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Oral Medicine BDS4 > Infectious diseases of the oral mucosa > Flashcards

Infectious diseases of the oral mucosa Flashcards

(121 cards)

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1
Q

What is the term for a candidal infection in the UK?

A

Candidosis

In the US, it is referred to as candidiasis.

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2
Q

What is the most common species associated with candidal infections?

A

Candida Albicans

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3
Q

What percentage of the normal population are carriers of Candida albicans?

A

> 70%

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4
Q

What type of infection is Candida considered when it invades deeper tissues?

A

Opportunistic infection

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5
Q

What are the two categories of host defenses against infections?

A
  • Local
  • Systemic
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6
Q

What are local defenses of the oral mucosa?

A
  • Physical barrier
  • Innate immunity (lysozyme, T cells, phagocytes)
  • Oral microbiome
  • Saliva (mechanical cleansing, antimicrobial peptides, IgA antibodies)
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7
Q

What are the local risk factors for oral candidosis?

A
  • Xerostomia
  • Poor oral hygiene
  • Dental appliances
  • Mouth piercings
  • Smoking
  • Irradiation to the mouth
  • Inhaled corticosteroids
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8
Q

What are the systemic risk factors for oral candidosis?

A
  • Extremes of age
  • Malnutrition
  • Diabetes
  • HIV/AIDS
  • Haematinic deficiency
  • Broad-spectrum antibiotics
  • Chemotherapy
  • Haematological malignancy
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9
Q

What is the first step in managing candidal infections?

A

Investigate and manage predisposing factors

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10
Q

What are two types of topical antifungals used for candidal infections?

A
  • Miconazole oral gel
  • Nystatin oral mouthwash
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11
Q

What is a systemic antifungal used for candidal infections?

A

Fluconazole capsules

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12
Q

What is Acute Pseudomembranous Candidosis also known as?

A

Thrush

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13
Q

What is the typical appearance of Acute Pseudomembranous Candidosis?

A

White slough on mucosa surface

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14
Q

What is Chronic Hyperplastic Candidosis also known as?

A

Candidal leukoplakia

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15
Q

Where does Chronic Hyperplastic Candidosis commonly occur?

A

Buccal mucosa at the labial commissure

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16
Q

What is a potential risk associated with Chronic Hyperplastic Candidosis?

A

Potentially malignant disorder

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17
Q

What is Denture-Related Stomatitis?

A

Candidal infection of mucosa beneath a dental appliance

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18
Q

What is the most common location for Denture-Related Stomatitis?

A

Complete upper dentures

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19
Q

What is the classification of Denture-Related Stomatitis according to Newton?

A
  • 1 - localized inflammation
  • 2 - generalized erythema
  • 3 - granular type
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20
Q

What is Acute Erythematous Candidosis also known as?

A

Atrophic candidosis

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21
Q

What common symptom is associated with Acute Erythematous Candidosis?

A

Burning feeling in the mouth

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22
Q

What is the role of oral hygiene in managing candidal infections?

A

Essential for preventing relapse

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23
Q

Fill in the blank: Miconazole is an _______ antifungal.

A

Azole

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24
Q

True or False: Fluconazole has different interactions than Miconazole.

A

False

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25
What is a common cause of xerostomia that can lead to candidal infections?
Smoking
26
What is another name for Matous Candidosis?
Atrophic candidosis
27
What common symptom is associated with Matous Candidosis?
Burning feeling in the mouth
28
Which area is most commonly affected by Matous Candidosis?
Palate
29
List some predisposing factors for Matous Candidosis.
* Recent broad-spectrum antibiotics * Corticosteroids * Diabetes * HIV * Nutritional factors
30
How is Matous Candidosis diagnosed?
Clinical diagnosis and oral rinse/oral swab
31
What is the management approach for Matous Candidosis?
* Medical referral for blood tests * Topical antifungal * Systemic antifungal
32
Where does Median Rhomboid Glossitis occur?
Posterior aspect, midline of tongue dorsum
33
What causes Median Rhomboid Glossitis?
* Steroid inhalers * Smoking
34
What is a potential sign of Median Rhomboid Glossitis on the palate?
Kissing lesion
35
What is the typical management for Median Rhomboid Glossitis?
* Address predisposing factors * Oral/denture hygiene * Topical antifungal * Systemic antifungal if topical fails
36
What is Angular Cheilitis?
Infection of mucocutaneous region around corners of mouth
37
What are common signs and symptoms of Angular Cheilitis?
* Soreness * Erythema * Fissuring * Crusting * Bleeding
38
What mechanical factors contribute to Angular Cheilitis?
* Ageing * Edentulous * Dentures lacking vertical height
39
What is the management for Angular Cheilitis?
* Address predisposing factors * Denture hygiene and oral hygiene * Topical antifungal (miconazole cream) * Topical antibacterial (sodium fusidate ointment) * Combine with steroid if significant dermatitis
40
What is the summary statement regarding Candidosis?
Disease of the diseased
41
What does the term 'acute' refer to in viral infections?
A stage of viral infection characterized by a rapid onset and short duration
42
What types of viruses are covered in the lecture?
* Herpes simplex virus * Human Immunodeficiency Virus * Hepatitis C * Coxsackie virus
43
What is the characteristic feature of Herpes Simplex Virus infections?
Latency and re-activation later in life
44
What are the primary types of Herpes Simplex Virus?
* HSV 1 – oral cavity affected * HSV 2 – anogenital affected
45
What is the typical presentation of Primary Herpetic Gingivostomatitis?
* Fever * Malaise * Red, fiery, oedematous gingivae * Vesicles and ulcers
46
What is the management for Primary Herpetic Gingivostomatitis?
* Supportive care * Hydration * Pain relief (paracetamol) * Oral hygiene reinforcement * Urgent care for pregnant women and neonates
47
What triggers Recurrent Herpes Simplex Virus reactivation?
* Sunlight (UV radiation) * Fever * Tissue injury * Stress * Immunosuppression * Hormonal changes
48
What is a common complication of HSV?
* Bell's palsy * Erythema multiforme * Herpetic whitlow * Eye disease (herpetic keratoconjunctivitis)
49
What is Varicella commonly known as?
Chickenpox
50
What is Zoster commonly known as?
Shingles
51
What is a key characteristic of shingles?
Follows dermatomes
52
What is the management for Zoster?
* Aciclovir 800mg tablets within 72 hours of onset * Refer to GP
53
What is a potential complication of Zoster?
Post-herpetic neuralgia
54
What is post-herpetic neuralgia?
Persisting pain lasting > 6 months after mucocutaneous healing ## Footnote It is characterized by a “burning” pain that may require neuropathic medications.
55
What medications are used to manage post-herpetic neuralgia?
* Gabapentin * Amitriptyline / Nortriptyline * Carbamazepine ## Footnote These medications help calm the nerve down.
56
What is Ramsay Hunt syndrome?
Reactivation within geniculate ganglion (CN7) ## Footnote It presents with facial nerve palsy, vesicular rash around the ear, and oral vesicles.
57
What should be done for all patients with zoster?
Refer all patients to their GP! ## Footnote This is crucial for proper management and follow-up.
58
Who should be referred to a specialist regarding zoster?
Immunocompromised patients ## Footnote They may require specialized care due to their compromised immune systems.
59
What is a complication associated with zoster?
Post-herpetic neuralgia ## Footnote This complication can significantly impact the quality of life.
60
True or False: Post-herpetic neuralgia can be treated with conventional analgesics.
False ## Footnote Neuropathic medications are needed for effective management.
61
62
What percentage of the population has been infected with Epstein-Barr Virus?
90-95% ## Footnote Epstein-Barr Virus is very common and often asymptomatic.
63
How is Epstein-Barr Virus primarily transmitted?
In saliva ## Footnote It is commonly known as 'The kissing disease.'
64
What is the primary clinical impact of Epstein-Barr Virus infection?
Often minimal, can present as Infectious mononucleosis (glandular fever) in some ## Footnote This is referred to as primary infection.
65
Where does Epstein-Barr Virus establish latency?
Lymphoid tissue
66
What are potential reactivations of Epstein-Barr Virus?
* Oral hairy leukoplakia* * Burkitt’s lymphoma* * Nasopharyngeal cancer*
67
What is Oral hairy leukoplakia associated with?
HIV positive patients when CD4 counts drop ## Footnote Also seen in chemotherapy and leukaemia.
68
What is the cause of Kaposi Sarcoma?
Human Herpesvirus 8 (HHV 8)
69
What are common oral presentations of Kaposi Sarcoma?
Hard palate, gingivae, or tongue ## Footnote More common on the face.
70
What indicates immunocompromise in relation to HHV 8?
* HIV/AIDS* * Following organ transplant*
71
How is Kaposi Sarcoma diagnosed?
Incisional biopsy
72
What is the management for Kaposi Sarcoma?
* Address underlying immunosuppression* * Excision of lesion* * Cryotherapy* * Intralesional vinblastine* * Chemotherapy for disseminated disease*
73
What type of virus is HIV?
RNA virus
74
How is HIV primarily transmitted?
* Sexual transmission* * Needlestick injuries* * Splashes* * Vertical transmission (mother to child)*
75
What cells does HIV enter and destroy?
CD4 T helper cells
76
What occurs as HIV disease progresses?
Increasingly immunocompromised as CD4 T cell levels drop
77
What is the end-stage of untreated HIV infection?
Acquired immunodeficiency syndrome (AIDS)
78
What are effective treatments for HIV?
* ART (anti-retroviral treatment)* * PrEP (pre-exposure)* * PEP (post-exposure)*
79
What is the estimated number of people living with HIV in the UK?
105,200 people
80
What is the low threshold for testing for HIV?
Blood test for antibodies and p24 antigen
81
What is the goal of ART in HIV treatment?
Halt HIV replication and achieve normal CD4 count and undetectable viral load
82
What are AIDS-Defining Illnesses?
* Kaposi sarcoma* * Pneumocystis jirovecii pneumonia (PCP)* * Cytomegalovirus infection* * Candidosis* * Lymphomas* * Tuberculosis*
83
What are common oral AIDS-Defining Illnesses?
* Oral candidosis* * Acute necrotising ulcerative gingivitis (ANUG)* * Kaposi Sarcoma* * Oral hairy leukoplakia* * Non-Hodgkin’s lymphoma* * Aphthous-like ulcers*
84
What virus causes Hepatitis C?
RNA virus
85
How is Hepatitis C primarily spread?
By blood and bodily fluids
86
What is the treatment duration for Hepatitis C?
8-12 weeks with antiviral medications
87
What are the complications of Hepatitis C?
* Liver cirrhosis* * Hepatocellular carcinoma*
88
What virus family does Coxsackie Virus belong to?
Family of RNA viruses
89
What is a common oral presentation of Hand, Foot and Mouth Disease?
Vesicles/ulcers on labial, buccal, and tongue mucosa
90
What is Herpangina characterized by?
Numerous vesicles and ulcers on the soft palate, uvula, and fauces
91
What is the management for Coxsackie Virus infections?
* Supportive care* * Fluids* * Paracetamol, ibuprofen* * Soft diet* * Chlorhexidine for oral hygiene* * Difflam mouthwash*
92
What are the primary origins of most bacterial infections in the mouth?
* Odontogenic* * Salivary origin*
93
Name two common sexually transmitted infections.
* Syphilis* * Gonorrhoea*
94
What is the causative agent of syphilis?
Treponema pallidum
95
What are the phases of syphilis?
* Primary* * Secondary* * Tertiary*
96
What characterizes primary syphilis?
Chancre at the site of inoculation
97
What occurs in secondary syphilis?
Non-specific symptoms like lethargy, malaise, and rash
98
What are gummatous lesions associated with?
Tertiary syphilis
99
What is the diagnosis method for syphilis?
* Incisional biopsy* * Blood test for IgG and IgM antibodies*
100
What is the management for syphilis?
STAT dose of IM benzylpenicillin (benpen)
101
What are the causative agents of gonorrhoea and chlamydia?
* Gonorrhoea: Neisseria gonorrhoea* * Chlamydia: Chlamydia trachomatis*
102
What are common symptoms of gonorrhoea in males?
Urethral discharge and dysuria
103
What are common symptoms of chlamydia in females?
Altered vaginal discharge and dysuria
104
What is the diagnosis method for gonorrhoea and chlamydia?
* Clinical (oral)* * Specialist swabs for microscopy and sensitivity*
105
What is the primary causative agent of tuberculosis?
Mycobacterium tuberculosis
106
How is tuberculosis primarily transmitted?
Through respiratory secretions
107
What is a major complication of untreated tuberculosis?
Dissemination to almost any organ including the mouth
108
What is the causative agent of tuberculosis?
Mycobacterium tuberculosis ## Footnote Major global disease burden with 1.5m deaths/year globally.
109
How is tuberculosis primarily transmitted?
Through respiratory secretions ## Footnote Infected respiratory secretions are the main route of transmission.
110
What are common symptoms of tuberculosis?
Fever, weight loss, night sweats, cough, haemoptysis ## Footnote These symptoms can indicate the presence of TB.
111
List three risk factors for tuberculosis.
* Close contact with TB patient * Born in high-prevalence regions * HIV ## Footnote Other risk factors include diabetes, leukemia, alcohol excess, socioeconomic deprivation, and homelessness.
112
What are the oral manifestations of tuberculosis?
* Ulceration * Lip swelling ## Footnote These manifestations can occur due to the infection's effects on the body.
113
What type of inflammation is associated with tuberculosis?
Granulomatous inflammation ## Footnote Similarities exist with orofacial granulomatosis and Crohn’s disease.
114
What diagnostic method is used to identify tuberculosis in oral lesions?
Incisional biopsy with H+E staining ## Footnote Ziehl-Neelsen staining shows TB as red.
115
What is the recommended management for tuberculosis?
Combination antibiotics for 3-6 months ## Footnote Specialist referral is also advised.
116
True or False: Untreated tuberculosis can lead to complications such as infertility.
True ## Footnote Complications can include pelvic inflammatory disease.
117
Fill in the blank: The diagnosis of tuberculosis may involve __________ staining to show TB as red.
Ziehl-Neelsen ## Footnote This staining technique is specific for Mycobacterium species.
118
What should be considered to improve a patient’s health concerning infections?
Underlying/predisposing factors ## Footnote These factors need to be investigated and managed.
119
What is a suggested investigation method for microbiology?
Swab of lesion, oral rinse ## Footnote These methods help identify infectious agents.
120
What does the H+E staining method look for in a biopsy?
Granulomas ## Footnote Granulomas indicate a response to infection or inflammation.
121
List two blood tests that can be part of possible investigations.
* FBC * HbA1c/glucose ## Footnote These tests help assess overall health and detect underlying conditions.

Oral Medicine BDS4 (3 decks)

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