Oral Manifestations of Bacterial Infections Flashcards
Necrotizing Ulcerative Gingivitis (NUG/ANUG)
Painful, erythematous gingiva with necrosis of the interdental papillae (Yellow/red fibrin in the interdental papillae and blunting)
Etiology: Fusiform bacillus and the spirochete Borrelia vincentii
Clinical features: foul odor, metallic taste, possible fever and lymphadenopathy
Txt of NUG
Metronidazole** used for the treatment of NUG (anti-bact)
Prescribe and re-evaluate in 2 weeks and then f/u with OHI
Streptococcal tonsillitis and pharyngitis
Streptococcal sore throat (Strep throat)
Etiology: Group A, b hemolytic streptococci
Transmission: person-to-person contact with infectious nasal or oral secretions
Tested by rapid chair side tests for Strep and wait to see before prescribing
Antibiotics
Clinical Presentation:
- Sudden onset sore throat
- Fever
- Dysphagia
- Erythema of the oropharynx and tonsils
- Tonsillar hyperplasia with exudate
- Cervical lymphadenopathy
Prominent sign in BACTERIAL tonsilitis
neutrophil filled yellow pus on the tonsils
xt of Strep
Most cases are self-limiting; resolve within 4 days
Goal: Prevention of complications
- Sensitive to penicillin, cephalosporins (more expensive), erythromycin (patients allergic to penicillin)
Complications of Strep Infection
> Scarlet fever:
- Systemic infection with group A, β-hemolytic
streptococci
- Organisms produce an erythrogenic toxin that
attacks blood vessels and produces a skin rash
- Strawberry Tongue
> Rheumatic fever
- An acute, immunologically mediated, multisystem
inflammatory disease that occurs a few weeks
following an episode of streptococcal sore throat
- Acute carditis may progress to chronic rheumatic
heart disease
> Post streptococcal glomerulonephritis
- An immunologically mediated inflammatory disease
of glomeruli that follows streptococcal infection of
the pharynx or skin (impetigo)
Noma (Cancrum oris, Gangrenous stomatitis)
rapidly progressive, destructive, opportunistic infection caused by components of the oral microflora that become pathogenic during periods of compromised immune status
Key players: Fusobacterium and Prevotella*
Typically affects children (1-10 years) or adults with major debilitating disease or HIV
Risk Factors for Noma
- Significantly compromised systemic health
- Immunodeficiency including AIDS
- Severe malnutrition
- Poor oral hygiene
- Pre-existing bacterial infections (ANUG)
Txt of Noma
- Debridement of gross necrotic tissue
- Antibiotics: penicillin, metronidazole
- Reconstruction after healing
Actinomycosis
- Bacterial Infection caused by Actinomyces israelii
- May be acute or chronic
- Slowly spreading lesion associated with fibrosis
- Organism typically enters tissue through an area of prior trauma
Clinical Presentation:
> Indurated “woody” area of fibrosis
> Draining abscess with characteristic “sulfur granules” (yellow colored colonies)
> usually does not involve lymphatics
> does not spread along usual fascial planes
> Feels firm, leathery, woody, fibrotic, and exudes sulfur granules
Diagnosis of Actinomycosis
-Culture
> Clinical features with “sulfur granules”
-Biopsy
> shows bacterial colonies surrounded by neutrophils
“island of bacteria in a sea of neutrophils”
Txt of Actinomycosis
Antibiotic therapy with penicillin or amoxicillin– prolonged high dose
Abscess drainage
Excision of the sinus tracts
Cat scratch disease
Comes from contact with cat
Begins in the skin and involves the adjacent lymph nodes
Etiology: Bartonella henselae enters skin through a cat scratch or bite
Begins as a papule or pustule that develops along the scratch line
Lymp node enlargement follows about 3 weeks later
Diagnosis Cat Scratch Disease
Contact with a cat
Indirect fluorescent antibody assay (serological) for detecting antibodies to Bartonella henselae
ELISA for IgM antibodies to the organism
Negative results for other causes of lymphadenopathy
Lymph node biopsy
Txt of Cat Scratch Disease
Self-limiting; usually resolves within 4 months
Aspiration of node if suppurative
Antibiotics reserved for prolonged or severe cases
(Azithromycin or erythromycin)
Syphilis
Etiology: Treponema pallidum (spirochete)
Transmission: Direct contact; sexual or mother-to-fetus
Three Stages
1. Primary - infectious
Chancre ( yellow ulcer with red rolled border
- found on genitalia and tongue most
frequently)
Regional lymphadenopathy
2. Secondary – infectious
skin rash (palms and soles of feet)
oral lesions
mucous patches (gelatinous, mucoid
form that cannot be wiped off)
3. Tertiary – NOT infectious
Gumma (granulomatous inflammation)
CNS involvement
Microscopic Identification of Spirochetes
Silver stain or Darkfield
Serologic Tests for Syphilis
> Reagin
- VDRL – Venereal Disease Research Laboratory - RPR – Rapid plasma reagin - Complement fixation tests – Wassermann - Tests for reagin are sensitive but not specific - Many false positives
> Antitreponemal antibodies
- TPI
- FTA-ABS
- These tests are more specific than reagin tests
- Tests become positive at the time of the
development of the first lesion and remain positive
for life
Mechanism of Syphilis
Intracellular pathogen
Rapid dissemination through the endothelium
Immune evasion to antibodies
Bacteria reside in tissues quiescently
Bacteria reactivation (mechanism unknown)
Congenital Syphilis
- crosses the placental barrier
- any tissue can be infected
- children who survive may show abnormal tooth development such as Hutchinson’s incisors, Mulberry molars
- preventable if mother is treated early for her syphilis infection - txt with pencillin
Hutchinson triad
deafness, keratitis, tooth defects
Tuberculosis
Etiology: Mycobacterium tuberculosis
Oral lesions
Secondary infection from pulmonary lesions
Scrofula
Involvement of cervical lymph nodes from drinking contaminated milk (M. bovis)
Clinical Features
Primary TB: usually asymptomatic
Secondary TB: fever, malaise, night sweats, weight loss, productive cough
Progressive TB: wasting syndrome
Oral Manifestations of TB
Chronic, non-healing, progressively enlarging, indurated ulcers
Mimics a malignancy
(SCC or deep fungal)
Nodular granulomatous proliferations
Usually painless
Diagnosis of Oral TB
Biopsy showing lymphocytic infiltrate, granulomas, and necrosis
Biopsy - acid fast bacilli (AFB) stain shows presence of bacilli
Txt of Oral TB
Multiagent therapy for several months: isoniazid, rifampin, pyrazinamide, ethambutol
Prevention: BCG vaccine worldwide, restricted in US due to controversial effectiveness
Osteomyelitis
Inflammation of bone and bone marrow
Acute osteomyelitis- extension of periapical abscess, bacteremia, may not be seen on x-ray
Chronic osteomyelitis- long-standing inflammation of bone, Paget disease, bone irradiation, x-ray shows diffuse and irregular radiolucency with focal radiopacities
Txt of Osteomyelitis
- Drainage of area
- Debridement
- Appropriate systemic antibiotics
- Hyperbaric oxygen
