selected infectious diseases

Question 1

what is lupus vulgaris

Answer 1

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.

Question 2

WHAT IS SCROFULA

Answer 2

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.

Question 3

CERVICOFACIAL ACTINOMYCES

Answer 3

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

Question 4

What is the suppurative reaction of actinomycosis

Answer 4

• 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

Question 5

What is the tx for actinomycosis

Answer 5

• Chronic fibrosing cases • Prolonged high dose antibiotics – 6 months (penicillin/amoxicillin) • Abscess drainage • Excision of sinus tracts • Acute cases • Localized removal of infected tissue

Question 6

which form of candidiasis is associated tiwh invasion of tissues

Answer 6

hyphen form (yeast form is innocuous)

Question 7

What factors determined clinical evidence of infection

Answer 7

• Host immune status • Oral environment • C. albicans strain

Question 8

what are the four clinical patterns of candidiasis

Answer 8

• Pseudomembranous • Erythematous • Chronic hyperplastic • Mucocutaneous

Question 9

PSEUDOMEMBRANOUS CANDIDIASIS

Answer 9

• Best recognized form of candidiasis • Aka “thrush” • White mucosal plaques (cottage cheese) • Plaques can be removed, usually revealing red, irritated tissue

Question 10

Where are the most common sites for pseudomembranous candida

Answer 10

• Most common sites are buccal mucosa, dorsum of tongue, and palate

Question 11

what are symptoms of pseudomembranous candidiasis

Answer 11

Symptoms may include mild chronic burning, bad taste (salty, bitter), “blisters”

Question 12

What are the predisposing factors for candidiasis

Answer 12

Pre-disposing factors • Recent history of broad spectrum antibiotic • Immune dysfunction (HIV, leukemia) • Infants (underdeveloped immune system

Question 13

what are the subtypes of erythematous candida

Answer 13

• Acute atrophic candidiasis • Median rhomboid glossitis • Chronic multifocal candidiasis • Angular cheilitis • Denture stomatitis

Question 14

Acute atrophic candidiasis

Answer 14

• “Antibiotic sore mouth” – recent course of broad spectrum antibiotics • Burning, scalded sensation • Red, bald tongue due to diffuse loss of filiform papillae

Question 15

Median rhomboid glossitis

Answer 15

• 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

Question 16

Chronic multifocal candidiasis

Answer 16

Involvement of dorsal tongue as well as other areas, usually junction of hard and soft palate (“kissing lesion”) and corners of the mouth

Question 17

Angular cheilitis

Answer 17

• Red, fissured, scaling lesions at the mouth corners • Common patient: older, with reduced vertical dimension

Question 18

what bacteria is usually connected with angular chelitis

Answer 18

s. aureus

Question 19

Cheilocandidiasis

Answer 19

type of angular chelitis Involvement of perioral region, often due to lip or thumb sucking

Question 20

Denture stomatitis

Answer 20

• 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

Question 21

CHRONIC HYPERPLASTIC CANDIDIASIS

Answer 21

• Aka candidal leukoplakia • White patch cannot be removed by rubbing • May represent secondary candidal infection of a leukoplakic lesion

Question 22

location of chronic hyper plastic candidiasis and description

Answer 22

• Usually located on anterior buccal mucosa • May be speckled red and white • Hyphae are present • Diagnosis is confirmed by lesion resolution after antifungal therapy

Question 23

MUCOCUTANEOUS CANDIDIASIS

Answer 23

• 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

Question 24

which candida may be associated with iron deficiency anemia

Answer 24

MUCOCUTANEOUS CANDIDIASIS

Question 25

Endocrine-candidiasis syndrome:

Answer 25

• Hypothyroidism • Hypoparathyroidism • Hypoadrenocorticism (Addison’s) • Diabetes mellitus

Question 26

CANDIDIASIS DIAGNOSIS • Combination of?

Answer 26

Clinical presentation • Exfoliative cytology • Biopsy • Level of response to anti-fungal treatment

Question 27

CANDIDIASIS TREATMENT • Mucosal Tissue:

Answer 27

• Mycelex troches, 5x/day for 10 days. One in morning, then 30 minutes after each meal, and one more before bed.

Question 28

treatment for candida on Complete dentures:

Answer 28

• 1 cup of water plus 1 teaspoon bleach, soak denture overnight

Question 29

tx of candida on partials

Answer 29

• NO bleach. Use Nystatin elixir, 480 mL; place cup in refrigerator and instruct the patient to drop FPD’s in cup each night

Question 30

ASPERGILLUS

Answer 30

• 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.

Question 31

Sinonasal aspergillosis, three categories:

Answer 31

• Allergic fungal sinusitis (AFS) • Mycetoma (fungus ball) • Invasive fungal sinusitis

Question 32

where are AFS and mycetoma commonly seen

Answer 32

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.)

Question 33

who is commonly target of zygomycosis

Answer 33

Immunocompromised patients – uncontrolled insulindependent diabetics

Question 34

What can happen with max sinus involvement of zygomycosis

Answer 34

• Opacification; patchy bony wall effacement radiographically • Intraoral swelling of palate/alveolus • Palatal ulceration and tissue destruction • Black-colored necrosis

Question 35

ZYGOMYCOSIS TREATMENT

Answer 35

• High-dose amphotericin B systemically • MRI to determine infection margins • Radical surgical debridement of necrotic and infected tissue • Control of underlying disease

Question 36

HISTOPLASMOSIS

Answer 36

• 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.

Question 37

JUVENILE LARYNGEAL PAPILLOMATOSIS

Answer 37

• 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.

Question 38

hhv 1

Answer 38

– Peri-oral herpes • Spread mostly through saliva or active peri-oral lesions • Two patterns of clinical infection • Primary infection • Secondary/recurrent

Question 39

hhv 2

Answer 39

genital herpes

Question 40

hhv 3

Answer 40

varicella-zoster

Question 41

hhv4

Answer 41

epstein bar • Implicated in many diseases/conditions • Oral hairy leukoplakia • Infectious mononucleosis • Nasopharyngeal carcinoma • Burkitt’s lymphoma • Hodgkin lymphoma • Others

Question 42

hhv5

Answer 42

cytomeglavirus

Question 43

hhv6 &7

Answer 43

– Non-specific roseola; usually asymptomatic, reactivation in immunocompromised patients

Question 44

hhv8

Answer 44

kaposis sarcoma

Question 45

hsv1 primary infection types

Answer 45

• Acute herpetic gingivostomatitis • Younger patients – 6 mos to 5 years usually • Pharyngotonsillitis • Adult primary infection

Question 46

Acute Herpetic Gingivostomatitis

Answer 46

• 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

Question 47

• Pharyngotonsillitis

Answer 47

• 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

Question 48

HSV-1 SECONDARY (RECURRENT) INFECTION

Answer 48

• 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

Question 49

HERPES SIMPLEX VIRUS TREATMENT

Answer 49

• 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)