Quiz 4 LO's: Infectious Diseases

LO1: Define opportunistic infections

infections caused by organisms that are usually nonpathogenic, but something has changed so they can now cause disease

LO1: What are some things that allow an opportunistic infection to develop?

decrease in salivary flow

antibiotic administration

immune system alterations

LO2: What is the inflammatory response to the immune system like?

nonspecific, rapid first response to injury

includes cells of the innate immune system like neutrophils and macrophages

results in edema and accumulation of a large number of WBCs at the injury site

LO2: What is the immune response to the immune system like?

specific, humoral and cell-mediated, work to prevent injury and defend against m/os

has a memory

m/os are antigens in which specific antibodies are created to fight the specific antigens

LO3: What are some examples of opportunistic infections that can occur in the oral cavity?

Oral Candidiasis --> overgrowth of candida albicans

includes:

- pseudomembrane candidiasis

- erythematous candidiasis

- denture stomatitis

- chronic hyperplastic candidiasis

- angular cheilitiis

- chronic mucocutaneous candidiasis

- median rhomboid glossitis

LO4: What organism causes tuberculosis? Where does it go in the body?

infectious chronic granulomatous disease caused by mycobacterium tuberculosis

primary infection of the lungs or other areas like head, neck, larnyx, and cervical lymph node

LO4: What is the route of transmission for tuberculosis?

inhaled droplets of the bacteria lodge in the alveoli of the lungs --> cause fever, fatigue, cough, weight loss

after undergoing phagocytosis, they become resistant and multiply in the macrophages

they then flow into the blood stream and spread through the body via the vascular system

can be transmitted through dental health care personnel - avoid dental work with active TB

LO4: How is a diagnosis made for tuberculosis?

Oral lesions are identified by biopsy

Granulomas as the characteristic histopathological lesions of TB --> composed of areas of necrosis surrounded by macrophages, multinucleated giant cells, and lymphocytes

Skin tests with injection of purified protein derivative - if the body have a Type 4 hypersensitivity reaction, then the body knows the bacteria and chest radiographs are taken to determine if TB is active

How do we treat tuberculosis?

treat primary disease

antituberculosis agents --> isoniazid, rifampin, rifapentine

LO4: What organism causes actinomycosis?

actinomyces israelii

LO4: What is the route of transmission for actinomycosis?

infection often follows trauma, nonvital tooth, periodontal infection, tooth extraction, or abrasion of mucosa

LO4: How is a diagnosis made for actinomycosis?

known for the formation of abscess that drain by the formation of sinus tracts

organisms appear in the pus as tiny, yellow grains and are called sulfur granules

diagnosis is made by identifying the colonies in the tissue from a culture of the lesion

How do you treat actinomycosis?

long-term high doses of antibiotics --> amoxicillin or tetracycline

LO4: What organism causes syphillis?

treponema pallidum

LO4: What is the route of transmission for syphilis?

through direct contact of people, sexual contact, transfusion of infected blood, transfer from placenta to fetus

bacteria can penetrate mucous membranes, but need a break in the skin to invade there

LO4: Describe the primary stage of syphilis

lesion is called chancre --> highly infectious and forms at the site where bacteria enters the body, typically the lips (males = upper lip, women = lower lip)

Chancre, small size in soft tissue only

regional bilateral lymphadenopathy occurs

lesion heals spontaneously and enters a latent period

can be treated at this stage

LO4: Describe the secondary stage of syphilis

occurs 6 weeks after initial lesion

diffuse eruptions of skin and mucous membranes occur

skin lesions can appear as a rash & sore throat, fever, and lymphadenopathy also occur

oral lesions are mucous patches --> painless, grey plaques covering ulcerated mucosa and MOST INFECTIOUS

lesions heal spontaneously, but can recur for months or years

disease may be latent for years before entering stage 3

LO4: Describe the tertiary stage of syphilis

occurs years after initial infection if it has not been treated

involves problems with the CV, CNS, and vascular system, organ complications

lesion is called a gumma and is noninfectious --> commonly appears on the tongue and palate as a firm mass that becomes an ulcer

gumma can be destructive to the palatal bone

gumma can cause interstitial glossitis on the tongue

What is congenital syphilis? What does it cause in the fetus?

syphilis that is passed from mother to fetus

facial and dental abnormalities --> abnormally shaped teeth, deafness, saddle nose, frontal bossing, vaulted palate, ocular keratosis

LO4: How is a diagnosis made for syphilis?

SKIN: dark field examination to identify spirochetes

ORAL: Venereal Disease Research Lab test or fluorescent treponemal antibody absorption test

**must have the correct antibodies formed in the body for the test to be correct

How do we treat symphilis?

penicillin

LO5: What is the relationship between streptococcal tonsillitis, pharyngitis, scarlet fever, and rheumatic fever?

Many different organisms can cause tonsillitis and pharyngitis, but when they are caused by group A beta-hemolytic streptococci, it is very serious because of its relationship with scarlet and rheumatic fever

Scarlet fever: 103 fever for a week, generalized red skin rash, pastia lines, strawberry tongue, and abdominal pain, headaches and nausea

Rheumatic fever: antibodies are made to the cell wall of the bacteria and the antibodies react with different tissues causing inflam involving heart, joints, and CNS, permanent damage to heart valves

LO6: What disease are pastia lines are strawberry tongue associated with?

scarlet fever

LO6: What is strawberry tongue?

fungiform papillae are red and prominent

dorsal surface initially has a white coating and then sheds and becomes red

LO6: What are pastia lines?

transverse red streaks seen in areas of skin folds

caused by capillary fragility

What type of infection is impetigo?

bacterial infection

What causes impetigo?

Staphylococcus aureus or Streptococcus pyogenes

What part of the body does impetigo affect?

skin - face and extremities

areas of trauma

What are the signs of impetigo?

red blisters and sores

fluid filled vesicles or crusted lesions

may look like finger nail scratches

itchy, swollen lymph nodes, fever

How do we treat impetigo?

topical or systemic antibodies

What kind of infection is tonsillitis and pharyngitis?

bacterial vs viral infection

What bacteria causes tonsillitis and pharyngitis?

streptococcus pyogenes

What are the signs of tonsillitis and pharyngitis?

enlarged tonsils

erythema mucosa

onset of fever, sore throat, dysphagia

How do we treat tonsillitis and pharyngitis?

systemic antibody if bacterial --> penicillin V or amoxicillin

azithromycin or clindamycin is allergic to the above

What is necrotizing ulcerative gingivitis?

chronic, painful erythematous gingivitis with punched out papilla

bad breath, spontaneous bleeding, rapid infection, decreased resistance to infection, fever, swollen lymph nodes

What causes necrotizing ulcerative gingivitis?

spirochetes and fusiform bacilli

How do we treat necrotizing ulcerative gingivitis?

debridement and antibiotic rinse and medications

What is pericoronitis?

an inflammation of the gingiva around a partially erupted tooth

What causes pericoronitis?

result of infection by bacteria that proliferate in the pocket between the soft tissue and crown

having a suppressed immune system increase the risk

What is the most common area for pericoronitis and what happens here?

md third molars

an operculum --> soft tissue flap covering the distal portion of the tooth, becomes inflamed due to opposing molar and impaction of food under the soft tissue flap

How do we treat pericoronitis?

debridement and irrigation of the pocket, antibiotics, extraction of tooth

What is acute osteomyelitis?

acute inflammation of the bone and bone marrow

What are the signs of acute osteomyelitis?

pain, swollen lymph nodes

What causes acute osteomyelitis in the jaw?

periapical abscess as a result of fracture, surgery, or bacterium

How do we treat acute osteomyelitis?

draining exudate and antibiotics

What is chronic osteomyelitis?

long standing inflammation of bone

may be related to pts taking biphosphonates

What are the signs of chronic osteomyelitis?

bone is painful and swollen

x rays show a diffuse and irregular radiolucency that can become radiopaque due to bone growth

How do we treat chronic osteomyelitis?

debridement and systemic antibiotics

What type of infection is candidiasis?

fungal infection

most common oral lesion associated with immunodeficiency

What causes candidiasis?

overgrowth of candida albicans

What can cause the overgrowth of candida albicans?

antibiotics, corticosteroids, diabetes, cell mediated immune system deficiency

What are the types of oral candidiasis?

Pseudomembranous candidiasis

Erythematous candidiasis

Denture stomatitis

Chronic hyperplastic candidiasis

Angular cheilitis

Chronic mucocutaneous candidiasis

Describe pseudomembranous candidiasis

white, curd like material that can be wiped off the mucosa

underlying mucosa is red and may bleed

burning and metallic taste may occur

Describe erythematous candidiasis

red, painful mucosa

irregular, patchy, depapillation of tongue

Describe denture stomatitis

also called chronic atrophic candidiasis

limited to the area covered by denture, typically palate or mx alveolar ridge

red mucosa, petechias (small colored lesion), or more generalized and granular

asymptomatic

Describe chronic hyperplastic candidiasis

(also called candidal leukoplakia and hypertrophic candidiasis)

white lesion that does not rub off mucosa

if caused by candidiasis, it will respond to antifungal medication

Describe angular cheilitis

swollen, red patches at the corners of the mouth

Describe chronic mucocutaneous candidiasis

severe form of candidiasis occurring in immunocompromised pts

skin lesions, nails, skin folds, chronic oral and genital mucosal candidiasis

oral lesions appear psuedomebranous, erythematous, hyperplastic candidiasis, or angular cheilitis

Are median rhomboid glossitis and candidiasis related?

in some cases, median rhomboid glossitis is treated with antifungal medications, but other times it doesn't work

so not associated and the cause median rhomboid glossitis is not clear

How can we treat candidiasis?

antifungal medication

What are deep fungal infections?

Histoplasmosis

Coccidioidomycosis

Blastomycosis

Cryptococcosis

usually involves the lungs --> oral lesions are caused by implantation of organism carried by sputum from lungs to oral mucosa

systemic antifungal medications to treat

What are the rare fungal infections?

Mucormycosis: m/os in soil and affect diabetic or debilitated patients, affects nasal cavity / hard palate

Aspergillosis: mold, affects immunocompromised pts in lungs and sinuses and appears as a mycetoma - mass of aspergillosis

What kind of infection is HPV?

viral, 130 diff types

creates neoplasia or benign lesions

How does HPV occur?

direct contact affecting skin and oral mucosa

must infect the basal cells of epithelium, requiring a break in surface of tissue

matures in spinous layer where virus is then released onto surface of the tissue

What are HPV-infected cells called?

Koilocytes

irregular nucleus surrounded by clear cytoplasm

What is verruca vulgaris?

common wart, papillary oral lesion or skin lesion caused mainly by HPV 2

What is a common site for verruca vulgaris?

lips

What does verruca vulgaris appear as?

white, papillary, exophytic lesion

How do we treat verruca vulgaris?

excision

What is condyloma acuminatum? Causes?

benign papillary lesion/ warty growth on genital skin

due to HPV type 6 or 11

sexual contact

What does condyloma acuminatum look like?

pink, papillary, bulbous masses anywhere in oral mucosa

How do we treat condyloma acuminatum?

excision

What is multifocal epithelial hyperplasia? What does it look like?

associated with HPV types 13 and 32

multiple white/pink nodules in oral mucosa

resolve on their own

What is the difference between HSV type 1 and 2?

Type 1 causes oral lesions, initial and secondary forms

Type 2 causes genital lesions

What is primary herpetic gingivostomatitis? (acute herpes simplex infection)

initial oral infection with the herpes simplex type 1 virus

What does primary herpetic gingivostomatitis look like?

painful, red, swollen gingiva and multiple tiny vesicles on perioral skin, vermillion border of lips, and oral mucosa

become ulcers

systemically appears as fever, malaise, and swollen lymph nodes

Define subclinical infections

infection that is present without symptoms

herpes simplex virus can be this

What is recurrent herpes simplex infection?

after primary infection, herpes simplex virus persists in a latent state in the trigeminal ganglion and causes localized recurrent infections

What are signs of recurrent herpes simplex infection?

appear on vermilion border of the lips called herpes labials or cold sore/fever blister

reappear due to sunlight, menstruation, fever, etc

intraorally, ulcers attached to keratinized tissue and bone and irregular borders

can affect eyes and fingers

With herpes simplex virus, the amount of virus present is highest in what stage?

vesicle stage

How do you treat herpes simplex virus?

antiviral drugs --> acyclovir

What is varicella zoster virus?

human herpescirus 3, causes CHICKEN POX or SHINGLES

What is chickenpox?

highly contagious disease appearing as vascular and pustular eruptions on skin and mucosa membranes

systemic signs are headache, fever, and malaise

mostly in children

What is shingles? (also called herpes zoster)

highly contagious disease appearing as unilateral, painful eruptions of vesicles along the sensory nerve

mostly in adults, often occurs in association with immunodeficiency or malignancies

What are the phases of shingle?

INITIAL: severe neuralgia and acute burning and paine

MIDDLE: clusters of vesicles along affected sensory nerve

FINAL: postherapeutic neuralgia

What branches of the trigeminal neuralgia are responsible for oral lesions when affected by shingles?

mx and md

What branches of the trigeminal neuralgia are responsible for skin lesions when affected by shingles?

opthalmic

How do you treat varicella zoster viruses?

antiviral or corticosteroids

preventative vaccinations

What is Epstein-Barr virus (EBV)?

human herpesvirus 4, disease in the oral cavity

infectious mononucleosis, hairy leukoplakia, mucocutaneous ulcer

What is infectious mononucleosis?

kissing disease, associated with atypical activated T lymphocytes

sore throat, fever, swollen lymph nodes, splenomegaly, malaise, fatigue

palatal petechiae, skin rashes

What is hairy leukoplakia?

Irregular, corrugated (ridges, grooves) white lesion most commonly occur on the lateral borders of the tongue

EBV found in epithelial cells

associated with HIV or immunocompromised pts

What is mucocutaneous ulcer?

when associated with EBC, it is a persistent, nonhealing ulcer

seen in immunocompromised pts that have received transplants, are HIV positive, or in older adults

What are the types of coxsackievirus infections? How are they spread?

herpangina, hand/foot/mouth disease, and acute lymphonodular pharyngitis

spread thru fecal/oral contamination, saliva, and respiratory droplets

usually resolved on their own

What is herpangina?

vesicles on soft palate, fever, malaise, sore throat, difficulty swallowing, erythematous pharyngitis

What is hand/foot/mouth disease?

children under 5 yrs old

oral lesions anywhere in the mouth, painful ulcers and vesicles

multiple macules and papules on skin

What is acute lymphonodular pharyngitis?

Hyperplastic lymphoid tissue of the soft palate or tonsillar pillars appears as yellowish or dark pink nodules

fever, sore throat, headaches

Can measles and mumps cause oral manifestations?

yes

Measles --> koplik spots or small red macules with with necrotic centers

Mumps --> infection of salivary glands and swelling of parotid glands and epithelial tissues

How is HIV transmitted?

blood, semen, vaginal secretions, breast milk

How are AIDS and HIV related?

HIV causes AIDS

What immune system cell does HIV target?

helper T cell, CD4 carrier