Course and forms of infection Special in oral

Course and forms of infection Special in oral cavity MUDr. Lenka Černohorská, Ph. D.

Natural history of infectious disease n n The incubation period: time between acquisition of the organism/toxin and 1 st symptoms The prodromal period: non specific symptoms (fever, loss of apetite) The acute specific illness: characteristic signs and symptoms The recovery period: the patient returns to health

Course and forms of infection n Acute (running nose) – hours to days Subacute (endocarditis) – weeks Chronic (HIV) – years

Communicable diseases n n n endemic – low level in a specific population (Malaria in African countries) epidemic – much more frequently than usual (epidemic influenza in the winter) pandemic – worldwide distribution (HIV)

Course and forms - others n n n Inapparent (subclinical) infection – without symptoms, asymptomatic although infected Chronic carriers – once infected, body can not completly eliminate the pathogen after recovery Latent state – after period of a time reactivation and recurrence of symptoms may occur (primary infection of herpes reside in a latent state in ganglion, causing reccurent labial herpes).

Types of infection n n Exogenous origin – transmission from external sources Endogenous – are caused by members of the normal flora (opportunist pathogen)

The ways of transmission n Inhalation – the airborne route (grip) Ingestion – faecal contamination of food and water (salmonela) Inoculation – sexual contact, needles, skin contact, blood transfusions or biting insects (HIV…)

Determinants of infection n n n Immune status (immunocompromited) Genetic constitution Age (children, old people) Hormonal status Pregnancy Personal habits (smoking, drug using…)

Microbial diseases in oral cavity

Oral manifestation of bacterial infection n. Scarlet fever - Streptococcus pyogenes, forming erytrogennous toxin, exanthema on soft palate curves and uvula, coalescent, scarlet red enanthema, white coated tongue, rich red with markedly exserted papillae –raspberry tongue, enlarged+painfull submandibular lymph nodes. Skin rush – coalescent light red spots missing in perioral area Therapy: penicillin Source: Wikipedia

Oral manifestation of bacterial infection n Diphtheria - Corynebacterium diphtheriae pseudomembranous tonsilitis/laryngitis (croup). A thick, adherent pseudomembrane is present on tonsils or pharynx, may involve nasal mucosa, the pharyngeal wall and the soft palate. Oedema involving the cervical lymph glands may occure in the anterior tissues of the neck – bullneck diphteria.

Oral manifestation of bacterial infection n Gonorrhoea - gonococci - tonsilitis and faryngitis

Oral manifestations of bacterial infection - Syphilis Primary – chancre – lips, tongue Secondary – mucous patches of the tonsils, soft palate, cheek Tertiary syphilis – gumma – hard palate, lips and tongue primary syphilis

Oral manifestations of bacterial infection - Syphilis Typical changes seen on permanent teeth (congenital) : n Hutchinson´s incisors upper central incisors: barrel-shaped, crescentic notch at the incisal edge n Mulberry (moon) molars first molar teeth have a roughened dirty, yellow, hypoplastic occlusal surface, poorly developed cusps resembling the surface of mullbery. mullberry molars Hutchinson´s incisors Source: kmil. trios. cz/Obr. Lues/hutchin 1. JPG

TBC and Leprosy in oral cavity TBC ulcers, granulomas, fissures, diffuse inflamatory lesions n Leprosy Tuberculoid leprosy - paraesthesia of the face, lips, tongue, palate, cheeks or gingiva Lepromatous leprosy – saliva is infectious, tooth loss, premaxillary bone resorption, saddle nose, intraoral nodules with tend to ulcerate n

Viruses in oral cavity Herpes simplex (HSV) HSV-1 (oral), HSV-2 (genital) Pathogenesis: Primary infection of children – innaparent or gingivostomatitis. Lesions on tongue, palate and gingiva + itching or burning sensation, blisters develope-enlarge-rupture- become encrusted. Gingiva – oedema, painfull, redish Latent infection – activation due to stress etc. - herpes labialis Dg. Smears from lesions to transport medium, antigen detection - immunofluorescence, serology Therapy: Acyclovir n Dentist – frequent in paronychium, disease from work

Viruses in oral cavity Varicella-zoster (VZV) Before the typical skin rash in chickenpox develops- lesions on the hard palate, pillars of the fauces and uvula: small ulcers surrounded by an area of erythema, quickly rapture Oral manifestations of zoster – severe pain like in toothache, one side enantem n Epstein-Barr (EBV) – infectious mononucleosis Petechial haemorrhages at the junction of the hard and soft palates – Holzel´s sign, later pseudomembrane tonsilitis, submandibular lymfadenitis. Edema of Waldeyer lymphatic circle cause problems with breathing n

Viruses in oral cavity n n Human herpesvirus 6 (HHV-6) - exanthema subitum/roseola infantum (6 th exantematic disease). Virus is present in the saliva, forms erythematous papules seen in soft palate and uvula (Nagayama´s spots) Morbillivirus – in prodromal state, Koplik‘s spots on bucal mucose against molares – little white spots surrounded by dark red margine Koplik´s spots

Viruses in oral cavity n • • Coxsackievirus Herpangina small (1 -2 mm in diameter) papulovesicular lesions, with greysh-white surface surrounded by red areolae, especially in the palate/uvula - herpetic like - A 2, A 4 -6, A 8 Hand-foot-mouth disease – briht-red macules, in oral cavity later form oval/grey vesicles with red areolae Hand-foot-mouth disease http: //pathmicro. med. sc. edu/virol/picorna. htm

HIV in oral cavity n Mycotic: Oral candidosis n Viruses: EB-virus specific damage - not painfull whitish corrugated lesions on the tongue margines – hairy leukoplakia, Kaposi´s sarcoma, herpetic gingivostomatitis and oral papilloma n Bacterial infection: gingivitis (linear marginal erytema/ ulcerous gingivitis), necrotizing stomatitis and necrotizing ulcerous parodontitis n Cervical lymphadenopaty, lymphomas

Mycotic infection Oral candidiasis - Candida albicans Oportunne patogen. Predisposition – skin laesions, teeth implantates, malnutrition, diabetes mellitus, leukaemia, surgical operations, burnings, AIDS, immunosupresive therapy, antibiotic use n n Therapy - local (clotrimazol), systemic (fluconazol, itraconazol, amphotericin B), autovaccines

Mycotic infection n Pseudomembranous candidiasis (thrush) – erythematous mucous membrane with milk white pablanes - newborns, older people, in immunocompromised is chronic, in HIV may spread into oesophagus Erythematous (atrophic) candidiasis Acute - result after broad-spectrum antibiotic therapy, dysmicrobie of oral cavity – mucous membrane. Oral cavity: erythematous areas, burning sensation. Chronic - protetic stomatitis – frequently observed in elderly people wearing full dentures orthodontic appliances. Erythema+oedema of the mucosa. Therapy: removal of dentures at night, desinfection of dentures, carbohydrate diet n n Hyperplastic candidiasis (candida leukoplakia) – chronic, from small, palpable, whitish areas to large, dense plaques, hard and rough to touch, on the inside surface of cheeks. High risk of malignant transformation! n Angular candidiasis - in one or both angles of the mouth, especially as a complication of protetic stomatitis, erythema and fissuring, vit. B 12 deficiency

Salivary gland infection - bacterial n n n Acute suppurative parotitis (sialoadenitis suppurativa acuta) - painfull Agens: alfa-haemolytic streptococci, S. aureus, haemophilus, eikenela, peptostreptococci After intraabdominal operation acute afteroperation parotitis, first serous, later absceding

Salivary gland infection – viral - non suppurative Parotitis epidemica (mumps) - replication in salivary duct epithelial cells – pain on chewing, redening of the opening of the duct, enlargement of gland + decrease of saliva secretion Complications: meningitis, orchitis of adult males (painfull+sterility), pancreatitis (increase of amylase level), nephritis Dg. : electron microscopy, serology (Ig. M detection – IF) n n CMV - after reactivation of latent infection sialoadenitis (AIDS, immunosupression, cytostatic therapy) n HIV - minority - xerostomia and enlargement of the major salivary gland+ Sjögren´s syndrom (dry keratoconjunctivitis and progresive polyartritis)