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A - BDS4 Oral Medicine > Infectious diseases of the oral mucosa > Flashcards

Infectious diseases of the oral mucosa Flashcards

1
Q

Gives examples of infectious diseases found in the oral mucosa

A

fungal
- candida
viral
- HSV
- HIV
- Varicella-zoster
- hepatitis C
- coxsackie virus
bacterial
- sexually transmitted infections: syphilis, gonorrhoea, chlamydia
- tuberculosis

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2
Q

oral candidosis - define

A

infection of mucosa caused by candida species

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3
Q

Candida - features

A

can harmlessly colonise mucocutaneous surfaces

can invade deeper tissues and cause infection if conditions are right
- opportunistic infection

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4
Q

Local oral defences against disease

A

oral mucosa
- physical barrier
- innate immunity - lysozyme, T cells, phagocytes
oral microbiome
- competition and inhibition
saliva
- mechanical cleansing
- antimicrobial peptides - muffins, defensives, histamines
- IgA antibodies

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5
Q

systemic defences against disease

A

immune system
- adaptive immunity

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6
Q

oral candidosis local risk factors

A

xerostomia
poor oral hygiene
dentures
smoking
mouth piercings
irradiation to the mouth or salivary glands
inhaled/topical corticosteroids e.g. asthmatics

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7
Q

systemic risk factors for oral candidosis

A

extremes of age
- neonates, elderly
malnutrition
diabetes
HIV/AIDS
Haematinic deficiency
broad-spectrum antibodies
chemotherapy
haematological malignancy

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8
Q

candida infections - management

A

investigate and manage predisposing factors
- systemic disease
- smoking
- dry mouth
- steroid inhaler
- denture hygiene
oral hygiene
- toothbrushing
- dentire hygiene
topical antifungals
- miconazole oral gel
- nystatin oral mouthwash
systemic antifungals
- fluconazole capsules

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9
Q

Miconazole oral gel contraindications (same as fluconazole capsules)

A

warfarin
- increases anti-coagulant effect
stations
- risk of rhabdomylosis and myopathy with some statins

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10
Q

clinical presentations of oral candida infections

A

white
- acute pseudomembranous candidosis
- chronic hyperplastic candidosis
red
- denture related stomatitis
acute erythematous candidosis
median rhomboid glossitis
angular chelitis

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11
Q

Acute pseudomembranous candidosis features

A

‘thrush’
- white flecks resemble breast of thrush bird
commonly seen in neonates
in adults - “disease of the diseased”

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12
Q

acute pseudomembranous candidosis appearance

A

white slough on mucosa surface
- easily wiped off
underlying erythematous base

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13
Q

acute pseudomembranous candidosis diagnosis

A

usually clinical
- over diagnosed?
microbiology investigations
- oral rinse or swab

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14
Q

acute pseudomembranous candidosis (oral thrush) management

A

predisposing factors need to be investigated and dealt with
oral hygiene
topical
- miconazole oral gel
- nystatin oral mouthwash
systemic id topical ineffective or infection is extensive or severe
- fluconazole capsules

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15
Q

chronic hypeplastic candidosis features

A

candodal leukoplakia
white or speckled red/white
potentially malignant disorder
- up to 12.1%

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16
Q

chronic hyperplastic candidosis clinical signs (candidal leukoplakia(

A

usually occur on buccal mucosa
- at labial commissure/corner of the mouth
often bilaterally
can occur on tongue - less common

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17
Q

chronic hyper plasmic candidosis diagnosis

A

incisional biopsy
- PAS stain
- dysplasia?
give fluconazole before biopsy
- to allow pathologist to see potential dysplasia more clearly

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18
Q

chronic hyperplastic candidosis management

A

predisposing factors - treat
systemic antifungal
stop smoking
careful clinical follow up in oral med clinic or GDP
- management of dysplasia as required

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19
Q

denture-related stomatitis features

A

candida infection of mucosa beneath a dental appliance
common in patients in care facilities
- elderly, dry mouth, high sucrose diet, poor OH
common upper complete denture
- micro-environment

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20
Q

Denture-related stomatitis - how does this occur?

A

candida in 90% of cases
- mixed infections occur - staph, strep
acrylic resin and soft liners = good habitat for candidal adherence
denture trauma potentiates infection
overnight denture wear cultivates biofilm

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21
Q

denture-related stomatitis - diagnosis

A

clinical diagnosis
- but if not resolving, investigate pre-disposing factors

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22
Q

denture related stomatitis clinical signs and symptoms

A

pain or discomfort
bad breath
dryness
burning sensation in mouth
redness

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23
Q

denture related stomatitis - classification

A

Newtons’s classification
1 - localised inflammation (pinpoint)
2 - generalised erythema covering denture-bearing area
3 - granular type

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24
Q

denture-related stomatitis management

A

denture hygiene
- remove dentures at night
- gentle daily brushing - before and after soaking, after meals with denture cleaning solution (not toothpaste)
- chlorhexidine immersion (for 20 minutes)
- dilute hypochlorite immersion
- microwave disnfection
- alkaline peroxide
re-make if required
brushing palate
antifungals
- if other measures fail
- miconazole gel can be applied to fitting surface before denture insertion
-

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25
Q

acute erythematous candidosis features

A

aka atrophic candidosis
most commonly presents with ‘burning

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26
Q

acute erythematous candidosis predisposing factors

A

recent broad spectrum antibiotics
corticosteroids
diabetes
HIV
nutritional factors

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27
Q

acute erythematous candisosis diagnosis and management

A

diagnosis
- clinical
- oral rinse or swab
management
- medical referral
- topical antifungal
- systemic antifungal

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28
Q

median rhomboid glossitis features

A

posterior aspect, midline of tongue dorsal
sometimes a kissing lesion on the palate
depapillation in a regular shape
linked to steroid inhalers and smokers

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29
Q

median rhomboid glossitis diagnosis and management

A

diagnosis
- clinical
management
- predisposing factors
- oral/denture hygiene
- topical or systemic antifungal

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30
Q

angular chelitis features

A

infection of mucocunatneous region around corners of the mouth
- often associated with dermatitis
mixed infection
- candida
- staph and streptococcus
often have associated intra-oral infection
- denture induced stomatitis

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31
Q

angular chelitis signs and symptoms

A

soreness
erythema
fissuring
crusting
bleeding
at corners of mouth

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32
Q

the role of mechanical factors in angular chelitis

A

ageing
edentulous
dentures lacking vertical height
all encourage saliva pooling

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33
Q

angular chelitis diagnosis

A

usually clinical
swab for microbiology

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34
Q

angular chelitis management

A

predisposing factors
- may require new dentures
- underlying disease or deficiency?
denture hygiene
OHI
topical antifingal - miconazole cream - effective against fungus and some bacteria
topical antibacterial - sodium fusidate ointment
- when clearly bacterial in nature e.g. non-denture wearer

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35
Q

Angular chelitis management -if there is significant associated dermatitis

A

combined miconazole and hydrocortisone cream/ointment
- cream if wet surface
- ointment if dry surface

36
Q

human herpes virus features

A

family of DNA viruses
transmitted in saliva, respiratory secretions, direct contact
often encountered early in life
characterised by latency and re-activation, when immunity drops

37
Q

HSV1. and HS2 infection features and stages

A

herpes simples
1 - oral
2 - anogenital
primary infection
- lesions mouth, oropharynx, anogenital regions
latency
reactivation during relative immunosuppression

38
Q

primary herpetic gingivostomatitis (can be mistaken for teething) symptoms

A

fever
malaise
red, fiery oedamatous gingiva
vesicles - ulcers

39
Q

primary herpetic gingivostomatitis diagnosis and management

A

diagnosis
- clinical and history
- viral swab for PCR if uncertain (compliance)
management
- largely supportive
- fluids, paracetamol, soft diet, chlorhexidine to aid oH, Differ mouthwash
- urgent specialist care for pregnant women and neonates - systemic antivirals

40
Q

recurrent herpes simplex virus features

A

15% population
usually lips
- herpes labials - cold sore
- but can occur intraorally

41
Q

Factors which can cause reactivation of HSV

A

sunlight
- UV radiation
unwell
- fever
tissue injury
stress
immunosuppression
hormones
- menstrual cycle

42
Q

recurrent herpes simplex virus stages

A

prodromal period
- pain, burning, tingling, itching
- up to 48 hours before
-herpes labialise and intra-oral hepres
typically crops of of ulcers
- painful
- scab within 72 hours
- resolution by 10 days

43
Q

recurent herpes simplex virus diagnosis

A

mostly clinical

44
Q

recurrent herpes simplex virus management

A

avoidance of triggers
antivirals in prodrome period
- acyclovir 5% cream every 2 hour (herpes labialis)
- acyclovir 200mg tablets 5x per day for 5 days (intra-oral herpes)
immunocompromised - specialist referral

45
Q

recurrent HSV potential complications

A

disseminated herpes infection
- if immunocompromised
Bell’s palsy
erythema multiforme
herpetic whitlow
- fingers
eye disease
- herpetic keratoconjuctivitis

46
Q

Varicella-zoster virus features

A

varicella = chicken pox
- primary infection in children
latency
- in dorsal root ganglion
zoster = shingles
- reactivation - usually adults

47
Q

varicella signs and symptoms

A

mainly children
- complication risk in adults
highly contagious
- via respiratory droplets or lesion
fever
malaise
truncal rash
- itch, papules, vesicles, scabs
oral ulcers

48
Q

varicella management

A

supportive
referral to specialist care in pregnant women, neonates and immunocompromised patients

49
Q

zoster features

A

zoster = belt
recurrent of varicella zoster virus
classically in one sensory dermatome
- trigeminal divisions = face and oral cavity
usually in elderly and immunocompromised

50
Q

zoster - signs and symptoms

A

rash in one dermatome - scabs
pain before, during and after lesions
vesicles and ulcers intra-orally

51
Q

what is a dermatome?

A

a specific area of skin connected to a single spinal nerve root

52
Q

zoster diagnosis

A

clinical

53
Q

zoster management

A

acyclovir 800mg tablets
- within 72 hours of onset
- can help healing and minimise post-herpetic neuralgia
refer all patients to GP
immunocompromised = refer to specialist

54
Q

zoster potential complications

A

post herpetic neuralgia
- persisting >6 months after mucocutanous healing
burning pain
- treat with gabapentin, amitriptyline or carbamazepine

Ramsay Hunt syndrom e
- reactivation within geniculate ganglion
- facial nerve palsy and vesicular rash around ear
- oral vesicles

55
Q

Epstein Barr virus features

A

90-95% of population have been infected
transmission in saliva
- “the kissing disease”
establishes latency in lymphoid tissue - primarily B cells

56
Q

how can Epstein bar virus be reactivated?

A

oral hairy leukoplakia
burkitt’s lymphoma
nasopharyngeal cancer

57
Q

HIV features

A

human immonodeficiency virus
RNA virus - blood borne
- sexual transmission, needle stick injuries, splashes, vertical transmission
enters and destroy CD4 T helper cells
increasingly immunocompromised as disease progresses
AIDS - acquired immunodeficiency syndrome
- end stage of untreated disease

58
Q

HIV treatment

A

very effective
ART
- antiretroviral therapy
- halt HIV replication
- normal CD4 count and undetectable viral load
- can cause oral hyperpigmentation
PrEP
PEP

59
Q

oral AIDS defining illnesses

A

oral candidosis
acute necrotising ulcerative gingivitis
kaposi sarcoma
oral hairy laukoplakia
non-hodgkin’s lymphoma
aphthous-like ulcers

60
Q

hepatitis C virus features

A

RNA virus
- infects liver
- chronic infection
spread by blood and body fluids
no vaccine available
curable
- with antiviral medications 8-12 weeks
oral lichen planus?

61
Q

hepatitis C complications

A

liver cirrhosis
- dental implications
hepatocellular carcinoma

62
Q

Coxsackie virus features and oral presentations

A

family of RNA viruses
spread faecal-oral route and saliva
oral presentation
- hand, foot and mouth disease
- herpangina

63
Q

Hand foot and mouth disease features and symptoms/signs

A

common
- young children mainly nursery
- clusters
7-10 days
systemic
- fever
- reduced appetite
- malaise
hand
- vesicles/blisters on palms
feet
- vesicles/blisters on soles
mouth
- vesicles/uclers on labial, buccal and tongue mucosa

64
Q

herpangina signs

A

numerous vesicles and ulcers
- soft palate
- uvula
- fauces/throat

65
Q

coxackie virus diagnosis and management

A

clinical diagnosis
management
- supportive
- fluids
- paracetamol, ibrupforen
- soft diet
- chlorhexidine to aid oral hygiene
- difflam/benzydamine mouthwash

66
Q

oral Bacterial infections origins

A

odontogenic or salivary
- periapical
- periodontal
- pericoronal
- bacterial sialadentis
- STI’s - syphillis, gonorrhoea, chlamydia
- Tuberculosis

67
Q

Sexually transmission infections - management

A

refer/signpost
- sexual health clinic
- GP

68
Q

STI risk factors

A

previous sti
under 25 years of age
a new sexual partner
more than one sexual partner in the last year
no condom use
paying for sex
socioeconomic deprivation
Chemsex

69
Q

syphillis features

A

multi-system disease
- aphthous stomatitis, traumatic ulceration, oral cancer, vesiculobullous disorders
primary, secondary and tertiary

70
Q

primary syphilis features and signs

A

chancre at site of inoculation
painless ulcer
usually genital but can be oral
self limiting
- heals by 8 weeks
associated lymphadenopathy in 80%
if untreated, infection spreads lymphoedema’s-vascular

71
Q

secondary syphilis features and signs

A

4-6 weeks after initial infection
non specific symptoms
- lethargy
- malaise
- fever
- rash
- musculoskeletal pain
mucosal white patches
‘snail track’ ulcers

72
Q

tertiary syphilis signs and features

A

progression from untreated infection
presents 1-30 years after inoculation
granulomatous inflammation
neurosyphilis
- dementia
- cranial nerve palsies
cardiovascular syphilis
- aortic aneurysms

73
Q

syphilis diagnosis

A

incisional biopsy
blood test
- high false positives

74
Q

syphilis management

A

by sexual heat specialist
screening for other STI’s
contact tracing
STAT dose of IM benzylpenicillin

75
Q

gonorrhoea and chlamydia features and symptoms

A

sexually transmitted infections
primarily affected urethra, endocervix, rectum and pharynx
- can be asymptomatic
male
- urethral discharge, pain or burning sensation when urinating (dysuria)
female
- altered vaginal discharge, dysuria

76
Q

Gonorrhoea and chlamydia oral presentation

A

non specific
uncommonly reported
pharyngitis

77
Q

Gonorrhoea and chlamydia diagnosis

A

clinical - oral
specialist
- vulvoanginal or urethral swabs

78
Q

gonorrhoea and chlamydia management

A

by sexual health clinic
gonorrhoea
- STAT dose of IM ceftriaxone
chlamydia
- 8 days oral doxycycline
screening for other STI’s
contact tracing

79
Q

bacteria responsible for tuberculosis

A

mycobacterium tuberculosis

80
Q

Tuberculosis - how it infects people

A

transmission through respiratory secretions
infects macrophages in lung
- can disseminate via bloodstream to almost any organ

81
Q

tuberculosis signs and symptoms

A

fever
weight loss
night sweats
cough
haemoptysis
- coughing up blood

82
Q

ruberculosis risk factors

A

close contact with TB patient
born in high-prevalence regions
- india, pakistan, somalia, eritrea, Romania
HIV
diabetes
leukaemia
alcohol excess
socio-economic deprivation
homelessness

83
Q

tuberculosis oral manifestations

A

ulceration
lip swelling
granulomatous inflammation
- also seen in Crohn’s and orofacial granulomatosis

84
Q

tuberculosis diagnosis (oral)

A

incisional biopsy
- H and E staining
- Ziehl - Neelsen stain

85
Q

tuberculosis management

A

specialist
- combination antibiotics for 3-6 months

86
Q

possible investigations for infectious oral mucosal diseases

A

Blood
- FBC
- Haematinics
- HbA1c glucose
- blood borne virus screen
imaging
- clinical photographs
saliva
- unstimulated saliva flow rate
microbiology
- swab of lesion
- oral rinse
biopsy
- H and E staining
- PAS staining - candida
- Ziehl-Neelssen stain - TB

A - BDS4 Oral Medicine (9 decks)

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