-Infectious Disease of the Oral & Maxillofacial Complex-

Etiology - malnourished, immune suppressed, kids > adults, staph & strep

Clinical/radiographic features - broken skin, highly infectious, redness, blisters, pus, "stuck on" honey colored crusts, 70% have red flat areas, angular cheilitis (cold sore on corner of mouth), lymphadenopathy (swollen lymph nodes), fever-rare

Histo -

Dx - may resemble HSV or exfoliative cheilitis (inflammation of the lip)

Tx - topical (mupirocin (Bacroban))  or systemic antibiotic (for bullous clindamycin, cephalexin, dicloxacillin), redness may take several weeks to resolve

Prognosis - should heal without scarring

Etiology - group A hemolytic strep (GAS) (common with strep tonsillitis or pharyngitis), exotoxin released by strep pyogenes, can counteract with proteins in kidneys, "pharyngitis with a rash", aerosol direct contact, contaminated milk

Clinical/radiographic features - fever for 6 days (103), enanthem (erythema, petechiae, mucosal sloughing, "strawberry/rasberry tounge", circumoral pallor, exanthem (rash, "sunbrun w/ goose pimples", more intense an areas of pressure (Pastia's lines), diffuse erythema, swollen lymph nodes (very common w/ many diseases), rash clears in 1 week then epithelial desquamation (flakes of skin) for several months,

Histo -

Dx - throat culture or rapid detection method of GAS clinical

Tx - incubation 7 days, penicillin or erythromycin (10 days)

Prognosis - excellent with tx, complication w/ glomerulonephritis (renal disease) or rheumatic fever

Etiology - group A strep 15-30% of acute pharyngitis in kids and 5-10% adult, p2p...,

Clinical/radiographic features - palatal petechiae, swollen lymph nodes (lymphadenopathy), yellowish exudate (pus), fever 101-104

Histo -

Dx -

Tx - incubate 2-5 days, penicillin, amoxicillin, cephs (cephalexan), erythromycin if allergic, after 24 hours noncontagious

Prognosis -

Etiology - strep pneumonia, H. influenza, M. catarrhalis (large range of bacteria), common w/ allergies or fungal, many times after viral infx, history of rhinitis, 10% from odontogenic infx from maxillary teeth, dental trauma, noninflammatory odontogenic pathoses, iatrogenic, if antrolith (calcified mass) develops consider aspergillus

Clinical/radiographic features - soft tissue extending into sinus w/ nonviral tooth, implant causing rxn

Histo -

Dx -

Tx - difficult to manage, endo, apical surgery (Caldwelll-Luc), amoxicillin (2-4 weeks)

Prognosis -

Etiology - often follows tonsillitis

Clinical/radiographic features - stones from bacterial colony, may become entrapped and impacted, any age, usually asymptomatic, may be radio opaque if no mineral deposited, pain, abscess, ulcer, dysphagia (difficult to swallow), halitosis (bad breath), pneumonia from aspirated material and bad taste, seen on pano

Histo - desquamated keratin and debris

Dx - clincial or radiographic, actinomycosis (bact infx)

Tx - optional unless tonsillar hyperplasia present or clinical sx (symptoms), tonsillectomy, enucleation (removing it w/o cutting into it), irrigation w/ chlorhexidine, abx, laser cryptolysis

Prognosis - excellent w/ tonsillectomy

Etiology - treponema pallidum, bact likes to live in blood vessels

Clinical/radiographic features - obliterative endarteritis (occlusion of artery lumen), primary and secondary highly infx, 1 chancre (std, painless ulcer, 1-2% oral), heals w/o scarring, large lymph nodes, 1-12 (2-3) weeks after contact, 2 anywhere on body, fever, malaise, headache, sore throat, rash, mucous patches (snail track ulcer), oral erythema 30%, oral condyloma lata oral ulcer, immunocompromised HIV (lues maligna), 1-3 months after infx, latent asymptomatic, can last 1-30 yrs, 3 ascending aorta and CNS aneurysm, gumma (ulcer) of palate or tongue, luetic glossitis, 1/3 of all untreated 3-30 yrs after, congenital mother to child, Hutchinson's Triad 75% (teeth, eye keratitis, deafness), born w/ 2 so rash and cartilage destroyed, notched permanents, wrinkles around mouth (carotitis)

Histo -

Dx - scraping of lesion to see spirochetes only from genital, pain 4/10 max, biopsy for RPR (rapid plasma reagin), screening, may weeken during latency,

Tx - prednisone, penicillin, hard to tx in CNS & LN, allergic then erythromycin, tetracyline

Prognosis -

Etiology - gram - diplococci

Clinical/radiographic features - 2-5 days after infx, young people, std, asymp. purulent 10% men 50% women w/ 20% oral, can destroy repoductive organs, homosexual men and women up to 20% in std clinic, co-exist w/ chlamydia

Histo -

Dx - culture of neisseria gonorrhea (gram - diplococci), neutrophils have diplococci, antibiotic dots = resistance

Tx - abx resist, prophy antibiotics, cefixime, ofloxacin, etc...

Prognosis -

Etiology - myobacterium tb, advanced age, poverty, crowded situations

Clinical/radiographic features - active 5-10% especially AIDS, miliary tb gets in blood, ghon focus seen in chest xray, miliary tb goes everywhere (granulomas), fever, malaise, anorexia, night sweats, cough, "consumption". lupus vulgaris (facial lesion), scrofula (lesion in drainage lymph node), tongue palate lip most common oral

Histo - histiocytes, lymphocytes, macrophages form around antigen w/ necrosis in middle, multinucleated giant cell

Dx - skin test, chest xray, granulomatous (walled off) inflammation w/ necrosis, caseous necrosis, acid fast bacilli identified by Ziehl-Neelsen, fluorescent antibody

Tx - isoniazide, rifampin, prob w/ resistance

Prognosis -

Etiology - mycobacterium leprae, prefers cold areas of body (nerves), long term exposure

Clinical/radiographic features - similar to tb, tuberculoid-paucibacillary (few microorganisms in tissue), lepromatous-multibacillary (many mos bc bad immune system = many lesions), oral 11-60% (give 2 weeks then biopsy)

Histo -

Dx - granulomatous inflammation like tb w/o necrotic center, fite stain to identify acid fast bacilli

Tx - incubation 8-10 yrs, for tbp - 6 mo. rifampin and dapsone, lm - 2 yrs rifampin, clofazimin, dapson, thalidomide

Prognosis - good

Etiology - from normal oral flor due to immune suppressed, malnourished, viral infx, can begin w/ ANUG (NUG), usually w/ kids, dehydration, poor oral hygeine, measles, herpes, malignancy, HIV (p. aeruginosa 40% fatal), perio disease, stress

Clinical/radiographic features - gangrenous (necrotizing) stomatitis(inflammation of mucal lining), fever, distinct odor

Histo - mass of bact overunning granular tissue that has neutrophils and plasma

Dx -

Tx - w/ HIV be conservative use abx w/ fever, avoid surgery until calmed down, no HIV abx (chlorhexidine), penicillin, metron, wound debridement

Prognosis - 10% mortality and sever deformity of face

Etiology - gram positive, filamentous, branching mos, can grow in plaque and calculus, grows in pockets (anaerobic)

Clinical/radiographic features - very common aka ray fungus, acute/chronic fibrosis (wood), 55% cervicofacial (lumpy jaw), pus (sulfur granules), oral: soft tissue injury, perio or periapical, salivary gland, extraction sites, osteomyelitis (bone marrow infx), can get into lungs, leads to perio problems

Histo - sea of neutrophils around fungus (looks like mushroom)

Dx - expressed pus

Tx - debride, long term abx, pen, tetra, 5-12 weeks, curette 2-3 weeks

Prognosis -

Etiology - bartonella henselae (gram - bacillus), 40% of cats infected, bacillary angiomatosis common w/ HIV

Clinical/radiographic features - 80% kids <21, swollen lymph ipsilateral, 90% cat 8% dog, 50% malaise and fever, 50% node in H&N and axillla, red lesions (erythema), oral lesions, submandibular swollen nodes mimic odontogenic infxs, bac. angio. (elevated nodule wart like, seen in HIV)

Histo - bac. angio. granulamatous infl. w/ lymphocytes and some neutrophils

Dx - biopsy of enlarged lymph node, lymph node changes w/ pleomorphic bac, Hanger-Rose not used today

Tx - abx for sick kids gentamycin, oral trimethoprim-sulf, rifampin, adults ciprofloxin and HIV erythro or doxycycline

Prognosis - swollen nodes resolve up to 24 months

Etiology - engogenous, oportunistic, p2p, candida albicans (most common)

Clinical/radiographic features:

Psuedomembranous - most common, white lesion, can be rubbed off, scrape off and send to lab, tx w/ antifungals for great px

Chronic Erythematous -

Inflammatory papillary hyperplasia - removed w/ laser, doesn't resolve w/ antifungals

Leukoplakia - doesn't scrape off, immun sup

Endocrine Related -

Disseminated -

Angular Cheilites - 20% c. albicans, 60% mixed c. albicans and staph, 20% staph

Median Rhomboid Glossitis (central papillary atrophy) -  chronic persistant fungal infx, langerhan cells decreased, "kissing lesion", increased in diabetics, tx fluco, loss of filiform papilla, parakertosis, acanthosis, elongated rete ridges, PEH, microabscesses, fungal hyphae, seen w/ pas or silver (perpendicular sausages), PEH mimics SCCA (cancer), tx antifungal, px recent lesion complete resolution, chronic lesion complete or partial, w/ malignancy rare

Carcinoma Lingual Dorsum - cheesy tongue, may mimic MRG, white lesion, amyloidosis, granular cell tumor

Histo - spherical yeast 4-6mm

Dx - cytologic smear, biopsy, culture, KOH

Tx - angular che (oravig) miconazole nitrate 2%, betamethasone clotrimazole 1% and steroid for inflam, nystatin, clotrimazole, ketoconazole once a day, fluconazole, itraconazole, voriconazole well in imm sup, chlorhexidine, clean prosthesis

Prognosis -

Etiology - histoplasma capsulatum, dimorphic (mold, yeast), spores inhaled, bird poop

Clinical/radiographic features - flu sxs, 2-3 wks after infx, t cell granul. infl., antibody many wks later, acute lungs 1% for 2 wks, calcification of hilar nodes, chronic lungs in immunosupressed and elderly, extrapulmonary rare 2-10% HIV, oral lesions mimics cancer

Histo - granulomatous infl, no ct, many macrophages, yeast, PEH (pseudoepitheliomatous hyperplasia)

Dx -tissue sections, biopsy bc lesion is cancer like, H. capsulatum antigen

Tx - self-limited (analgesics and antipyretics), for chronic amphotericin B, ketoconazole, itraconazole (same for desseminated)

Prognosis - chronic w/o treatment 20% fatal, disseminated 20% fatal w/ treatment

Etiology - common w/ males, rare in immune suppressed, mold in soil, inhaled spores, blastomyces dermatitidis (8-20 microns in diameter)

Clinical/radiographic features - acute pneumonia, fever, cough, night sweats, angina, chronic mimics tb, disseminated in skin and oral mimic cancer

Histo - PEH (islands of epithelium), mimics cancer microscopically, acute, granulo. inflam., blastomyces dermatitidis (8-20 microns in diameter, doubly refractile cell wall)

Dx - examination of tissue, biopsy,

Tx - common for no tx, if very ill itraconazole, ketoconazole, amphotericin B

Prognosis - rarely fatal, prior to amphotericin 80-90% fatal, itra. has 95% cure

Etiology - coccidiodes immitis dimorphic fungus in soil, inhaled, 1-4 weeks incubation, disseminated in immune suppressed, lungs

Clinical/radiographic features - cutaneous lesion

Histo - c. immitis 20-60 microns, acute gran inflam, pas and silver help identify

Dx - biopsy, cytology, culture, serological test

Tx - for immune sup keto or fluco, amphotericin

Prognosis - HIV 43-60% fatal and life long tx, mild excellent

Etiology - cryptococcus neoformas, inhaled from soil, spread by pigeons, 10% HIV, immune suppress

Clinical/radiographic features - asx or flu like, desseminated 20% skin, meninges, bones, prostate, oral is rare

Histo - destroyed by neutros and macros, gran. inflam., 4-6 microns oval mo w/ clear capsule, stain w/ pas (periodic acid shift stain carbs), methenamine and silver or mucicarmine, vascular malignancy called Kaposi's Sarcoma

Dx - biopsy, culture, detect cryptococcal antigen in CSF

Tx - ampho, fluco and itra

Prognosis - guarded, depends

Etiology - oportunistic usually saprophytic mo, absidia, mucro, rhizopus, inhaled spores, sever rhinocerebral form in immune suppressed (poor controlled diabetes, HIV, leukemic)

Clinical/radiographic features - facial and nasal sxs, in max sinus swelling, ulcers, sinus can be filled, opacified, mimics cancer, in immune sup mucormycosis and phycomycosis (serious fungal infx)

Histo - 6-50 microns long right angle branching, nonseptate hyphae, involve small vessel and oclude (angiotrophic mo), necrosis after infarction

Dx - histology

Tx - surgical debride, ampho, control other diseases (diabetes and leukemia), tx leads to renal failure

Prognosis - poor

Etiology - allergic rxn or invasive in immune sup, aspergillus saprophytic mo in soil or water, most common a. flavus/fumigatus, inhales spores, nosocomial (hospital)

Clinical/radiographic features - low grade = fungus balls in sinus (aspergilloma), high = disseminated from lung to CNS, eye, skin, bone, GI (leukemia, corticosteroids)

Histo - 3-4 microns, septate hyphae, angiotrophic (occlude vessels), tissue absent in immune sup

Dx - biopsy, culture from lesions, in disseminated sputum and blood culture can be neg

Tx - IV amphotericin, maybe surgical

Prognosis - disseminated 30-40%, poor if underlying not controlled

Etiology - caused by protozoa (protozoa toxoplasma gondii), serious in fetus, HIV, transplants, cancer

Clinic/Radio - multiple large lymph nodes H&N, low grade fever, encephalitis, pneumonia, myositis, myocarditis

Histo -

Dx - biopsy maybe of lymph node, rising antibody titers 10-14 days, pregnant women avoid cat litter and raw meat 

Tx - not usually, sulfadiazine and pyrimethamine + folic acid, clindamycin, HIV prophy trimethoprim and sulfmethoxazole if CD4 less than 100 cell/uL

Px -

Etiology - p2p, std, survives 2-24 hours on surface

Clinic/Radio - primary gingivostomatis, recurrent herpes labialis, cold sore, fever blister, 1 and 2 genital,

Histo -

Dx -

Tx -

Px - latent for life