Ch5 Bacterial up to Syphilis Flashcards
What are the 2 bugs causing IMPETIGO?
Staph aureus (alone or incombo with Strep Pyogenes), step pyogenes (group A, Beta-hemolytic)
What are the 2 patterns of impetigo? Which bug causes each? What % of overall cases are each?
1.non-bullous (70%) mix of Staph Aureus and Strep Pyogenes and 2. bullous (30%) predominantly caused by Staph Aureus
What is the English translation for Impetigo (Latin)?
ATTACK (c/o the scabbing eruption)
What is the term for secondary involvement of impetigo in an area of dermatitis?
impetiginized dermatitis
What are three co-morbidities that increase a patient’s risk of developing impetigo
HIV, Type II DM, Dialysis
Alternate name for nonbullous impetigo?
impetigo contagiosa
Where does nonbullous impetigo most often occur? IF they occur on the face, where?
legs (less common on trunk, scalp, face)…around the nose / mouth
What age range for nonbullous impetigo? When is the infection most common?
school-aged children..summer/early fall
What have the crusts of impetigo been characterized as? What are two other entities is impetigo often mistaken for?
“cornflakes” glued to the surface of the lesion…exfoliative chelitis, recurrent HSV
What is the term for when a nonbullois impetigo develops a central area of the crust that becomes necrotic and forms a deep indurated ulceration?
ECTHYMA
Bullous impetigo is AKA?
Staphylococcal impetigo
What is the most common age for bullous impetigo? Location?
infants and newborns…extremities, trunk, face
What is the buzzword for the appearance of bullous impetigo?
“lacquer”
3 drugs for nonbullous impetigo
All tompical: 1.mupirocin 2.fusidic acid (canada/euro, no USA) 3. RetaPAMulin (for MRSA)
4 drugs for bullous impetigo (NO MRSA)
All oral: 1.Cephalexin 2.dicloxacillin 3.FLUCLOXacillin 4.Amoxicillin-clavulanic acid
4 drugs for bullous impetigo (MRSA)
1.Trimethoprim/sulfamethoxazole 2.clindamycin 3.tetracycline 4. fluoroquinolones
What is a classic complication of untreated bullous impetigo?
acute glomerulonephritis
WHAT superficial skin infection is most commonly
associated with β-hemolytic streptococci (usually group A, such as S. pyogenes, but occasionally other groups, such as group C, B, or G)???
ERYSIPELAS
What group of Strep is associated with erysipelas? What does erysipelas mean in Greek?
Beta-hemolytic (usually group A like Strep Pyogenes, but can be group c,b,g too)…“red skin”
Erysipelas infection rapidly spreads through the _______channels….this causes the term (buzzword) _______
lymphatic channels…“St. Anthony’s Fire”
What is the age range for erysipelas? Where is the most common location?
young/older adult pts who are debilitated..the LEG (affected by tinea pedis “athletes foot”) areas of previous trauma
How do the change in seasons affect the LOCATION of an erysipelas infection?
Winter/spring = face vs summer = lower extremities
What other condition can mimic erysipelas because of the facial clinical presentation?
SLE (“butterfly” rash on face)
If the eyelids are involved in erysipelas, what can it resemble?
angioedema
What common description is made for the surface of the skin in ERYSIPELAS?
peau d’orange
What is the treatment of choice for erysipelas?
penicillin (backups include macrolides (such as, erythromycin), cephalosporins
(such as, cephalexin), and fluoroquinolones (such
as, ciprofloxacin)
What % of pharyngitis cases are caused by bacteria (kids vs adults)? What kind of bacteria?
20-30% of acute pharyngitis in kids, 5-15% in adults; group A, Beta-hemolytic streptococci
Age range and time of year for most acute pharyngitis cases?
5-15 years old, winter/early spring
What are two tests for viral vs bacterial pharyngitis?
culture and rapid antigen detection
What are two possible systemic sequellae of pharyngitis?
acute rheumatic fever or acute glomerulonephritis
Initiation of appropriate therapy within the first (HOW LONG?) after development of the pharyngitis prevents rheumatic fever. Patients are considered noncontagious HOW LONG after initiation of appropriate antibiotic therapy?
9 days…..24 hours
What is the antibiotic of choice for group A streptococci pharyngitis?
Penicillin V or amoxicilin
What is the name for a systemic infection produced by group A, β-hemolytic streptococci?
Scarlet fever
A destruction of blood vessels may take place in scarlet fever patients as a result of ___________________?
a lack of antitoxin antibodies
In severe cases of scarlet fever, the exudates may become confluent and can resemble _______
diptheria
Scarlet fever: Scattered _____ may be seen on the soft palate in up to 10% of affected patients
petechiae
What are the two tongue manifestations of scarlet fever and what is their timing sequelae?
white strawberry tongue (first 2 days)…red strawberry tongue (4th-5th day)
What is the classic rash of scarlet fever described as? What is the texture of the skin described as?
“Sunburn with goose pimples”….sand paper texture
In scarlet fever, the skin rash is more intense in areas of pressure and skin folds causing TRANSVERSE STREAKS that are nicknamed….
PASTIA lines
What is the standard test in the diagnosis of streptococcal pharyngitis and scarlet fever? What is a good adjunct?
throat culture = standard…rapid antigen testing = adjunct
The oral antibiotic of choice for group A streptococci is either _______ or _______ and _________ can be used to reduce the fever and relieve the associated discomfort
penicillin V or amoxicillin….Ibuprofen
The contents of the invaginations in the tonsillar crypts (keratin & bacterial colonies) often become compacted and form a mass of FOUL-SMELLING material known as a _________…Occasionally, the condensed necrotic debris and bacteria undergo dystrophic calcification and form a _________
tonsillar concretion….tonsillolith
Tonsilloliths are discovered on panoramic radiographs as radiopaque objects superimposed WHERE?
midportion of the mandibular ramus
What are the three possible culprits for DIPHTHERIA? What is associated with the two less common culprits?
1.Corynebacterium diphtheriae 2. C. Ulcerans 3. C. Pseudotuberculosis….(ulcerans and pseudotb assoc with DAIRY and FARM ANIMALS)
What is the alternate name for C. Diphtheria?
Klebs-Loffler bacillus
Name that infection: The oropharyngeal exudate begins
on one or both tonsils as a patchy, yellow-white, thin film
that thickens to form an adherent gray covering. With time, the membrane may develop patches of GREEN or BLACK necrosis…GROSS
Diphtheria
Palatal perforation has been rarely reported in what infection?
Diphtheria
Diphtheria can involve the tonsils and lead to significant cervical lymphadenopathy, which often is associated with an edematous neck enlargement known as “_______”
BULL NECK
What two bugs can be found on skin ulcers caused by diphtheria?
S. Aureus and S. Pyogenes
What is the most commonly seen manifestation of neuropathy in severe diphtheria?
palatal paralysis
If a pt with diphtheria develops peripheral polyneuritis, what condition can this mimic?
Guillain-Barre syndrome
What are the three frontline meds for diphtheria?
Erythromycin, procaine penicillin, or intravenous (IV) penicillin may be used
How often is a diphtheria vaccination booster needed?
every 10 years
What environmental situation is T. Pallidum susceptible to? Therefore what are the 2 primary modes of transmission?
dry air….sexual contact or mother-fetus
A syphilitic patient is highly infectious only during
the WHICH STAGE(S)?, but pregnant women also may transmit the infection to the fetus during the _____ stage.
first 2 stages…latent
What is the classic sign of primary syphilis? WHERE does it occur (in general)? and HOW LONG does it take to develop?
CHANCRE…develops AT THE SITE of inoculation…3-90 days after exposure
What % of chancres develop in the oral cavity? where do a majority develop?
4% in oral cavity..85% in the genital region
How long does it take for a chancre to heal?
3-8 weeks
What is the alternate name for secondary syphilis? How long does it take to be discovered clinically after infection? What are two of the most common, GENERAL signs?
desseminated…4-10 weeks..painless lymphadenopathy and a maculopapular cutaneous rash (widespread)
About 30% of ________ patients will develop mucous patches in the oral cavity?
secondary syphilis
What are the elevated mucous patches centered over the crease of the ORAL COMMISURE found in SECONDARY SYPHILIS?
SPLIT PAPULES
What is the name for a papillary lesion arising during secondary syphilis?
condylomata lata
How long does it take for the lesions of secondary syphilis to resolve?
3-12 weeks
How long can latent syphilis occur? What % of latent syphilis cases convert into tertiary syphilis?
1-30 years…only 30%!
What are the four vascular compliactions most often associated with tertiary syphilis?
Aortic aneurysm, left ventricular hypertrophy, aortic regurgitation, and congestive heart failure
Involvement of the CNS in tertiary syphilis may result in ________, general paralysis, psychosis, dementia, paresis, and death.
tabes dorsalis (loss of coordination of movement)
Three ocular complications of tertiary syphilis are iritis, choroidoretinitis, and _________ - WHICH the pupils ______ upon focusing, but they fail to respond to bright light…NICKNAMED “________” because they accommodate but do NOT react
ARGYLL ROBERTSON…..CONSTRICT…..”PROSTITUTE’S PUPIL”
What is the name for the characteristic scattered foci of GRANULOMATOUS inflammation in Tertiary Syphilis affecting the skin,
mucosa, soft tissue, bones, and internal organs?
GUMMA
What is the differential for palatal perforation? (6 entities)
INFECTIONS: 1)Tertiary syphilis - gumma…2) Diphtheria….3) Leishmaniasis CANCER: 4) NK/T cell lymphoma…… DRUGS 5)Oxycodone-related palatal perforation…..6) cocaine
What is the term for when the tongue may be involved diffusely in tertiary syphilis with gummata (large, lobulated, and irregularly shaped)?
interstitial glossitis
What is the condition of diffuse atrophy and loss of the dorsal tongue papillae in the setting of tertiary syphilis?
Leutic glossitis (LUES is another name for syphilis, in LATIN means “plague”, so used loosely for diseases, but mostly for syphilis in particular)
What is the HUTCHINSON TRIAD associated with tertiary syphilis?
1.Hutchinson teeth 2.Ocular interstitial keratitis 3.Eighth nerve deafness
WHAT ARE THE 6 MOST COMMON STIGMATA OF CONGENITAL SYPHILIS?
- Frontal bossing
- Short maxilla
- High-arched palate
- Saddle nose
- Mulberry molars
- Hutchinson incisors (the rest (14 total) are less common including interstitial keratitis and eighth nerve deafness, SABER SHINS, Rhagedes, Higoumenaki sign(clavicle)..the other parts of hutchinson’s triad)
What is the clinical term for the circumoral radial skin fissures found in congenital syphilis?
rhagades
Untreated infants with untreated congenital syphilis who survive will then develop which stage of syphilis?
tertiary
Hutchinson’s incisiors: the widest mesial-distal width is in the middle third of the crown and tapers toward the incisal edge resembling what buzzword?
“straight edge” (flat head?) screwdriver
What are three general stains that can be used to look for spirochetes if syphilis is suspected?
Warthin-starry, Steiner, Immunoperoxidase
Which stage of syphilis is the most difficult to find T. Pallidum on histology? What might you see instead?
Third..granulomatous inflammation (immune response instead of T. Pallidum causing the inflammation
How many serologic tests can verify syphilis? How many are general and how many are specific? How long does it usually take after exposure to yield positive results?
6 blood tests: 2 general, 4 specific..the specific tests stay positive for life…..3 weeks after exposure. tests would be positive in stages 1 and 2
What is the frontline treatment for syphilis? Where can the spirocetes evade the abx?
BENZATHINE PENICILLIN G….lymph nodes and CNS
