Chapter 5 - Bacterial Infections

Question 1

Gonorrhea

Answer 1

Bacteria: Neisseria gonnorhoeae
Symptoms: purulent discharge, dysuria
STD - most common reportable infectious disease

Question 2

Congenital Syphillis

Answer 2

Hutchinson’s triad: Hutchinson’s incisors (screw driver shape), ocular interstitial keratitis, 8th nerve deafness
Other characteristics: Mulberry molars

Question 3

Hutchinson’s Triad

Answer 3

Associated with congenital syphilis

• Hutchinson’s incisors
• Ocular interstitial keratitis
• 8th nerve deafness

Question 4

Syphilis

Answer 4

Bacteria: Treponema pallidum
STD or vertical transmission
Types: Primary, Secondary, Tertiary, Congenital

Question 5

Primary Syphilis

Answer 5

Chancre develops at site of inoculation (painless ulceration)

• Anus
• External genitalia
• Oral lesions (2%) - lip

Question 6

Secondary Syphilis

Answer 6

AKA Disseminated syphilis 
Symptoms
- ORAL --> Mucous patches
- Painless lymphadenopathy
- ALWAYS - diffuse, painless, maculopapular, cutaneous, widespread rash

Question 7

Tertiary Syphilis

Answer 7

30% of patients progress to tertiary syphilis from latent syphilis
- Cardiac complications
- Ocular lesions
- Tongue lesions
- Gumma
* Palatal tissue dies, bone dies, hole formed
in palate
- Intraoral lesion
* Syphilitic glossitis - white patches don’t
come off

Question 8

Gumma

Answer 8

Characteristic of tertiary syphilis

- scattered foci of granulomatous inflammation

Question 9

Cardiac complications of Tertiary Syphilis

Answer 9

Aneurysm of the ascending aorta
Congestive heart failure
CNS involvement
Paralysis
Psychosis
Death

Question 10

Impetigo

Answer 10

Bacteria: Strep pyrogens and staph aureus
Forms: bollus and nonbollus
Increased prevalence: HIV, Type 2 diabetes, dialysis

Question 11

Impetigo - bollus

Answer 11

Most commonly in infants
Untreated - can lead to meningitis, pneumonia, and glomerulonephritis
Bullae rupture - form thin brown crust

Question 12

Impetigo - nonbollus

Answer 12

More prevalent that bolls
School-aged children (contagious)
Effected areas: 
- Legs (most common) 
- Face around nose and mouth
Amber colored crusts

Question 13

Diphtheria

Answer 13

Bacteria: Cornebacterium diphtheriae (produces a lethal exotoxin)
Humans are sole reservoir
Affects mucosal tissue first
Tissue necrosis and cardiac complications

Question 14

Tonsilitis and Pharyngitis

Answer 14

“Strep throat”
Pathogen: Group A strep, influenza, Epstein-Barr virus
- Usually caused by a virus
Symptoms: sore throat, dysphagia, tonsillar hyperplasia, fever, headache, other constitutional symptoms

Question 15

Sequelae of Streptococcal pharyngitis/tonsillitis

Answer 15

Scarlet fever
Rheumatic fever
Rheumatic heart disease
Acute glomerulonephritis

Question 16

Tuberculosis

Answer 16

Mycobacterium tuberculosis
ACID FAST BACILLUS

Airborne droplets – look at chest X-rays

Caseating granulomatous inflammation

Question 17

Oral manifestation of Tuberculosis

Answer 17

Painless chronic ulceration

Question 18

Lupus Vulgaris

Answer 18

TB of the skin

Question 19

Scrofula

Answer 19

Myobacterial infection caused by drinking contaminated milk (infected cow)

Question 20

Leprosy

Answer 20

Mycobacterium leprae
Host – armadillo
Collapsed bridge of the nose

Question 21

Noma

Answer 21

Polymicrobial:

• Fusobacterium necrophorum
• Prevotella intermedia

Rapidly progressive

Opptunistic infection - most frequently follows measles (immune system compromised, lesions)

Zones of necrosis develop in gingiva or soft tissue – does not follow tissue planes

High mortality rate if untreated

Question 22

Painless Ulcers (2 diseases)

Answer 22

Syphillis – Chancre

Tuberculosis

Question 23

Actinomycosis

Answer 23

Actinomyces israelii

Colonization occurs in healthy patients:

• Tonsillar Crypts
• Plaque
• Carious Dentin

Clinical signs are diagnostic

• Suppurative reaction of infection may discharge YELLOW material
• SULFUR GRANULES - colonies of bacteria

Treatment: Long term high dose antibiotics

Question 24

Two bacteria that cause impetigo

Answer 24

Strep pyrogens (Group A strep) and staph aureus

Question 25

Scarlet Fever

Answer 25

Result of disseminated Group A
Oral features:
- White strawberry tongue
(white coating with only visible fungiform papillae)
- Red strawberry tongue (erythematous dorsal surface w/ hyper plastic fungiform papillae)

Dermatologic features:

• Skin erythema
• Desquamation
• Pastia’s lines

Question 26

Oral features of Scarlet Fever

Answer 26

White strawberry tongue - white coating w/ visible fungiform papillae

Red strawberry tongue - erythematous dorsal surface with hyper plastic fungiform papillae

Question 27

Cat-Scratch Disease

Answer 27

Bartonella henselae

Chronic regional lymphadenopathy - children
Arises after contact with cat –> Scratches, licks, bite

Self limiting condition – antibiotics can be appropriate

Resolves in 4 months

Question 28

Sinusitis

Answer 28

Most common health complaint in US

Blockage of ostiomeatal complex
May become chronic

Radio-opaque sinus in Xray
Calcification –> antrolith

Sinus infection should be strongly considered when patients complain of pain from several teeth

Treatment – self limiting, ABX, surgery

Question 29

Chronic sinusitis that becomes calcified?

Answer 29

Antrolith

Question 30

Maxillary Sinusitis

• Increased pain when —
• Decreased pain when —

Answer 30

Increased –> when head is upright

Decreased –> when patient is supine

Question 31

Pastia’s lines

Answer 31

Scarlet Fever

Rash in areas of pressure and skin folds presenting as transverse red streaks

Question 32

Tonsillar concretions

Answer 32

Compacted contents of invaginations in tonsils (tonsillar crypts)

Foul smelling

Actinomyces

Question 33

Tonsillolithiasis

Answer 33

Calcification of tonsillar concretions

Can be seen on panoramic x-ray (radiopaque) - mid portion of mandibular ramus

Question 34

At home treatment of tonsillar concretions/tonsillolithiasis

Answer 34

Gargle warm salt water

Use pulsating jets of water