Oral Cavity and Esophagus

Question 1

Streptococcus mutans/viridian

Answer 1

Oral cavity and esophagus
General
-Gr+ cocci, usually short chains
-E.g. S. salivarius, S. mutans, S. mitis, S. sanguinis (*recognize these)
-Normal microbiota *mouth, nasopharynx, GI, GU
-causes dental caries
-Nonmotile
-Facultative anaerobes
-Catalase -
-a-hemolytic
-optochin resistant
Virulence
-Adhesins = Produce *dextrans (sticky deposit for other bacteria to attach)
-biofilms

Question 2

Lactobacillus

Answer 2

Oral cavity and esophagus
General
-Nonendospore-forming Gr+ rod
-Normal microbiota mouth, stomach, intest., GU
-involved in progression of dental caries
-can also cause endocarditis
-Facultative anaerobe (to anaerobe)
-Acidophilic  ~pH 4

Question 3

Fusobacterium

Answer 3

Oral cavity and esophagus
General
-Gr- *long, tapered bacillus
-Normal microbiota mouth, intest., GU 
-*Bridging bacterium in plaque
-*Most common anaerobe in advanced periodontal disease
-Bite wounds; intraabdominal infect.; periodontal disease→→ head and neck infect., brain abscesses
-Colorectal cancer 
-Aero tolerant anaerobe
Virulence
- adhesins, LPS

Question 4

Actinomycetes Israelii

Answer 4

Oral cavity and esophagus
General
-Gr+ non-endospore forming bacilli
-Tendency to form branches, filaments that fragment easily
-Aerobes to strict anaerobes
-normal microbiota oropharynx, intest., GU
-Anaerobic to facultative to microaerophilic
-Non-acid fast
-Fastidious (and slow), capnophilic
-**causes cervicofacial actinomycosis

Question 5

Cervicofacial Actinomycosis

Answer 5

Oral cavity and esophagus
-caused by A. israelii
Risk factors
-tooth decay, facial/dental operations, maxillofacial trauma, diabetes, immunosuppression
Diagnosis
-needle aspiration
-notify lab of suspicion
-most characteristic form in pus, tissues is *‘sulfur granule’
-Gram stain = Gram + filaments on the edge of the granule
Treatment
-drainage to debridement + penicillin or ampicillin (wks to months)

Question 6

Candida Albicans

Answer 6

Oral cavity and esophagus
General
-*dimorphic fungus
-ubiquitous- air, water, soil 
-normal microbiota skin, mouth, GI, GU
-opportunist 
-causes *candidiasis=thrush
Virulence
-adhesins, proteinases, phospholipases, biofilms, dimorphic
Labs
-*germ tube test

Question 7

Oropharyngeal Candidiasis

Answer 7

Oral cavity and esophagus
-caused by C. albicans
Pseudomembranous candidiasis= thrush
-white plaques (*pseudomembranes) on buccal mucosa, palate, tongue, gingivae, pharynx
-pseudomembrane=mucosal cells + yeast cells + pseudohyphae + (hyphae) + PMNs + necrotic tissue
-usually asymptomatic
-if symptomatic, cottony feeling in mouth, loss of taste, odynophagia
Erythematous candidiasis
-red lesions various size on any part oral mucosa
-denture stomatitis
o most common older adults
o often under dentures
o erythema w/o plaques
o pain while wearing
Angular chelitis= angular stomatitis= perlèche
-painful fissuring (inflamm.) at corners mouth
Symptoms
-can incl. burning pain, altered taste, odynophagia
Diagnosis
-usually based on clinical signs, symptoms
-if needed, scrape lesions→ stain→microscopy
-culture on SDA as needed
Treatment
-mild: nystatin swish and swallow or clotrimazole lozenges
-moderate to severe: oral or IV fluconazole

Question 8

Esophageal candidiasis

Answer 8

Oral cavity and esophagus
-caused by C. albicans
-usually in immunosuppressed!
-E.g. AIDS, hematologic malignancies, chemo, radiation
-*Candida albicans esophagitis is an AIDS-defining condition
-other risk factors
-antibiotics, disruption of mucosa, illnesses that interfere w/ esophageal peristalsis, diabetes, alcoholism, elderly
-oropharyngeal candidiasis may progress to esophageal candidiasis, esp. in immunocompromised
Symptoms
-hallmark symptom odynophagia
-dysphagia
Diagnosis
-w/ endoscopy
-white mucosal plaque-like lesions to confluent pseudomembranes
Tx
-systemic fluconazole

Question 9

Helicobacter Pylori

Answer 9

Stomach
General
-G- rod, Body curved-to-spiral bacillus
-motile: (+) flagella
-Class I Carcinogen 
-microaerophile
-optimum pH 6-7!
-**urease +++++!
-*oxidase +
-*catalase +
-*nitrite+
-fastidious
-most common chronic bacterial infix in humans
-*causes most gastric and duodenal ulcers
-*can cause gastric cancer
Labs
-*Stool antigen testing (noninvasive)
-*Biopsy Urease Test (invasive)
Virulence
-**Genetic diversity!
-*LPS (lipoprotein Polysaccharide)
   -*Lipid A 
   -*O side chains
-*urease
-*flagella
-*exotoxins (*cagA, *vacA)