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BDS5 oral disease > viruses and bacteria > Flashcards

viruses and bacteria Flashcards

1
Q

how does syphilis present? (3)

A
  • primary = painless ulcer (chancre) at inoculation site + enlarged LNs
  • secondary = snail track ulcer, widespread red/brown rash, generally unwell
  • tertiary (10-30yrs later) = gumma, nasal speech, Holmes Adie pupil, leukoplakia
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2
Q

s/s of primary syphilis (2)

A
  • painless ulcer (chancre) at inoculation site (self-limiting)
  • enlarged LNs
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3
Q

s/s of secondary syphilis (3)

A
  • snail track ulcer
  • widespread red/brown rash
  • generally unwell
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4
Q

s/s of tertiary syphilis (4)

A

10-30yrs later:
- gumma
- nasal speech
- Holmes Adie pupil
- leukoplakia

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5
Q

describe syphilitic gumma (4)

A
  • feature of tertiary syphilis
  • highly destructive, deep, subcutaneous nodule that grows and adheres to the skin
  • central site ulcerates
  • releases viscous, gum-like pus
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6
Q

which bacteria causes tuberculosis

A

Mycobacterium tuberculosis

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7
Q

s/s of tuberculosis (9)

A
  • malaise
  • reduced appetite
  • weight loss
  • fever
  • night sweats
  • cough with purulent/rusty red sputum
  • deep oral ulcers with punched out centre and red margin
  • hilar lymphadenopathy
  • caseating granulomas
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8
Q

common sites for tuberculosis-related oral ulcers (3)

A

BM
hard palate
tongue

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9
Q

describe Staphylococcus aureus scalded skin syndrome (age, presentation, tx)

A
  • <6yo
  • peeling skin with background erythema
  • SPARES mucous membranes
  • tx with IV antibiotics if needed
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10
Q

which virus is HHV1?

A

herpes simplex (primary and recurrent)

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11
Q

which virus is HHV2

A

herpes simplex (predominantly genital)

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12
Q

which virus is HHV3?

A

varicella zoster virus

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13
Q

which virus is HHV4?

A

Epstein Barr virus

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14
Q

which virus is HHV5?

A

cytomegalovirus

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15
Q

what condition is HHV6 linked to?

A

multiple sclerosis

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16
Q

what condition is HHV8 related to?

A

Kaposi’s sarcoma

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17
Q

describe primary herpetic gingivostomatitis (what, age, s/s)

A
  • manifestation of HSV1
  • <5yo
  • fever, submandibular lymphadenopathy, headache
  • coalescing ulcers, red gingiva, ooze and serous exudate
  • affecting keratinised areas, pharynx, perioral region and lips
18
Q

primary herpetic gingivostomatitis age

A

<5yo

19
Q

s/s of primary herpetic gingivostomatitis (4)

A
  • fever
  • coalescing ulcers
  • red gingiva
  • ooze and serous exudate
20
Q

primary herpetic gingivostomatitis management (5)

A
  • immunocompetent = resolves spontaneously within 14 days
  • rest, soft diet (cold, bland)
  • adequate fluid intake
  • analgesics
  • antivirals (within 48 hours of starting) +/- systemic treatments if severe or immunocompromised
21
Q

describe herpes labialis (4)

A
  • recurrent form of HSV1 infection
  • triggered by stress, coinfection, hormones, immunosuppression
  • small blisters on the lips, gums, throat
  • ulcers with crusting
22
Q

HSV infection histology (3)

A
  • acantholysis
  • enlarged herpes-infected cells (multinucleated, ground glass appearance)
  • immunohistochemistry = brown nuclei in keratinocytes
23
Q

what does HHV3 cause? (virus, infections with descriptions)

A
  • Varicella Zoster virus
  • varicella = primary infection “chickenpox”; highly infective but self-limiting, pruritus, scarring, secondary infections
  • zoster = reactivated form “shingles”, in extremes of age, unilateral vesicles/ulcers with crusting, pyrexia, malaise
24
Q

describe chickenpox (virus, presentation)

A
  • Varicella Zoster virus
  • primary infection
  • highly infective but self-limiting
  • pruritus, scarring, secondary infections
  • pyrexia, malaise, pharyngitis
25
Q

management of chickenpox

A
  • antipyretic/analgesia
  • adequate hydration, soft diet
  • oral antiviral if risk of complications (eg immunocompromised)
26
Q

describe shingles (virus, presentation)

A
  • Varicella Zoster virus
  • reactivated form, in extremes of age
  • unilateral vesicles/ulcers with crusting
  • pyrexia, malaise
27
Q

what is HHV4 associated with? (4)

A
  • Epstein Barr virus
  • infectious mononucleosis/glandular fever
  • oral hairy leukoplakia
  • Burkitt’s lymphoma
  • nasopharyngeal carcinoma
28
Q

describe infectious mononucleosis (cause, age, symptoms)

A
  • Epstein Barr virus
  • teens and young adults
  • sore throat, malaise, pyrexia
29
Q

describe oral hairy leukoplakia (cause, demographic, presentation)

A
  • recurrent form of Epstein Barr virus
  • immunocompromised pts
  • vertical linear corrugated white patches on lateral tongue
30
Q

oral hairy leukoplakia histology (4)

A
  • hair-like projections with hyperkeratosis
  • linear band of vacuolated (clear) cells in prickle cell layer
  • often fungal hyphae colonisation without inflammation
  • in situ hybridisation - blue nuclei in prickle keratinocytes
31
Q

what is HHV5 associated with? (3)

A
  • cytomegalovirus
  • illness similar to infectious mononucleosis
  • CMV sialadenitis (mimics mumps)
  • oral ulceration in immunocompromised pts (deep, indurated or flat and irregular)
32
Q

what does cutaneous Kaposi’s sarcoma look like?

A

diffuse, small, like a bruise, may be multiple

33
Q

what does oral Kaposi’s sarcoma look like?

A

macular, nodular - like a bruise or proliferative
may be multiple

34
Q

describe Kaposi’s sarcoma (what, association, histology)

A
  • form of angiosarcoma related to HHV8
  • associated with thrombocytopaenia
  • lamina propria replaced by tumour with vasodilation and many extravasated RBCs
  • immunohistochemistry shows brown nuclei
35
Q

describe hand-foot-mouth disease (cause, oral presentation)

A
  • coxsackie viruses
  • self-limiting, very infectious
  • multiple sore small vesicles on soft palate with large areas of erythema
36
Q

give some topical treatments for viral diseases (3)

A
  • acyclovir 5% cream - 5x/day, 3-4 hours intervals
  • penciclovir 1% cream - every 2 hours
  • idoxyuridine in dimethyl sulfoxide (traditional) - QDS
37
Q

why do systemic viral treatments tend to have low compliance?

A

high frequency of pills

38
Q

give some systemic viral treatments (4)

A
  • acyclocir 200mg 5x/day for 5/7
  • valcyclovir 1g TDS for 7 days (VZV) or 500mg BD for 5 days (HSV)
  • famiciclovir 1500mg single dose (HSV, USA)
  • CMV = IV gancyclovir, cidofovir, foscarnet
39
Q

how are most primary viral infections managed in healthy patients? (3)

A
  • bed rest
  • fluids
  • simple analgesics
    (self-limiting, supportive)
40
Q

what are Koplik’s spots? (3)

A
  • bright red spots with white or bluish-white centres
  • buccal mucosa
  • diagnostic/pathognomic feature of measles in the pre-eruptive stage

BDS5 oral disease (26 decks)

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