CMS and microbiology Flashcards
A 10-year-old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination, you note generalised white plaque that scrapes off easily and leaves an erythematous base.
- What is your diagnosis?
Pseuomembranous candidosis.
A 10-year-old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination, you note generalised white plaque that scrapes off easily and leaves an erythematous base.
Name 4 pre-disposing factors for this condition, 2 local and 2 medical
2 local:
broad spectrum antibiotics use
Local corticosteroid use e.g. asthmatic using inhaler without rinsing mouth out
poor OH
Xerostomia
2 medical:
Diabetes Mellitus
HIV
Immunodeficiency
immunocompromised
smoking
Radiation exposure
A 10-year-old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination, you note generalised white plaque that scrapes off easily and leaves an erythematous base.
Make an oral swab and an oral rinse, give an advantage and disadvantage of each
Oral swab-
Adv- simple and site specfic
Disadv- can be easily contaminated and uncomfortable.
Oral rinse- Records the whole mouth and can separate healthy organisms.
Disadv- Not site specific. Process is difficult for patients to do. It is a quantifiable amount but difficult to standardise.
A 10-year-old boy presents at your surgery with his mother. His only complaint is a bad taste in his mouth. On examination, you note generalised white plaque that scrapes off easily and leaves an erythematous base.
What is your 1st line medication for this condition, state 2 drugs that it interacts
with and the nature of interaction
After first line treatment (Mechanical disruption of the biofilm)
1. Miconazole oromucosal gel- 20mg/ g. Apply a pea sized amount after food 4 times a day.
2. Fluconazole (7 50mg capsules- 1 daily)
Except for patients on:
wafarin (miconazole increases the anticoagulant effect)
Statins (increased risk of myopathy & hepatoxicity)
We use nystatin fot these patients (30ml oral suspension- 1ml after food four times daily)
The patient has attended with generalised white plaques that scarape off easily and leave an erythematous base.
What information is required on a lab sheet for sample? (10)
o Patient details – Name, address, DOB, CHI, telephone number
o GDP and GMP details – Name, address, contact number
o Patient medical, drug, dental and social history
o Clinical description of the problem
o Provisional diagnosis
o Test previously done and test required to be done e.g. culture, viral, ESR
o specimen site and type
o Antibiotic use previous, currently and resistance
o Date and time of sample
o Referring clinician name, signature
Patient has attended with denture stomatitis.
What is your 1st line treatment?
Erythematous candidosis
Local measures first:
Denture Hygiene Instruction
brush palate daily
clean denture thoroughly - soak in CHX or sodium hypochlorite (acrylic only) for 15 mins 2x per day.
Wear dentures as little as possible
No resolution:
Miconazole 20mg/g 4xdaily.
Fluconazole 50mg (1 tablet for 7 days)
new dentures made when health restored
Patient has attended with denture stomatitis.
What is your 2nd line treatment?
Combine the improvement in OH with :
Topical antifungal
Miconazole oromucosal gel (20mg/g) applied 4 times daily after food.
Systemic antifungal- Fluconazole 50mg capsule 1 daily for 7 days.
If contraindicated (so for patients taking warfarin or statins)
Nystatin 30ml (100,000 units per ml oral suspension 1ml after food 4x daily for 7 days.
What is a biofilm?
A biofilm comprises of an aggregate of microorganisms, whose cells adhere to one another and embed in a surface. The adherent cells become embedded within a self-produced matrix of extracellular polymeric substances which allows the adherence to a surface.
What are the stages of colonisation of a biofilm?
Reversible attachment-
Irreversible attachment- reduced production of flaggela gene
Maturation 1- cell clusters embedded in the biofilm
Maturation 2-Colonisation of the bacteria.
Dispersion- of the bacteria.
Give 4 methods of identifying the bacteria
- Microbiological culture- on a suitable agar material allowig isolationof the bactiera and identification through suitable tests .
- DNA probes- Label the segment of DNA with chemoluminescent of fluoronescent. When the bacteria is denatured- the labelled DNA will bind to its complementary strand.
- PCR- Selecting a target sequence of DNA and amplifying it.
- ELISA- enzyme linked immunosorbant assay- using enzymes to attach to the antibody.
What are the virulence factors for P, gingivalis?
Host cell tissue adherence and invasion (fimbriae)
Proteases (Degradative enzymes e.g. gingipans)
Endotoxin (LPS)
Metabolic by-products
What are the virulence factors for Candida, albicans? (4)
Altering the target site to prevent azoles binding
Changing the cell membrane composition to prevent the insertion of polyene into the cell membrane.
Hyphae causing damage to host tissue.
Hydrolytic enzymes- attachment to host cells & causes cell structure.
What are the virulence factors for Strep mutans? (3)
o Adhesions, glucagon and polysaccharide production
o Biofilm formation
o Acid tolerance- through the acid ATP pup to maintain pH balance and adaptation
Give 5 ways in which antibiotics work?
3x inhibit synthesis
1x injure
1 extra
- Inhibit cell well synthesis
- Inhibit protein synthesis
- Inhibit DNA acid replication and transcription
- Injure the plasma membrane
- Inhibit the synthesis of essential metabolites
Give 3 disadvantages of antibiotic use?
Antibiotic resistance
Interactions with other medications
Hypersensitivity / anaphylaxis (e.g. penicillin allergy)
