Infectious

• 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.

• Bacterial

• Viral

• Fungal Bacterial infections • • • • • Pyogenic • • Tetanus • Cat scratch disease • Pyostomatitis vegetans Bacterial infections • • • • ANUG • • • • Tonsillitis & Pharyngitis • Sinusitis Impetigo • Superficial • pyogenes or • Flaccid bullae‐‐‐ Amber crusts(Honey colored ) • Similar to recurrent , exfoliative 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 • Pastia lines ( Capillary fragility in zones of stress) SCARLET FEVER

RASPBERRY TONGUE WHITE STRAWBERRY TONGUE or RED STRAWBERRY TONGUE Syphilis ORAL MANIFESTATIONS OF SYPHILIS

Primary syphilis – lip

Secondary syphilis Mucous patches on mucosa

Snail track ulcers

Rubbery enlarged lymph nodes

Tertiary syphilis Gumma on palate

Glossitis

Syphilitic Primary syphilis

Chancre Primary syphilis Primary syphilis Secondary syphilis

Eryhtematous rash

Mucous patch Tertiary syphilis

Syphilitic Tertiary syphilis

Gumma

Gumma perforating the palate • Frontal bossing • Short maxilla • High palatal arch • • Higoumenaki’s sign • Rhagades and saber shin • Hutchinsons triad Hutchinsons triad

• Hypoplasia of teeth

• VIIIth nerve deafness

• Interstitial keratitis Congenital syphilis Congenital syphilis (Granuloma pyogenicum) • 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 (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 Scattered vessels and granulation tissue inflammatory cells Pregnancy tumor

• Third month of pregnancy

• Result of minor trauma or irritation

• Tissue reaction intensified by endocrine

alteration Cat scratch disease

• 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 Cat scratch disease

Intra-nodal area of formation Diphtheria

• Diphtheriae

• Bull neck

• Diphtheritic membrane

• Strangling angel of children Tetanus (Lock Jaw )

• Infection of nervous system

• 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

• tuberculosis‐ Rod shaped,

non‐spore forming, thin aerobic acid fast

bacilli

• ‐ Bovine tuberculosis PATHOGENESIS OF TB LYMPHADENITIS Inhalation of the Bacilli

Phagocytosis by Macrophages

Resist degradation (Development of Type IV Hypersensitivity)

Persistence of Injurious agent

Cell Mediated Agent sequestered within Immune Response Macrophages

Recruitment of macrophage – Epitheloid Cells And giant cell formation

Granuloma Tuberculosis

• Necrotic material undergoing calcification‐ ranne complex

• TB of submaxillary and cervical lymph nodes – scrofula

• Primary TB of skin‐ ( Papular nodules which ulcerate) Tuberculosis FINE NEEDLE ASPIRATION Tuberculoma GRANULOMA Granuloma is defined as a circumscribed, tiny lesions, about 1mm in diameter, composed predominantly of collection of modified, macrophages called as epitheloid cells and rimmed at the perephery by lymphoid cells. Tuberculoma

An near Collection of foamy the upper lip macrophages Ares of caseous necrosis with multinucleated giant cells Tuberculous ulcer

• 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 Investigations

¾Chest radiographs ¾Mantoux test ¾Staining of microscopy smears ¾Culture ¾Radioimmunoassays ¾Fluorescent antibody test ¾ELISA ¾DNA probes ¾PCR FINE NEEDLE ASPIRATION CYTOLOGY

¾ Smear shows several cluster of epitheloid cells,reactive histocytes, (macrophages)along the cells of lymphoid series.

9The features suggestive of granulomatous adenitis. 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

• ‐ 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 Leprosy

HISTOPATHOLOGY

Sheets of lymphocytes and Acid fast stain – Numerous histiocytes exhibiting scattered lepra mycobacterial organisms in clusters cells Actinomycosis

• Granulomatous suppurative and fibrosing disease • Gram positive filamentous • Common organism –A . Israelli • Others –A. naersuundii, A. viscosus, A. odontolyticus and A. propionica • A. bovis – Lumpy jaw in the cattle Actinomycosis

• Sulfur granules – • Based on location: Cerviofacial Abdominal Pulmonary • Etiopathogenesis –trauma –Extracted socket, periodontal pcket, non‐vital tooth or mucosal abrasions Actinomycosis

• Localized 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 appearance • Methenamine silver stain Actinomycosis Actinomycosis

Ray fungus appearance

Peripheral club ends exhibiting rosette pattern NOMA ( Cancrum oris; gangrenous ) • 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‐ • Foul odor • High temperature ; toxemia • Site –gingiva, jaws , lips and cheeks NOMA ANUG Tonsillitis & Pharyngiits

• Group A ‐ β hemolytic streptococci Oral lesions • Erythema and 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