HD10 Orofacial infections

Question 1

Pharyngitis can be caused by these pathogens:

Answer 1

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)

Question 2

On blood agar, what colour is alpha haemolysis?

2) partial or full?

Answer 2

1) green

2) partial

Question 3

On blood agar, what colour is beta haemolysis?

2) partial or full?

Answer 3

1) yellow

2) full

Question 4

What is quinsy?

Answer 4

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

Question 5

What is the treatment of quinsy?

Answer 5

drainage as it is an abscess

Question 6

What group of bacteria are we concerned may be present in patients with pharyngitis?

Answer 6

Group A streptococci

Question 7

What things can group A streptococci cause?

Answer 7

1. phayngitis
2. quinsy
3. sepsis
4. rheumatic fever
5. glomerulonephritis
6. scarlet fever

Question 8

What antibiotic is prescribed for a suspected infection (either scarlet fever or sepsis) caused by group A streptococci?

Answer 8

pencillin, as it always works against strep

Question 9

What is glomerulonephritis?

2) How long does it take to present following a sore throat?

Answer 9

inflammation of the tiny filters in your kidneys (glomeruli)

2. weeks

Question 10

What are the clinical presentations of scarlet fever?

2) How long does it take to present following a sore throat?

Answer 10

1) sand paper like rash on skin

2) days

Question 11

What antibiotics can be used if a patient is allergic to penicillin?

Answer 11

Tetracyclines (e.g. doxycycline), quinolones (e.g. ciprofloxacin), macrolides (e.g. clarithromycin), aminoglycosides (e.g. gentamicin) and glycopeptides

Question 12

What are the red flags for sepsis?

Answer 12

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

Question 13

Why else other than sepsis do patients present with a purpuric rash?
2) What can be done to confirm its sepsis?

Answer 13

1. trauma, aspiration pneumonia and burns

2. blood tests

Question 14

If sepsis is suspected what is the treatment?

Answer 14

3 in and 3 out

In: O2, fluids and antibiotics
Out: lactate, urine and blood cultures

Question 15

What percentage of the flora in quinsy is by group A streptococcus

Answer 15

30

Question 16

Corynebacterium diphtheriae

1) What is the pathological thing of this bacterium?
2) WHat does it do?
3) Who gets infections?

Answer 16

Diphtheria toxin

2) inhibits protein synthesis
3) Non-immunized children under 15

Question 17

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.

Answer 17

Corynebacterium diphtheriae

Question 18

What infection is this?

Serosanguineous nasal discharge

Answer 18

Corynebacterium diphtheriae

Question 19

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?

Answer 19

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)

Question 20

What are dentoalveolar infections?

2) What sampling for microbial analysis should be carried out and why?

Answer 20

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

Question 21

What is a severe consequence of a dentoalveolar infection if untreated?

Answer 21

encephalatits

Question 22

without getting it shitty anatomy just think basic, where does the infection spread to from the tooth to get to the blood (sepsis)?

Answer 22

1. apical foramen
2. periodontal ligament
3. blood stream (as there are periapical blood vessels there)

Question 23

patient presents with fever , what’s the probable diagnosis

1) lumps in neck unilateral
2) lumps in neck bilateral

Answer 23

1) dentoalveolar infection thats now caused sepsis

2) mumps

Question 24

What are antibiotics ineffective against abscesses/ dentoalveolar infections?

Answer 24

Many bacteria cause abscesses therefore antibiotics are ineffective

Question 25

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?

Answer 25

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

Question 26

Osteomyelitis is not an infection, and more often affects the lower jaw.
true or false

Answer 26

true

Question 27

What is the TP fro osteomyelitis

Answer 27

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)

Question 28

what are the complications of osteomyelitis of the jaw?

Answer 28

• 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

Question 29

Which is more commonly affected by osteomyelitis, maxilla or mandible?

Answer 29

mandible- poorer blood supply

Question 30

If osteomyelitis is due to an infected tooth, TP ?

Answer 30

extract

Question 31

If osteomyelitis is due to an open fracture, TP?

Answer 31

If it is due to an open fracture, antibiotics may suffice. If infection persists, look for a sequestrum and remove it.

Question 32

What is a sequestrum?

Answer 32

is the necrotic bone that is embedded in the pus/infected granulation tissue

Question 33

What is involucrum?

Answer 33

the new bone laid down by the periosteum that surrounds the sequestra

Question 34

What is the cloaca?

Answer 34

is the opening in the involucrum through which pus and sequestra make their way out

Question 35

Why must infectiosn sequestered in bones be surgically removed like you would for a stone in the parotid?

Answer 35

For antibiotics to work , the must penetrate the bone, bacteria and layer of dead cells

Question 36

HAI=

Answer 36

healthcare associated infection

Question 37

What is the most commmon surgical site infection or HAI?

Answer 37

Staphylococcus aureus

Question 38

Multi-drug resistant organisms incl.:

(more commonly seen in HAI or surgical site infection:

Answer 38

• 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)

Question 39

Why do you need ot reconsider antibiotic prescribing if infection is healthcare acquired?

Answer 39

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.

Question 40

What 2 STIs cause oral infection?

2) WHat do you do if pt has this?

Answer 40

gonorrhoea
or syphilis
2) refer pt AND partner to GUM clinic

Question 41

why is special media used to culture gonorrhoea?

Answer 41

it is fastidious (hard to grow), may consider a viral swab for PCR

Question 42

What are the symptoms of gonorrhoea?

Answer 42

Burning sensation of pharynx (impossible to distinguish from other bacterial causes of pharyngitis)
Oro-genital contact can result in oral lesions

Question 43

What the 2 ways to diagnose syphilis?

Answer 43

PCR-based or serology-based diagnosis
– Swab lesions for PCR
– Blood for serology (antigen-antibody reaction-based test)

Question 44

Can syphylsis be cultured?

Answer 44

nope, not in vitro

Question 45

If syphilis is left untreated what occurs?

Answer 45

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.

Question 46

mycobacterium tuberculosis, can be identified with a Ziehl–Neelsen staining why?

Answer 46

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.

Question 47

What percentage of the population have TB?

Answer 47

1/3 but there are only 3 cases per 100,000 people in the USA.

Question 48

How do you notify the correct authorities about infectious disease cases? (e..g scarlet fever, mumps, TB, acute infectious hep)?

Answer 48

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