Infectious Diseases - 2
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- 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
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?
- Active disease - especially with AIDS
- Secondary - Reactivation of prior infection
- Hmatologic dissemination - miliary TB
What is the etiological agent for TB?
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
- 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?
Clinical feature of TB in the skin of the face
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
What is important to remember for TB treatment?
It can be multiagent and requires multiple drugs due to drug resistance.
- 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?
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?
Which one of the two kinds of leprosy has an absence of cell-mediated immune response?
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?
What is the incubation period for the lepromatous multibacillary?
what is the incubation period for 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
- 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.
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?
- poor OH
- recent illness (measles, herpes virus)
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
- Staph. aureus
- Pseudomonas aeruginosa
What are the risk factors when combining Necrotising stomatitis with HIV?
- Impaired immune state
- antiviral therapy
- periodontal disease
- Emotional stress
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?
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
The clinical feature of a Lumpy jaw is often found in what condition?
The clinical feature of sulfur granules is often found in what condition?
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
- 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
What is another name for cat scratch disease in patient with HIV?
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?
- - 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).
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