Orofacial Infection Flashcards
0
Q
T/F Candida can be isolated from
Healthy mouths?
A
T
1
Q
What is the most common type of fungal oral mucosal infective agent?
A
Candida albicans
2
Q
What are local factors which predispose to oral candidiasis?
A
Denture wearing at night
Dry mouth
Steroid therapy esp inhaled
High carb diet
3
Q
How can candida be categorised?
A
Acute
Chronic
4
Q
What systemic factors predispose to or candidiasis?
A
Immunocompromised T cell defects (HIV, diabetes,leukaemia) Age extreme AB therapy Diabetes mellitus Anaemia
5
Q
What are examples of acute candida ?
A
Acute pseudo membranous candidiasis
Acute erythmatous/strophic candidiasis
6
Q
Name examples of chronic candidal infection?
A
Chronic hyperplastic candidiasis (leukoplakia )
Chronic erythmatous candidiasis (denture stomatitis)
Candida associated lesion:
Angular chelitis
Median rhomboid glossitis
Mucocutaneous candidiasis
7
Q
How does oral thrush present?
A
White patches on the oral mucosa which are easily removed by rubbing off may leave mucosal erythema
A disease if a disease
Seen in neonates which haven’t yet developed immunity
8
Q
What microbiological tests can be performed with people that babe candidiasis?
A
Swab: culture and sensitivity testing
Phosphate buffered mouthwash: not site specific
9
Q
What tests can be done for thrush?
A
Correct any local or systemic cause
Check FBC/B12/folate/blood glucose and HIV tests
Microbiological
10
Q
How do you threat thrush?
A
Topical: MAN
Systemic: for Immunocompromised or where wide spread lesions
11
Q
What is another name for chronic hyperplastic candida?
A
Candidal leukoplakia
12
Q
How does candidal leukoplakia
Present?
A
Non remove able white lesion on commissaries of buccal mucosa
Frequently
Bilateral
Typically seen in smokers
13
Q
How do you diagnosis CHC?
A
Clinicslly BUT need histopathology confirmed
14
Q
How do you manage CHC?
A
Manage risk factors
Topical AF
Systmic AF
Follow up long term since malignancy risk of 9-40
15
Q
How does acute erythematous candida present?
A
Erythmatous area
16
Q
What are the risk factors for acute erythmatous candida?
A
Steroid inhalers and AB
17
Q
What is another name for denture stomatitis?
A
Chronic erythmatous candida
18
Q
How do you treat acute erythmatous candid?
A
Topical AF
rinse mouth after steroid inhaler
19
Q
How does chronic erythmatous candida present?
A
Usually on palate with upper surface of denture it is often a symptomatic
20
Q
How do you treat chronic erythmatous candida?
A
Topical AF therapy and denture hygiene
21
Q
What is an example of a candida associated lesions?
A
Median rhomboid glossitis
Angular chelitis
22
Q
How does median rhomboid glossitis present?
A
Lobulated lesion at junction between post and anterior tongue
It is usually asymptomatic
And dx is clinical
Topical AF therapy needed
23
Q
What is a less common bacterial infectjon of the mouth?
A
Alveolar abscess/cellulitis
24
name some bacterial infections of the mouth?
```
ANUG
Osteomyelitis
Periaplical abscess
Periodontal abscess
Periocoronitis
Infected cyst
```
25
What is the difference between alveolar abscess and cellulitis ?
Abscess is collection of pus
| Cellulitis diffuse pus
26
Which spaces can infection spread in head and neck?
```
SM space
SL space
Submental space
Mental space
Buccal space
Canine/infraorbital space
Submasseteric space
Pterygomandibular space
Deep temporal space
Superficial temporal space
```
27
Where does infection from upper centrals drain?
Labial
| Nasal cavity if long roots
28
Where does infection from upper 2's spread?
Palate
29
Where does infection from
| Upper canines spread?
Labial sulcus or infraorbital
30
Where does infection from maximal let posterior teeth drain?
Buccal sulcus due to thin buccal place and high attachment of buccinator
31
Where do lower incisors point?
Since mentalis attaches above apices, it usually drains at chin point or submental space
32
Where do mandibular molars drain to?
If apices are above Mylohyoid then sublingual
If below Mylohyoid then submandibular
33
Where do periodontal abscesses drain to?
Via gingival sulcus or laterally
34
Which bacteria are commonly imbued in periodontal abscesses?
Gram neg anaerobes eg PG/ fusobacteria
spirochete sand actinomyces
35
What agents are involved in ANUG?
Poly microbial
Anaerobes
Boriella vincentii
Fusobacteria nucleatum
36
What predisposes you to ANUG?
```
Poor OH
Smoking
Immunocompromised
Stress
Vit C def
Viral resp infections
```
37
What key features relate to ANUG?
Halitosis
Loss of interdental papilla
Slough
Pyrexia?
38
How do you treat ANUG?
Metronidazole 400mg tds
39
What are the potential risks of untreated dental infections?
```
Osteomyelitis
Cellulitis
Fistula formation
Septacaemia
Spread into tissue spaces
Meningitis
```
40
Which organisms are associated with CST?
Staph aureus
41
What is cavernous sinus thrombosis?
Formation of blood clot in Cavernous sinus
42
What can predispose to CST?
```
Nasal infection 50%
Sinus infection (30%)
Dental infection (10%)
```
43
What is osteomyelitis ? And how can it be classified?
Inflammation of the bone marrow
Suppurative
-acute suppurative osteo
-chronic suppurative osteo
non suppurative
- diffuse sclerosimg
- focal sclerosimg
- proliferative periostitis
- ORN
44
What are the symptoms of CST?
```
Palpebral oedema
Cyanosis
Exophthalmos
Proptosis
Dilated pupil
Limited eye movement
Rigors
Pyreixa
```
45
What are the sources of osteomyelitis?
Periaplical or peridontal infection
Fractures
Penetrating injuries
46
What are the predisposing factors for osteomyelitis?
Osteoradionecrosis
| Osteopetrosis
47
What are the signs and symptoms of osteomyelitis ?
```
Deep seated throbbing pain
Sweeping
Halitosis
Anorexia
Parasthesia
Malaise
Fever
Cervical lymphadenopathy
Tooth mobility
Pus
Leukocytosis
```
48
What causes syphylis?
STI
| Treponema palladium
49
What are the sequelae following infection with T Pallidium?
Primary syphylis: primary chancre at site of inoculation following oral sex, causes painless ulcer and lymphadenopathy
Secondary : snail track ulcers 2-6 weeks later
Terriary: leukoplakia and gumma on palate
50
What causes TB?
Mycobacterium Tuberculosis
51
How do you treat syphylis?
Benzathine pencillin for 1 month
52
Oral lesions are rare in TB? T/F
T
53
How may TB present in Head and neck?
Ulcer on dorsal of tongue
Salivary gland swelling
Lymphadenopathy
54
How do you treat TB?
Rifampicin
Isomiazid
Ethambutol
Spiramycin
55
How do oral lesions in TB develop in mouth?
Tubercle bacilli in sputum coughed into mouth
56
What is erysipelas?
Acute streptococcal infection which spreads via lymphatic system
Usually caused by strep pyogenes which produced exotoxin and then rash
57
What is actinomycosis?
Chronic supportive infection which is rare. Swelling at angle of the mouth
Multiple sinus formation and trimsus and caused by gram pos organisms, a israelli and aa
Tropical country
58
What signs indicate acinomycosis?
Extra oral sinus with no oral cause
May occur following jaw surgery or neck
59
What are the demographics associated with actinomycosis?
30-60 male
60
When does a israelli become pathogenic?
When tissue is non vital and reduced oxygen
61
How do you treat actinomycosis?
Pencillin
| Drainage
62
What are the 5 of infective periodontal diseases?
```
Linear gingival erythema
NUG
NUP
ANUG
Cancrum oris
```
63
What is the agent involved in Linear Gingival Erthema?
Fungus
64
Which bacteria are involved in acute ulcerative gingivitis?
Spirochete and fusiform
They invade muscle
65
What happens to the tissue in AUG?
Gross oedema which spreads outwards destroying soft tissues and bone
66
Why do the tissues slough away in AUG?
Because gangrenous infection occurs leading to loss of teeth and necrotic sequestra
67
In what demographics is AUG mainly seen in?
```
Children under 10
Immunocompromised
Protein deficiency
Anaemia
Poor OH
Systemic infection eg measles
```
68
What can AUG lead to?
Cancrum oris
69
Which fusiform bacteria are involved in Cancrum oris?
Porphyromonas
Fusiform necrophorum
Boriella vincentii
70
How can viral infections be diagnosed?
In the lab
| Clinically
71
What features are considered when diagnosing viral infection clinically?
History of contact
Incubation period
Clinical features
72
What effect can viruses have on the tissues?
Cell death and Persistant infection
73
What is an example of a latent viral infection?
Herpes simplex
74
What is an example of a chronic viral infection?
Hep B
75
What is an example of a slow viral infection?
HIV
76
What is an example of an acute viral infection?
Measles
77
How can you use lab methods to detect viruses?
```
Antibody response
Viral particles( Culture, smear, PCR, EM)
```
78
what type of viruses are herpes viruses?
large
icosahedral
dsDNA
79
Which herpes viruses exist?
```
HSV1/HSV2= HHV1 and 2
HHV3=VZV
HHV4=EBV (GF)
HHV5=CMV (GF)
(HHV6= GF HHV7)
HHV8 = kaposi sarcoma
```
80
What disease is associated with HSV1/HSV2 primary infection?
HSV1: herpes labialis and oral ulceration
Primary infection as a child is usually sub clinical but when is clinical leads to Primary herpetic gingivostomatitis only affects around 5% of people,
HSv2: oral ulceration
81
What disease is associated with latent HSV1 infection?
Latent virus in periods of stress fever UV and immuno suppression there is either:
1. asymp shedding of virus
2. Herpes labilis
3. RIOHU
82
how do you diagnose HSV1 infection?
mainly clinical but can do viral and serolgy testing
83
how is HSV transmitted between persons?
saliva
| Direct contact with infected lesions
84
What disease is associated with latent infection of HSV2?
cold sores
85
how are HSV2 infections transmitted?
infected saliva, semen and bodily fluids
| more sever infections with HSV2 than HSV1
86
what diseases can HSV1 and HSV2 cause?
primary herpetic gingivostomatis
herpetic whitlow
herpes labialis
recuurent herpes
87
What disease is caused upon contraction of VZV?
```
Chicken pox
Herpes zoster (Shingles)
```
88
What are the sequale following VZV infection? How can it be diagnosed?
macular, papular rash
latent infection as virus remains dormant in the posterior root ganglion and nerve cells bodies
in those that become immunocomprimsed and elderly there is recrudescence.
this leads to shingles infection (follows dermatome) doesnt cross the midline introrwl and extra oral distribution
Diagnosis: clinical and history but can do lab tests to confirm.
1. Serology: specific VZV IgM AB only occurs during chickenpox or active herpes zoster
2. Four fold rise in VZV specific IgG which can be demonstrated over a 2 week period in a true phase so retrospective only
3. Swab taken and in special transport media for PCR
89
Where is the DNA held in EBV?
nucelocapsid
90
What is the incubation period of EBV?
20-40 days
91
What can EBV cause? How is EBV transmitted?
GF/IM/hairy leukoplakia, burkitts lymphoma
| saliva
92
What disease is caused by Coxsackie A virus?
Hand foot and Mouth
| Herpangina
93
How does Herpangina present?
Fever, sore throat, vesicles, vominitkng and a do pain,
ulcers on the soft palate, and post aspect of pharynx
Fever subsides within 2-4 days
cervical lymph
Takes one week to resolve
94
how does HFM presnt?
mild malaise, oral ulceration and
rash on hands and feet more commonly seen in children than adults
5-10 vesicles that rupture and show shallow ulceration
caused by coxscakie A
Management: spontaneous resolution
95
What type of DNA are paramyxoviruses?
RNA!!
| Large pleiomophic enveloped
96
what do paramyxoviruses cause?
Measles and Mumps
97
How do measles presnt?
koplik spots
macular papular rash
fever and malaise
98
What is the incubation period for paramyxoviruses when causing measles?
7-14 days
99
How do mumps present?
mainly affects parotid glands causing sialadentitis
| adults can get orchitis, balanitits and meningioencephalitis
100
what should adults suffering from mumps take? and why?
steroids to prevent infertitly
101
how long is the paramyxoviruses incubation period in mumps?
2-3 days
102
T/F people develop immunity o further attacks of acute viral sialadentits?
TRUE
103
what is the structure of papilloma virus?
small icosahedrral DNA
104
What do papilloma virus cause?
Soft tissue neoplasms, wart like any location in the oral cavity
105
How do papillomas present?
pedunculated or sessile may also be on digits of patients with oral infecting
106
Which other viruses are associated with papilloma virus?
HPV 13 + 33 HECKS and FEH
| HPV 6 and 16: cancer
107
what is the structure of poxvirus?
Large DNA, brick shaped and enveloped
108
what causes molluscum contagiosum and what is its clinical appearance?
poxvirus
umbilicated papules on the face and body
109
which people are commonly affected with molluscum contagiosum?
children and HIV
| common STI
110
what are the symptoms of herpetic whitlow?
Lymphadenopathy
| swollen finger
111
which species of candida are seen more commonly in immunocompromised patients?
glabrata
kruisei
trpoicalis
112
which serotype of candida is more commonly seen in immunocompromised pts?
B
113
which serotype of candida is more commonly seen in healthy individuals?
A=B
114
What are the four host defenses against candida?
oral epithelium
microbial interactions
salivary non immune(mechanical washing) and immune (IgA)
115
when would you prvide prophylaaxis for people against candidiasis?
chemotherapy,immunosuppressant therapy,prlonfed ab, history of candida followinf short course of ab
NOT HIV
116
white colour lesions are present in candidiasis?
red and white
117
which form of candida does white lesions predominate in?
hyphal
118
which form of candida does red lesions predominate in?
yeast
119
where is primary candida confined to?
oral and peri-oral tissues
120
where is secondary candida confined to?
other parts of the body
121
what is a complication arising from acute erythmatous candidasis?
lesions for more than month can lead to chronic multifocal candida
122
what other organism other than candida is implicated in angular chelitis?
staph aureus
123
which factors predispose to angular chelitis?
decreased vertical dimension
denture wearer
deficiency state
enlarged lips (OFG, Crohns, Downs)
124
how does angular chelitis present?
fissurung at angle of mouth
triangular in shape
lesions may extend beyond the vermillion border in linear furrows and rhagades
chin may also be affected
125
how do you manage angular chelitis?
MAN and consider fusidic acid if staph aureus possible cause
126
what is the definition of chronic hyperplastic candidasis?
persistant white plaques which cannot be wiped off
127
what is chronic mucocutanous candidais ? and how do you treat it?
candida that affects the nails mouth and skin.
| treat using systemic AF
128
what is chronic mucocutanoues candidasis associated with?
immune defect and endocrine diseases (autoimmune hypoparathyoidism and hypoadrenocortiscm) or thymus disease
129
what can CMV cause?
HHV5 and associated with oral ulceration and retitnits
130
How do you manage herpes zoster infection?
antivirals: 10 days aciclovir 800mg 5 times/day
131
where does EBV replicate?
replicates in the mucosal cells and salivary glands then spreads to B cells and blood stream
132
how do you manage OHL?
valaciclovir therapy
133
what are the viral causes of lymph node enlargment?
```
URTI
paramyxic virus (measles)
herpex simplex
zoster
HFM
herpangina
GF
HIV
```
134
what are the causes of bacterial lymph node enlargement?
syphilis
Local head and neck infections
Cat scratch
135
What are the protozoal causes of infection?
toxoplasmosis
136
in children less than 10 what are the causes of cervical lymph node enlargemet?
Viral infection (URTI)
kawasaki disease
HSV
137
in an adolescent less than 20 years old, what are the causes of cervical lymph?
```
viral URTI
bacterial infection
GF
HIV
Toxoplasmosis
```
138
what is kawasaki disease?
```
AI vascilitis which occurs when there is an underlying systemic infection
Fever for more than 5 days plus 4 of:
Cervical lymphadenopathy (>1.5cm)
Non supparative conjuctivitits
Oral MM changes eg strawverry tongue
Periperheral odema, erthythema, desquamm
Polymorphous rash on trunk
```
139
A bcaterial infection of the mandible can lead to what?
ludwigs angina
| polymicrobial infection of the sublingual and aubmanidbular neck spaces
140
what is GF syndrome caused by?
EBV (HHV4)
CMV (HHV5)
acute HIV
Toxoplasmosis
141
What are the symptoms of GF?
```
Fever, malaise and weightloss
Cervival lymphadenopathy
Exudative tonsillitis
petechial rash on palate
splenomegaly
```
142
What happens when amoxicillin is adminstred to people with GF?
Rash if EBV is cauastive agent
143
how do you diagnose GF syndrome?
```
Atypical lymphocytosis
Paul-bunnel test
Monospot test
Viral serological tests
raised liver enzyme
```
144
what causes toxoplasmosis?
Toxoplasma gondii
145
what are the sources of t.gondii?
cats and soil, incompletely cooked meat
146
what are the symptoms of Toxoplasmosis?
Fever, malaise, cervical lymphadenopathy
147
what is the histology behind toxoplasmosis?
follicular hyperplasia of lymph nodes
148
how do you treat toxoplasmosis?
self lumiting or long course tetracycline
149
what are the complications of toxoplasmosis?
congenital defects since can cross the placenta
| immunocomprised pateints can cause multifocal necrotising encephalitis
150
what is the causative agent in cat scratch?
bartonella henselae
151
what is the source of bartonella henselae?
cats/thorns/animals
152
what are the symptoms of cat scratch?
papules which arise 3-4 days post infection
fever and malaise
lymph uniltaeral
LN suppuration
153
what is the histology behind cat scratch?
Necrotising granulamatous inflam
154
what is the treatment for cat scratch?
self limiting/long dose tetracycline
155
what are the causes of lymph node enlargement in a patient of less then 40?
```
malignancy
HIV
Bacterial
syphilis
GF/IM
```
156
what are the causes of lymph node enlargement in a patient less more the 40?
HIV and malignancy
157
what are the neoplasms of the lymph nodes?
Primary: Lymphoma and Leukaemia
Secondary: Metastatic
158
which drugs can cause cervical lymph?
phenytoin, carbamezapine
159
which connective tissue disorders can cause lymph node enlargement?
SLE
160
what is sarcoidosis?
mutlisystem granulomatous disease
161
what is the incidence of sarcdoidosis?
young adults mainly
| F:M 2:1
162
what are the symptoms of sarcoidosis?
Pulmonary lesions, fever, malaise, weight loss, bilateral hilar lymph, cervical lymph, cough, dysponea, oral lesions
163
what oral lesions occur in sarcoidosis?
```
lip swelling
skin lesions
cobble-stoning mucosa
ulcers and swellings
hyperplastic gingivitis
salivary swellings/dry eyes/dry mouth
heerfodt syndrome
```
164
what s heerfordt syndrome?
Pyrexia
parotitis
uveitis
facial nerve palsy
165
what are the microscopial features of sarcoidosis?
```
HELLN
heals with scars
Epitheloid cels
Langerhans giant cells
Lymphocytes
Noncaseatig epitheloid granulomas
```
166
how do you investigate sarcodiosis?
```
chest x ray
liver US
SACE enzyme is raised
ESR/Serum calcium
Transbronchial lung biopsy
Minor salivary gland biopsy
Kveim test
```
167
how do you treat sarcoidosis?
systemic steroids
168
what is a branchial cyst?
developmental remnant of any of the paired pharyngeal/branchial pouches in the side of the throat of an early embryo
169
what type of cyst is a branchial cyst?
lymphoepithelial cyst
170
how do you treat branchial cysts?
surgical removal otherwise branchial fistula may develop
171
what skin cysts can cause neck lumps?
dermoid cyst: epidermis and skin appedndages
| epidermoid cysts: epidemis only
172
what is the incidence of dermoid cysts?
15-35, M=F
173
how do dermoid cysts present?
doughy/fluctutant swelling in the FOM or midline of neck, can dssplace the tongue affecting speech, eting and breathing
174
how do you treat dermoid cysts?
surgical removal
175
how do you test for syphylis?
VRDL test
176
What causes verruca vulgaris?
Human papilloma 2 and 4
177
How do verruca vulgaris appear?
Skin warts involving the oral mucosa
White sessile and pedunculated
Solitary or multiple
Most commonly on lips, hard palate and gingival
178
What are the causes of cervical lumps?
Lymph: Infective, Neoplastic, sarcoidoisis, drugs, CTD
glands: Salivary gland, thyroid gland
other: branchial cyst, skin cyst, soft tissue neoplasm
