Oral Pathology: Bacterial Infections Flashcards
What are the symptoms of congenital syphilis?
- Notched permanent incisors
- Hypoplastic first molars or mulberry first molars
- Nasal bone deformities (saddle/concave shaped nose)
What are the symptoms of (acquired) primary syphilis?
- Development of infectious chancre (painless ulcerated localised lesion) in area of infection
- Heals within 2-8 weeks
- Regional lymphadenopathy (enlarged lymph nodes)
- Possibly negative serology
What are the signs and symptoms of (acquired) secondary syphilis?
- Develop 6-8 weeks after initial lesion
- Positive serology
- Rash or skin macules (flat skin spots)
- Infectious Oral mucous patches
- Condyloma latum (raised warty lesion)
- Duration: weeks to months
What are the signs and symptoms of (acquired) tertiary syphilis?
- Can develop 3-10 years after secondary stage
- Positive serology
- Gumma (slow, persistent, ulcerated granulomatous inflammation that can be destructive and lead to perforations), can involve any organ
- CV problems
- Neurosyphilis: can affect mental health
- Syphilitic glossitis: potential increased risk for squamous cell carcinoma
What are some histological features of syphilis?
- Chancre will appear as non-specific lesion
- May cause peri-vascular changes/inflammation with lymphocytes and macrophages
- Proliferative endarteritis: proliferation of endothelial wall may result in smaller lumen
- Gumma: appears as a localised area of necrosis and granulomatous inflammation (macrophages + giant cells)
What are the classic signs of leprosy (oral manifestations)?
- Caused by mycobacterium leprae
- Red macule
- Purple papules
- Nodules and papules on tongue
- Soft+hard palate ulceration
- Histological chronic inflammation (some cases mononuclear macrophage type)
What is the pathogenesis of tuberculosis?
Infection:
- Inhalation of droplet nuclei
- Larger nuclei lodge in upper respiratory tract
- Smaller nuclei may reach alveoli
Proliferation
-Bacteria multiply rapidly within inactivated macrophages–>form ghon foci
Granuloma
-T Cells surround macrophages to form granuloma/tubercles
-Secrete cytokines to induce infected macrophages to kill bacteria
-Sometimes directly kill infected macrophages
-Centre of granuloma has casseous consistency
(Disease may arrest here)
Miliary TB
- Some poorly activated macrophages at periphery of tubercle
- Allows spread of TB and growth of tubercle, resulting in spread to other areas of lung and potential spread to extra pulmonary areas via blood and lymphatic vessels (Miliary TB)
Liquefaction
- Centre of granuloma liquefies: resulting in faster growth + spread extracellularly
- Antigen load causes lung tissue to breakdown and rupture–> allowing spread to other areas and causing bloody sputum
Key histological feature: giant cells
What are the signs and symptoms of gonorrhea?
Bacteria: N gonorrhoeae
- Pharyngitis
- Oral ulceration (rare and if occur non-specific)
- Mucosal erythema
- Cervical lymphadenopathy
What are some predisposing features of NUG?
- Smoking
- Stress
- Fatigue
- Poor OH
- Decreased immunity/host response
- Usually occurs in younger patients
What is Cancrum oris?
- Severe localised destruction of jaws and bone
- Thought to arise due to spread of NUG to nearby tissues
- At risk groups are malnourished children
- Treatable though facial deformities can be severe
What is actinomyces?
-Infection with actinomyces due to lowered immunity
Characterised by:
-Localised foci of chronic suppuration (pus drainage)
-Firm swellings, usually in submandibular region
-Pus contains small granules representing different colonies of actinomyces
Histology:
- Characterised by granulomatous inflammation and radiating mass of bacteria
- Contains tangled organisms
What are the causes of osteomyelitis?
Periapical infection Periodontal infection Fractures/penetrating wounds NUG Periocoronitis (infection around crown of tooth, usually caused by operculum/flap due to P/E tooth)
What are some pre-disposing factors for osteomyelitis?
Local
Fractures/injury
Radiation
Paget’s disease (increased turnover rate of bone)
Systemic:
- Immune suppression
- Diabetes
- Malnutrition
What are some signs of acute osteomyelitis?
- Pain
- Swelling
- Pus
- Gingival Inflammation
- Subperiosteal bone formation
- Tooth tenderness and mobility
- Trismus/swallowing difficulty
- Systemic symptoms of acute inflammation
What are some signs of chronic osteomyelitis?
- Variable pain
- Swelling
- Loose teeth
Radiographic Changes:
- Moth eaten appearance
- Focal zones of sclerosis
What are some histological signs of acute osteomyelitis?
- Pus in bone marrow spaces
- Increased osteoclastic activity
- Decreased osteoblastic activity
- Areas of bone necrosis
How is osteomyelitis managed?
- Bacterial culture + sensitivity testing
- Antibiotics
- Drainage of pus
- Pain control
- Debridement/removal of infection source
How can acute hypertrophic candidiasis be diagnosed?
- White patched
- Can be scraped off
- Can have some areas of redness/inflammation
Note: most common form for people who are immunosuppressed but may have other systemic risk factors
How can acute atrophic candidiasis be diagnosed?
- Sudden onset
- Generalised or localised red patches of inflammation, however not as distinct as the chronic form
- Can also present with non-specific pain (burning sensation)
How can chronic hypertrophic candidiasis be diagnosed?
- White patch that can not be removed
- Usually on tongue and buccal mucosa, but can occur anywhere
- Requires a biopsy as appearance is similar to lichenoid reactions/ squamous cell carcinoma
How can chronic atrophic candidiasis be diagnosed?
- Usually occurs overtime due to non-removal of denture/build up of fungi underneath
- Distinct red patch, will follow shape of denture if denture induced
- Usually asymptomatic/painless, though can present with pain in some cases
May also present with:
- Non-specific red areas
- Denture stomatitis
- Median rhomboid glossitis (loss of lingual papillae in midline in front of circumvillate papilla)
- Papillary hyperplasia of hard palate
- Angular chelitis
What are some pre-disposing factors for candidiasis?
- Poor denture hygiene
- Reduced OVD (folding of mucosa creates niche)
- If poor fitting can cause accumulation/affect gingiva
- Porosity from not cleaning properly
- Reduced salivary flow
- Extremes of age
- Immunosuppression
- Endocrine disturbances
- Advanced malignancies
- Malnutrition
- Antibiotic therapy
- Blood dyscrasias: vitamin B-12/iron deficiency
- Post-operative state
What is the progression of Herpes Simplex virus infection?
Seronegative individual
Primary disease
Latent disease
Secondary disease (may regress to latent which can then reactivate)
What are the signs and symptoms of the primary infection of Herpes Simplex?
Usually subclinical (assymptomatic)
If symptomatic, usually consists of:
- Generalised gingivostomatitis
- Widespread vesicular eruptions that can burst and leave ulcers (painful)
- Prodromal symptoms: may get tingling sensation where vesicles are about to erupt
- Systemic signs: fever, arthralgia, malaise, headache, cervical lymphadenopathy
What are the signs and symptoms of secondary herpes simplex virus?
- Localised vesicular eruptions/ulcers compared to the more widespread lesions in primary disease, generally affect attached mucosa (palate, gingiva)
- Development of vesicular lesions on peri-oral tissues, particularly herpes labialis
What can trigger reactivation of latent herpes simplex infection?
- Sunlight
- Stress
- Immunosuppression
What are some histological features of herpes simplex virus infection?
- Acantholysis
- Intraepithelial vesicle formation
- Viral inclusions
What effects can immunosuppression/deficiency have on herpes infections?
- Increased pain/discomfort
- Increased risk of fungal/bacterial infections
- More widespread mucosal lesions
- Can present as chronic infections rather than self limiting
What are some possible differential diagnoses for primary and secondary herpes simplex?
Primary:
- ANUG
- Streptococcus pharyngitis
- Erythema multiforme
Secondary:
- Aphthous ulcer
- Developmental (e.g. epidermolysis bullosa)
- Other vesicular (e.g. pemphigus)
What is a common name for the primary infection of varicella-zoster virus and what are the signs and symptoms?
How can it spread?
Chicken pox
-spread via direct contact or droplet inhalation
- Itchy rash which can develop into vesicles, may affect the oral mucosa
- Lesions may result in secondary skin infections
Where can herpes virus lay dormant?
Sensory ganglia
What is the common name for secondary/recurrent varicella-zoster virus disease and what are the signs and symptoms?
Shingles
- Vesicular eruptions corresponding to dermatomes of infected sensory nerve where virus laid dormant (e.g. trigeminal nerve dermatomes)
- May have prodromal symptoms of pain/paraesthesia where vesicles are about to arupt
- May also develop further complications such as post-herpatic neuralgia and secondary infections
Differential diagnosis: vesicles stop in the midline as follow nerve dermatome distribution
What can Epsten-Barr Virus cause?
- Oral hairy leukplakia
- Nasopharyngeal carcinoma
- Burkitts lymphoma
- Infective mononucleosis (glandular fever)
What can coxsackie virus cause?
Herpangina
Hand foot mouth disease
What are the signs and symptoms of hand foot mouth disease?
How is it spread?
- Oral mucosa ulceration
- Vesicular rash on extremities
- Resolves within 1-2 weeks (self-limiting infection)
- Systemic symptoms: lymphadenopathy, fever, malaise
- Airborne or oro-faecal transmission
What are the signs and symptoms of herpangina?
How is it transmitted?
- Vesicular eruptions on soft palate, fauces, diffuse pharyngitis
- Systemic symptoms: fever, malaise, sore throat
- Resolves within 1 week
- Transmitted via saliva or oro-faecal transmission
What is HPV and what diseases can be caused by it?
Human papilloma virus, typically affects epithelium particularly basal cells
- Squamous papilloma
- Condyloma accuminatum
- Oropharyngeal carcinoma
- Focal epithelial hyperplasia
What are the signs and symptoms of squamous papilloma?
- Hyperkeratinised, hyperplastic exophitic growth of oral mucosa, usually cauli-flower shaped
- Slow growing
- White coloured due to keratinisation
- Asymptomatic
- Usually solitary
- Surface is corrugated (has many grooves/ridges)
What are the histological features of squamous papilloma?
- Papillary/finger-like projections of epithelium with central core of fibro-vascular tissue
- Can be dysplastic (in HIV lesions)
- Exophytic
What are possible differential diagnoses of squamous papilloma?
- Condyloma accuminatum
- Verruciform xanthoma
- Papillary hyperplasia (of hard palate)
What are the signs and symptoms of condyloma accuminatum?
How is the disease transmitted?
- Pink, broad based nodules that grow and coalesce forming an exophytic lesion
- Less keratinised and faster growing than squamous papilloma
- Does not have cauliflower appearance of squamous papilloma
Transmitted through direct contact
What are the histological features of condyloma accuminatum?
- Papillary/finger-like projections of hyperplastic epithelium but with no dysplasia
- May see koilocytic cells in upper layers
What are some features of focal epithelial hyperplasia?
- Multiple nodular, squamous papilloma like lesions over mucosa
- Assymptomatic
- Histological acanthosis and parakeratosis
What are the signs and symptoms of leukoedema?
- Bilateral
- Assymptomatic
- Diffuse, translucent white/grey patch
- Poorly defined margins
- Disappears upon being stretched
What are some histological features of leukoedema?
- Intracellular edema of superficial half of oral mucosa
- Pyknotic nuclei
- Vacuolated cells
- Thickened, broad based rete tags
- Acanthosis
- Thickened parakeratin layer
- Hyperkeratinisation
What are the signs and symptoms of white sponge nevus?
- Diffuse, irregular, opaque white thickening of mucosa
- Early onset (ask patient if had lesion for entire life)
- No well defined borders
What are some histological features of white sponge nevus?
- Extensive edema of superfical half of epithelial layer, particularly prickle cell layer
- Pyknotic nuclei
- Vacuolated cells
- Acanthosis
- Hyperkeratinisation
- Thicked parakeratin layer
- Few cells undergoing mitosis, no dysplasia
What are the signs and symptoms of gingival fibromatosis?
- Diffuse, painless enlargement of gingiva
- Non-drug induced
- Solitary
- Other than excess tissue, generally healthy gingiva (no redness, no bleeding, no exudate, quite firm/hard)
What are the histological features of gingival fibromatosis?
- Dense, avascular, fibrous CT
- Some inflammation due to overgrowth onto crown making it difficult to clean
- Elongated rete pegs
What are some differential diagnosis of gingival fibromatosis?
- Drug induced hyperplasia
- Neoplastic disease
- Granulomatous disease
What is a haemangioma?
- Localised proliferation of endothelial cells
- Can have bony involvement
- May have single or multiple
- Can cause excessive bleeding when cut
- Presents as a localised, bluish purple swelling that can go white when pressure applied (due to squeezing blood out of it)
What are the histological features of haemangioma?
- Normal epithelium
- Lobules of proliferation of capillaries
- Can have capillary or cavernous types (dilated vessels), but clinical behaviour much the same
What is a lymphangioma?
- Localised proliferation of lymphoid tissue
- Usually present as small swellings, classically on the tongue, may get macroglossia
- Histologically can see proliferation and enlargement of lymph vessels
- Usually occur superficially
- Different for haemangiomas in that vessels lack red blood cells, instead have VERY pale pink fluid
- Can have occasional lymphocytes
What is cystic hygroma?
- Large lymphangioma affecting the cervical region
- Life threatening
- Can have respiratory distress, intralesional haemorrhage, disfigurement
What is calibre persistent labial artery?
- Mental artery retains normal size after leaving mental foramen (i.e. inferior alveolar artery does not shrink)
- Results in palpable, pulsatile, sessile (broad based), nodule in lower lip
- May increase risk of trauma
What are fordyce spots?
- Ectopic sebaceous glands growing in the oral cavity (this is abnormal as sebaceous glands are usually associated with skin/hair)
- Present as slightly elevated, small, yellow-ish or white nodules (about 1-3mm)
- Can be discrete or confluent (if confluent may be mistaken for pathology)
- Appear histology like sebaceous glands (collections of sebaceous cells): foamy cytoplasm, dark nucleus, occasionally hyperplastic mass
- Ducts don’t communicate with mucosa
What is lingual thyroid tissue?
- Nodular mass of thyroid tissue at the foramen caecum area
- Caused by incomplete descent of thyroid to neck
- May be the only thyroid tissue present: do not remove
- Can manifest during pregnancy or puberty
- May cause dysphagia
What can occur in ectopic/hyperplastic lingual tonsil?
- Present as lymphoid aggregates, usually affecting posterior lateral of tongue
- Variable clinical appearance, usually results in development of folds of tissue which leads to formation of crypt
- Usually occur in response to infection, will reduce after infection subsides
- Sometimes if tonsils become inflamed can lead to blockage of crypts: present as yellow nodule
What is benign migratory glossitis?
- Also known as geographic tongue
- Loss of areas of filiform papillae with associated inflammatory erythema
- Sometimes thickened white border
- Denuded areas regenerate, but new areas develop
- May persist for months to years
- More florid presentations may be associated with increased candidiasis /burning mouth syndrome risk
What causes pigmented gingiva?
-Normal number of melanocytes but increased melanin production
What are oral melanotic macules?
- Localised, uniform brown pigmentation of mucosa with clearly defined margins
- Assymptomatic
- Flat lesion
- Histologically increased melanin deposition but same number of melanocytes; may also get melanin incontincence/phagocytosis of melanin in adjacent tissue (if melaine released into CT);
What is mucosal melanocytic nevus?
- Benign proliferation of nevus cells/melanocytes resulting in dark brown/black lesion
- Usually (but not always) slightly raised lesion compared to macule which is flat (if macule=freckle, nevi=mole)
- Non-neoplastic, grow at the same rate as surrounding tissue, stays within tissue of origin, simply more cells in that area, as such can be described as harmartomatous
What is a harmartoma?
- Non-neoplastic proliferation of tissue
- Located at tissue/site of origin
- Grow at same rate as surrounding tissue, simply more cells
- example is oral melanocytic nevus
What are the different types of nevi?
Junctional: confined to basal cell layer at junction of epithelium/CT
Intramucosal: Proliferation of cells below basement membrane
Compound: combined junctional and intramucosal
Blue: Proliferation of melanocyte like cells but these are spindle shaped rather than normal
What are amalgam tattoos?
- Pigmented lesion caused by uptake of amalgam into tissues
- Characterised histologically by black amalgam granules in tissue
- May have radiopaque areas in radiogrpah in soft tissue that have no other explanation
Where are melanocytes derived from?
Neural crest cells
