Course and forms of infection
Special in oral cavity
MUDr. Lenka Černohorská, Ph.D.
Natural history of infectious disease
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The incubation period: time between
acquisition of the organism/toxin and 1st
symptoms
The prodromal period: non specific
symptoms (fever, loss of apetite)
The acute specific illness: characteristic signs
and symptoms
The recovery period: the patient returns to
health
Course and forms of infection
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Acute (running nose) – hours to days
Subacute (endocarditis) – weeks
Chronic (HIV) – years
Communicable diseases
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endemic – low level in a specific
population (Malaria in African countries)
epidemic – much more frequently than
usual (epidemic influenza in the winter)
pandemic – worldwide distribution (HIV)
Course and forms - others
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Inapparent (subclinical) infection – without
symptoms, asymptomatic although infected
Chronic carriers – once infected, body can not
completly eliminate the pathogen after recovery
Latent state – after period of a time reactivation
and recurrence of symptoms may occur (primary
infection of herpes reside in a latent state in
ganglion, causing reccurent labial herpes).
Types of infection
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Exogenous origin – transmission from
external sources
Endogenous – are caused by members of
the normal flora (opportunist pathogen)
The ways of transmission
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Inhalation – the airborne route (grip)
Ingestion – faecal contamination of food
and water (salmonela)
Inoculation – sexual contact, needles, skin
contact, blood transfusions or biting insects
(HIV…)
Determinants of infection
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Immune status (immunocompromited)
Genetic constitution
Age (children, old people)
Hormonal status
Pregnancy
Personal habits (smoking, drug using…)
Microbial diseases in oral cavity
Oral manifestation of bacterial infection
Scarlet
fever - Streptococcus pyogenes, forming erytrogennous toxin,
exanthema on soft palate curves and uvula, coalescent, scarlet red enanthema,
white coated tongue, rich red with markedly exserted papillae –raspberry
tongue, enlarged+painfull submandibular lymph nodes.
Skin rush – coalescent light red spots missing in perioral area
Therapy: penicillin
Source: Wikipedia
Oral manifestation of bacterial infection
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Diphtheria - Corynebacterium diphtheriae pseudomembranous tonsilitis/laryngitis (croup). A thick,
adherent pseudomembrane is present on tonsils or pharynx,
may involve nasal mucosa, the pharyngeal wall and the soft
palate. Oedema involving the cervical lymph glands may
occure in the anterior tissues of the neck – bullneck diphteria.
Oral manifestation of bacterial infection
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Gonorrhoea - gonococci - tonsilitis and faryngitis
Oral manifestations of bacterial infection - Syphilis
Primary – chancre – lips, tongue
Secondary – mucous patches of the tonsils, soft palate, cheek
Tertiary syphilis – gumma – hard palate, lips and tongue
primary syphilis
Oral manifestations of bacterial infection - Syphilis
Typical changes seen on permanent teeth (congenital) :
 Hutchinson´s incisors upper central incisors: barrel-shaped,
crescentic notch at the incisal edge
 Mulberry (moon) molars first molar teeth have a roughened
dirty, yellow, hypoplastic occlusal surface, poorly developed
cusps resembling the surface of mullbery.
mullberry molars
Hutchinson´s incisors
Source: kmil.trios.cz/ObrLues/hutchin1.JPG
TBC and Leprosy in oral cavity
TBC
ulcers, granulomas, fissures, diffuse inflamatory lesions
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Leprosy
Tuberculoid leprosy - paraesthesia of the face, lips,
tongue, palate, cheeks or gingiva
Lepromatous leprosy – saliva is infectious, tooth loss,
premaxillary bone resorption, saddle nose, intraoral
nodules with tend to ulcerate
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Viruses in oral cavity
Herpes simplex (HSV)
HSV-1 (oral), HSV-2 (genital)
Pathogenesis: Primary infection of children – innaparent or
gingivostomatitis. Lesions on tongue, palate and gingiva +
itching or burning sensation, blisters develope-enlarge-rupturebecome encrusted. Gingiva – oedema, painfull, redish
Latent infection – activation due to stress etc. - herpes labialis
Dg. Smears from lesions to transport medium, antigen detection immunofluorescence, serology
Therapy: Acyclovir
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Dentist – frequent in paronychium, disease from work
Viruses in oral cavity
Varicella-zoster (VZV)
Before the typical skin rash in chickenpox develops- lesions on the
hard palate, pillars of the fauces and uvula: small ulcers
surrounded by an area of erythema, quickly rapture
Oral manifestations of zoster – severe pain like in toothache, one
side enantem
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Epstein-Barr (EBV) – infectious mononucleosis
Petechial haemorrhages at the junction of the hard and soft palates
– Holzel´s sign, later pseudomembrane tonsilitis,
submandibular lymfadenitis.
Edema of Waldeyer lymphatic circle cause problems with
breathing
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Viruses in oral cavity
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Human herpesvirus 6 (HHV-6) - exanthema subitum/roseola
infantum (6th exantematic disease). Virus is present in the saliva,
forms erythematous papules seen in soft palate and uvula
(Nagayama´s spots)
Morbillivirus – in prodromal state, Koplik‘s spots on bucal
mucose against molares – little white spots surrounded by dark
red margine
Koplik´s spots
Viruses in oral cavity
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Coxsackievirus
Herpangina small (1-2 mm in
diameter) papulovesicular lesions, with
greysh-white surface surrounded by red
areolae, especially in the palate/uvula herpetic like - A 2, A 4-6, A 8
Hand-foot-mouth disease – briht-red
macules, in oral cavity later form
oval/grey vesicles with red areolae
Hand-foot-mouth disease
http://pathmicro.med.sc.edu/virol/picorna.htm
HIV in oral cavity
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Mycotic: Oral candidosis
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Viruses: EB-virus specific damage - not painfull whitish
corrugated lesions on the tongue margines – hairy
leukoplakia, Kaposi´s sarcoma, herpetic gingivostomatitis and
oral papilloma
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Bacterial infection: gingivitis (linear marginal erytema/
ulcerous gingivitis), necrotizing stomatitis and necrotizing
ulcerous parodontitis
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Cervical lymphadenopaty, lymphomas
Mycotic infection
Oral candidiasis - Candida albicans
Oportunne patogen. Predisposition – skin laesions, teeth
implantates, malnutrition, diabetes mellitus,
leukaemia, surgical operations, burnings, AIDS,
immunosupresive therapy, antibiotic use
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Therapy - local (clotrimazol), systemic (fluconazol,
itraconazol, amphotericin B), autovaccines
Mycotic infection
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Pseudomembranous candidiasis (thrush) – erythematous mucous
membrane with milk white pablanes - newborns, older people, in
immunocompromised is chronic, in HIV may spread into oesophagus
Erythematous (atrophic) candidiasis
Acute - result after broad-spectrum antibiotic therapy, dysmicrobie of oral cavity
– mucous membrane. Oral cavity: erythematous areas, burning sensation.
Chronic - protetic stomatitis – frequently observed in elderly people wearing full
dentures orthodontic appliances. Erythema+oedema of the mucosa.
Therapy: removal of dentures at night, desinfection of dentures, carbohydrate
diet
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Hyperplastic candidiasis (candida leukoplakia) – chronic, from small,
palpable, whitish areas to large, dense plaques, hard and rough to touch, on
the inside surface of cheeks. High risk of malignant transformation!
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Angular candidiasis - in one or both angles of the mouth, especially as a
complication of protetic stomatitis, erythema and fissuring, vit. B12
deficiency
Salivary gland infection - bacterial
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Acute suppurative parotitis (sialoadenitis suppurativa acuta)
- painfull
Agens: alfa-haemolytic streptococci, S. aureus, haemophilus,
eikenela, peptostreptococci
After intraabdominal operation acute afteroperation parotitis,
first serous, later absceding
Salivary gland infection – viral - non suppurative
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Parotitis epidemica (mumps) - replication in salivary duct
epithelial cells – pain on chewing, redening of the opening of
the duct, enlargement of gland + decrease of saliva secretion
Complications: meningitis, orchitis of adult males
(painfull+sterility), pancreatitis (increase of amylase level),
nephritis
Dg.: electron microscopy, serology (IgM detection – IF)
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CMV - after reactivation of latent infection sialoadenitis
(AIDS, immunosupression, cytostatic therapy)
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HIV - minority - xerostomia and enlargement of the major
salivary gland+ Sjögren´s syndrom (dry keratoconjunctivitis
and progresive polyartritis)