Noma. Etiology, Pathogeny, Clinic, Diagnostics, Medical Treatment

MINISTRY OF HEALTH OF UKRAINE Ukrainian medical stomatological academy “Approved” On the meeting chair Of Propaedeutics Surgical Stomatology The Head of the Department prof. Novikov V.M. ___________ “ ____ ” _____________ 20 ____ GUIDELINES Individual work of students Educational discipline Surgical stomatology Module № 2 Inflammatory diseases in maxillofacial region. Nonodontogenous inflammatory diseases in Content module № 4 maxillofacial region Noma. Etiology, pathogeny, clinic, diagnostics, Theme lesson medical treatment. Vegener’s Syndrome, signs of AIDS in the oral cavity. Course 3 Faculty Stomatological Poltava 2018 1. Actuality of the topic: Noma, also known as cancrum oris and gangrenous stomatitis, is a rare disease of childhood that is characterized by a destructive process of orofacial tissues. The mechanism by which predisposing factors allow the microorganisms to become virulent pathogens is not understood. Wegener's granulomatosis is an inflammatory condition of unknown etiology. Efforts to identify a cause have generally focused on infection and immunologic dysfunction but have been unproductive. AIDS is the terminal stage of infection with the human immunodeficiency virus (HIV), which is recognized as undergoing a number of mutations. The underlying severe immunodeficiency leads to a number of oral manifestations which, although not pathognomonic, should raise the possibility of HIV infection. 2. The objectives of the studies: Etiology, pathogens, pathological anatomy, classification, features of a clinical course, methods of diagnostics noma, Vegener’s syndrome and AIDS. To be able: to establish the diagnosis of noma, Vegener’s syndrome and AIDS. 3. Basic knowledge, skills, skills necessary for study topics (interdisciplinary integration). Name of previous courses These skills Microbiology Agents who produce above named diseases, their property. Pathological anatomy An etiology, pathogens, of noma, Vegener’s syndrome and AIDS. Pathophysiology A pathogenesis of above named diseases. Pharmacology Drug for the treating of noma, Vegener’s syndrome and AIDS. Propedeutics of a surgical Methods examination of patients stomatology 4. Tasks for independent work in preparation for the classes. 4.1. A list of key terms, parameters, characteristics that must learn the student in preparation for the lesson: Term Definition Noma also known as cancrum oris and gangrenous stomatitis, is a rare disease of childhood that is characterized by a destructive process of orofacial tissues Wegener is a rare multisystem autoimmune disease of unknown etiology. granulomatosis (WG) Human Acquired immunodeficiency syndrome (HIV/AIDS) is a disease of the immunodeficiency human immune system caused by the human immunodeficiency virus virus infection (HIV) 4.2. Theoretical questions to lesson: 1. Give definition of of noma, Vegener’s syndrome and AIDS. 2. The etiology and pathogen of noma. 3. Clinic of noma. 4. Complex medical treatment of noma. 5. Medical treatment of noma. 6. Possible complications of noma and Vegener’s Syndrome. 7. The etiology and pathogen of Vegener’s Syndrome. 8. Clinical motion of Vegener’s Syndrome erysipelas. 9. Diagnostics is that differential diagnostics of noma, Vegener’s syndrome and AIDS. 10. Medical treatment and prophylaxis of Vegener’s syndrome. 11. The etiology and pathogen of AIDS. 12. Clinic of AIDS. 4.3. Practical works (tasks) are performed in class: − To take possession of technique of realization observation of the patients with noma, Vegener’s syndrome and AIDS. − To make a treatment planning of noma, Vegener’s syndrome and AIDS. − To acquire technique of carrying out observation of patient with noma, Vegener’s syndrome and AIDS. − To make the plan of examine of the patient with noma, Vegener’s syndrome and AIDS. − To make the plan of local treatment of patients with noma, Vegener’s syndrome and AIDS. 5. Theme contents: NOMA Etiology and Pathogenesis. Noma, also known as cancrum oris and gangrenous stomatitis, is a rare disease of childhood that is characterized by a destructive process of orofacial tissues. Necrosis of tissue occurs as a consequence of invasion by anaerobic bacteria (fusiform bacilli and Vincent's spirochetes) in a host whose systemic health is significantly compromised. Malnutrition is the most frequently cited predisposing factor, although debilitation from systemic disease, such as pneumonia or sepsis, has been described. The mechanism by which predisposing factors allow the microorganisms to become virulent pathogens is not understood. Noma shares many features with the more limited and more benign acute necrotizing ulcerative gingivitis (ANUG, or Vincent's infection). Both are caused by the same organisms, both require compromised hosts, and both result in tissue necrosis. Noma is rarely seen in the United States. It is typically found in relatively underdeveloped countries, especially those in which malnutrition or protein-deficient states are prevalent. Clinical Features. The initial lesion of noma is a painful ulceration, usually of the gingiva or buccal mucosa, that spreads rapidly and eventually necrotizes. Denudation of the involved bone may follow, eventually leading to necrosis and sequestration. Teeth in the affected area may become loose and may exfoliate. Penetration of organisms into the cheek, lip, or palate may also occur, resulting in fetid necrotic lesions. Before antibiotics were developed, fatalities from this disease were common. Treatment. Therapy involves treating the underlying predisposing condition as well as the infection itself. Therefore, fluids, electrolytes, and general nutrition are restored, along with the introduction of antibiotics (usually penicillin). Debridement of necrotic tissue may also be beneficial if there is extensive destruction. WEGENER'S GRANULOMATOSIS Etiology. Wegener's granulomatosis is an inflammatory condition of unknown etiology. Efforts to identify a cause have generally focused on infection and immunologic dysfunction but have been unproductive. Clinical Features. Typically, the triad of upper respiratory tract, lung, and kidney involvement is seen in this condition. Occasionally, only two of the three sites are affected. Lesions may also present in the oral cavity and skin and, potentially, in any other organ system. The basic pathologic process that is common to all foci is necrotizing vasculitis with granuloma formation. This is a rare disease of middle age. Initial presentation often occurs with head and neck symptoms. Symptoms typical of sinusitis, rhinorrhea, nasal stuffiness, and epistaxis may be seen with or without non-specific complaints of fever, arthralgia, and weight loss. In a majority of cases, nasal or sinus (usually maxillary) involvement is seen and is often present early in the course of the disease. Destructive lesions are typically ulcerated, with necrosis and perforation of nasal septum occasionally seen. Perforation of the hard palate is uncommonly seen in Wegener's granulomatosis. Intraorally, red granular gingival lesions have been reported. The process is generalized and results in relatively uniform enlargement. Most patients have kidney involvement that consists of a focal necrotizing glomerulitis. Renal failure is the final outcome of kidney disease. Inflammatory lung lesions, varying in intensity from slight to severe, may eventually lead to respiratory failure. Histopathology. The basic pathologic process is granulomatous, with necrotizing vasculitis usually present. Variable numbers of acute and chronic inflammatory cells are seen in the granulomatous zones. Necrosis and multinucleated giant cells may be seen in the granulomatous areas. The affected small vessels show a mononuclear infiltrate within their walls in the presence of fibrinoid necrosis. Definitive diagnosis in the absence of vascular changes is difficult, since the microscopy would be nonspecific. Diagnosis. Diagnosis is generally dependent upon the finding of granulomatous vasculitis in biopsy tissue of upper respiratory tract lesions, evidence of involvement of lung, or kidney lesions. Development of labeled antineutrophil cytoplasmic antibodies (ANCA) has provided serologic correlation with biopsy-proven vasculitis. On both a clinical and a microscopic level, chronic infectious processes, such as TB, syphilis, histoplasmosis, and blastomycosis, and neoplastic processes, such as lymphoma and undifferentiated squamous cell carcinoma, might be serious considerations in a differential diagnosis of this disease. Culture and tissue identification of microorganisms, when negative, would help rule out infectious processes. Immuno-histochemical staining or immune-fluorescent procedures could be used to help rule out neoplasia, especially on frozen sections. Treatment. Before the development of chemotherapeutic agents, renal failure and death were frequent outcomes of this disease process. The use of the cytotoxic agent cyclophosphamide and corticosteroids has provided patients having this disease with a relatively good prognosis. Remissions are seen in approximately 75% of cases. ORAL MANIFESTATIONS OF HIV INFECTION AND AIDS AIDS is the terminal stage of infection with the human immunodeficiency virus (HIV), which is recognized as undergoing a number of mutations. The underlying severe immunodeficiency leads to a number of oral manifestations which, although not pathognomonic, should raise the possibility of HIV infection. It is virus infections caused by Human Immune Deficiency Virus (HIV) Over 80% of the reported cases were

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