selected infectious diseases Flashcards
what is lupus vulgaris
mucocutaneous lesions of secondary tuberculosis; hematogenous or lymphatic spread of disease. Nose and cheeks are most common sites of involvement. May be ulcerative and destructive; healing may result in scarring and deformity.
WHAT IS SCROFULA
Cervical lymph node involvement by Mycobacteria. Periparotid, periauricular, and submental LNs possible, but usually high cervical lymph nodes in the submandibular gland region. Usually presents as a unilateral neck mass; patients are afebrile. May be TB or MOTT (Mycobacteria Other Than Tuberculosis). Enlarged, firm LN(s). Overlying skin ulceration possible.
CERVICOFACIAL ACTINOMYCES
ACTINOMYCOSIS • Filamentous, branching, gram-positive anaerobic bacteria • Normal part of oral flora • Tonsillar crypts (tonsilloliths), caries, perio pockets; immunocompetent people • “Infection” (overgrowth) may be acute or chronic; immunocompromised patients • Over 50% of all cases are cervicofacial
What is the suppurative reaction of actinomycosis
• Sulfur granules – large yellow flecks • Spreads via direct extension through soft tissue; not along fascial planes or lymphatic/vascular: sinus tract • Classic: wooden, indurated fibrosis with central soft area of abscess
What is the tx for actinomycosis
• Chronic fibrosing cases • Prolonged high dose antibiotics – 6 months (penicillin/amoxicillin) • Abscess drainage • Excision of sinus tracts • Acute cases • Localized removal of infected tissue
which form of candidiasis is associated tiwh invasion of tissues
hyphen form (yeast form is innocuous)
What factors determined clinical evidence of infection
• Host immune status • Oral environment • C. albicans strain
what are the four clinical patterns of candidiasis
• Pseudomembranous • Erythematous • Chronic hyperplastic • Mucocutaneous
PSEUDOMEMBRANOUS CANDIDIASIS
• Best recognized form of candidiasis • Aka “thrush” • White mucosal plaques (cottage cheese) • Plaques can be removed, usually revealing red, irritated tissue
Where are the most common sites for pseudomembranous candida
• Most common sites are buccal mucosa, dorsum of tongue, and palate
what are symptoms of pseudomembranous candidiasis
Symptoms may include mild chronic burning, bad taste (salty, bitter), “blisters”
What are the predisposing factors for candidiasis
Pre-disposing factors • Recent history of broad spectrum antibiotic • Immune dysfunction (HIV, leukemia) • Infants (underdeveloped immune system
what are the subtypes of erythematous candida
• Acute atrophic candidiasis • Median rhomboid glossitis • Chronic multifocal candidiasis • Angular cheilitis • Denture stomatitis
Acute atrophic candidiasis
• “Antibiotic sore mouth” – recent course of broad spectrum antibiotics • Burning, scalded sensation • Red, bald tongue due to diffuse loss of filiform papillae
Median rhomboid glossitis
• Aka central papillary atrophy • Found in adults, consistently associated with c. albicans • Well-outlined erythema in midline of posterior dorsal tongue • Loss of filiform papillae; may be smooth or lobulated • Often asymptomatic, may resolve with antifungal therapy
Chronic multifocal candidiasis
Involvement of dorsal tongue as well as other areas, usually junction of hard and soft palate (“kissing lesion”) and corners of the mouth
Angular cheilitis
• Red, fissured, scaling lesions at the mouth corners • Common patient: older, with reduced vertical dimension
what bacteria is usually connected with angular chelitis
s. aureus
Cheilocandidiasis
type of angular chelitis Involvement of perioral region, often due to lip or thumb sucking
Denture stomatitis
• Aka chronic atrophic candidiasis • Denture-bearing areas under maxillary removable prosthesis • The fungus shows very little invasion into tissue, and lesion is usually asymptomatic • Heavier fungal colonization on denture than tissue
CHRONIC HYPERPLASTIC CANDIDIASIS
• Aka candidal leukoplakia • White patch cannot be removed by rubbing • May represent secondary candidal infection of a leukoplakic lesion
location of chronic hyper plastic candidiasis and description
• Usually located on anterior buccal mucosa • May be speckled red and white • Hyphae are present • Diagnosis is confirmed by lesion resolution after antifungal therapy
MUCOCUTANEOUS CANDIDIASIS
• Seen within a rare group of immune disorders, usually sporadic or autosomal recessive • Candidiasis of mouth, nails, skin, etc from a young age • Thick white, foul-smelling plaques cannot be rubbed off, but can be controlled throughout life by anti-fungals
which candida may be associated with iron deficiency anemia
MUCOCUTANEOUS CANDIDIASIS
Endocrine-candidiasis syndrome:
• Hypothyroidism • Hypoparathyroidism • Hypoadrenocorticism (Addison’s) • Diabetes mellitus
CANDIDIASIS DIAGNOSIS • Combination of?
Clinical presentation • Exfoliative cytology • Biopsy • Level of response to anti-fungal treatment
CANDIDIASIS TREATMENT • Mucosal Tissue:
• Mycelex troches, 5x/day for 10 days. One in morning, then 30 minutes after each meal, and one more before bed.
treatment for candida on Complete dentures:
• 1 cup of water plus 1 teaspoon bleach, soak denture overnight
tx of candida on partials
• NO bleach. Use Nystatin elixir, 480 mL; place cup in refrigerator and instruct the patient to drop FPD’s in cup each night
ASPERGILLUS
• Fungus, member of the Monilaceae family, class Hyphomycetes, phylum Deuteromycota. Abundant in soil and decaying matter; mode of transmission is inhalation. Often see pulmonary or sinonasal cases.
Sinonasal aspergillosis, three categories:
• Allergic fungal sinusitis (AFS) • Mycetoma (fungus ball) • Invasive fungal sinusitis
where are AFS and mycetoma commonly seen
immunocompetent patients; Maxillary and ethmoid sinuses most common. Prominent opacification can be seen on imaging, due to calcium oxalate crystal formation (common with A. niger.)
who is commonly target of zygomycosis
Immunocompromised patients – uncontrolled insulindependent diabetics
What can happen with max sinus involvement of zygomycosis
• Opacification; patchy bony wall effacement radiographically • Intraoral swelling of palate/alveolus • Palatal ulceration and tissue destruction • Black-colored necrosis
ZYGOMYCOSIS TREATMENT
• High-dose amphotericin B systemically • MRI to determine infection margins • Radical surgical debridement of necrotic and infected tissue • Control of underlying disease
HISTOPLASMOSIS
• Fungal infection, may be seen in normal or immunosuppressed individuals. • Histoplasma capsulatum. • Typically involves lung, but may be seen in a wide variety of mucosal sites. • Grossly, ulcerated or nodular mucosal lesions.
JUVENILE LARYNGEAL PAPILLOMATOSIS
• Most common benign neoplasm of larynx. • Most appear in infants or children, but may occur at any age. • Usually begins in glottis but can extend throughout respiratory tract. • HPV type 6/11 most common; ?more aggressive disease with types 16 & 18. • 2% incidence of carcinoma; 2-14% mortality; 2-15% extend into tracheobronchial tree.
hhv 1
– Peri-oral herpes • Spread mostly through saliva or active peri-oral lesions • Two patterns of clinical infection • Primary infection • Secondary/recurrent
hhv 2
genital herpes
hhv 3
varicella-zoster
hhv4
epstein bar • Implicated in many diseases/conditions • Oral hairy leukoplakia • Infectious mononucleosis • Nasopharyngeal carcinoma • Burkitt’s lymphoma • Hodgkin lymphoma • Others
hhv5
cytomeglavirus
hhv6 &7
– Non-specific roseola; usually asymptomatic, reactivation in immunocompromised patients
hhv8
kaposis sarcoma
hsv1 primary infection types
• Acute herpetic gingivostomatitis • Younger patients – 6 mos to 5 years usually • Pharyngotonsillitis • Adult primary infection
Acute Herpetic Gingivostomatitis
• Abrupt onset, fever, nausea, anorexia, irritability, mouth sores • Mild to debilitating • Numerous small vesicles, rapid collapse and coalesce into larger ulcers • Movable and attached mucosa • Distinctive punched out erosions, midfacial free gingival margins • May extend past wet/dry labial line
• Pharyngotonsillitis
• Sore throat, fever, malaise, headache • Many small vesicles on tonsils and posterior pharynx, rapid rupture to form shallow ulcers • 90% of cases confined posterior to Waldeyer’s ring
HSV-1 SECONDARY (RECURRENT) INFECTION
• Virus lies dormant in nerve ganglion • Numerous triggers for recurrent HSV: • Trauma, UV light, stress, illness • At site of inoculation OR any surface supplied by involved ganglion • Herpes labialis common
HERPES SIMPLEX VIRUS TREATMENT
• Primary infection • Treat symptoms • Acyclovir suspension (rinse and swallow) in first 3 days, shortens duration of symptoms • 15 mg/kg up to adult dose of 200 mg • Secondary infection • Penciclovir cream during prodrome • Systemic acyclovir, valacyclovir, famciclovir • Valacyclovir: 2 g during prodrome, then 2 g 12 hours later (most effective)
