oral path infectious diseases

defense mechanisms of an organism

• intact skin/mucosa

• antimicrobial secretions

• normal microbial flora

• inflammatory response

• immune response

types of infections

• bacterial

• fungal

• viral

examples of bacterial infections

• impetigo

• tonsillitis/ pharyngitis

• tb

• actinomycosis

• syphllis

• NUG

• pericoronitis

• osteomyelitis

examples of fungal infections

• candidiasis

• deep fungal infections

• mucomycosis

examples of viral infections

• papillomavirus

• HPV

• HIV/AIDS

• chicken pox

• coxackievirus

transmission mechanisms

• air, dust, water

• direct contact

• hands, objects

• body fluids

oppurtunistic infection

changes in an oral flora that can transform pathogenic organisms into disease causing organisms

impetigo

• strep & staph

• non- intact skin

• amber colored vessicles/ crust

• itchy

• regional lymphadenopathy

• more common in children in face 

• tx by topical or systemic ab

tonsillitis & pharyngitis

• causes include.. strep, adenovirus, flu, mono

• sore throat, fever, tonsillar hyperplasia, oropharyngeal mucosa

• transmission through contact w nasal or oral secretions

• tx by ab

• linked to scarlett fever or rheumatic fever

tuberculosis

• infectious, chronic, granulomatous

• miliary (widespread to organs)

• tb lymphadenitis

• lung infections

• painful ulcers common on tongue and palate (rare)

• tx by combination drugs

actinomycosis

• causes include.. bacterium actinomyces isrealii

• found in oral cavity but only occasional

• involves sinus tracts

• bright yellow exudate (sulfur granules)

• tx by incision and drainage or high dose ab

syphillis

• causes include.. spirochete penetrating mucosa 

• transmission by direct, sexual contact, infected blood transfusion, transplacental

• primary stage: highly infectious 

  • forms at site where spirochete entered body

  • lips are common site

  • regional lymphadenopathy

  • goes away spontaneously

• secondary: 6 weeks after lesion appears

  • diffuse mucous patches

  • lesions are most infectious

  • can recur for months or years

• tertiary: infects cv and CNS system

  • years after initial infection if untreated

  • not infectious

  • firm mass, ulcer, or bone loss in oral cavity (tongue or palate)

  • tx by penicillin

NUG

• painful gingivitis

• foul odor, metallic taste, fever, lymphadenopathy

• necrosis, cratered papillae

• tx by ab

pericoronitis

• inflamed tissue around erupting/ impacted tooth

• normal flora

• compromised host defense leads to higher risk

• causes include.. trauma, food under flap

• tx by debridement, irrigation, or ab

acute ostomyelitis

• inflammation of bone or marrow

• extension of PA abscess, injury, surgery, or bacteria

• tx by drainage or ab

chronic osteomyelitis

• long term inflammation of bone

• can be suscesptible due to pagets disease, sickle cell, or bone irridation

• from untreated acute phase

• diffuse radiolucencies, focal opacities in xrays

• tx by debridement, systemic ab, or hyperbaric oxygen

candidiasis

• AKA moniliasis, thrush, candidosis

• most common fungal infection

• overgrowth of candida albicans

• part of normal flora

• affects superficial layers of epithelium

• tx: antifungals, eval for underlying systemics

conditions associated with candida overgrowth

• ab therapy

• chemo

• steroids

• dentures

• diabetes

• xerestomia

• HIV

• hypoparathyroid

• newborn

• malignancies w bone marrow

• T cell deficiency

types of candidiasis

• pseudo-membranous

• erythematous

• chronic atrophic (denture stomatitis)

• chronic hyperplastic

• angular chelitis

• chronic mucotaneous

deep fungal infection

• regional distribution

• signs: lung infections

• chronic non- healing lesions

• tx by systemic antifungals, may be latent

mucormycosis

• AKA phycomycosis

• rare condition

• attacks poorly controlled diabetics

• effects nasal cavity, max sinus, and hard palate

• very destructive

human papillomavirus

• infects skin, oral mucosa

• direct contact

• 35 types in oral mucosa

  • high risk: 16 and 18

• 6.9% prevalance in oral cavity

• verruca vulgaris

• condyloma acuminatum

• focal epithelial hyperplasia

verruca vulgaris

• skin and lips

• wart- like (keratinized)

• direct contact/ autoincoculation

• tx by surgical excision

condyloma acuminatum

• HPV 6 & 11

• benign

• sexual contact

• occurs anywhere in mucosa

• papillary, bulbous masses

• diffuse, less keratinized

• tx by excision

multifocal epithelial hyperplasia

• AKA hecks disease

• HPV 13 & 32

• asymptomatic

• numerous soft nodules (blister- like)

• discrete or clustered

• labial, buccal mucosa, or tongue

• no tx

human herpes virus

• group of viruses

  • varicella- zoster

  • epstein barr

  • cytomegalovirus

  • HHV-8

  • herpes simplex

herpes simplex

• type 1:causes oral lesions

• type 2: genital ulcers

• persistant

• clinically latent

• lesions on firmly bound tissue

• burning, tingling

• coalescing vesicles and ulcers

• heals 1-2w

• direct contact

• tx by anti-viral drugs

varicella zoster (chicken pox)

• transmitted by respiratory aerosols

• contact w secretions from skin lesions

• can lead to shingles

• highly contagious

• 2 week incubation

• vesicles, pustules

• effects skin and mucous membranes

• systemic symptoms

herpes zoster (shingles)

• unilateral

• painful cluster of vesicles along sensory nerve path

• oral ulcers

• weeks—> month recovery

• tx by anti- virals, steroids

cytomegalovirus

• HIV association

• predilection for salivary tissue

• unilateral/ bilateral parotid swelling

• xerestomia

• oral ulcerations

epstein- barr virus

• infectious mono

• petechiae on palate

• systemic infl

• enlarged spleen

• fatigue

• transmission by saliva

• resolves 4-6w

• hairy leukoplakia on lat border of tongue (HIV related)

HHV-8

• linked to kaposi sarcoma

• classic

  • more common in older Mediterranean men

  • reddish brown macules on lower extremities

• african or endemic

  • agressive

  • immunocompetent children

  • nodules on edematous limbs

  • visceral lymphatic involvement

• organ transplant

  • ppl w immunosuppressive therapy

  • agressive

  • lesions on mucosa, lymph nodes

• HIV

  • most aggressive form

  • gay men

  • skin lesions and attacks visceral organs like lungs and GI tract

• tx by laser, radiation, cryotherapy, chemo, immunotherapy

coxackieviruses

• transmission by fecal- oral contamination, saliva, or droplets

• forms…

  • herpangina: vesicles on soft palate

    • fever, mailaise, sore throat, dysphagia, less than 1w, no tx

  • hand- foot- and mouth: common in 5 and under

    • painful vesicles or ulcers anywhere in mouth

    • multiple macules on skin, resolves in 2w

  • acute lymponodular pharyngitis: systemic hyperplastic lymphoid tissue 

    • soft palate

    • yellow or dark pink nodules on tonsils, no tx, goes away in 2w

measles

• systemic symptoms

• skin rash

• koplik spots

mumps

• AKA epidemic parotitis

• effects salivary glands

• bilateral

• swollen face

HIV and AIDS

• severe lymphocyte and T cells depletion

• esophageal candidiasis

• HIV related pulmonary tb, recurrent pneumonia, cervical cancer

• transmission by sexual contact, blood, or to infants by infected mother

progression of HIV

• immune system begins to fail

• decrease in T cells

• nonspecific problems

• deficient immune system

• life threatening infections and cancers

• AIDS