot wounds
3 clinical features of actinomycosis infection
acute deep supurative abscess multiple draining sinus tracts
sulfur granules
What area is common on the head and neck for actinomycosis infection
Area over the angle of the mandible
2 main treatments for actinomycosis infection
prolonged high doses antibiotics Abscess drain and excise sinus tract
Infectious disorder that begins in the skin but classically spreads to the adjacent lymph nodes
Cat scratch disease
Most common cause of regional lymphadenopathy in children
Cat Scratch disease
What is the bacterial cause of Cat Scratch disease
Bartonelle henselae, a gram negative rod
Clinical features of Cat Scratch disease
tender regional lymphadenopathy
Sterile supportive papules at scratch site w/in 3-14 days
How long can regional lymphadenopathy remain in Cat Scratch disease
3 weeks post scratch lasting for several months
What can make Cat Scratch disease hard to diagnose
Primary site of inoculation has healed before patient presents with lymphadenopathy
Cat Scratch disease treatment
self limiting with or without treatment in 1-2 months. Can give analgesics for pain, aspirate nodule, local heat
One of most common health complaints in US
Sinusitis
What are the bilateral sinuses of the adult
Frontal, Sphenoid, Ethmoid, Mastoid
What is the key to sinus disease
the osteomeatal complex with its narrow openings as primary site for inspired air foreign matter
