Neisseria gonorrhaeae

2-5 days after exposure

Dev symptoms 2-5 days after exposure

Young people

Sexually transmitted

Purulent discharge, 10% men; 50% women are asymptomatic

20% oral: tonsils, soft palate

Gram stain for gram negative diplococci

Culture & sugar fermentation tests

DNA probe

PCR essay

Ligand chair reaction

Fluorescent antibody test

Resistant to many antibiotics

Ceftriaxone plus one of azithromycin and doxycycline

rescreen 1-2 months post-treatment

Neonate eyes: prophylactic erythrommycin, tetracycline, or silver nitrate

Chronic infection disease, 1 billion case worldwide

Inhalation of airborne droplets from individual with active infection or ingestion of infected milk (T. bovis)

Primary infection

Active disease (5-10%) esp AIDS

Reactivation of prior infection - secondary TB

Hematologic dissemination - miliary TB

Low grade fever, malaise, anorexia (wt. loss), night sweats, cough, "consumption" old term

Lupus vulgaris & Scrofula

4-drug regimen: isoniazid, rifampin, pyrazinamide, either ethambutol or streptomycin

Multiagent, drug resistance is common

10-12 million people affected world-wide

Low infectivity, requires chronic exposure

Endemic in Louisiana & Texas

Animal reservoirs

M. lebra prefers nerves & cool temps

High immune reaction

Localized disease, mo not in skin biopsy, but responds to skin test

Incubation period 2-5 years

Absence of cell-mediated immune response

Many mo in biopsy, no response to skin test

Incubation period 8-12 years

Paucibacillary (TB) 6 mo. Rifampin & dapsone

Multibacillary (Lepromatous) - 2 yrs Rifampin, Clofazimine, Dapsone, Thalidomide

Opportunistic infection from normal oral flor

Borrelia vincentii, staph aureus, prevotella intermedia & nonhemolytic strep

Rapidly progressing

May begin as ANUG

Esp common in assoc w/ HIV/AIDS

Other risk factors: hospitalization, previous antibiotics, agranulocytopenia

40% mortality

Conservative antibiotic therapy, local debridement, improved OH, lavage with antiseptic agents, analgesic medication

Avoid perio curettage, dental extraction or aggressive surgery

Antibiotics: penicillin, metronidazole

Wound debridement

Adequate nutrition & fluid levels

Bacterial

Gram-positive, filamentous, branching into actinomyces species include israelii, naeslundii, viscosus, odontoyticus, meyeri and bovis

"Ray fungus" but is bacterial!

acute or crhonic develops fibrous (wooden texture)

Cervicofacial (55% "lumpy jaw"), abdominal, thoracic, cutaneous and genital

Pus contains bacterial colonies ("sulfur granules")

Debridement & long-term antibiotic coverage

Penicillin or tetracycline for 5-12 weeks

W/ localized tongue, periapical or pericoronal infections that have been curetted, 2-3 weeks is adequate

Need to know salivary flow rate

Cats 40% are infected, reservoir, arthropod vector: cat flea

Bacillary angiomatosis - common in HIV

2000 cases/year, 80% children

Lymphadenopathy develops 2-10 weeks after injury

Malaise & fever in 50%

Solitary node in 50%, usually H&N, axilla

Nodes are tender

Skin may be red & nodular - erythema nodosum

CBC is normal or slight leukocytosis

Lymph node biopsy

Self-limiting disease

Lymphadenopathy usually resolves in 2-4 mos

contact w/ cat, presence of scratch, primary cutaneous or ocular lesion

Positive cat scratch skin test (Hanger Rose) --Not used

Negative results for other causes of lymphadenopathy

Histologic presence of pleomorphic bacteria B. henselae

Indirect fluorescent-antibody test

self-limiting, resolution w/in 4 months

If acutely ill - azithromycin, oral trimethoprim-sulfamethoxazole, rifampin

HIV/AIDS: erythromycin, doxycycline, or combination isoniazid, rifampin and ethambutol

Gram negative bacillus B. henselae

Common in HIV infections