Bacterial Infections

1. Bacterial Infections Dent 451 Lecture 2 part 2 Dr Jumana Karasneh

2. Pathogens Micro-organisms can produce a disease: Bacteria Fungi Viruses Oral mucosa is protected by IgA present in the saliva attacks bacteria IgA forming complexs with epithelium acting as a protective coat of mucosa Washing effect of saliva

3. Pathogens Pathogens can be transferred via: Air on dust particles Water droplet. Hands & objects. Blood / other body fluids Opportunistic infection: Normal flora (non-pathogenic) starts to cause infection due to change in environmental conditions (Antibiotics, steroids, AIDS)

4. For a pathogen to cause a disease: It must get access & grow in the body: Overcome innate immunity (tears, skin, mucosa). Overcome competition of normal flora. Overcome inflammatory response. Overcome immune response.

5. Bacterial Infection Stphylococcus ? Impetigo Streptococcus ? Tonsillitis & pharyngitis Fusiform bacillus & Spirochete ? (ANUG) Mycobacterium ? Tuberculosis (TB) Treponema pallidum ? Syphilis

6. Bacterial InfectionImpetigo

7. Bacterial InfectionTonsillitis & Pharyngitis

8. Bacterial InfectionANUG Etiology: Caused by fusiform bacillus, spirochete & anaerobic rods. Clinical Picture: Sore & bleeding gingiva Crater-like ulcers caused by necrosis of inter-dental papillae Marked halitosis & metallic taste Fever, malaise & lymphadenitis in some patients Usually underlying predisposing factor exist Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.

9. Bacterial InfectionANUG Predisposing factors: Poor oral hygiene Tobacco smoking Stress Immunocompromised Diagnosis: Clinical picture Gram-stained gingival smear Treatment: Oral Hygiene (gentle debridement) Metronidazol 200mg tabX3X3 CHX mouthwash Gentle tooth brushing Stop smoking *if not improved, further investigation for underlying cause (hematological investigations Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.

10. Bacterial InfectionSyphilis Etiology: Caused by spirochete (Treponema pallidum). Ways of Transmission Sexual contact with affected person Blood transfusion of infected blood Trans-placental from infected mother to fetus ? Congenital Syphilis Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.

11. Bacterial InfectionSyphilis Clinical presentation 3 stages: Primary (3-12 Wks) Secondary (2-10Wks) Tertiary (years)

12. Bacterial InfectionSyphilis Clinical presentation Primary (3-12 Wks) Painless indurated red ulcer Occurs any where mainly tongue & cheeks Highly infectious Non-tender enlargement of lymph nodes (syphilitic collar)

13. Bacterial InfectionSyphilis Clinical presentation Secondary (2-10Wks) Skin macular lesions Mucous patches Snail track ulcers Lymphadinopathy

14. Bacterial InfectionSyphilis Clinical presentation Tertiary stage Gumma Syphilitic leukoplakia Fibrosing glossitis Syphilitic glossitis Wide spread in CNS

15. Bacterial InfectionCongenital Syphilis Hutchinson Triad Blindness Deafness Dental Anomalies Hutchinson incisors Mulberry molars

16. Bacterial InfectionSyphilis Diagnosis Isolation and examination in dark-ground microscopy Serological tests Venereal Disease Reference Laboratory (VDRL) Treponema Pallidum Haemagglutination Assay (TPHA) Fluorescent Treponema Antibody absorbed test (FTA) Treponema Pallidum immobilization test (TPI) Treatment Primary syphilis: Penicillin for 1 month Latent syphilis: penicillin for 12 weeks

17. Bacterial InfectionTuberculosis Reapeared due to HIV infection, can still be seen in immunocompetent pts who are elderly, or neglect treatment Patient may be carrier of the disease and reactivation may occur years later Lymphnodes starts as freely mobile then become fixed at later stagesReapeared due to HIV infection, can still be seen in immunocompetent pts who are elderly, or neglect treatment Patient may be carrier of the disease and reactivation may occur years later Lymphnodes starts as freely mobile then become fixed at later stages

18. Bacterial InfectionTuberculosis Oral Presentation: painful non-healing ulcer usually on tongue & palate White patches Granulating lesions Diagnosis: Biopsy & microscopic examination Treatment: Multiple antibiotics for long duration (years) Precautions: Universal precautions (mask, gloves, eye protection,…) NO elective treatment for pt with active TB Consult patient’s GP for TB status Ulcer starts as painless then it become bainfulUlcer starts as painless then it become bainful

19. Bacterial InfectionGonorrhoea Etiology: Neisseria gonorrhoea Ways of Transmission Direct mucosal contact Clinical presentation Oral presentation are very rare Oral Erythema & ulcers Tonsillitis Infective arthritis (TMJ) Diagnosis Gram-stained smear showing Gm –ve diplococci Management Pt should be referred to genitourinary specialist Antibiotics Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.

20. Bacterial InfectionNon-specific urethritis Etiology: Chlamydia species Ways of Transmission Sexually transmitted disease by direct mucosal contact Clinical presentation Burning sensation on micturition but can be asymptomatic Predispose patients to Reiter’s syndrome Reactive polyarthritis Uveitis Urethritis Macular lesions on palm & soles Oral lesions resemble erythema migrans (Circinate stomatitis) Diagnosis Microbiological tests Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis.[1] It has symptoms similar to various other conditions collectively known as "arthritis," such as rheumatism. It is caused by another infection and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. The symptoms of reactive arthritis very often include a combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis), and urethritis. A useful mnemonic is "the patient can't see, can't pee, can't bend the knee" or "can't see, can't pee, can't climb a tree." Most commonly known as Reiter’s syndrome after German physician Hans Conrad Julius Reiter, it is also known as arthritis urethritica, venereal arthritis and polyarteritis enterica. It is a type of seronegative spondyloarthropathy.Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis.[1] It has symptoms similar to various other conditions collectively known as "arthritis," such as rheumatism. It is caused by another infection and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult. The symptoms of reactive arthritis very often include a combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis), and urethritis. A useful mnemonic is "the patient can't see, can't pee, can't bend the knee" or "can't see, can't pee, can't climb a tree." Most commonly known as Reiter’s syndrome after German physician Hans Conrad Julius Reiter, it is also known as arthritis urethritica, venereal arthritis and polyarteritis enterica. It is a type of seronegative spondyloarthropathy.