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Infections of the Oral Mucosa 1

. Viral infectionsBacterial infectionsFungal infectionsHIV infection and AIDS. Herpes Viradae. Herpes Simplex 1Herpes Simplex 2Varicella ZosterEpstein-BarrCytomegalovirus (HHV5)Herpes 6Herpes 7Herpes 8. Herpes Simplex Virus. Most frequent cause of viral infections of the mouthPrimary HS

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Infections of the Oral Mucosa 1

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    1. Infections of the Oral Mucosa 1 Dr. Rima Safadi 22/6/2008

    2. Viral infections Bacterial infections Fungal infections HIV infection and AIDS

    3. Herpes Viradae Herpes Simplex 1 Herpes Simplex 2 Varicella Zoster Epstein-Barr Cytomegalovirus (HHV5) Herpes 6 Herpes 7 Herpes 8

    4. Herpes Simplex Virus Most frequent cause of viral infections of the mouth Primary HSV I Infectious (Acute Herpetic Gingivostomatitis) 5 days incubation, then 2 days of prodromal symptoms Acute onset of malaise, fever, and lymphadenopathy. Multiple vesicles and ulcers can occur any part in the oral mucosa and lips 10-14 days to resolve Spread by droplets or lesion contact Majority of cases are subclinical

    6. Herpes Simplex Virus Extraoral spread of infection: skin, fingers, nail bed, eyes

    7. Microscopic features Intraepithelial vesicle Ballooning degeneration: swollen , eosinophilic cytoplasm, pale vesicular nuclei Enlarged, multinucleated epithelial cells Tzanck cell: Access to nerve axons Due to ruptured epithelial cells

    10. Treatment Supportive Acyclovir in extreme cases Prognosis: self-limited resolves in 10-14 days

    11. Study Box 11.1 (latency of HSV) in your text book

    12. HSV remain latent in trigeminal sensory ganglia Virus reactivation associated with: Ultraviolet radiation Trauma Immunosuppression

    13. Recurrent Herpetic Stomatitis Prodrome: tingling burning paresthesia Vesicles and ulcers recur: most common herpes labialis Intraorally: hard palate and gingiva In small clusters

    15. Varicella-Zoster Virus Chickenpox and herpes zoster (shingles) Primary Infection: Varicella (Chicken pox) Prodrome: malaise, fever, lymphadenopathy Macules, papules, vesicles, ulcers on skin and oral mucosa Especially soft palate Skin lesions are pruritic.

    17. Microscopic features: identical to HSV Prognosis for varicella is usually mild in children. vaccine is available. Acyclovir in immunocompromised

    18. Treatment is supportive Antihistamines, topical lotions

    19. Zoster (Shingles) Multiple recurrence is rare Same latent state as HSV, in sensory ganglia Predisposing factors: Decreased immunocompetence Elderly patients Immunosuppressive drugs

    20. Zoster (Shingles) Unilateral vesicular eruptions Prodromes of pain and parasthesia for up to 2 weeks Trigeminal Nerve: Ophthalmic division is most frequently involved Intra or extra oral or both Complications Post herpetic neuralgia Ramsay Hunt syndrome: involvement of geniculate ganglion

    22. Coxsackievirus Enteroviradae Over 30 types Ones worth mentioning Herpangina Hand-foot and mouth Acute lymphonodular pharyngitis

    23. Herpangina Coxsackie Viruses, Group A, RNA Children Sudden onset of fever, sore throat, nausea, vomiting, diarrhea and lymphadenopathy. Vesicles and ulcers in posterior oral cavity D/D: primary herpes Treatment is symptomatic

    25. Hand foot and mouth disease Coxsackie A16 Spread in households Oral lesions almost always present Oral lesions resemble herpangina but can be larger 7-10 days.

    27. Infectious Mononucleosis (glandular fever) EBV Young adults Transmitted by saliva Clinically: pharyngitis, LN enlargement Fever, prolonged malaise Non specific oral manifestation Petechei on juncetion of hard and soft palate Serology: atypical peripheral lymphocytes

    29. Infectious mononucleosis (glandular fever) EBV Nasopharyngeal carcinoma Hairy leukoplakia Burkitts lymphoma Oral squamous cell carcinoma?

    30. Measles (Rubeola) Paramyxovirus Children Prodromal symptoms Koplik spots disappear as skin rash starts

    31. Measles (Rubeola) Skin rash: start on face, go to trunk Fever Complications Otitis media, pneumonia, encephalitis, brain damage Noma may be a complication in malnourished patients

    32. Cytomegalovirus Herpes group Rarely causes disease in immunocompetent Subclinical infection is common 40-60% of population Affects immunocompromised individuals Neonatal, transplant, immunosuppressant Affect salivary glands common but asymptomatic Cause non specific oral ulceration Atypical peripheral lymphocytes

    33. Bacterial infections

    34. Necrotizing Ulcerative Gingivitis NUG/ ANUG Endogenous, polymicrobial infection Predisposing factors: Immunsuppression, trauma Chronic gingivitis Association with AIDS Malnutrition and poverty Smoking, fatigue Overgrowth of fusospirochaetal complex F. fusifornis, T. vincentii High recurrence rate if underlying cause is untreated

    36. Noma (cancrum oris) Orofacial gangrene Malnourished children Immunosuppressed individuals Usually preceded by NUG

    37. Actinomycosis Chronic and endogenous, anaerobic, Gram positive Actinomyces israelli predominate Soft tissues of the submandibular region Source of infection: infected root canal or third molar Firm swelling (painless) that suppurate Multiple sinuses pointing to skin sulphur granules

    38. Actinomycosis

    40. Histopathology: Granulomatous inflammation Surrounded by granulation tissue Transport of organisms by macrophages Central suppuration

    41. Syphilis Treponema pallidum Primary: chancre : shallow ulcer Indurated base Associated with lymphadenopathy Heals spontanously

    42. 6 weeks later Secondary syphilis: skin rash and mucous patch Snail track ulcers, flat areas of ulceration that coalesced

    43. Years later Tertiary : Gumma: Necrosis and type IV hypersensitivity Perforation of palate Atrophic glossitis: due to endarteritis obliterance Followed by: Syphilitic leukoplakia Hyperkeratosis Followed by: Squamous cell carcinoma

    44. Congenital Syphilis Miscarriage, still birth or neonatal infection Collapse of nasal bridge Hutchinson triad: blindness, deafness, dental anomalies Hutchinson incisors (notched teeth) Screw driver teeth Peg shaped laterals Mulberry molars Constricted atrophic cusps Globular masses of hard tissue

    45. Tuberculosis Mycobacterium tuberculosis Oral infection is not common Primary oral infection Secondary oral infection: infected sputum from pulomonary TB

    46. Classical TB ulcer: Painless Undermind On the tongue

    47. Gingival involvement: Granulomatous inflammation

    48. TB lymphadenitis:

    49. Tuberculosis Diagnosis: Biopsy, granulomatous inflammation Granulomas with central necrosis Identification of Acid Fast Bacilli Treatment: 2 antimicrobial agents: isoniazide and rifampicin, 4-8 months

    50. Leprosy Mycobacterium leprae Endemic in tropical areas 2 forms of infection: Tuberculoid Lepromatous Oral lesions in lepromatous Secondary to nasal involvement Maxillary gingiva, palate

    51. Leprosy

    52. Tuberculoid leprosy

    53. Lepromatous leprosy

    54. Gonorrhoea Neisseria gonorrhea Mainly tonsillar and soft palatal lesions Erythema, vesicles, ulcers, pain

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