Infectious Diseases - 2

• 1. Gram negative diplococci bacteria
• 2. Causes Gonorrhea

• 1. symptoms 2-5 days
• 2. young people
• 3. Sexually tranmitted
• 4. Purulent discharge

• 1. young people
• 2. women are more asymptomatic

1. tonsils and soft palate

• 1. culture & sugar fermentation test
• 2. Flourescent antibody test

• 1. A gram negative diplococci
• 2. Neisseria gonorrhoeae

• 1. antibiotics - although many are resistant
• 2. Ceftriaxone and doxycycline.

Gonorrhea and Chlamydia trachomatis (which are often co-infections)

• 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)

inhalation of airborne droplets or ingested milk (T. bovis)

• Primary
• Active disease - especially with AIDS
• Secondary - Reactivation of prior infection
• Hmatologic dissemination - miliary TB

Mycobacterium tuberculosis

skin test, chest xray, biopsy specimen (only possible with a lesion)

• - granulomatous inflammation with necrosis
• - Grossly caseous necrosis
• - acid fast bacilli identified with the Ziehl-neelsen special stain

• 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.

• 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

Consumption

Clinical feature of TB in the skin of the face

Clinical feature of TB in the lymph node of the neck

Tongue, palate, and lips

Acid fast postive Ziehl-neelson

• 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

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

It has low infectivity and thus requires chronic exposure.

37 degrees

M. lepra stands for Mycobacterium leprae

• 1. Tuberculoid paucibacillary
• 2. Lepromatous multibacillary

Tuberculoid paucibacillary

Lepromatous multibacillary

Tuberculoid paucibacillary

Lepromatous multibacillary

8-12 years

2-5 years

• 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

• 1. granulomatous inflammation
• 2. used fite stain to ID the acid fast bacilli

the acid fast bacilli is mycobacterium leprae

• 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

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.

Borrelia vincentii, staph. aureus, prevotella intermedia, and nonhemolytic strep.

in greek, it means "to devour" due to the cancrum oris, gangrenous tomatitis, and necrotizing stomatitis.

It is usually in children and begins as ANUG - acute necrotizing ulcerous gingivitis

• It is caused by a variety of oppertunistic microbes:
• 1. Borrelia vincentii
• 2. Staph. aureus
• 3. Prevotella intermedia
• 4. nonhemolytic strep

A characteristic odor, blood tinged and swollen gingiva

• malnutrition
• dehydration
• poor OH
• recent illness (measles, herpes virus)
• Malginancy
• Immunosuppression
• stress

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.

• Treponema species
• prevotella intermedia
• Fusobacterium
• Staph. aureus
• Selenomonas
• Pseudomonas aeruginosa

• Impaired immune state
• malnutrition
• antiviral therapy
• periodontal disease
• Emotional stress

One of the etiological agents for Necrotising stomatitis

• - They are common in HIV/AIDS patients associated with Necrotising stomatitis
• - risk factors include: hospitalization, previous antibiotics, agranulocytopenia

Conservative - antibiotic therapy, local debridement, improved OH, lavage w/ antiseptic agents, analgesic medication

avoid periodontal curettage, dental extraction, or aggressive surgery

• 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

• 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.

• 1. gram +/-
• 2. facultative anaerobes/aerobes
• 3. spores
• 4. Viruses
• 5. yeast

antibiotics: penicillin, metronidazole

• 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)

• - gram positive, filmanetous, branching MO
• - Actinomyces israelii, naeslundii, viscosus, odontoyticus, meyeri and bovis

Ray Fungus

bacterial actinomyces species - not a fungus.

in the dental pockets, dental plaque/calculus, tonsillar crypts, carious dentin, gingival sulcus (everywhere)

• Acute or chronic fibrosis (wooden texture)
• Cervicofacial (lumpy jaw), abdominal thoracic, cutaneous and genital
• pus containing bacterial coloncies (sulfur granules)

• soft tissue injury
• periodontal or periapical injury
• salivary gland destruction
• extraction sites
• osteomyelitis

Actinomycosis

Actinomycosis

they are pus containing bacterial colonies.

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

- 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

• Rochalimaea henselae or afipia felis
• (it is the etiological agent of cat scratch disease)

• B. quintana
• body louse
• causes trench fever
• pelliosis

Bacillary angiomatosis

agent: bartonella henaselae

• lymphadenopathy develops 2-10 week after injury
• malaise and fever in 50%
• solitary node in 50% in H/N, axilla
• tender nodes

• erythema nodosum - skin may be red and nodular
• CBC is normal or slight leukocytosis (increased WBC)
• lymph node biopsy may be done

• 1. Self-limiting disease
• 2. lymphadenopathy resolves in 2-4 months

• 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)

• 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

• 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

A non-neoplastic condition presenting with little knots of capillaries in various organs caused by the same bacteria as cat scratch disease: Bartonella henselae

• 1. caused by bartonella henselae (same as cat scratch disease)
• 2. common in HIV infection

• HIV/AIDS:
• - erythromycin
• - doxycycline
• - A combination of isoniazid, rifampin, and ethambutol

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).