Infectious Diseases Flashcards
name 6 oral manifestations of fungal infections
- acute pseudomembranous candidosis
- chronic hyperplastic candidosis
- denture stomatitis
- acute erythematous candidosis
- median rhomboid glossitis
- angular cheilitis
what is the most common fungal infection
what is the subtype
why
candida albicans
hypal/pseudohypal
opportunistic infection = disease of the diseased
name the local vs systemic host defences
local =
- oral mucosa [barrier, innate immunity]
- oral microbiome [competition inhibition]
- saliva [mechanical cleansing, antimicrboail peptide, IgA antibodies]
systemic =
- immune system [adaptive immunity]
risk factors for candida infection
local vs system
local -
xerostomia, poor oh, dentures, piercings, smoking, steroids, irradiation
systemic -
age extremes, malnutrition, DM, haematinic deficiency, HIV/AIDS, broad spectrum abx, chemotherapy, haematological deficiency
general management of candida infections
predisposing, OH
topical - miconazole oral gel [x warfarin, statins], nystatin MW
systemic - fluconazole tabs [x warfarin, statins]
pt presents with white slough on their mucosa and palate, can be wiped off to reveal underlying erythema
what is ur diagnosis
how to diagnose
management
acute pseudomembranous candidosis
clinical, microbiology, rinse/swab
miconazole gel
nystatin mw
fluconazole
pt presents with white/red speckled appearance on buccal mucosa at labial commisure/corner of mouth
it is bilateral
what is ur diagnosis
how to diagnose
management
chronic hyperplastic candidosis
incisional biopsy + PAS stain to assess dysplasia
fluconazole beforehand to give visualisation and stop false positive
predisposing, fluconazole
careful follow up, dysplasia management
12.1%
pt presents with red, swelling, pain and burning palate when removing their denture
what is ur diagnosis
what is the cause
management
denture stomatitis
90% candida, staph/strep, acrylic resin + soft liner, dental trauma, overnight, poor hygiene
predisposing, denture hygiene, OHI, miconazole
what is the name of classification of denture stomatitis
describe the 3 stages
newtons
1- localised inflammation
2 - generalised erythema of denture bearing area
3 - granular type
pt presents white red burning palate
they don’t wear a denture
what is ur diagnosis
what is the cause/risks
how to diagnose
management
acute erythematous candidosis
predisposing = recent broad abx, corticosteroids, DM, HIV, nutritional
clinical rinse/swab
medical referral
miconazole
fluconazole
pt presents with a posterior/midline red depapillation lesion on their tongue with a “kissing” lesion on the palate
diagnosis
cause
management
median rhomboid glossitis
steroid inhalers, smokers
predisposing, d+OHI
miconazole
fluconazole
edentulous pt presents with a mucotaneous infection on the corners of their mouth, causing pain, erythema, crusting, fissuring, bleeding and associated dermatitis
it hurts to open mouth
diagnosis
cause/risks [denture**]
diagnose how
management
angular cheilitis
candida/strep/staph
ageing, edentulous, dentures, lacking vertical height as encourages saliva pooling
microbiology swab for culture and sensitivity
predispose, d+ OH, new dentures, underlying conditions
miconazole
antibacterial sodium dusidate ointment
if significant dermatitis = combined miconazole + hydrocortisone
[x warfarin, statins]
what is PAS stain
periodic acid-schiff
which bacterial disease is known as the great imitator
+ what does this mean?
syphilis
those with syphilis can present with aphthous stomatitis, traumatic ulcers, oral cancer, blistering disease
which bacteria is the cause of syphilis
treponema pallidum
tested for via blood tests for IgG and IgM antibodies
[high false positive]
discuss the primary, secondary and tertiary progression of syphilis
primary -
ulcer at inoculation site [oral/genital], self limiting 8 weeks, lymphadenopathy, spreads if untreated
secondary -
non-specific, malaise, musculoskeletal pain, rash, mucosal white patches, “snail patch” ulcers, warts [4-6wks post infection]
tertiary -
gummatous lesions, granulomatous infection, neurosphylis, dementia, CN palsy, aortic aneurysm
how do you test for syphilis
what is the management
incisional biopsy - microscopy, immunohistochemistry
blood test - IgG IgM antibodies for T.pallidum
sexual health specialist, STI screening
stat dose IM benzylpenicillin
contact tracing
untreated = infertility, pelvic inflammatory disease
what is the bacteria involved in gonorrhoea and chlamydia
gonorrhoea = neisseria gonorrhoea
chlamydia = chlamydia trachomatis
appearance, diagnosis and management of gonorrhoea and chlamydia
non-specific, pharyngitis, discharge, dysuria, endocervix
vulvovaginal/urethral swabs (NAAT) microscopy
STI screen, contact tracing
gonorrhoea => stat dose IM ceftriaxone
chlamydia => 7 days doxycycline
untreated = infertility, pelvic inflammatory disease
what is the bacteria that causes tuberculosis
mycobacterium tuberculosis
discuss the appearance, cause of tuberculosis
ulceration, lip swelling, granulomatosis inflammation [crohns, OFG]
respiratory condition, infects lung macrophages, disseminate via bloodstream to rogans
fever, weight loss, night sweats
what are the risk factors for tuberculosis
close contact
area [india, pakistaní, somalia]
HIV, DM, excess alcohol
leukaemia, homeless
low SE group
diagnosis and management of tuberculosis
incisional biopsy - H+E staining
Ziehl-Neelsen staining [granulomas, acid fast bacteria]
specialist, combination abx
what are the features of viral infections
requires a host
primary, latency, reactivation
