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Infectious Diseases Flashcards

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1
Q

What does the severity of infection depend on

A
  • Pathogenicity and virulence of infecting agent
  • Host resistance
  • Environmental factors
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2
Q

Definition of infection

A

-Process of tissue invasion by microorganisms characterized by multiplication of these microorganisms in the body of the host to produce disease

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3
Q

Definition of cross infection

A

-Transmission of infection between patients as well as patients and health care professionals

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4
Q

Classification of infections

A

-Community acquired infections
Present at the time of admission or a visit to a hospital or incubating at that time

-Health-Care Associated Infections/ Nosocomial Infections/ Hospital-Acquired Infections:
Induced from a source outside the patient’s body (exogenous) or from within the patient’s own body (autogenous) after a visit or admission to a hospital or health care centre

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5
Q

Examples of microorganisms that cause disease

A
  • Viral Infection
  • Bacterial Infection
  • Parasitic Infection
  • Fungal Infection
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6
Q

Steps in diagnosing an infectious disease

A 
-Taking a history
Foreign Travel
Immigrants
Occupation
Domestic Pets
Sexual Activity 
Drug Addiction 
Tattooing 
Injections 
Transfusions 
-Clinical Examination 
Oral Ulceration 
Rashes
Lymphadenopathy 
Hetaposplenomegaly
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7
Q

Investigations for general infectious diseases and explanation of each

A

-Baseline:
Full Blood Count- looking for abnormally high/low blood cells
Blood film- thin layer of blood smeared on a microscope slide, analysing for various blood cells
C-reactive protein, blood test marker for inflammation in the body
Erythrocyte Sedimentation Rate- how long it takes for the RBC to fall, the quicker it takes, the higher levels of inflammation

-Microbiological examination of body fluids

-Immunodiagnosis
Serology: specific IgG, IgM, IgA
Antigen Detection

-Tissue Diagnosis
Aspiration/Biopsy

-Imaging Procedures

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8
Q

Mum brings 5yo child because they have been complaining of a sore mouth

Been generally unwell for a few days with a fever

Examination reveals multiple yellow-crested ulcers on the lips
Well-circumscribed ulcers on the hard palate

What is the likely diagnosis

A

Multiple well-circumscribed lesions suggest it is not malignant

Most likely to be acute herpetic gingivostomatitis (Herpes)

Based on age and presentation

First exposure to Herpes is always as a kid

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9
Q

Definition, Pathogen, Types, Incubation Period of Herpes Simplex

A
  • Herpes Simplex is a viral infection caused by Herpes Simplex Virus
  • Incubation period is 2-12 days
  • Type 1 spread by infected saliva in the mouth and upper body
  • Type 2 spread by sexual contact
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10
Q

Clinical Features of Herpes Simplex 1 and 2

A

General Features:

  • Sore throat
  • Fever (pyrexia)
  • Lymphadenopathy
  • Recurrence

Oral Features:

  • Vesicles present on pharynx, buccal mucosa, gingiva, tongue, lips and face
  • Often painful and last for 10 days

Skin Features:

  • Can be either HSV1 or HSV2
  • Herpetic Whitlow: small blisters appear on the fingers and the fleshy area around the fingertip

Eye Features:

  • Usually HSV1
  • Corneal involvement is serious as it may cause blindness

Genital/Anal Infections:
-Usually HSV2

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11
Q

Examples of conditions of Herpes Simplex Virus

A
  • Herpetic Gingivostomatitis
  • Herpes Labialis (recurrent herpes)
  • Herpes Genitalis
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12
Q

Diagnosis of Herpes Simplex Virus Conditions

A

-Often clinical

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13
Q

Complications of Herpes Simplex Virus

A
  • Encephalitis- affects temporal lobes
  • Neonatal- serious since mortality is 60%, caused by vertical transmission of HSV2 from mother to child, which is an indication for a caesarian section
  • Erythema Multiforme- hypersensitivity reaction manifesting on the skin
  • Eczema herpeticum- infection causes cold sores to appear around and inside the mouth, leading to oral herpes
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14
Q

Definition and reactivating factors of herpes labialis

A
  • Commonly known as cold sores
  • Follows primary infection
  • Usually HSV1 but can be HSV2
  • Sunlight
  • Trauma
  • Chemical
  • Hormones
  • Stress
  • Immunosupression
  • Concurrent infections
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15
Q

Management of Herpes Simplex Condition

A
  • Hydration and soft diet to prevent pain from ulcers
  • Topical and systemic Acyclovir (antiviral)
  • Valacylcovir
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16
Q

Chickenpox definition, incubation period and spread

A
  • Initial infection of Varicella Zoster Virus
  • Spread through direct contact with patients with chicken pox/ shingles
  • Incubation period is 14-16 days
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17
Q

Clinical features and diagnosis of chickenpox

A

-Diagnosis clinical

  • Rash that progreses from macule to papule to vesicle
  • Starts on trunk of scalp
  • Spreads to limbs and face
  • Vesicles dry and crust
  • Pruritis- very itchy
  • Fever, malaise and lympodenopathy
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18
Q

Complications of chicken pox

A
  • Rare
  • Cellulitis (painful bacterial skin infection)
  • Impetigo (common and contagious skin infection)
  • Pneumonia
  • Congenital abnormalities
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19
Q

Management of chicken pox

A
  • Supportive
  • Antihistamines
  • Acyclovir for very severe cases or complications
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20
Q

55yo man comes to see you with right sided jaw and ear pain. He had an abscess around his upper right molar last year and had a similiar pain. He wonders if a similiar problem has recurred? You notice some a rash on his ear

A
  • Possible Herpes Zoster
  • Shingles where V2 or V3 branches of CNV are involved
  • Check for other symptoms
  • Differential Diagnsosis
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21
Q

Shingles, alternative name, and definition

A
  • Herpes Zoster
  • Characterised by the reactivation of the varicella zoter virus in a dermatomal distribution
  • Can include regions of CN V
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22
Q

Clinical Features of Herpes Zoster

A
  • Preceded by radicular pain and hyperaesthesia of the overlying skin
  • Unilateral, dermatomal rash
  • Intense erythema which rapidly becomes vesicles that crust
  • Oral, palatal or pharyngeal involvement if the trigeminal nerve is affected
  • Ocular involvement causes keratitis or uveitis which may result in blindness
  • Ramsay-Hunt Syndrome: when shingles (reactivation of VZV) occurs in the geniculate ganglion of the VII cranial nerve
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23
Q

Diagnosis of shingles

A

Usually clinical

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24
Q

Complications of shingles

A
  • Post-herpetic neuralgia

- Neurological eg. meningitis

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25
Treatment of shingles
- Acyclovir - Reduces the pain and accelerates healing - Has no effect on post-herpetic neuralgia
26
Dental Relevance of Herpes Simplex Virus conditions
- Oral manifestations - Vesicles present on pharynx, buccal mucosa, gingiva, tongue, lips and face - Often painful and last for 10 days - Herpetic whitlow
27
Dental Relevance of Herpes Zoster Virus
- Oral manifestations in chickenpox and shingles - In shingles, pain if V2 or V3 of CN-V is involved - Can often be misdiagnosed as tooth ache - Post-herpetic neuralgia -If a patient is having a recurrent zoster, need to question why. Immunosuppressent drugs, HIV, steroidal drugs???
28
A 5yo boy recently started school - Note lesions on palate etc - Generally unwell and feverish Where else would you like to examine to confirm diagnosis
- Perhaps chickenpox - Need to inspect - Other lesions in any other places - Any rashes - Any swellings on the glands
29
Infectious mononucleosis alternative name, definition, incubation period
- Glandular fever, kissing disease - Caused by Epstein-Barr Virus - Incubation period is 4-14 days - Infects B lymphocytes and causes antibody production - Not necessarily against EBV
30
Clinical features of infection mononucleosis
- Sore throat - Lymphadenopathy - Anorexia, fever, malaise - Intra-oral rash between hard and soft palate - Tonsilitis with white exudate - Palpable spleen - Sometimes jaundice
31
Diagnosis of infectious mononucleosis
- Often clinical - PCR - Monospot test- rapid blood test to check for EBV
32
Complications of infectious Mononucleosis
- Hepatitis - Respiratory obstruction - Ruptured spleen v rare
33
Management of Infectious Mononucleosis
- Supportive | - Paracetemol and water
34
Dental relevance of infectious mononucleosis
- Cervical lymphadenopathy - Creamy exudate over tonsils - Rash between hard and soft palate
35
Mumps definition, spread, common in and incubation period
- Caused by paramyxovirus (rna) - 16-20 days incubation period - Spread by droplets from saliva and nasopharyngeal secretions - Common childhood infection
36
Differential diagnosis of mumps
Swelling of the parotid/submandibular glands
37
Clinical features of mumps
- Asymptomatic in 40% - Fever, malaise - Enlargement of one of both parotids - Earache and displacement of the earlobe - Parotid papillae inflamed - Difficulty swallowing - Submandibular glands may be affected
38
Diagnosis of mumps
-Clinical
39
Complications of mumps
-Neurological Aseptic meningitis Encephalitis - Orchitis- inflammation of the testes - Non-parotid mumps- ovaries, thyroid, pancreas, breasts
40
Treatment of mumps
- Good oral hygiene as they may have some difficulties with dexterity - Prevention by immunisation from vaccine with children 12-15 months (MMR) - Supportive (analgesics, bed rest and fluids) - Scrotal support
41
Dental Relevance of mumps
- Enlarged, tender parotid gland - Oral hygiene may be impaired - Difficulty as sore
42
Exanthema definition and examples of childhood infections that can cause it
-Skin rash accompanied by a disease or fever - Measles - German measles - Enteroviral infection - Infection mononucleosis - Scarlet Fever - Erythema infectiosum - Roseola infactum - Drug eruption
43
Measles definition, incubation period and spread
- Paramyxovirus - Spread via droplet infection - Common childhoood infection - Incubation period is 10 days
44
Clinical features of measles
- Conjunctivitis - Lymphadenopathy - Koplik's spots on buccal mucosa - Florid maculopapular rash which begins behind the ears and spreads to the face and trunk- brownish discolouration remains after
45
Complications of measles
Gingivostomatitis
46
Diagnosis of measles
Often clinical but uncommon so sometimes lab tests may be done
47
Management of measles
- Supportive treatment (bed rest, analgesics and fluid) - Immunisation of children ages 12-15 months - MMR vaccine (measles, mumps and rubella)
48
Dental Relevance of Measles
- Koplik spots on the buccal mucosa - Pharyngitis - Facial rash
49
German Measles alternative name, definition and incubation period
- Rubella - Caused by rubivirus - Incubation period is 14-21 days
50
Clinical features of german measles
- Fever - Malaise - Sore throat - Lymphadenopathy - Rash that begins on the face and spreads to the trunk/limbs - Pink, maculopapular, non-confluent - Conjunctivitis - Macular rash appears on day 3 which coalesces to form a blush
51
Diagnosis of german measles
- Clinical | - Essential in pregnant women
52
Complication of german measles
-Congenital rubella
53
Dental relevance of german measles
- Enlarged cervical lymph nodes - Pharyngitis - Facial rash
54
Enteroviral Infections example and definition
- Caused by Coxsackie virus A and B - Very common in kids - Eg. Hand-foot and mouth disease
55
Clinical features of enteroviral infection
- Malaise, fever and anorexia - Sore mouth and throat - Vesicular rash involving buccal mucosa with or without the tongue, palate or gingiva - Hand involvement in 65% of cases - Feet also affected
56
Management of enteroviral infection
No specific treatment
57
Definition, alternative name for Erythema infectiosum
- Fifth Disease | - Parvovirus B19
58
Clinical features of eryhtema infectiosum
- Constitutional symptoms uncommon - Rash- livid erythema of cheeks - Maculopapular on extremities and trunk - As second fades it assumes a lacy reticular appearance
59
Diagnosis of erythema infectiosum
-Clinical diagnosis
60
Treatment of erythema infectiosum
-No specific treatment
61
Difference between Active and Passive immunity
- Active immunity is where the body develops its own antibodies through a disease or when you get a vaccine - Passive immunity is when antibodies are given to you
62
Subsets of active immunity
1) Live attenuated vaccine -Contains a version of living virus that has been weakened -eg. oral poliomyelitis measles mumps rubella yellow fever 2) Inactivated organisms -Made from microorganisms that have been killed through physical or chemical processes -eg. whooping cough typhoid cholera poliomyelitis HepB Rabies 3) Immiunizing components of an organism -eg. influenza pneumococcal meningococcal c conjugate 4) Toxoid (inactivated toxin) -eg. tetanus diptheria
63
Examples of passive immunity
1) Natural Mother-foetus 2) Artificial (high levels human/non-human immunoglobulin) Human normal immunoglobulin from pooled plasma of donors eg Hep A Specific immunoglobulin from pooled blood of convalescent patients eg. Tetanus and Hep B
64
Hepatitis B Virus definition, spread and incubation period
- Hepatitis B Virus DNA - Significant to oral infection - Present in saliva - 45-180 day incubation period - Parental, sexually, contact w infected blood therefore risk for healthcare workers - Also present in saliva
65
Clinical features of Hep B
-Malaise, Anorexia, nausea, muscle pains
66
Diagnosis of Hep B
- Serological Test | - HBsAg produced during replication of virus
67
Management of Hep B
- All members of dental team should be vaccinated against Hep B - Prevention by immunisation with recombinant DNA Hbs Ag vaccine - Treatment includes bed test and avoiding hepatotoxins such as alcohol
68
Dental Relevance of Hep B
- Immunisation of all health care workers - Cross-infection control - Abnormal drug metabolism - Abnormal clotting factors
69
Hepatitis C definition and clinical features
- Hep C Virus - RNA - Acute phase usually asymptomatic - Lichenoid reactions and Xerostomia unlike Hep B - No vaccination available
70
Dental Relevance of Hep C
- Xerostomia - Cross Infection control - Abnormal drug metabolism in the liver - Abnormal clotting factors
71
HIV dental relevance
-Clinical signs of viral infections are early indicator of conversion to aids Lesions strongly associated with HIV infection include: - Candidasis both erythematous and pseudomembranous - Hairy Leukoplakia - Kaposi's Sarcoma - Non-Hodgkin's Lymphoma - Periodontal disease including linear gingival erythema, necrotising ulcerative gingivitis and necrotising ulcerative periodontitis Lesions less commonly associated with HIV infection include: - Bacterial infections - Melanotic pigmentation - Necrotizing stomatitis - Salivary gland disease - Thrombocytopoenic purpura - Non-specific ulcerations
72
Scarlet Fever definition
- Group A streptococcus - Beta haemolytic - Produces an erythrogenic toxin that is responsible for the reddish appearance
73
Clinical features of scarlet fever
- Follows a pharyngeal infection - Rash- diffuse erythema which blanches on pressure - Skin folds are dark - Circumoral pallor - Strawberry tongue
74
Tx for scarlet fever
-Penicillin
75
Whooping cough definition, incubation period and clinical features
- Gram negative bacteria - Bordetella pertusis - 7 days incubation - Followed by catarrhal phase which lasts 1-2 weeks -Spasmodic phase occupies the next 4-6 weeks and consists of severe paroxysmal cough with an inspiratory whoop, vomiting, cyanosis
76
Complications of whooping cough
- Bronchopneumonia- secondary to inhalation of secretions during whoops - Convulsions - Pressure effects- subconjunctival haemorrhage - Facial petechiae during spasm - Cerebral haemorrhage - Prolapse of hernias - Laceration of lingual fraenum against the lower incisors
77
Investigations and tx of whooping cough
- Paranasal swabs and culture on bordet-gengou medium - Immunofluorescent antibody test - Treatment is basically symptomatic
78
Tuberculosis definition, what it affects and prevention
- Myobacterium tuberculosis - Becomes dormant before it progresses to active TB - Commonly affects the lungs and is communicable in this form - May also affect any organ sysstem including lymph nodes, CNS, liver, bones, genitourinary tract and GI tract - Prevention with immunization with BCG vaccine - Gloves and masks should be worn
79
Most common oral fungal infection and who they can affect
- Oral candidasis - Candida albicans - Elderly pts - Infants - Med compromised pts ``` Signs include Pseudomembranous Erythematous Hyperplastic Angular Cheilitis Median rhomboid glossitis ```

Human Disease (19 decks)

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