Infections Flashcards
Etiology of ANUG/P (including predisposing factors, causative organisms)
Predisposing factors:
- Immunosuppression
- Smoking
- Local trauma
- Poor OH
Causative organisms:
- Fusobac nucleatum
- Borrelia vincentii (spirochete)
- Prevotella intermedia
- Porphyromonas gingivalis
Can also occur in presence of psychologic stress - Trench mouth
What happens if ANUG is left untreated?
Can progress to ANUP if there is CAL. It can also spread to soft tissues, leading to necrotising ulcerative mucositis/stomatitis. Extension through the mucosa to the skin of the face is known as noma
Demographics and clinical findings of ANUG/P
- More common in young and middle aged adults, rare in general population but increased in stressed or malnourished populations
- Appears as highly inflamed interdental papillae which is erythematous, edematous and bleeds easily
- Affected papillae are blunted with areas of “punched out”, crater-like necrosis covered by greyish pseudomembrane and necrotic gingival tissue
- FETID ODOUR :(
- Exquisite pain and spontaneous haemorrhage
- Occasional lymphadenopathy, fever and malaise
Histopathology of ANUG/P
- Thick fibrinopurulent membrane
- Lamina propria infiltrated by inflammatory cells with extensive hyperaemia
- Extensive BACTERIAL COLONISATION
Management of ANUG/P
- Debridement (ScRP)
- CHX, warm salt water, H2O2 rinses for bacterial removal
- Systemic antibiotics if lymphadenopathy and fever present
- Remove predisposing factors
Etiology of actinomycosis
- Actinomycetes (normal oral flora component) infection
- Acute, rapidly progressing infection or chronic, slowly spreading lesion ASSOCIATED WITH FIBROSIS
- Organism enters tissue through area of prior trauma e.g. injury, perio pocket, non-fatal tooth, exo socket, infected tonsil
Clinical features of actinomycosis
- Suppurative reaction of infection may discharge large SULFUR GRANULES that represent bacteria colonies
- Indurated area of fibrosis forming central, softer area of abscess
- Infection may extend to surface as sinus tract
Histopathologic findings of actinomycosis
- Peripheral band of fibrosis encasing zone of chronically inflamed granulation tissue surrounding
- Large collections of PMN leukocytes
- Colonies of club-shaped filaments
Management of actinomycosis
- Drain abscess, excise sinus tracts
- Prolonged high antibiotic dosage to penetrate large areas of suppuration and fibrosis
- AB: penicillin/amox or tetracycline
How is HSV-1 transmitted and where is it commonly observed?
Via infected saliva or active perioral lesions.
Seen on oral, facial and oclular areas + pharynx, i/o mucosa, lips, eyes, and skin above the waist
How is HSV-2 transmitted and where is it commonly observed?
Via sexual contact
Seen on genital zones involving genitalia and skin below the waist
After HSV primary infection is established, virus is taken up by sensory nerves and transported to the _________
Trigeminal ganglion
Dental condition commonly observed in people infected with HSV at early age
Gingivostomatitis
Dental condition commonly observed in people infected with HSV at later age
Pharyngotonsilitis
How does HSV recurrent infection occur?
Reactivation of the virus due to old age, UV light, physical/emotional stress, fatigue, heat, cold, pregnancy, allergy, trauma, dental tx, respi illness, fever, menstruation, systemic diseases and malignancy
Demographics and clinical findings of acute herpetic gingivostomatitis
- Age: 6 months - 5 years
- Abrupt onset, prodromal s/s 12-24h prior to appearance
- Affected mucosa develops pinhead vesicles –> rapidly collapse to form numerous small red lesions –> enlarge and develop central ulceration covered by yellow fibrin
- Gingiva enlarged, painful and extremely erythematous, often exhibiting punched-out erosions along midfacial FGM
- Resolution 5-7 days (mild) to 2 weeks (severe)
Demographics and clinical findings of herpes labialis
- Prodromal signs: pain, burning, itching, tingling, localised warmth and erythema of involved epithelium 6-24h before
- Multiple small, erythematous papules develop and form clusters of fluid-filled vesicles
- Vesicles rupture and crust within 2 days, release virus-filled fluid may result in lesion spread
Histopathologic findings of HSV-infected epithelial cells
- Acantholysis –> Tzanck cells
- Nuclear clearing and enlargement
- Nuclear fragmentation with chromatin condensation around nucleus periphery
- Multinucleated epithelial cells formed by fusion
- Intracellular edema –> formation of intraepithelial vesicle
Management of patients with HSV
Healthy: supportive and symptomatic care with topical LA, analgesics and adequate nutrition
Systemic therapy: Acyclovir (not usually given to healthy patients)
Recurrent: supportive care with topical LA, protection (vaseline, ZnO, sunscreen lip balm), topical antiviral, prophylaxis
Where does VZV lie latent?
Sensory nerve ganglia
Herpes zoster (shingles) risk factors include:
- HIV infection
- Radiation
- Txt with cytotoxic or immunosuppressive agents
- Presence of malignancies
- Alcohol abuse
- Stress
- Old age
- Dental manipulation
Complications of varicella (chicken pox)?
- Reye’s syndrome
- Secondary skin infections
- Encephalitis
- Pneumonia
- GI disturbances
- Hematologic events: pancytopenia, thrombocytopenia, haemolytic anemia, sickle cell crisis
Complication of herpes zoster (shingles)?
- Ramsay Hunt syndrome –> facial paralysis, hearing deficits, vertigo
- Post herpetic neuralgia –> pain triggered by light stroking of area persisting > 3 months after initial rash with gradual resolution, usually in >60 y/o and requires use of famacyclovir long term
Dermatologic findings of varicella (chix pox)?
- Initial: pruritic rash involving face and trunk to extremities
- Erythema –> vesicle –> pustule –> crusting
- Lesions continue erupting for 4-7 days, old lesions can intermix with new lesions
- Contagious from 2 days before rash until all lesions crust
