Bacterial infections (4)

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  • 1. BACTERIALDISEASES Prepared by: Dr. Rea Corpuz
  • 2. Bacterial Diseases (1) Syphillis (2) Tuberculosis (3) Leprosy (4) Actinomycosis (5) Cancrum Oris (NOMA) (6) Gonorrhea
  • 3. (1) Syphillis sexually transmitted disease caused by spirochete Treponema Pallidum acquired by sexual contact with a partner with active lesions by:  transfusion of infected blood  transplacental inoculation of fetus by infected mother
  • 4. (1) Syphillis Pathogenesis  when disease is spread through direct contact  a hard ulcer, or chancre forms at site of spirochete  later there is development of painless, non-suppurative regional lymphadenopathy
  • 5. (1) Syphillis Pathogenesis  chancre heals spontaneously after several weeks without treatment, leaving patient with no apparent signs of disease
  • 6. (1) Syphillis Pathogenesis  after a latent period of several weeks, secondary syphilis develops • patients infected via transfusion bypass primary stage & begin with secondary syphilis
  • 7. (1) Syphillis Pathogenesis  secondary syphilis • fever • flulike symptoms • mucucutaneous lesions • lymphadenopathy • stage resolves spontaneously, • patient enters latency period
  • 8. (1) Syphillis Clinical Features  Primary Phase  Secondary Phase  Tertiary Phase  Congenital Phase
  • 9. (1) Syphillis Clinical Features  Primary Phase • does not produce exudate • location is usually on genitalia • lesions heals without therapy in 3-12 weeks, with little or no scarring
  • 10. (1) Syphillis Clinical Features  Primary Phase • Chancre, a chronic ulcer at site of infection
  • 11. (1) Syphillis Clinical Features  Secondary Phase • if left untreated, begins about 2-10 weeks • spirochetes are now disseminated widely • inflammatory lessions may occur in any organ during this phase
  • 12. (1) Syphillis Clinical Features  Secondary Phase • Oral mucous patches • condyloma latum • maculopapular rash
  • 13. (1) Syphillis Clinical Features  Tertiary Phase • manifestations take many years to appear & can be profound • there is predilection for cardiovascular system + CNS
  • 14. (1) Syphillis Clinical Features  Tertiary Phase • Gummas (destructive ulcers) • central nervous system • cardiovascular diseases
  • 15. (1) Syphillis Clinical Features  Congenital Form • abnormal shape of molars/ incisors • deafness • ocular keratitis • skeletal defects
  • 16. (1) Syphillis Treatment  drug of choice for treating all stages of syphillis is penicillin  Treponema Pallidum is sensitive to antibiotics such as: • Penicillin • Erythromycin • Tetracycline
  • 17. (2) Tuberculosis infects about 1/3 of world’s population kills approximately 3 million people per year most important cause of death in the world
  • 18. (2) Tuberculosis caused by aerobic, non-spore forming bacillus Mycobacterium Tuberculosis  has thick, waxy coat  does not react with Gram stains
  • 19. (2) Tuberculosis Pathogenesis  spread is through small airborne droplets • carry organism to pulmonary air spaces
  • 20. (2) Tuberculosis Clinical Features  skin testing + chest radiograph • provide only indicators of infection
  • 21. (2) Tuberculosis Clinical Features  in reactivated disease, • low-grade signs + symptoms of fever • night sweats • malaise • weight loss
  • 22. (2) Tuberculosis Clinical Features  with progression, • cough • hemoptysis • chest pain (pleural involvement)
  • 23. (2) Tuberculosis Clinical Features  oral manifestations • follow implantation of M. tuberculosis from infected sputum may appear on any mucosal surface • tongue + palate are favored locations
  • 24. (2) Tuberculosis Clinical Features  oral manifestations • typical lesion is indurated chronic, nonhealing ulcer that is usually painful • bony involvement of maxilla + mandible may produce tuberculosis osteomyelitis
  • 25. (2) Tuberculosis Treatment  First line drugs likely to used fro treatment of TB include • isoniazid • rifampin • pyrazinamide • exambuthol
  • 26. (2) Tuberculosis Treatment  drug combinations are often used in 6, 9, or 12 month treatment regimens  may be extended as long as 2 years.
  • 27. (2) Tuberculosis Treatment  Bacille Calmette Guerin (BCG) vaccine is effective in controlling childhood TB,  but loses efficacy in adulthood
  • 28. (3) Leprosy also known as Hansen’s disease chronic infectious disease caused by acid-fast bacillus, Mycobacterium leprae moderately contagious
  • 29. (3) Leprosy transmission of disease requires frequent direct contact with an infected individual for a long period inoculation through respiratory tract is also believed to be a potential mode of transmission
  • 30. (3) Leprosy Clinical Features  there is clinical spectrum of disease that ranges from a limited form (tuberculoid leprosy) to a generalized form (lepromatous leprosy)  latter has a more seriously damaging course
  • 31. (3) Leprosy Clinical Features  skin + peripheral nerves are affected  organism grows best in temperatures less than core body temp of 37C
  • 32. (3) Leprosy Clinical Features  cutaneous lesions appear as erythematous plaques or nodules • represents granulomatous response to organism  similar lesions may occur intraorally or intranasally
  • 33. (3) Leprosy Clinical Features  in time, severe maxillofacial deformaties can appear • producing classic destruction of anterior maxilla • facies leprosa
  • 34. (3) Leprosy Treatment  chemotherapeutic approach in which, several drugs are used for protracted period, typically years
  • 35. (3) Leprosy Treatment  commonly used drugs: • dapsone • rifampin • clofazimine • minocycline • teratogen thalidomide  useful to manage complications of leprosy therapy
  • 36. (4) Actinomycosis chronic bacterial disease exhibits some clinical + microscopic features that are fungilike caused by Actinomyces israelii  an anaerobic or microaerophilic gram-positive bacterium  not regarded as contagious because infection cannot be transmitted from one individual to another
  • 37. (4) Actinomycosis infections usually appear after  trauma  surgery  previous infection
  • 38. (4) Actinomycosis Clinical Features  most infections are seen: • thorax usually preceded • abdomen by trauma or direct • head + neck extension of contagious infectiom
  • 39. (4) Actinomycosis Clinical Features  when it occurs in head + neck • condition is usually designated cervicofacial actinomycosis  swelling of mandible  skin lesion are indurated  having woody hard consistency  results to osteomyelitis that may drain through gingiva
  • 40. (4) Actinomycosis Radiographic Feature  radiolucency  irregular + ill-defined margins
  • 41. (4) Actinomycosis Treatment  Long-term, high-dose penicillin  For sever cases, intravenous penicillin followed by oral penicillin  Tetracycline + Erythromycin can be used
  • 42. (4) Actinomycosis Treatment  drainage of abscess  surgical excison of scar + sinus tracts • to enhance penetration of antibiotics
  • 43. (5) Cancrum Oris (Noma) also known as gangrenous stomatitis devastating disease of malnourished children destructive process of orofacial tissues
  • 44. (5) Cancrum Oris (Noma) results from oral contamination by heavy infestation of Bacteroidaceae particularly Fusobacterium necrophorum
  • 45. (5) Cancrum Oris (Noma) consortium of other microorganisms:  Borrelia vincentii  Staphylococcus aureus  Prevotella intermedia
  • 46. (5) Cancrum Oris (Noma) these opportunistic pathogens invade oral tissues whose defense are weakened by:  malnutrition  acute necrotizing gingivitis  debilitating conditions
  • 47. (5) Cancrum Oris (Noma) these opportunistic pathogens invade oral tissues whose defense are weakened by:  trauma  other oral mucosal ulcers
  • 48. (5) Cancrum Oris (Noma) Clinical Features  typically affects children  related disorder, noma neonatorum, oocurs in low- birth-weight infants  who suffer from debilitating diseases
  • 49. (5) Cancrum Oris (Noma) Clinical Features  initial lesion is a painful ulceration  usually gingiva or buccal mucosa  spreads rapidly + eventually becomes necrotic
  • 50. (5) Cancrum Oris (Noma) Clinical Features  denudation of involved bone may follow  leading to necrosis + sequestration
  • 51. (5) Cancrum Oris (Noma) Clinical Features  teeth in affected area may become loose + exfoliate  penetration of organisms into • cheek • lip • palate
  • 52. (5) Cancrum Oris (Noma) Treatment  fluids  electrolytes  general nutrition are restored  along with antibiotics • clindamycin • piperacillin • aminoglycoside gentamicin
  • 53. (5) Cancrum Oris (Noma) Treatment  fluids  electrolytes  general nutrition are restored  along with antibiotics • clindamycin • piperacillin • aminoglycoside gentamicin
  • 54. (5) Cancrum Oris (Noma) Treatment  debridement of necrotic tissue may also be beneficial if destruction is extensive
  • 55. (6) Gonorrhea one of the most prevalent bacterial disease in humans caused by gram-negative diplococcus Neisseria gonorrhoeae  infects columnar epithelium of • lower genital tract • rectum • pharynx • eyes
  • 56. (6) Gonorrhea transmitted by direct sexual contact with an infected partner short incubation period of less than 7 days absence of symptoms in many individuals, especially females
  • 57. (6) Gonorrhea genital infections may be transmitted to oral or pharyngeal mucous membranes through orogenital contact transmission from an infected patient to dental personnel is regarded as highly unlikely
  • 58. (6) Gonorrhea organism is very sensitive to drying requires break in skin or mucosa to establish an infection gloves provide protective eyewear adequate protection mask from accidental transmission
  • 59. (6) Gonorrhea Clinical Features  no specific clinical signs have been consistently associated with oral gonorrhea  multiple ulcerations  generalized erythema
  • 60. (6) Gonorrhea Clinical Features  in the more common pharyngeal gonococcal infection, presenting signs are usally • general erythema • associated ulcers • cervical lymphadenopathy
  • 61. (6) Gonorrhea Clinical Features  chief complaint may be sore throat,  although many patients are asymptomatic
  • 62. (6) Gonorrhea Treatment  uncomplicated gonorrhea responds to single dose of appropriately selected antibiotic
  • 63. References: Books Neville, et. al: Oral and Maxillofacial Pathology 3rd Edition • (pages 24-32)