L9: bacterial and fungal infections part 1

Question 1

4 bacteria causing NUG

Answer 1

• Fusobacterium nucleatum
• Borrelia vincetii
• Prevotella intermedia
• Porphyromonas gingivalis
• polymicrobical infection by fusospirochaetal complex

Question 2

ANUG presents in what types of ppl?

Answer 2

• in young and middle aged adults
• often occurs when physiologic stress present

Question 3

predisposing factors of NUG

Answer 3

• immunosuppression - drug induced
• smoking
• local trauma
• poor nutritional status
• poor OH
• inadequate sleep/ rest
• recent illness

Question 4

clinical appearance of NUG

• highly inflamed _____ , erythematous, edematous and bleeds easily
• papillae are blunt and “_____”, with ______ lesions covered by greyish ________ + _____ gingival tissue
• very distinctive _____ odor
• ______ debri

Answer 4

• highly inflamed interdental papillae, erythematous, edematous and bleeds easily
• papillae are blunt and “punched out”, with ulcerative lesions covered by greyish psuedomembrane +necrotic gingival tissue
• very distinctive fetid odor
• necrotic debri

Question 5

untreated NUG can progress to NUP if there is _____

Answer 5

loss of attachment

Question 6

if NUG spreads to adjacent soft tissue, it will be known as _______

Answer 6

necrotizing ulcerative mucositis/ stomatitis

Question 7

if the NUG necrotizing infection extends through the mucosa to the skin of the face, it is known as

Answer 7

noma: cancrum oris

Question 8

histopatho features of NUG

• non specific features showing ______ changes with thick ______ membrane
• _______infiltrated by thick band of mixed _____ cells with extensive ____
• extensive ______ present

Answer 8

• non specific features showing ulcerative changes with thick fibrinopurulent membrane
• lamina propria infiltrated by thick band of mixed inflam cells with extensive hyperemia
• extensive bacterial colonisation present

Question 9

tx for ANUG

Answer 9

there is resolution when causative bacteria is removed
- debridement
- frequent rinse with CHX, warm salt water, hydrogen peroxide
- systemic AB if lymphadenopathy and fever are present

• improve OH

Question 10

in recalcitrant cases of NUG, what must we rule out?

Answer 10

HIV infection or infectious mononucleosis

recalcitrant may be because of underlying immunosuppressive states

Question 11

predisposing factors of fungal infection

Answer 11

changes in local oral flora
- may be due to AB therapy
- salivary gland dysfunction (decreased flow rate)
- removable dental appliances

changes in immunity
- local immunity: defensins, saliva, tissue injury
- immunosuppressive therapy
- medical conditions/ diseases
- cancer

inherited/ acquired autoimmune disease
- SCIDS/ DIGeroge’s syndrome/ other
- HIV/ AIDs

Question 12

two common candida species

Answer 12

• C albicans
• C glabrata

Question 13

risk factors for candidiasis

Answer 13

• xerostomia
• medications: AB, corticosteroid (topical/ systemic)
• smoking
• immune system changes
• dentures
• cancer

Question 14

clinical presentation of oral candidiasis
which are red and white?

Answer 14

white – pseudomembranous candidiasis, hyperplastic candidiasis

red – erythematous, angular cheilitis, median rhomboid glossitis, denture stomatitis

Question 15

clinical presentation of pseudomembranous candidiasis

Answer 15

• white plaques resembling cottage cheese/ curdled milk
• underlying mucosa is either normal or can be erythematous
• can wipe/ scrape off

Question 15

clinical presentation of pseudomembranous candidiasis

Answer 15

• white plaques resembling cottage cheese/ curdled milk
• underlying mucosa is either normal or can be erythematous
• can wipe/ scrape off

Question 16

symptoms of pseudomembranous candidiasis

Answer 16

• burning sensation
• unpleasant taste (salty/bitter)

Question 17

ddx of pseudomembranous candidiasis

Answer 17

leukoplakia and OLP
both white lesions but cant scrape off

Question 18

erythematous oral candidiasis is also known as what

Answer 18

atrophic oral candidiasis

Question 19

clinical presentation of erythematous candidiasis

Answer 19

• red macules
• ## smooth atrophic appearance of tongue (loss of filiform papillae, depapillation)

Question 20

location of erythematous candidiasis

Answer 20

• buccal mucosa
• posterior hard palate
• dorsal tongue
• because when we close our mouths, our tongue lies on hard palate so its likeluy to form a kissing lesion there

Question 21

what is median rhomboid glossitis

Answer 21

it is basically erythematous candidiasis but at the midline of posterior dorsal tongue

Question 22

clinical features of median rhomboid glossitis

Answer 22

• well demarcated erythematous zone
• atrophic mucosal areas (loss of filiform papillae). these areas are erythematous
• smooth/lobulated surface
• symmetrical
• asymptomatic

Question 23

how to differentiate between benign migratory glossitis vs median rhomboid glossitis

Answer 23

benign migratory glossitis = geographic tongue
- geographic tongue is inside red outside white (patches have white rim) vs median rhomboid glossitis dont have
- geographic tongue patches move around, median rhomboid always in the middle

Question 24

angular cheilitis clinical feature

Answer 24

- erythema - fissuring, scaling - tender - irritated, raw feeling

Question 25

cause of angular cheilitis

Answer 25

older px OVD decrease so saliva pools at folded corners of mouth -> favour yeast infection

Question 26

clinical features of denture stomatitis

Answer 26

- varying degrees of erythema - may have petechial hemorrhage - asymptomatic

Question 27

what kind of patient does chronic hyperplastic oral candidiasis occur in?

Answer 27

those on long term immunosuppressive drugs or those very immunosuppressed eg renal transplant patient, leukemia etc

Question 28

how do lesions of chronic hyperplastic oral candidiasis look like

Answer 28

whitish, ddx should be candidiasis differentiation can be done as normal candidiasis can be wiped off but chronic hyperplsatic cant

Question 29

why is it necessary to treat asymptomatic chronic erythematous candidiasis

Answer 29

- edematous soft tissue provides a poor base for prosthesis - chronic inflammation may increase bone resorption - may contribute to inflammatory papillary hyperplasia, which if severe may require surgical management

Question 30

how to dx candidiasis?

Answer 30

- clinical presentation - cytologic preparations (periodic acid schiff stain) - biopsy then H+E stain, PAS stain, GMS stain (show fungal hyphae)

Question 31

common fungal infections in immunocompromised px

Answer 31

- aspergillus - candida - histoplasma - mucor - rhizomucor

Question 32

histopatho findings of candidiasis - increase thickness of ______ layer with elongation of _______ - _____ inflammatory cell infiltrate in _____ immediately subajcent to infected ______ - small collections of _____ (microabscesses) in _____ and ______ layer - ______ embedded in parakeratin layer and rarely penetrate deeper, unless px severely _____

Answer 32

- increase thickness of parakeratin layer with elongation of rete ridges - chronic inflammatory cell infiltrate in CT immediately subajcent to infected epithelium - small collections of neutrophils (microabscesses) in parakeratin and superficial spinous layer - hyphae embedded in parakeratin layer and rarely penetrate deeper, unless px severely immunocompromised

Question 33

histopatho findings of candidiasis - _______ of parakeratin layer with elongation of rete ridges - chronic ______ infiltrate in CT _____ (at which location) - small collections of neutrophils (______) in parakeratin and _______ layer - hyphae ______ in ______ layer and rarely penetrate deeper, unless px severely immunocompromised

Answer 33

- increase thickness of parakeratin layer with elongation of rete ridges - chronic inflammatory cell infiltrate in CT immediately subajcent to infected epithelium - small collections of neutrophils (microabscesses) in parakeratin and superficial spinous layer - hyphae embedded in parakeratin layer and rarely penetrate deeper, unless px severely immunocompromised

Question 34

cause of zygomycosis

Answer 34

arise from inhalation or implantation of spores by minor trauma or insect bites then hypersensitivity reaction produces inflammation, granulations and necrosis, causing local destruction

Question 35

what is the most common type of zygomycosis

Answer 35

rhino-orbital-cerebral type in nose

Question 36

zygomycosis have regional spread via ____

Answer 36

paranasal sinus

Question 37

zygomycosis affects what group of px the most

Answer 37

diabetes mellitus

Question 38

how does zygomycosis spread into blood

Answer 38

angioinvasive properties of the fungi lead to arterial occlusion and infarction -> causes tissue necrosis then organism thrives in dead organic tissue, spreads along injured blood vessels (spread very fast and far)

Question 39

clinical signs of zygomycosis

Answer 39

- proptosis - cranial nerve defect - palatal ulcer - facial swelling - multiple clouded sinuses

Question 40

tx of zygomycosis

Answer 40

- debridement - intravenous amphotericin B regime to be implemented immediately

Question 41

what are some topical agents used for anti fungal therapy

Answer 41

- oral nystatin: first line, swish and spit - clotrimazole: troches, cream - itraconazole: swish and swallow - amphotericin B: rinse - CHX: rinse - povidone iodine: rinse