Infectious Disease
• The successive invasion of microorganisms into
the tissues of an individual, their multiplication,
production of toxins and the resulting disease
process is called infectious disease.
Infections
• Bacterial
• Viral
• Fungal
Bacterial infections
• Impetigo • Erysipelas • Scarlet fever• Syphilis • Pyogenic granuloma• Diphtheria • Tetanus • Cat scratch disease • Pyostomatitis vegetans
Bacterial infections
• Tuberculosis • Leprosy • Actinomycosis • ANUG• Noma • Granuloma inguinale • Tularemia • Tonsillitis & Pharyngitis • Sinusitis
Impetigo
• Superficial infection
• Streptococcus pyogenes or staphylococcus aureus
• Flaccid bullae‐‐‐ Amber crusts(Honey colored )
• Similar to recurrent herpes simplex , exfoliative cheilitis
IMPETIGO
AMBER CRUSTS OF THE CHIN
Erysipelas
• St anthony’s fire
• Butterfly rash
• D/D: SLE
ERYSIPELAS
Red swollen area of the cheek
Scarlet fever
• Β‐hemolytic streptococci
• Erythrogenic toxin
• White and red strawberry tongue
• Sun burn with goose pimples
• Pastia lines ( Capillary fragility in zones of stress)
SCARLET FEVER
WHITE STRAWBERRY TONGUE RASPBERRY TONGUE
orRED STRAWBERRY TONGUE
Syphilis ORAL MANIFESTATIONS OF SYPHILIS
Primary syphilis Chancre – lip
Secondary syphilis Mucous patches on mucosa
Snail track ulcers
Rubbery enlarged lymph nodes
Tertiary syphilis Gumma on palate
Glossitis
Syphilitic leukoplakia
Primary syphilis
Chancre
Primary syphilis
Primary syphilis
Secondary syphilis
Eryhtematous rash
Mucous patch
Tertiary syphilis
Syphilitic glossitis
Tertiary syphilis
Gumma perforating the palate
Gumma
Congenital syphilis
• Frontal bossing
• Short maxilla
• High palatal arch
• Saddle nose
• Higoumenaki’s sign
• Rhagades and saber shin
• Hutchinsons triad
Hutchinsons triad
• Hypoplasia of teeth
• VIIIth nerve deafness
• Interstitial keratitis
Congenital syphilis
Congenital syphilis
• Tumor‐like growth
• Botryomycotic infection , an infection in horses
• C/F: Elevated,pedunculated or sessile vascular mass withn smooth, lobulated or even a warty surface
• Facial aspect including the interdental papilla
• Deep red or reddish purple, depending on its vascularity,painless and soft in consistency
• Exudation of purulent material
Pyogenic granuloma (Granuloma pyogenicum)
Pyogenic granuloma (Pregnancy tumor )
Histologic features of pyogenic granuloma
• Atrophic epithelium
• Vast no of endothelial lined vascular spaces,
proliferating fibroblasts, budding endothelial
cells
• Older lesions‐ obliteration of capillaries –
becomes fibrous‐ fibro‐epithelial polyp or
fibroma
Pyogenic granuloma
Exophytic mass exhibiting granulation tissue
Scattered blood vessels and inflammatory cells
Pregnancy tumor
• Third month of pregnancy
• Result of minor trauma or irritation
• Tissue reaction intensified by endocrine
alteration
Cat scratch disease
• Bartonella hensalae – Gram negative bacillus
• Oculoglandular syndrome of parinaud
• Warthin starry silver staining
• Brown‐Hopps gram staining
Cat scratch disease
Papule on the forehead
Cat scratch disease
Submandibular lymphadenopathy
Cat scratch disease
Intra-nodal area of abscess formation
Diphtheria
• Corynebacterium Diphtheriae
• Bull neck
• Diphtheritic membrane
• Strangling angel of children
Tetanus (Lock Jaw )
• Infection of nervous system
• Clostridium tetani
• Acts at the synapse of interneurons of
inhibitory pathways and motor neurons to
produce blockade of spinal inhibition
Pyostomatitis
Snail track ulceration
Bacterial infections
• Tuberculosis • Leprosy • Actinomycosis • ANUG• Noma • Granuloma inguinale • Tularemia • Tonsillitis & Pharyngitis • Sinusitis
TUBERCULOSIS
A LUMP IN THE NECK…??
Umm…… SO…?????
DISTRIBUTION
DRAINAGE
DETECTION
Tuberculosis
• Mycobacterium tuberculosis‐ Rod shaped,
non‐spore forming, thin aerobic acid fast
bacilli
• Cattle‐ Bovine tuberculosis
PATHOGENESIS OF TB LYMPHADENITISInhalation of the Bacilli
Phagocytosis by Macrophages
Resist degradation (Development of Type IV Hypersensitivity)
Persistence of Injurious agent
Cell Mediated Agent sequestered withinImmune Response Macrophages
Recruitment of macrophage – Epitheloid CellsAnd giant cell formation
Granuloma
• Necrotic material undergoing calcification‐ ranne
complex
• TB of submaxillary and cervical lymph nodes –
scrofula
• Primary TB of skin‐ Lupus vulgaris (
Papular nodules which ulcerate)
Tuberculosis
Tuberculosis
FINE NEEDLE ASPIRATION
Tuberculoma
GRANULOMAGranuloma is defined as a circumscribed,
tiny lesions, about 1mm in diameter,composed predominantly of collection ofmodified, macrophages called as epitheloidcells and rimmed at the perephery bylymphoid cells.
Tuberculoma
An ulcer near the upper lip Collection of foamy
macrophages
Ares of caseous necrosis with multinucleated giant cells
• Ulcer ‐ characterised by
undermined edge and with
yellowish base and
surrounding areas of
erythema and edema
• Ulcer surrounded by single
or multiple nodules –
sentinal tubercles.
Tuberculous ulcer
Tuberculous gingivitis
Chest radiographs
Mantoux test
Staining of microscopy smears
Culture
Radioimmunoassays
Fluorescent antibody test
ELISA
DNA probes
PCR
Investigations
FINE NEEDLE ASPIRATION CYTOLOGY
Smear shows several cluster of epitheloidcells,reactive histocytes, (macrophages)along thecells of lymphoid series.
The features suggestive of granulomatousadenitis.
FNAC
LOW ‐ POWER HIGH ‐ POWER
Staining
Ziehl Nielsen staining
Kinyoun’s cold staining methods
Rhodamine staining for fluorescent microscopy
Culture
Culturing the mycobacteria from infected tissue
or sputum
• Conventional‐ 1. LJ medium
2.agar based media‐
(eg:Middle brook medium)
• Faster methods‐ 1.Rapid slide culture
2.radiometric culture
Leprosy
• Mycobacterium Leprae‐ Gram positive bacillus
Clinical features :
• Two polar forms‐ Tuberculoid and lepromatous
• Host response – Borderline and indeterminate
• Hypopigmented patches
• Leonine facies
• Loss of cutaneous sensation; facial paralysis
Oral Manifestations :
• Leproma
Leprosy
Histologic features :
• Granulomatous nodule
• Langhans type giant cells
• Lepra cells‐ sheets of lymphocytes with vacuolated macrophages
Diagnosis:
• Ziehl neelson method – 10 to the power of 11 bacilli
Leprosy
Sheets of lymphocytes andhistiocytes exhibiting scattered lepracells
Acid fast stain – Numerousmycobacterial organisms in clusters
Leprosy
HISTOPATHOLOGY
Actinomycosis
• Granulomatous suppurative and fibrosing disease
• Gram positive filamentous bacteria
• Common organism – A . Israelli
• Others – A. naersuundii, A. viscosus, A. odontolyticus and A. propionica
• A. bovis – Lumpy jaw in the cattle
Actinomycosis
• Sulfur granules – Botryomycosis
• Based on location:
Cerviofacial
Abdominal
Pulmonary
• Etiopathogenesis – trauma – Extracted socket, periodontal pcket, non‐vital tooth or mucosal abrasions
Actinomycosis
• Localized abscesses following a woody appearance
• Actinomycotic osteomyelitis
• Simulation of pulp related infection
Actinomycosis
• MNGC + macrophages
• Individual colony‐ round or lobulated ; peripheral club shaped ends of filaments
• Ray fungus appearance
• Methenamine silver stain
Actinomycosis
Actinomycosis
Ray fungus appearance
Peripheral club ends exhibitingrosette pattern
NOMA
( Cancrum oris; gangrenous stomatitis )
• Devour ( Spreading sore)
• Debilitated and nutritionally deficient persons
• Internees of the belson concentration camp ( world war II)
• Secondary complication of systemic disease
• Vincents organism
• Other organisms – Pseudomaonas Aerugiosm , E.coli, klebsiella, S. Aureus
NOMA
• Small ulcer
• Stagnation around FPD
• Blackening of skin‐ gangrene
• Foul odor
• High temperature ; toxemia
• Site – gingiva, jaws , lips and cheeks
NOMA
ANUG
Tonsillitis & Pharyngiits
• Group A ‐ β hemolytic streptococciOral lesions
• Erythema and inflammation of the oro‐pharynx and tonsils.
• Palatal petechiae
• Enlarged tonsils
• Yellowish tonsillar exudate – patchy or confluent.
Diagnosis
• Clinical sign and symptoms
• Throat culture
• Rapid antigen detection test