Manifestation of bacterial and viral diseases in oral cavity

1. I. Manifestationofbacterial and viraldiseases in oral cavity 6DM

2. Common childhood affections in oral cavity • Viral –primary herpetic gingivostomatitis, secondary herpes labialis, herpangina, chickenpox, mumps, measles, gladular fever, HIV • Bacterial –impetigo, streptococcal stomatitis, acute ulcerative gingivitis (rare under 16) • Fungal -candida • Miscellaneous –aphtous ulceration

3. 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

4. Measles - Morbilli • 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.

5. 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.

6. Small white spotswith 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,

7. 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. • 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

8. Measles - Morbilli • 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

10. Inflammation and Infection: Hand – Foot – Mouth disease • 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. • Cause Coxsackie virus, enterovirus. • Incubation period: 3-7days • Incidence The infection commonly affects young children from 2 weeks to 3 years old.

11. Inflammation and Infection: Hand – Foot – Mouth disease • 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.

12. Inflammation and Infection: Hand – Foot – Mouth disease • 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

13. Inflammation and Infection: Hand – Foot – Mouth disease • Treatmentsymptomatic. - salt water mouth rinses can be soothing. An adequate fluid intake is important. Rivanol, vit.B,C, liquid powder, ATB, Zovirax • Complications - possible convulsions with high fever (febrile seizures). - viral meningitis.

15. Gingivostomatitisherpetica • HSV • The most common viral stomatitis, primary infection • Occurrence: in children 1-6 years                adolescents and adults up to 35 year • Transmission: droplet infection and direct contact • Incubation period: 5-7 days • Clinically: prodromal stage with uncharacteristic symptoms, sore throat, enlarged lymph nodes. After 1-4 days, the generalsymptomssubside and intraoral appear. A typical small intraepithelial vesiclesthe reddened oral mucosa, including gingiva

19. Mumps - Parotitis epidemica • CAUSE:Mumps virus, Paramyxoviridae • TRANSMISSION:direct contact with droplets of saliva • INCUBATION PERIOD:18-22 days • SYMPTOMS:sudden onset of fever (38C,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

20. Mumps - Parotitis epidemica • 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,

21. Mumps - Parotitis epidemica • 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

22. Mumps - Parotitis epidemica • 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

23. 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

24. Rubella – German measles I.O.: small, red papules on the area of the soft palate, tongue non-specific, as in morbilli • 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

25. 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

27. 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

28. DIAGNOSIS:clinical picture, lymphocytosis, Paul-Bunnell 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

29. Mononucleosis – Glandular fever ACUTE FORM: • 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)

31. Chickenpox - Varicella • 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

32. Chickenpox - Varicella • DIAGNOSIS:clinical, typical prodromal symptoms, vesicle fluid examination, or direct fluorescent antibody • TREATMENT:symptomatic, sodium bicarbonate baths or antihistamine medication ease itching, paracetamol , liquidtalcwithmenthol

33. Chickenpox - Varicella • 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

34. Smallpox - Variola • 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 • Any surgery is contraindicated • ATB to prevent secondary infection

35. Scarlet fever - Scarlatina • CAUSE:exotoxin released by β-haemolytic streptococci • TRANSMISION: airborne droplet emision • INCUBATION PERIOD: 1-7 days • SYMPTOMS:very painfulsore 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

36. Scarlet fever - Scarlatina strawberrytongue • 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 C-reactive 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

37. TREATMENT: ATB(PNC,clindamycin or erythromycin) - agrimony tea irrigation, intensive oral hygiene COMPLICATIONS:septic complications due to spread of streptococcus in blood

38. Diphtheria 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

39. Diphtheria 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 ore • Sore throat, vomiting, fever, enlargement of cervical LN, slightly painful • DIAGNOSIS:. isolation of Corynebacterium diphtheriae from a clinical specimen, histopathology

40. 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 others- Erythromycin, Procaine penicillin, Rifampin or Clindamycin - Local - mouthwashes, intensive oral hygiene

41. Pertussis – whooping cough • 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).

42. I.O.: catarrhal stage – non-specific stomatitis paroxysmal stage – ulcusfrenulilinguae, 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

43. Impetigo is a highly contagious bacterialskininfection most common among pre-school children. People who play close contact sports such as rugby, American footballand wrestling are also susceptible, regardless of age. Impetigo is not as common in adults. The name derives from the Latinimpetere It is also known as school sores. Impetigo contagiosa This common form of impetigo, also callednonbullous impetigo, most often begins as a red sorenear 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.[3]

44. Impetigo contagiosa This common form of impetigo, also callednonbullous impetigo, most often begins as a red sorenear 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.

45. 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.

46. Treatment For generations, the disease was treated with an application of the antisepticgentian 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.

48. Inflammation and Infection: Candidiasis (Oral Thrush) • 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.

49. 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 anti-cancer 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.

50. 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.