Oral Pathology Chapter 4- Fungal, Bacterial, and Viral infections

Term

Definition

Big 5 risk factors for opportunistic fungal infections (DISHS)

Diabetes, Immunosuppression (HIV, leukemia, transplant), Steroids/Smoking, Hospital drugs (especially antibiotics), Saliva decrease (xerostomia).

Candida

Normal oral flora that becomes pathogenic when host defenses decrease, Candida increases, or the oral environment favors growth.

Factors determining Candida infection

Immune status, oral environment, and Candida strain.

PEACH mnemonic for candidiasis

Pseudomembranous, Erythematous, Angular cheilitis, Chronic hyperplastic, Hidden under dentures (denture stomatitis).

Pseudomembranous candidiasis (Thrush)

White curd-like plaques that wipe off leaving a red surface; associated with antibiotics, HIV, leukemia.

Treatment for thrush

Nystatin, Clotrimazole, Fluconazole, or Itraconazole.

Erythematous candidiasis

Red, burning mucosa with smooth tongue; includes acute atrophic candidiasis and median rhomboid glossitis.

Angular cheilitis

Cracks at the corners of the mouth caused by Candida with or without Staphylococcus aureus.

Denture stomatitis

Red palate beneath a denture; treatment requires disinfecting both the patient and the denture.

Hyperplastic candidiasis

White plaque that does NOT wipe off; biopsy recommended because dysplasia is possible.

Which Candida lesion does NOT wipe off?

Hyperplastic candidiasis.

Candida treatment mnemonic (NCFI)

Nystatin, Clotrimazole, Fluconazole, Itraconazole.

HAMB mnemonic

Histoplasmosis, Aspergillosis, Mucormycosis, Blastomycosis.

Histoplasmosis organism

Histoplasma capsulatum.

Histoplasmosis features

Most common systemic fungal infection; occurs in immunocompromised patients; oral ulcers, plaques, masses, may mimic oral cancer.

Aspergillosis features

Usually affects diabetics or immunocompromised patients; often begins as sinus infection and may become invasive.

Mnemonic for Aspergillosis

A = AIDS + Aspergillus.

Progression of Group A Streptococcal disease

Strep pharyngitis → Scarlet fever → Rheumatic fever if untreated.

SPR mnemonic

Strep → Pink rash → Rheumatic fever.

Scarlet fever findings

Strawberry tongue, diffuse rash, caused by erythrogenic toxin.

Rheumatic fever

Autoimmune complication of untreated Group A Streptococcal infection affecting the heart, joints, brain, and skin.

Primary syphilis

Painless chancre (single sore).

Secondary syphilis

Mucous patches, diffuse rash, condyloma lata, widespread disease.

Tertiary syphilis

Gummas with serious cardiovascular and neurologic complications.

Congenital syphilis (Hutchinson triad)

Hearing loss, interstitial keratitis, Hutchinson incisors.

Tuberculosis features

Cough, weight loss, night sweats, caseating granulomas, upper lung involvement; oral ulcers are uncommon.

Primary tuberculosis

Often asymptomatic.

Secondary tuberculosis

Reactivation disease with most oral lesions.

Actinomycosis features

Wooden induration, sulfur granules, draining sinus tracts; often follows trauma, extraction, or non-vital teeth.

Classic clue for actinomycosis

Yellow sulfur granules.

Osteomyelitis

Inflammation and infection of bone.

Acute osteomyelitis

Fever, pain, swelling, sequestrum formation.

Chronic osteomyelitis

Poor antibiotic penetration; often requires surgery.

Sequestrum

Dead bone separated from living bone.

Involucrum

New bone that forms around a sequestrum.

Why opportunistic viral infections develop

Viruses remain latent and reactivate when immunity declines.

STRESS mnemonic for HSV reactivation

Stress, Trauma (including dental treatment), Radiation/UV, Elderly, Systemic disease/immunosuppression, Sunlight.

Common opportunistic viral infections in HIV

HSV, VZV, Epstein-Barr virus (hairy leukoplakia), HHV-8 (Kaposi sarcoma).

Squamous papilloma

HPV 6 & 11; direct contact; single papillary lesion.

Verruca vulgaris

HPV 2 & 4; direct contact; rough wart.

Condyloma acuminatum

HPV 6, 11, 16, 18; sexually transmitted; multiple clustered papillary lesions.

Heck disease

HPV 13 & 32; familial/direct contact; multiple papules in children; often regresses spontaneously.

Primary HSV-1 transmission

Saliva or direct contact.

Primary HSV-1 oral findings

Primary herpetic gingivostomatitis.

HSV-2 transmission

Sexual contact.

HSV-2 oral findings

Rare oral lesions.

Varicella (Chickenpox) organism

VZV transmitted by airborne droplets or contact; diffuse vesicles that ulcerate.

Herpes zoster (Shingles)

Reactivation of VZV causing painful unilateral ulcers that do not cross the midline.

Hairy leukoplakia

Epstein-Barr virus; white corrugated lesion on the lateral tongue that does not wipe off; common in HIV.

Kaposi sarcoma

HHV-8; purple lesions on the palate or gingiva in immunocompromised patients.

PVC mnemonic for oral HPV lesions

Papilloma, Verruca vulgaris, Condyloma acuminatum.

Squamous papilloma appearance

Single pedunculated lesion with finger-like projections; common on soft palate, uvula, and faucial pillars.

Mnemonic for squamous papilloma

Pretty Pedunculated Papilloma.

Verruca vulgaris appearance

Rough wart usually on lips, vermilion border, or tongue.

Mnemonic for verruca vulgaris

Very Rough Wart.

Condyloma acuminatum appearance

Multiple broad-based clustered papillary lesions associated with sexually transmitted HPV.

High-risk HPV types

HPV 16 and 18.

Heck disease patient population

Children, especially Native Americans.

Clinical case: Burning before lip blister with grouped vesicles and crusts

Herpes labialis (recurrent HSV-1).

Clinical case: White corrugated lateral tongue lesion in HIV

Hairy leukoplakia (Epstein-Barr virus).

Clinical case: Painful unilateral oral ulcers that never cross midline

Herpes zoster (Shingles).

Clinical case: Multiple papillary lesions with STD history

Condyloma acuminatum.

HSV-1

Primarily affects oral tissues and skin above the waist; causes gingivostomatitis and cold sores.

HSV-2

Primarily affects genital tissues below the waist; causes genital herpes; oral disease is uncommon.

Primary HSV infection

Usually occurs in children with fever, diffuse oral ulcers, painful gingivitis, lymphadenopathy, and involvement of the entire mouth.

Secondary HSV infection

Localized recurrent infection on attached mucosa with burning or tingling prodrome followed by clustered vesicles.

Primary HSV mnemonic

Whole mouth.

Secondary HSV mnemonic

Same spot again.

HSV vs aphthous ulcer

HSV begins as vesicles on attached mucosa with burning prodrome; aphthae occur on movable mucosa and never begin as vesicles.

Recurrent intraoral herpes

Occurs only on attached mucosa and begins with vesicles.

Primary VZV (Chickenpox)

Children, airborne transmission, diffuse rash, vesicles, and ulcers.

Secondary VZV (Shingles)

Older adults; painful unilateral lesions following one dermatome and stopping at the midline.

ZIP mnemonic

Zoster = Intense Pain; unilateral and stops at midline.

ALDA mnemonic for HIV progression

Acute infection, Latency, Declining CD4 count, AIDS.

Acute HIV (Stage 1)

Occurs 2-6 weeks after infection; flu-like illness; antibodies may not yet be detectable.

Latency (Stage 2)

Can last years; patient often asymptomatic while virus continues replicating.

Declining CD4 (Stage 3)

Night sweats, weight loss, diarrhea, lymphadenopathy, memory problems.

AIDS (Stage 4)

CD4 count below 200 with opportunistic infections.

Common oral findings in AIDS

Candidiasis, hairy leukoplakia, Kaposi sarcoma, HSV, VZV.

Most common systemic fungal infection

Histoplasmosis.

Classic oral finding of scarlet fever

Strawberry tongue.

Classic clue for hyperplastic candidiasis

White lesion that cannot be wiped off and requires biopsy.

Most important treatment step for denture stomatitis

Treat both the patient and the denture.

Most common oral lesion caused by Epstein-Barr virus

Hairy leukoplakia.

Virus causing Kaposi sarcoma

Human herpesvirus-8 (HHV-8).

Most important clue for shingles

Painful unilateral lesions that never cross the midline.