Infectious - India’s Premier Educational Institution · Infectious Disease ... • Facial aspect...
Transcript of Infectious - India’s Premier Educational Institution · Infectious Disease ... • Facial aspect...
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Infectious Disease
• The successive invasion of microorganisms into
the tissues of an individual, their multiplication,
production of toxins and the resulting disease
process is called infectious disease.
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Infections
• Bacterial
• Viral
• Fungal
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Bacterial infections
• Impetigo • Erysipelas • Scarlet fever• Syphilis • Pyogenic granuloma• Diphtheria • Tetanus • Cat scratch disease • Pyostomatitis vegetans
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Bacterial infections
• Tuberculosis • Leprosy • Actinomycosis • ANUG• Noma • Granuloma inguinale • Tularemia • Tonsillitis & Pharyngitis • Sinusitis
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Impetigo
• Superficial infection
• Streptococcus pyogenes or staphylococcus aureus
• Flaccid bullae‐‐‐ Amber crusts(Honey colored )
• Similar to recurrent herpes simplex , exfoliative cheilitis
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IMPETIGO
AMBER CRUSTS OF THE CHIN
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Erysipelas
• St anthony’s fire
• Butterfly rash
• D/D: SLE
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ERYSIPELAS
Red swollen area of the cheek
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Scarlet fever
• Β‐hemolytic streptococci
• Erythrogenic toxin
• White and red strawberry tongue
• Sun burn with goose pimples
• Pastia lines ( Capillary fragility in zones of stress)
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SCARLET FEVER
WHITE STRAWBERRY TONGUE RASPBERRY TONGUE
orRED STRAWBERRY TONGUE
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Syphilis ORAL MANIFESTATIONS OF SYPHILIS
Primary syphilis Chancre – lip
Secondary syphilis Mucous patches on mucosa
Snail track ulcers
Rubbery enlarged lymph nodes
Tertiary syphilis Gumma on palate
Glossitis
Syphilitic leukoplakia
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Primary syphilis
Chancre
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Primary syphilis
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Primary syphilis
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Secondary syphilis
Eryhtematous rash
Mucous patch
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Tertiary syphilis
Syphilitic glossitis
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Tertiary syphilis
Gumma perforating the palate
Gumma
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Congenital syphilis
• Frontal bossing
• Short maxilla
• High palatal arch
• Saddle nose
• Higoumenaki’s sign
• Rhagades and saber shin
• Hutchinsons triad
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Hutchinsons triad
• Hypoplasia of teeth
• VIIIth nerve deafness
• Interstitial keratitis
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Congenital syphilis
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Congenital syphilis
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• Tumor‐like growth
• Botryomycotic infection , an infection in horses
• C/F: Elevated,pedunculated or sessile vascular mass withn smooth, lobulated or even a warty surface
• Facial aspect including the interdental papilla
• Deep red or reddish purple, depending on its vascularity,painless and soft in consistency
• Exudation of purulent material
Pyogenic granuloma (Granuloma pyogenicum)
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Pyogenic granuloma (Pregnancy tumor )
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Histologic features of pyogenic granuloma
• Atrophic epithelium
• Vast no of endothelial lined vascular spaces,
proliferating fibroblasts, budding endothelial
cells
• Older lesions‐ obliteration of capillaries –
becomes fibrous‐ fibro‐epithelial polyp or
fibroma
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Pyogenic granuloma
Exophytic mass exhibiting granulation tissue
Scattered blood vessels and inflammatory cells
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Pregnancy tumor
• Third month of pregnancy
• Result of minor trauma or irritation
• Tissue reaction intensified by endocrine
alteration
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Cat scratch disease
• Bartonella hensalae – Gram negative bacillus
• Oculoglandular syndrome of parinaud
• Warthin starry silver staining
• Brown‐Hopps gram staining
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Cat scratch disease
Papule on the forehead
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Cat scratch disease
Submandibular lymphadenopathy
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Cat scratch disease
Intra-nodal area of abscess formation
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Diphtheria
• Corynebacterium Diphtheriae
• Bull neck
• Diphtheritic membrane
• Strangling angel of children
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Tetanus (Lock Jaw )
• Infection of nervous system
• Clostridium tetani
• Acts at the synapse of interneurons of
inhibitory pathways and motor neurons to
produce blockade of spinal inhibition
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Pyostomatitis
Snail track ulceration
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Bacterial infections
• Tuberculosis • Leprosy • Actinomycosis • ANUG• Noma • Granuloma inguinale • Tularemia • Tonsillitis & Pharyngitis • Sinusitis
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TUBERCULOSIS
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A LUMP IN THE NECK…??
Umm…… SO…?????
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DISTRIBUTION
DRAINAGE
DETECTION
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Tuberculosis
• Mycobacterium tuberculosis‐ Rod shaped,
non‐spore forming, thin aerobic acid fast
bacilli
• Cattle‐ Bovine tuberculosis
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PATHOGENESIS OF TB LYMPHADENITISInhalation of the Bacilli
Phagocytosis by Macrophages
Resist degradation (Development of Type IV Hypersensitivity)
Persistence of Injurious agent
Cell Mediated Agent sequestered withinImmune Response Macrophages
Recruitment of macrophage – Epitheloid CellsAnd giant cell formation
Granuloma
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• Necrotic material undergoing calcification‐ ranne
complex
• TB of submaxillary and cervical lymph nodes –
scrofula
• Primary TB of skin‐ Lupus vulgaris (
Papular nodules which ulcerate)
Tuberculosis
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Tuberculosis
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FINE NEEDLE ASPIRATION
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Tuberculoma
GRANULOMAGranuloma is defined as a circumscribed,
tiny lesions, about 1mm in diameter,composed predominantly of collection ofmodified, macrophages called as epitheloidcells and rimmed at the perephery bylymphoid cells.
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Tuberculoma
An ulcer near the upper lip Collection of foamy
macrophages
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Ares of caseous necrosis with multinucleated giant cells
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• Ulcer ‐ characterised by
undermined edge and with
yellowish base and
surrounding areas of
erythema and edema
• Ulcer surrounded by single
or multiple nodules –
sentinal tubercles.
Tuberculous ulcer
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Tuberculous gingivitis
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Chest radiographs
Mantoux test
Staining of microscopy smears
Culture
Radioimmunoassays
Fluorescent antibody test
ELISA
DNA probes
PCR
Investigations
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FINE NEEDLE ASPIRATION CYTOLOGY
Smear shows several cluster of epitheloidcells,reactive histocytes, (macrophages)along thecells of lymphoid series.
The features suggestive of granulomatousadenitis.
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FNAC
LOW ‐ POWER HIGH ‐ POWER
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Staining
Ziehl Nielsen staining
Kinyoun’s cold staining methods
Rhodamine staining for fluorescent microscopy
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Culture
Culturing the mycobacteria from infected tissue
or sputum
• Conventional‐ 1. LJ medium
2.agar based media‐
(eg:Middle brook medium)
• Faster methods‐ 1.Rapid slide culture
2.radiometric culture
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Leprosy
• Mycobacterium Leprae‐ Gram positive bacillus
Clinical features :
• Two polar forms‐ Tuberculoid and lepromatous
• Host response – Borderline and indeterminate
• Hypopigmented patches
• Leonine facies
• Loss of cutaneous sensation; facial paralysis
Oral Manifestations :
• Leproma
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Leprosy
Histologic features :
• Granulomatous nodule
• Langhans type giant cells
• Lepra cells‐ sheets of lymphocytes with vacuolated macrophages
Diagnosis:
• Ziehl neelson method – 10 to the power of 11 bacilli
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Leprosy
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Sheets of lymphocytes andhistiocytes exhibiting scattered lepracells
Acid fast stain – Numerousmycobacterial organisms in clusters
Leprosy
HISTOPATHOLOGY
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Actinomycosis
• Granulomatous suppurative and fibrosing disease
• Gram positive filamentous bacteria
• Common organism – A . Israelli
• Others – A. naersuundii, A. viscosus, A. odontolyticus and A. propionica
• A. bovis – Lumpy jaw in the cattle
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Actinomycosis
• Sulfur granules – Botryomycosis
• Based on location:
Cerviofacial
Abdominal
Pulmonary
• Etiopathogenesis – trauma – Extracted socket, periodontal pcket, non‐vital tooth or mucosal abrasions
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Actinomycosis
• Localized abscesses following a woody appearance
• Actinomycotic osteomyelitis
• Simulation of pulp related infection
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Actinomycosis
• MNGC + macrophages
• Individual colony‐ round or lobulated ; peripheral club shaped ends of filaments
• Ray fungus appearance
• Methenamine silver stain
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Actinomycosis
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Actinomycosis
Ray fungus appearance
Peripheral club ends exhibitingrosette pattern
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NOMA
( Cancrum oris; gangrenous stomatitis )
• Devour ( Spreading sore)
• Debilitated and nutritionally deficient persons
• Internees of the belson concentration camp ( world war II)
• Secondary complication of systemic disease
• Vincents organism
• Other organisms – Pseudomaonas Aerugiosm , E.coli, klebsiella, S. Aureus
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NOMA
• Small ulcer
• Stagnation around FPD
• Blackening of skin‐ gangrene
• Foul odor
• High temperature ; toxemia
• Site – gingiva, jaws , lips and cheeks
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NOMA
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ANUG
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Tonsillitis & Pharyngiits
• Group A ‐ β hemolytic streptococciOral lesions
• Erythema and inflammation of the oro‐pharynx and tonsils.
• Palatal petechiae
• Enlarged tonsils
• Yellowish tonsillar exudate – patchy or confluent.
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Diagnosis
• Clinical sign and symptoms
• Throat culture
• Rapid antigen detection test