Neisseria gonorrhoeae 1. Gram negative diplococci bacteria 2. Causes Gonorrhea Gonorrhea clinical features 1. symptoms 2-5 days 2. young people 3. Sexually tranmitted 4. Purulent discharge Gonorrhea is more prominent in? 1. young people 2. women are more asymptomatic oral manifestations of gonorrhea 1. tonsils and soft palate how do you test for gonorrhea? 1. culture & sugar fermentation test 2. Flourescent antibody test Gonorrhea is caused by? 1. A gram negative diplococci 2. Neisseria gonorrhoeae Treatment for gonorrhea? 1. antibiotics - although many are resistant 2. Ceftriaxone and doxycycline. Ceftriaxone and doxycycline are two antibiotics that cover which infections? Gonorrhea and Chlamydia trachomatis (which are often co-infections) what are some antibiotics for gonorrhea? 1. Cefixime 400mg 2. Ceftriaxone 125 mg 3. Ciprofloxacin 500mg 4. Ofloxacin 400 mg 5. Levofloxacin 250 mg 6. Azithromycin 1g 7. Doxycycline 100mg Mycobacterium tuberculosis 1. causes tuberculosis (TB) How is mycobacterium tuberculosis transfered? inhalation of airborne droplets or ingested milk (T. bovis) What are the different types of TB? Primary Active disease - especially with AIDS Secondary - Reactivation of prior infection Hmatologic dissemination - miliary TB What is the etiological agent for TB? Mycobacterium tuberculosis What is the diagnosis for TB? skin test, chest xray, biopsy specimen (only possible with a lesion) What does an active TB lesion contain? - granulomatous inflammation with necrosis - Grossly caseous necrosis - acid fast bacilli identified with the Ziehl-neelsen special stain What is a Ghon Focus? A cheesy deposit in the lungs as a result of Mycobacterium bacilli in primary TB. It is a small area of granulomatous inflammation that has been calcified. In normal individuals it will heal, but immunosuppresed patients can suffer from miliary TB if it gets into the blood stream. What are the clinical features of TB? low grade fever malaise, anorexia weight loss, night sweats cough consumption - it consumes people (pre-antibiotic) Lupus Vulgaris - tb in the face Scrofula - TB in the lymph nodes What was the old name for TB? Consumption Lupus Vulgaris? Clinical feature of TB in the skin of the face Scrofula? Clinical feature of TB in the lymph node of the neck Where are the most common areas to develop TB in the oral cavity? Tongue, palate, and lips What is one way to scan for TB? Acid fast postive Ziehl-neelson What are the treatments for TB? Isoniazide and rifampin for 9 months or Isoniazide and rifampin with pyrinamide for 2 months followed by isoniazide and rifampin for 4 months Ethambutol Streptomycin What is important to remember for TB treatment? It can be multiagent and requires multiple drugs due to drug resistance. Mycobacterium Leprae 1. Leprosy 2. Acid fast bacteria that likes to live inthe periphery of the body where the temp is cooler What is unique about leprosy transmition? It has low infectivity and thus requires chronic exposure. What temp does M. Lepra prefer? 37 degrees M. lepra stands for Mycobacterium leprae What are two kinds of leprosy? 1. Tuberculoid paucibacillary 2. Lepromatous multibacillary Which one of the two types of leprosy causes a high immune reaction in clinical features? Tuberculoid paucibacillary Which one of the two kinds of leprosy has an absence of cell-mediated immune response? Lepromatous multibacillary Which one of the two leprosy has MO in the skin biopsy and no response to skin test? Which one has MO in biopsy and also no response to skin test? Tuberculoid paucibacillary Lepromatous multibacillary What is the incubation period for the lepromatous multibacillary? 8-12 years what is the incubation period for tuberculoid paucibacillary 2-5 years Tuberculoid paucibacillary 1. high immune reaction 2. localized disease, MO not in skin biopsy, but responds to skin test 3. incubation period 2-5 years Lepromatous multibacillary 1. no cell-mediated response 2. many MO in the biopsy, no response to skin test 3. incubation for 8-12 years What is the histological diagnosis of leprosy? 1. granulomatous inflammation 2. used fite stain to ID the acid fast bacilli the acid fast bacilli is mycobacterium leprae What is the treatment for leprosy? for paicibacillary tuberculoid - 6 months on rifampin and dapsone for multibacilary lepromatous - 2 years of rifampin, clofazimine, dapsone, thalidomide (no longer used) These medications have a good prognosis Which medication that was previously used for leprosy is no longer in use and why? Thalidomide is no longer used b/c it stops the development of limb bud. NOMA It is an opportunistic infection caused from normal oral flora borrelia vincentii, staph. aureus, prevotella intermeida, and nonhemolytic strep. What are the etiological agents for NOMA? Borrelia vincentii, staph. aureus, prevotella intermedia, and nonhemolytic strep. What does NOMA mean? in greek, it means "to devour" due to the cancrum oris, gangrenous tomatitis, and necrotizing stomatitis. Who typically gets NOMA? It is usually in children and begins as ANUG - acute necrotizing ulcerous gingivitis What is true about the etiological agent of NOMA? It is caused by a variety of oppertunistic microbes: 1. Borrelia vincentii 2. Staph. aureus 3. Prevotella intermedia 4. nonhemolytic strep what is a distinct clinical feature of NOMA? A characteristic odor, blood tinged and swollen gingiva What are predisposing factors to NOMA? malnutrition dehydration poor OH recent illness (measles, herpes virus) Malginancy Immunosuppression stress What is Necrotising stomatitis? An inflammatory disease of the mouth characterized by the destruction of epithelium, connective tissue, and papillae (may lead to NOMA). It is a deadily disease with a 40% mortalitly rate. What are the MO associated with Necrotising stomatitis? Treponema species prevotella intermedia Fusobacterium Staph. aureus Selenomonas Pseudomonas aeruginosa What are the risk factors when combining Necrotising stomatitis with HIV? Impaired immune state malnutrition antiviral therapy periodontal disease Emotional stress Pseudomona aeruginosa? One of the etiological agents for Necrotising stomatitis What are some of the risk factors with pseudomonas aeruginosa? - They are common in HIV/AIDS patients associated with Necrotising stomatitis - risk factors include: hospitalization, previous antibiotics, agranulocytopenia What is the treatment of necrotising stomatitis w/ HIV? Conservative - antibiotic therapy, local debridement, improved OH, lavage w/ antiseptic agents, analgesic medication What are some things to avoid when being treated with necrotising stomatitis & HIV? avoid periodontal curettage, dental extraction, or aggressive surgery What is chlorhexidine? 1. An antimicrobial mouthwash that is a broad spectrum treatment for gram +/-, facultative anaerobic and aerobic bacteria, spores, viruses, and yeasts. 2. At low concentrations its bacteriostatic - activates low m'ler weight substances so Phosphorus & potassium can leak out without irreversible cell damage 3. At high concentrations it causes cytoplasmic percipitation What is chlorhexidine used for? 1. It is a mouthrinse that is used in periodontal treatment and oral infections 2. Topically it is used as 0.12% - 2% 2x a day 3. It has low tissue toxicity both systemic and locally. What can chlorhexidine be used for? 1. gram +/- 2. facultative anaerobes/aerobes 3. spores 4. Viruses 5. yeast What are the medication treatments of NOMA? antibiotics: penicillin, metronidazole What are the treatments of NOMA? What is the prognosis of treatment? antibiotics: penicillins, metronidazole wound debirdement (gentle) adequate nutrition and fluir levels with antibiotics there is a 10% mortality but usually there is significant morbidity (severe deformities) Actinomycosis etiological agent? - gram positive, filmanetous, branching MO - Actinomyces israelii, naeslundii, viscosus, odontoyticus, meyeri and bovis What is the common name of actinomycosis? Ray Fungus What is the main culprit of actinomycosis? bacterial actinomyces species - not a fungus. In the oral cavity, where is actinomycosis often found? in the dental pockets, dental plaque/calculus, tonsillar crypts, carious dentin, gingival sulcus (everywhere) What are the clinical features of actinomycosis? Acute or chronic fibrosis (wooden texture) Cervicofacial (lumpy jaw), abdominal thoracic, cutaneous and genital pus containing bacterial coloncies (sulfur granules) What are the oral clinical manifestations of actinomycosis soft tissue injury periodontal or periapical injury salivary gland destruction extraction sites osteomyelitis The clinical feature of a Lumpy jaw is often found in what condition? Actinomycosis The clinical feature of sulfur granules is often found in what condition? Actinomycosis they are pus containing bacterial colonies. What are the histological features of actinomycosis? Ray fungus where the bacteria is surrounded by many neutrophils Gram positive filamentous MO they can also be found in the lungs. Although about 55% of them will be in the head and neck area (i.e. oral cavity) so grow familiar with them What is the treatment of actinomycosis? - debridement and long term antibiotic coverage with penicillin or tetracycline for 5-12 weeks Bartonella henaselae? 1. The etiological agent for Cat Scratch Disease 2. It is a gram negative bacillus What was bartonella formerly known as? Rochalimaea henselae or afipia felis (it is the etiological agent of cat scratch disease) What are some other names of Bartonella henselae? B. quintana body louse causes trench fever pelliosis What is another name for cat scratch disease in patient with HIV? Bacillary angiomatosis agent: bartonella henaselae What are the clinical features of Cat scratch disease? lymphadenopathy develops 2-10 week after injury malaise and fever in 50% solitary node in 50% in H/N, axilla tender nodes What are noticeable clinical features with Cat scratch disease? erythema nodosum - skin may be red and nodular CBC is normal or slight leukocytosis (increased WBC) lymph node biopsy may be done What is the treatment for Cat Scratch Disease? 1. Self-limiting disease 2. lymphadenopathy resolves in 2-4 months What are oral clinical features with Cat Scratch Disease? Facial skin may develop oral lesion submandibular lymphadenopathy mimics odontogenic infection Acute, painful axillary nodes on the ipsilateral hand (same side as the cat scratch) How do you diagnose Cat Scratch Disease? Positive hanger-rose test (not used today b/c you infect a person with the material from a diseased individual and see if there is a positive result) negative results for other causes of the lymphadenopathy histologic presence of lymphnode changes, especially in the presence of pleomorphic bacteria B. henselae IDed with warthin-starry stain direct flourescent-antibody test for B. henselae What is the treatment for Cat scratch disease? Self-limiting, resolution within 4 months if ill, children can take: gentamycin, oral trimethoprim sulfamethoxazole, rifampin if ill, adults take ciprofloxin In HIV pts: erythromycin, doxycycline, or combination isoniazid, rifampin and ethambutol What is bacillary angiomatosis? A non-neoplastic condition presenting with little knots of capillaries in various organs caused by the same bacteria as cat scratch disease: Bartonella henselae What are characteristcs of Bacillary angiomatosis? 1. caused by bartonella henselae (same as cat scratch disease) 2. common in HIV infection What is the treatment of Bacillus bartonella henselae? HIV/AIDS: - erythromycin - doxycycline - A combination of isoniazid, rifampin, and ethambutol How do you detect bacillary angiomatosis? It is a non-neoplastic condition presenting with little knots of capillaries in various organs and can be detected with a silver stain - warthin-starry stain. Black stains indicates a positive result for the etiological agent (bartonella henselae).