infections of the upper GI tract Flashcards
what type of infections are more prevelant in soft tissue rich areas
anerobic
examples of normal oropharyngeal bacteria (6)
- streprococci viridans
- strep milleri (!)
- strep pyogenes (group A strep)
- diphtheroids
- staph aureus
- moraxella
what bacteria is implicated in appendicitis, GI abcessess and quinsey
streptococcus milleri
what are aphthous ulcers (stomatitis)
a common ulcerative condition of the oral mucosa, presents as a painful punched-out sore on oral or genital mucous membranes
what organisms can cause oral aphthous ulcers + mgx (2)
- HSV1 (immunocomprimised pts) -> aciclovir
- candida (HIV, immunocomprimised, diabects, oral steroid users) ->oral hygeine, Nystatin (prevention), fluconazole
what type of disease are dental caries
chronic infectious disease
what bacteria is particularly involved in dental carie formation and how
S.mutans -> colonised oral cavity anf produces glycosyl transferase which promotes attachment to tooth pellicle -> converts sugar from food into lactic acid -> demineralisation of tooth enamel in plaques
what is gingivitis
pockets of infection affecting the gums
what non-oral condition can S.mutans result in
infective endocarditis
what is ludwig’s angina
suppurative infection of hypoglossal tissue -> life threatening cellulitis of the soft tissue involving the floor of the mouth and neck
why might ludwig’s angina be life threatening
airway threatened -> oedema and exudate push tongue up and backwards
ludwig’s angina presentation (5)
rapid onset
1. pain
2. fever
3. dysphagia
4. stridor
5. bull-neck (bilateral neck swelling)
ludwig’s angina mgx (3)
- broad spectrum abx
- corticosteroids
- surgical drainage
what is vincent’s angina
unilateral tonsillitis due to a mixed infection by spirochetes and fusobacteria that manifests as a one-sided sore throat and difficulty swallowing
what 2 bacteria cause vincent’s angina
- borrelia vincenti (spirochaetes)
- fusiformis (anaerobic bacteria)
usually due to poor dental hygeine
vincent’s angine presentation
- extremely sore mouth/gums
- offensive smell (halitosis)
vincent’s angina mgx
- metranidazole
- ampicillin
- improved mouth care
what bacteria can cause streptococcal pharyngitis
- group A strep beta haemolytic - strep. pyogenes (also causes scarlet fever!)
- group C strep- S.equilisimus, S.anginosus
streptococcal pharyngitis presentation (6)
- sudden onset sore throat
- pain when swallowing
- fever
- headache
- abdominal pain
- nausea/vomiting
- NO cough, hoarsenss, rhinorrhoea, conjunctivitis etc.
pharyngitis investigations (3)
- throat swab for culture
- bloods - raised WBC
- serology - ASO titre >400
mgx for pharyngitis
abx - ampicillin, amoxicillin or eythromycin (oral if mild) or IV benzylpenicillin (severe)
complications of pharyngitis
- rheumatic fever
- poststreoptococcal glomerulonephritis
- peritonsillar abscess (quinsy)
- cervical lymphadenitis
- bacteraemia
what is lemierre’s syndrome
a rare complication of bacterial pharyngitis/tonsillitis and involves an extension of the infection into the lateral pharyngeal spaces of the neck with subsequent septic thrombophlebitis of the internal jugular vein -> usually immunosuppressed pts
what bacteria is responsible for lemierre’s syndrome
fusobacterium necrophorum (gram -ve)
what is actinomycosis
a rare subacute to chronic infection caused by the gram-positive filamentous non-acid fast anaerobic to microaerophilic bacteria -> has fungi like properties
what bacteria are implicated in acute epiglottitis (2)
- H.influenzae
- S.pyogenes
why should amoxicillin not be given to an EBV suspected pt
if EBV is present it can cause an amoxicillin induced rash
4 organisms that cause oesophagitis
- candida
- cytomegalovirus (CMV)
- HSV
- varicella-zoster virus
oesophagitis presentation (5)
- dysphagia
- odynophagia
- retrosternal discomfort
- anorexia
- fever
risk factors for oesophagitis
- abx use (candidia)
- HIV (CMV, candida)
- leukaemia
- lymphoma (candida, HSV)
- corticosteroids (candida)
oesophagitis investigations (4)
- flexible endoscopy
- x ray (barium)
- swab/brushings
- tissue biopsy
endoscopic findings of CMV infection (3)
- erythema
- ulcers
- gastric wall thickening (associated with overlying erosion)
HSV oesophagitis appearance
numerous small ulcerations
candidiasis oesophagitis appearance
typical white plaques/nodules
mgx for candida oesophagitis
- antifungal (fluconazole, itraconazole)
- amphotericin B
mgx for HSV/VZV oesophagitis
- antiviral (aciclovir, famciclovir etc.)
- foscarnet (if resistant)
mgx for CMV oesophagitis
- valganciclovir
complications of diptheria infection
- attacks cardiac muscle (early)
- attacks myelin (late) -> leading to respiratory arrest due to diaphragm paralysis
