Transcript Manifestation of systemic diseases in oral cavity

I.
Manifestation of
bacterial and viral
diseases in oral cavity
6DM
Common childhood
affections in oral cavity
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Viral – primary herpetic gingivostomatitis,
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Bacterial – impetigo, streptococcal
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secondary herpes labialis, herpangina,
chickenpox, mumps, measles, gladular fever, HIV
stomatitis, acute ulcerative gingivitis (rare under
16)
Fungal - candida
Miscellaneous – aphtous ulceration
Influenza
CAUSE: influenza viruses, Orthomyxoviridae, RNA
 TRANSMISION: airborne droplets
SYMPTOMS: chills and fever, sore throat, muscle pains,
severe headache, coughing, weakness and general
discomfort.
 I.O.: dry mouth, coated tongue +hyperemia and edema,
sometimes vivid red color, rarely enanthema bucally, later
vesicles, erosions
 Little papulae on the mucosa of hard palate, dry lips,
rhagade
 DIAGNOSIS: Diagnostic tests available for influenza
include viral culture, serology, rapid antigen testing,
polymerase chain reaction (PCR), and immunofluorescence
assays
 TREATMENT: symptomatic
 COMPLICATIONS: pneumonia
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Measles - Morbilli
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most frequent of child’s diseases
CAUSE: paramyxovirus of the genus
Morbillivirus
SYMPTOMS: high fever, cough,
coryza(runny nose), conjunctivitis and a
generalized maculopapular,
erythematous rash (exanthema)
TRANSMISSION: through respiration,
highly contagious
INCUBATION PERIOD: 10–14 days
(during which there are no symptoms).
Infected kids remain contagious from
the appearance of the first symptoms
until 3–5 days after the rash appears.
Measles - Morbilli
CL.pic.:
Koplik spots seen in prodromal stage
inside the mouth, are pathognomonic
(diagnostic) for measles but are not
often seen, even in real cases of
measles, because they are transient
and may disappear within a day of
arising.
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Small white spots with an erythematous margin on
the bucal, palatal and palatal arches mucosa, size of
a pinhead.
The characteristic measles rash is classically
described as a generalized, maculopapular,
erythematous rash that begins several days after
the fever starts. It starts on the head, spreads
behind ears, on the neck, body and extremities,
often causing itching.
Tongue is coated, hyperemia and hypetrophy of
papilae,
Measles - Morbilli
DIAGNOSIS:
Clinical diagnosis - a history of fever of at least
three days together with at least one of the
three C. Observation of Koplik's spots is also
diagnostic of measles.
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Alternatively, laboratory diagnosis of measles
can be done with confirmation of positive
measles IgM antibodies or isolation of measles
virus RNA from respiratory specimens.
DIF.DG.: gsh, stomatitis catarrhalis, candidosis
TREATMENT: symptomatic
Measles - Morbilli
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COMPLICATIONS: mild diarrhea, pneumonia and
encephalitis (subacute sclerosing
panencephalitis), corneal ulceration leading to
corneal scarring. Complications are usually more
severe amongst adults who catch the virus.
MMR vaccine (measles, mumps, rubella), the
routine administration of MMR vaccine at ages
12-15 months and at 4-6 years
after disease life-long immunity
Inflammation and Infection:
Hand – Foot – Mouth disease
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A rash with blisters affects the
throat, tonsils, hands and feet.
Ulcers on oral mucosa and gingiva.
The illness is usually mild and the
rash heals in 7 days.
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Cause Coxsackie virus,
enterovirus.
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Incubation period: 3-7days
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Incidence The infection commonly
affects young children from 2
weeks to 3 years old.
Inflammation and Infection:
Hand – Foot – Mouth disease
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Symptoms
prodromal: fever, sore throat,
headache, cough and loss of
appetite, enlarged LN. Blisters
or ulcers form in the throat
and mouth (buccal, palate,
tongue).
A rash (exanthema) with
blisters forms on the hands,
feet and diaper area,
periungual localisation.
Recovery is usually complete in
5 to 7 days.
Inflammation and Infection:
Hand – Foot – Mouth disease
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Prevention avoid contact with those who are
thought to be infected.
Diagnosis is made on physical examination and
history of recent illness. Histology –
intraepitelial vesicle
Dif.dg.: herpangina, g.s.h
Inflammation and Infection:
Hand – Foot – Mouth disease
Treatment symptomatic.
- salt water mouth rinses can be soothing. An
adequate fluid intake is important. Rivanol,
vit.B,C, liquid powder, ATB, Zovirax
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Complications
- possible convulsions with high fever (febrile
seizures).
- viral meningitis.
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Gingivostomatitis herpetica
HSV
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The most common viral stomatitis, primary infection
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Occurrence: in children 1-6 years
adolescents and adults up to 35 year
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Transmission: droplet infection and direct contact
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Incubation period: 5-7 days
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Clinically: prodromal stage with uncharacteristic symptoms, sore
throat, enlarged lymph nodes. After 1-4 days, the general symptoms
subside and intraoral appear. A typical small intraepithelial vesicles
the reddened oral mucosa, including gingiva
GSH
AFTA
Lesion
multiple
solitary
Locality
Hard palate, gingiva,
tongue, possible
extraoral localisation
Floor of the mouth,
vestibular gingiva
Size
< 1 mm
2mm - cm
Mumps - Parotitis epidemica
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CAUSE: Mumps virus,
Paramyxoviridae
TRANSMISSION: direct contact
with droplets of saliva
INCUBATION PERIOD: 18-22 days
SYMPTOMS: sudden onset of fever
(38 C, lasting 3-7days), pain and
parotid swelling, elevated earlobe
Parotid inflammation (or parotitis) causes swelling and local pain,
particularly when chewing.
Classically on one side first
(unilateral), later bilateral swelling.
Hard and painful mouth opening,
mild trismus, difficult swallowing
Mumps - Parotitis epidemica
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Orchitis, referring to painful
inflammation of the testicle. Males
past puberty who develop mumps
have a 30 percent risk of orchitis.
I.O.: enanthem on bucal mucosa,
Inflamated red swollen d. Stenoni,
normal or hyposalivation,
Mumps - Parotitis
epidemica
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Sometimes submandibular gland is affected as
well, but sublingual very rarely
Other symptoms of mumps can include sore face
and/or ears and occasionally in more serious
cases, loss of voice.
DIAGNOSIS:. based on clinical picture and no
confirmatory laboratory testing is needed, or
PCR if uncertain in specific cases
DIF.DG.: other types of parotid inflammation
Mumps - Parotitis
epidemica
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TREATMENT: symptomatic - bed rest,
Paracetamol for pain relief. Warm salt water
gargles, soft foods, and extra fluids, avoid fruit
juice or any acidic foods
COMPLICATIONS: orchitis, mastitis,
pancreatitis, meningoencephalitis, hearing loss
MMR vaccine (measles, mumps, rubella), life-long
immunity
Rubella – German measles
CAUSE: Rubella virus, RNA virus, genus Rubivirus,
Togaviridae
 TRANSMISION: via airborne droplet emission
 INCUBATION PERIOD: 14-21 days
 SYMPTOMS:
- often mild,
- rash (exanthema) on the face which spreads to the
trunk and limbs,
- low grade fever,
- swollen glands (post cervical lymphadenopathy),
- joint pains (transient arthropathy), headache,
conjunctivitis
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Rubella – German measles
I.O.: small, red papules on the area of the soft
palate, tongue non-specific, as in morbilli
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DIAGNOSIS:. the presence of these antibodies
(Rubella virus specific IgM antibodies) along with,
or a short time after, the characteristic rash
confirms the diagnosis.
DIF.DG.: morbilli, scarlatina
TREATMENT: symptomatic
COMPLICATIONS: congenital rubella syndrome comprises cardiac, cerebral, ophthalmic and auditory
defects. The risk of major defects or organogenesis
is highest for infection in the first trimester.
MMR vaccine (measles, mumps, rubella), life-long
immunity
Mononucleosis – Glandular
fever
"the kissing disease"
 CAUSE: Epstein-Barr virus (EBV), which infects
B cells (B-lymphocytes), less commonly CMV
 TRANSMISION: infected saliva
 INCUBATION PERIOD: 4-14 days
 SYMPTOMS: vary widely in severity (acute,
subacute, chronic form) - sore throat,
generalized lymphadenopathy, fever, headache,
malaise, maculo-papular rash, hepatosplenomegaly
 I.O.: may mimic g.s.h., widespread oral
ulcerations, petechiae, bruising
DIAGNOSIS: clinical picture, lymphocytosis, PaulBunnell test to exclude EBV, abnormal liver function
tests
DIF.DG.: Diphtheria, tularemia, leukemia, infectious
hepatitis
TREATMENT: symptomatic, Penicillin or other
antibiotics should be administered to treat the strep
throat, rest, liver diet
Ampicillin, amoxicillin should not be given to patients
with sore throat – rash
COMPLICATIONS: subacute form - several moths:
fatigue, hepatopathy,
lifelong imunity
Mononucleosis – Glandular
fever
ACUTE FORM:
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Sudden onset, high fever,
petechiae on soft palate, edema of
eyelids, malaise, headache,
abdominal pain, vomiting, anorexia,
diarrhea. Fever 39-40st.C, 4-5
days, within 3 days sore throat,
tonsils coated, enlarged, LN
submandibular, cervical, auricular
enlarged (check LN in axilla and
inguina)
Chickenpox - Varicella
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CAUSE: VCV varicella-zoster virus, Herpesviridae,
primary infection – chickenpox, reactivation - shingles
TRANSMISION: spread easily through aerosolized
droplets or through direct contact with secretions
from the rash.
INCUBATION PERIOD: 10-21 days, a person with
chickenpox is contagious from one to five days before
the rash appears and until all vesicules have formed
crust (5 to 10 days)
SYMPTOMS: start as a two to four millimeter red
papule which develops an irregular outline (a rose
petal), later vesicle, breaks leaving a crust, which
falls off after seven days, may leave a crater-like
scar
Chickenpox - Varicella
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DIAGNOSIS: clinical, typical
prodromal symptoms, vesicle
fluid examination, or direct
fluorescent antibody
TREATMENT: symptomatic,
sodium bicarbonate baths or
antihistamine medication
ease itching, paracetamol ,
liquid talc with menthol
Chickenpox - Varicella
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COMPLICATIONS:
congenital varicella
syndrome/neonatal varicella,
conjunctivitis, stomatitis
I.O.: pustula pinhead size,
rupture, maceration,
aphta/ulcer-like lesions
Localisation: bucal, hard
palate, tongue, lips
Smallpox - Variola
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The global eradication of smallpox was certified,
based on intense verification activities in
countries, by a commission of eminent scientists
on 9 December 1979 and subsequently endorsed
by the World Health Assembly on 8 May 1980
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Any surgery is contraindicated
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ATB to prevent secondary infection
Scarlet fever - Scarlatina
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CAUSE: exotoxin released by β-haemolytic
streptococci
TRANSMISION: airborne droplet emision
INCUBATION PERIOD: 1-7 days
SYMPTOMS: very painful sore throat –
tonsillitis, pharyngitis, malaise, headache, high
fever (40st.C), vomiting,
skin rash - fine sandpaper rash over the upper
body, begins to fade three to four days after
onset and desquamation (peeling) begins.
No rash circumorally – “white mustache” –
Filatov’s sign
Scarlet fever - Scarlatina
strawberry tongue
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I.O.: strawberry tongue,
enanthema especially soft
palate tonsils and bucal areas
DIAGNOSIS: clinical, if blood
test - leukocytosis with
neutrophilia, high erythrocyte
sedimentation rate (ESR) and Creactive protein (CRP),
DIF.DG.: morbilli, rubella,
toxoallergic drug exanthema
Enathema, yellowish coating, edema,
teeth impression on the sides of
tongue, keratinisation disorders,
hyperkeratosis of papillae, the tip and
sides of tongue vivid red colour
Rarely vesicles-necrosis-glossitis
necrotisans
TREATMENT: ATB (PNC,
clindamycin or erythromycin)
- agrimony tea irrigation, intensive
oral hygiene
COMPLICATIONS: septic
complications due to spread of
streptococcus in blood
Diphtheria
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Bull’s neck
upper respiratory tract illness characterized by
sore throat, low fever, and an adherent membrane
(a pseudomembrane) on the tonsils, pharynx,
and/or nasal cavity
eradicated in developed nations through
widespread vaccination
DPT (Diphtheria–Pertussis–Tetanus) vaccine
CAUSE: Corynebacterium diphtheriae, G+
TRANSMISION: direct physical contact or
breathing the aerosolized secretions of infected
individuals
INCUBATION PERIOD: 1-7 days
Diphtheria
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Bull’s neck
SYMPTOMS: The onset of disease is usually
gradual. Symptoms include fatigue, fever, a mild
sore throat and problems swallowing. Later tonsils
and oropharynx vivid red color, whitegray / yellow
pseudomembranes, adherent, cannot be wiped off,
stomatitis diphterica, coated tongue, foetor ex
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Sore throat, vomiting, fever, enlargement of
cervical LN, slightly painful
DIAGNOSIS:. isolation of Corynebacterium
diphtheriae from a clinical specimen,
histopathology
TREATMENT:
- diphtheria anti-toxin
- antibiotics do not help healing of local infection,
used in patients or carriers to eradicate C.
diphtheriae and prevent its transmission to othersErythromycin, Procaine penicillin, Rifampin or
Clindamycin
- Local - mouthwashes, intensive oral hygiene
Pertussis – whooping
cough
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CAUSE: Bordetella pertusis
TRANSMISION: contact with airborne
discharges from the mucous membranes of
infected people
INCUBATION PERIOD: 7–21 day
SYMPTOMS: initially by mild respiratory
infection symptoms such as coughing, sneezing,
and runny nose (catarrhal stage). After one to
two weeks, the cough changes character, with an
increase of coughing followed by an inspiratory
"barking" sound (paroxysmal stage).
I.O.: catarrhal stage – non-specific stomatitis
paroxysmal stage – ulcus frenuli linguae,
trauma by lower teeth during coughing, edema of
face and eyelids (dif.dg. Periostitis)
DIAGNOSIS: culturing of nasopharyngeal swabs,
polymerase chain reaction (PCR), serology
TREATMENT: antibiotic (erythromycin or
azithromycin)
COMPLICATIONS: pneumonia, encephalitis,
pulmonary hypertension, and secondary bacterial
superinfection
Impetigo is a highly contagious bacterial skin infection
most common among pre-school children.
People who play close contact sports such as rugby,
American football and wrestling are also susceptible,
regardless of age.
Impetigo is not as common in adults.
The name derives from the Latin impetere
It is also known as school sores.
Impetigo contagiosa
This common form of impetigo, also called nonbullous imp
most often begins as a red sore near the nose or mouth w
leaking pus or fluid, and forms a honey-colored scab follo
a red mark which heals without leaving a scar.
Sores are not painful but may be itchy.
LN in the affected area may be swollen, but fever is rar
Touching or scratching the sores may easily spread the i
[3]
Impetigo contagiosa
This common form of impetigo, also called nonbullous
impetigo, most often begins as a red sore near
the nose or mouth which soon breaks leaking pus
or fluid, and forms a honey-colored scab followed by
a red mark which heals without leaving a scar.
Sores are not painful but may be itchy.
LN in the affected area may be swollen,
but fever is rare.
Touching or scratching the sores may
easily spread the infection to other parts of the body.
Causes
It is primarily caused by Staphylococcus aureus,
and sometimes by Streptococcus pyogenes.
Transmission
The infection is spread by direct contact with
lesions or with nasal carriers.
The incubation period is 1–3 days. Dried
streptococci in the air are not infectious to intact
skin. Scratching may spread the lesions.
Diagnosis
Impetigo generally appears as honey-colored scabs
formed from dried serum, and is often found on
the arms, legs, or face.
Treatment
For generations, the disease was treated with an
application of the antiseptic gentian violet.
Today, topical or oral antibiotics are usually
prescribed.
Mild cases may be treated with bactericidal
ointment, more severe cases require oral
antibiotics, such as dicloxacillin, flucloxacillin or
erytromycin.
Inflammation and Infection:
Candidiasis
(Oral Thrush)
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Causes
Candida albicans is a normal commensal of the mouth.
Its growth is normally kept under control by the
other normal micro-organisms of the mouth.
Overgrowth of Candida can be caused by factors
which reduce the individuals natural resistance. These
factors include stress, long term use of
corticosteroids or drugs, which suppress the immune
system, and AIDS. Other conditions can upset the
balance of normal micro-organisms in the mouth
allowing the Candida to proliferate. This is commonly
associated with antibiotics, DM, and hormonal
changes occurring in pregnancy.
• Incidence - Candidiasis is most common in:
Infants and toddlers – undernourished, prolonged atb or
steroids th
• Individuals whose immune responses have been
suppressed by disease or drugs.
• Long term use of antibiotics, corticosteroids and anticancer drugs.
• Symptoms
• Ulcers form in the mouth, usually on the tongue or
inner cheeks.The lesions are painful, slightly raised,
and creamy white in appearance.
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Prevention
Good oral hygiene is important. Those at risk can
be given prophylactic antifungal medication.
Tests
Removal of the white lesions reveals a red,
tender area which may bleed. A microscopic
examination of tissue from the lesion will
confirm Candida.
Treatment
 It is important to treat any underlying condition.
 Antifungal medications such as nystatin,
miconazole or clotrimazole can be given to treat
the infection.
 Good oral hygiene helps the healing process.
Especially in denture induced candidal infections.
 Complications
These include insufficient nutrition, as the oral
thrush can be very painful. The Candida may
spread to the GIT, lungs or other areas.
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