HD10 Orofacial infections Flashcards
Pharyngitis can be caused by these pathogens:
1)Streptococcal pharyngitis
ß-haemolytic streptococci (Groups A, C, G)
2) genus: Arcanobacterium haemolyticum (similar to streptococci on agar but are gram positive vacilli). Can cause bacterial pharyngitis,
3)• Corynebacterium diphtheriae/ulcerans/pseudotuberculosis: in rare cases we look for this bacteria where people aren’t vaccinated against diphtheria.(vaccinations won’t have occurred in developing countries)
On blood agar, what colour is alpha haemolysis?
2) partial or full?
1) green
2) partial
On blood agar, what colour is beta haemolysis?
2) partial or full?
1) yellow
2) full
What is quinsy?
peritonsillar abscess ( s a rare and potentially serious complication of tonsilitis). The abscess ( a collection of pus) forms between one of your tonsils and the wall of your throat
What is the treatment of quinsy?
drainage as it is an abscess
What group of bacteria are we concerned may be present in patients with pharyngitis?
Group A streptococci
What things can group A streptococci cause?
- phayngitis
- quinsy
- sepsis
- rheumatic fever
- glomerulonephritis
- scarlet fever
What antibiotic is prescribed for a suspected infection (either scarlet fever or sepsis) caused by group A streptococci?
pencillin, as it always works against strep
What is glomerulonephritis?
2) How long does it take to present following a sore throat?
inflammation of the tiny filters in your kidneys (glomeruli)
2. weeks
What are the clinical presentations of scarlet fever?
2) How long does it take to present following a sore throat?
1) sand paper like rash on skin
2) days
What antibiotics can be used if a patient is allergic to penicillin?
Tetracyclines (e.g. doxycycline), quinolones (e.g. ciprofloxacin), macrolides (e.g. clarithromycin), aminoglycosides (e.g. gentamicin) and glycopeptides
What are the red flags for sepsis?
A suspected/ proven infection + 1. saO2 is less than 90% therefore supplemental O2 required 2. RR is morethan 25 3. lactate is more than 2 4. HR is less more than 130 5. systolic BP is less than 90 6. AVPU (so not fully awake i.e. responds to only voice or pain , doesn't respond purpuric rash
Why else other than sepsis do patients present with a purpuric rash?
2) What can be done to confirm its sepsis?
- trauma, aspiration pneumonia and burns
2. blood tests
If sepsis is suspected what is the treatment?
3 in and 3 out
In: O2, fluids and antibiotics
Out: lactate, urine and blood cultures
What percentage of the flora in quinsy is by group A streptococcus
30
Corynebacterium diphtheriae
1) What is the pathological thing of this bacterium?
2) WHat does it do?
3) Who gets infections?
Diphtheria toxin
2) inhibits protein synthesis
3) Non-immunized children under 15
What infection is this:
Asymmetrical, greyish white membrane, especially if it extends to the uvula and soft palate. That can be removed with instruments. They may also have difficulty breathing.
Corynebacterium diphtheriae
What infection is this?
Serosanguineous nasal discharge
Corynebacterium diphtheriae
Arcanobacterium haemolyticum How does it affect the population? 2) Presentation 3) What is the route of infection? 4)How does it differ from streptococcus on agar?
1) Sporadic cases in young adults
2) Chronic skin ulcers
3) Throat and wound infections
4) is also cocci but is gram positive (and thus alpha haemolytic while streptococcus is beta)
What are dentoalveolar infections?
2) What sampling for microbial analysis should be carried out and why?
infection of teeth and their sockets
2) take samples of the pus not swabs, as swabs will come back so oral flora which isn’t helpful
What is a severe consequence of a dentoalveolar infection if untreated?
encephalatits
without getting it shitty anatomy just think basic, where does the infection spread to from the tooth to get to the blood (sepsis)?
- apical foramen
- periodontal ligament
- blood stream (as there are periapical blood vessels there)
patient presents with fever , what’s the probable diagnosis
1) lumps in neck unilateral
2) lumps in neck bilateral
1) dentoalveolar infection thats now caused sepsis
2) mumps
What are antibiotics ineffective against abscesses/ dentoalveolar infections?
Many bacteria cause abscesses therefore antibiotics are ineffective
Whats another word for salivary gland infection?
2) whats the most common cause?
3) who do you suspect this in?
4) if the salivary gland infection is caused by bacteria , how does this work?
1) sialadenitis
2) mumps
3) non-immunized teenagers
4) Bacterial infections are generally caused by endogenous oral flora, secondary to diseases causing reduced salivary flow , possible due to stones this will require surgery
Osteomyelitis is not an infection, and more often affects the lower jaw.
true or false
true
What is the TP fro osteomyelitis
Requires weeks of antibiotic treatment, if that doesn’t work look for where it is being sequestered.
(errr this is wrong for alveolar osteomyelitis me thinks, as you treat with chlorohexidine syringe wash out and grass stuff packed)
what are the complications of osteomyelitis of the jaw?
- cutaneous abscesses & fistulae (pus in a confined space, so abscess is pointed out so exits through the skin, these infections are difficult to treat through antibiotics alone and will require surgery)
- cellulitis
Which is more commonly affected by osteomyelitis, maxilla or mandible?
mandible- poorer blood supply
If osteomyelitis is due to an infected tooth, TP ?
extract
If osteomyelitis is due to an open fracture, TP?
If it is due to an open fracture, antibiotics may suffice. If infection persists, look for a sequestrum and remove it.
What is a sequestrum?
is the necrotic bone that is embedded in the pus/infected granulation tissue
What is involucrum?
the new bone laid down by the periosteum that surrounds the sequestra
What is the cloaca?
is the opening in the involucrum through which pus and sequestra make their way out
Why must infectiosn sequestered in bones be surgically removed like you would for a stone in the parotid?
For antibiotics to work , the must penetrate the bone, bacteria and layer of dead cells
HAI=
healthcare associated infection
What is the most commmon surgical site infection or HAI?
Staphylococcus aureus
Multi-drug resistant organisms incl.:
(more commonly seen in HAI or surgical site infection:
- MRSA (i.e. flucloxacillin-resistant S. aureus), by the time you choose an antibiotic that is not a beta lactam, the infection has spread.
- CPE (carbapenem-resistant coliforms)
- VRE (vancomycin-resistant enterococci)
Why do you need ot reconsider antibiotic prescribing if infection is healthcare acquired?
more likely to be a mult-resistant organism
The type of antibiotic that you can use if the infection is health cared acquired then there is a lot less choice. In summary, you need to reconsider guideline if healthcare acquired infection has occurred i.e. look at other tests to determine appropriate antibiotic to use.
What 2 STIs cause oral infection?
2) WHat do you do if pt has this?
gonorrhoea
or syphilis
2) refer pt AND partner to GUM clinic
why is special media used to culture gonorrhoea?
it is fastidious (hard to grow), may consider a viral swab for PCR
What are the symptoms of gonorrhoea?
Burning sensation of pharynx (impossible to distinguish from other bacterial causes of pharyngitis)
Oro-genital contact can result in oral lesions
What the 2 ways to diagnose syphilis?
PCR-based or serology-based diagnosis
– Swab lesions for PCR
– Blood for serology (antigen-antibody reaction-based test)
Can syphylsis be cultured?
nope, not in vitro
If syphilis is left untreated what occurs?
it is a chronic progressive disease, the primmary stage is chancre often on lip (look like scabs), secondary is mucous pateches on mucose “snail track” ulcers & rubber cervical lymphadenopathy, tertairy is gumma , glossitis and syphilitc leukoplakia.
mycobacterium tuberculosis, can be identified with a Ziehl–Neelsen staining why?
they are – Acid-Alcohol Fast Bacilli (AAFB). These Acid-fast organisms like Mycobacterium contain large amounts of lipid substances within their cell walls called mycolic acids. The reagents used for Ziehl–Neelsen staining are – carbol fuchsin, acid alcohol, and methylene blue. Acid-fast bacilli are bright red after staining.
What percentage of the population have TB?
1/3 but there are only 3 cases per 100,000 people in the USA.
How do you notify the correct authorities about infectious disease cases? (e..g scarlet fever, mumps, TB, acute infectious hep)?
Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent, securely: – by phone – letter – encrypted email – secure fax machine
