Bacterial and fungal
infectious diseases,
affecting the oral mucosa
Acute disease from the group of
respiratory infections which
characterized by fibrinous
inflammation of mucous
membranes of oral cavity,
nasopharynx, larynx with toxic
lesion of cardiovascular and
nervous systems
Etiology
Corynebacterium
diphtheriae
Grampositive, nonmotile
(Leffler rod)
Don’t forms spores and capsules
Coloured by Neisser in brown-yellow color
Ru, Leffler, Clauberg mediums - blood agar with tellurium salts
Cultural-biochemical types of C. diphtheriae - mitis, gravis,
intermedius
Production of very strong exotoxin (gene tox +)
Structure of exotocin - dermanecrotoxin, hemolysin,
neuraminidase, hyaluronidase
Firm to low temperature, long save on a dry surfaces; high
responsive to heating and desinfection solutions
Epidemiology
Source – sick person or carrier (convalescent
or health) of toxicogenic strains
Ways of transmission - airborne, contact household (occasionally)
Sensibility is high, adults more often become
sick (80 %)
Case rate sporadic, outbreaks are possible
Immunodefence antitoxic, postvaccine
Seasonal character - autumn - winter
Diphtheria cases reported to World Health
Organization between 1997 and 2007
Pathogenesis
Penetration of the agent through
entrance gate (mucous of upper
respiratory tract, sometimes
conjunctivas, skin)
Production of exotoxin
Local and systemic effects of the toxin:
Dermonecrotoxin - necrosis of a surface
epithelium, retardation of blood stream,
rising of a permeability of vessels, their
fragility, transuding of plasma in ambient
tissues, formation of a fibrinous film,
edema of tissues; downstroke of pain
sensitivity
Pathogenesis
Neuraminidase - replacement of
cytochrome, blockage of cellular
respiration, destruction of a cell,
violation of a function of organs and
tissues (central and peripheric nervous
system, cardiovascular system,
kidneys)
Hyaluronidase - destruction of a stroma
of a connecting tissue (rising of
permeability of vessels, edema of
tissues)
Hemolysin - hemorrhagic set of
symptoms
Clinical manifestation
Incubation period – 2-10 days
Phenomena of intoxication (high fever,
malaise, general weakness, headache)
Pharyngalgia - moderate
Changes of a throat mucous - soft hyperemia,
edema of tonsills, covers on their surface
(grey colour, dense, hard to remove with
bleeding, slime), spread out of tonsills limits
(palatopharyngeal arches, uvula, soft palate)
Augmentation and moderate morbidness of
regional lymph nodes
Edema of a hypodermic fat of a neck
Peculiarities of diphtheria covers
(Grey colour, dense, hard to remove with bleeding, slime), spread
out of tonsills limits (on uvula, soft palate, palatopharyngeal archs)
Edema of a hypodermic tissues of a neck
Swollen neck in diphtheria
Features of diphtheria toxicosis
(In wide-spread, combined, hypertoxical,
hemorrhagic forms) toxicosis І, ІІ, ІІІ
Edema of the neck hypodermic tissues
Paleness of skin
Cyanosis of lips
Decreasing of arterial pressure
Tachycardia
Decreasing of a body temperature
Diphtheria of larynx
Real croup (stenosis of a larynx)
І degree (catarrhal) - labored inspiration,
retraction of intercostal spaces, rasping “dog
barking" cough, “horse” voice
ІІ degree (stenosis) - noisy respiration,
inspiratory dyspnea with an elongated
inspiration, participation in respiration of
auxiliary muscles, aphonia
ІІІ degree (asphyxia) - acute oxygen
insufficiency, sleepiness, cyanosis, cold
sweat, cramps, paradoxical sphygmus
Complications
Infectious-toxic shock
Intra vessels disseminated syndrome
Myocarditis (early, late)
Polyradiculoneuritis (early, late)
Nephrosonephritis etc.
LABORATORY DIAGNOSTIC
Detection of the agent in smears from a throat
and nose (taking of material on border
between effected area and normal mucous)
Microscopy (colouring by Neisser) – typical
locating of rods, grains of volutin in bacterias
Sowing on convolute serum or telluric blood
agar for allocation of clean culture and
recognizing of toxigenisity
Serological tests mirror a condition of immune
defence (efficiency of vaccination)
Treatment
Immediate hospitalization
Bed regimen (at localized forms - 10 days, at toxic not less than 35-45 days)
Specific treatment - introducing of antitoxic
antidiphtherial Serum (from 30-50 thousand IU at the
localized forms up to 100-120 thousand IU at toxic,
by Bezredka method)
Glucocorticoids (in toxic forms and croup)
Antibiotics (penicilini, tetracyclini, erythromycini)
Strychninum (in toxic forms)
In case of croup - inhalations, broncholitics, diuretics,
glucocorticoids, antibiotics, antihistamine, lytic
admixture; under the indications - intubation,
tracheotomy
Conditions of
discharging from a
hospital
Clinical convalescence
2 negative results of bacteriological
research of smears from a throat and a
nose with two-day interval
For decret group - additional double
bacteriological examination in polyclinic
Prophylaxis
Plan immunization (vaccination in 3, 4, 5
months. With АPДT vaccine, revaccination in 18
months; 6, 11, 14, 18 years and adults every 10
years with АДT-М vaccine)
In the focus –
7 days medical observation after contact persons
Bacteriological examination
Sanation of detected carriers
Final disinfection
Revaccination
Desinfection
Aeration and ultra-violet lighting of puttings,
wet cleaning with usage of 2/3-basic salt of
perchloron, calcium of hypochlorite, 3 % of
solution of chloraminum, 1 % of solution
amfolan
Sputum, the outwashes from a nasopharynx
hash with double quantity of solutions,
exposition 2 hours. The tableware is boiled in
2 % potassium solution 30 mines. Bedclothes and clothes if necessary to
decontaminate in desinfection camera
Differential diagnosis
Tonsillitis, including Plaut-Vincent-Simanovsky
Herpetic tonsillitis
ARVI (adenoviral infection, false croup)
Paratonsillar abscess
Infectious mononucleosis
Scarlet fever
Pseudotuberculosis
Tonsillo-bubonic form of tularemia
Mycotic affection of tonsills
Epidemic parotitis
Typhoid fever
Lues
Hematological diseases (acute leukosis,
agranulocytosis)
Acute infection of respiratory tract,
which
is
caused
by
meningococcous
(Neisseria
meningitidis)
and
clinically
represents in the forms of
nasopharyngitis,
sepsis
or
meningitis
The source of disease:
carriers (1 case per 2000 carriers)
patients with meningococcal
nasopharyngitis
patients with generalized forms of
infection
Mechanism of transmission – air-drop
Seasonal occurrence – February-April
Most of the patients are children under 10
Morbidity is sporadic, sometimes epidemic
Immunity is type-specific, steady
Classification:
I. Primarily localized forms:
- meningococcal carrier state;
- acute nasopharyngitis;
II. Hematogenic generalized forms:
- meningococcemia;
- meningitis;
- meningoencephalitis;
III. Mixed forms (meningococcemia+meningitis);
IV. Rare forms (endocarditis, arthritis, irideocyclitis,
pneumonia).
Complications: severe brain edema, infectious-toxic
shock
Rashes peculiarities:
haemorrhagic;
localization on buttocks, thighs, shins, trunk;
a lot of elements;
different sizes of elements – from patechial to the spread
hemorrhages;
non correct form, often star-like;
different coloring and brightness of elements;
necrosis in place of considerable hemorrhages with
formation of defects;
often combination of hemorrhages with roseolla and
papules.
Laboratory diagnostics
1. Revealing of infectious agent in smears
from pharynx, blood, liquor
- the material for stain should be taken without
touching of mucous membrane of cheeks and
tongue.
Microscopy: gram-negative diplococci with
intracellular localization
2. Serologic tests: in dynamic with interval 57 days
3. Express-diagnosis: immunofluorescent
method.
Treatment
Generalized forms:
- immediate hospitalization
- antibiotics in large doses (benzylpenicilline 200
000 – 500 000 U/kg, levomycetini succinatis)
- corticosteroids
- dehydratation therapy (in case of meningitis)
- desintoxication
- treatment of disseminated intravessel
coagulation (heparin, contrical, human plasma)
Sanation of meningococcus carriers:
- antibiotics in common doses (ampicillini,
levomycetini, rifampicini)
- local sanation (ultraviolet, ultrasonic)
- desensibilisation therapy
HIV-Infection viral disease of human, which is passed mainly
by sexual and parenteral ways and
characterized by long-term persistence. Defeat
of the thymus gland’s system of immunity,
causes clinically expressed form – syndrome
of acquired immune deficiency (AIDS) with
lymphadenopathy, intoxication, spreading of
infectious diseases and oncological processes
Properties of Kaposhi
sarcoma in patients with
AIDS:
- strike the persons of age young and middle
- primary elements appear on a head and trunk
- become purulent and varicosity
- metastasizes in internal organs, has a malignant
course
- is marked by high lethality, patients more frequent
does not exceed 1,5 year
Thanks for your
Attention!