bacterial origin— cervicofacial actinomycosis

rheumatic fever occurs _____ to _____ after group A strep pharyngitis

10 days to 6 weeks

when does a chancre appear? where?

- 2-6 weeks after exposure -appears where the organism entered

where do secondary mucous patches occur

-labial mucosa -buccal mucosa -tongue -palate

actinomycosis can also occur in ...

-lungs -CNS -GU -GI

how does necrosis spread in NOMA

-necrosis doesnt follow tissue planes -spreads through anatomic barriers such as muscle

syphilis stages

-primary -secondary -latency -tertiary -congenital

how common is tertiary syphilis

-rare -develops only in a subset of untreated syphilis infections

describe the rash from scarlet fever

-red rash that looks like sunburn -feels like sandpaper

what is a chancre

-solitary indurated painless ulcer

actinomyces treatment

-surgical drainage -abx (prolonged course)

what are gummas

-tertiary syphilis -a nodular mass that can occur virtually anywhere in the body. -destructive lesion

infection of bone can perforate the cortex in cervicofacial actinomycosis. this can cause what?

a localized red-purple lump on the overlying skin of the face with pus leaking out of a sinus tract.

when does secondary syphilis occur

begins 6-8 weeks after initial infection if the pt remains untreated

tonsilitis and pharyngitis is _____

common

scarlet fever usually resolves with _____

scarlet fever usually resolves with NO SEQUELAE

scarlet fever can occur after a _____.

sore throat

what stage does the chancre form

syphilis primary stage

t/f chancres are painless

true ish usually painless but can be a little painful

clinical features of NOMA

-extensive areas of discolored necrotic tissue -destruction starts in soft tissue and can progress to bone

t/f once chancre lesions go away, the pt is no longer infectious

-false -lesion goes away but is contagious

t/f syphilis has an increasing rate of abx resistance

-false -responds well in all stages to IV penicillin for the past 70 yrs

if tonsilitis and pharyngitis is caused by bacteria, what bacteria are at fault

-group A beta hemolytic strep (strep pyogenes)

2 main organs affected by tertiary syphilis

-heart -cns

when is the worst time for a newborn to get syphilis

-in utero or during time of development

tonsilitis and pharyngitis sometimes appears with 3 things

-lymphadenopathy -fever -cough

epidemiology of NOMA

-mainly developing countries esp children w/ malnutrition and systemic diseases

oral manifestations of congenital syphilis

-malformed teeth -hutchinson's incisors -mulberry molars

how long does syphilis latency last

-many years

when does tertiary syphilis occur

-many years after non-tx of secondary syphilis

are tonsilitis and pharyngitis cause by bacteria or viruses

-most often viral -can also be bacterial

describe the oral mucous patches seen in secondary syphilis

-multiple serpiginous lesions with an erythematous border -raised erosions or ulcers -overlying silvery grey membrane -either painless or painful

what is hutchinsons triad

-ocular keratitis -malformed teeth -8th nerve deafness

how are syphilis oral lesions categorized

-primary -secondary -tertiary -congenital

what can you observe from pressing on a actinomycosis sinus tract

-pus and sulfur granules coming out

manifestations of actinomycosis

-reddish-purple lump on skin overlying sinus tract (which will occasionally drain) -no ulcers or erythema in the mouth associated -hard lump with draining sinus

developmental defects pf congenital syphilis (4)

-saddle nose -frontal bossing -rhagades (linear fissures around mouth) -hutchinson's triad

what is the only way to detect syphilis

-serology

describe the appearance of condylomata lata

-soft, broad-based elevations -flat top with lobulated or warty surface -loaded with organisms

symptoms of tonsilitis and pharyngitis

-sore throat -dysphagia -tonsilar hyperplasia with or without exudate

oral changes from scarlet fever

-strawberry tongue -hyperemic, enlarged fungiform papillae

group A beta hemolytic strep is associated with what conditions

-tonsilitis/pharyngitis -rheumatic fever -scarlet fever

actinomycosis portals of entry

-trauma -carious teeth -periodontally involved teeth -extractions

epidemiology of scarlet fever

-usually children -under 15 -peak 4-8

bacteria that causes cervicofacial actinomycosis

Actinomyces israelii, an anaerobic, gram-positive filamentous bacterium

______ is another manifestation of secondary syphilis

condyloma lata

congenital syphilis can cause ________ or ________, which might be detected ______

congenital syphilis can cause STILLBIRTH or DEVELOPMENTAL DEFECTS, which might be detected YEARS LATER

congenital syphilis is ____ in the US but in the past 10 years, the number of cases started to ____

congenital syphilis is RARE in the US but in the past 10 years, the number of cases started to RISE

other than secondary syphilis, what condition also has serpiginous lesions

geographic tongue

what is actinomyces

group of gram positive, filamentous, branching commensal BACTERIA (not fungi)

rheumatic fever is ____ mediated

immunologically

actinomycosis affects (max/mand) more

mand >max

what is MRONJ

medication-related osteonecrosis of the jaw

what does NOMA stand for

necrotizing stomatitis

should you prescribe abx for tonsilitis and pharyngitis

no, it is usually viral in origin

condyloma lata patches are not ____ and are generally ____

not sensitive gen asymptomatic

secondary syphilis exhibits ______

oral mucous patches

gummas in the mouth can result in ______

palatal perforation

scarlet fever tx

palliative tx

the disease actincomycosis occurs when the bacteria ______-

penetrate deeper tissues

congenital syphilis is when the organism is transferred to the fetus via _____

placenta

describe the pus found in cervicofacial actinomycosis lesions

pus contains yellow sulfur granules = actinomycotic colonies

when oral mucous patches of secondary syphilis occur at the commissure, they are known as ______

split papules

what condition is known as "the great imitator"

syphilis -name is bc of the myriad of dermatological and systemic manifestations

syphilis is an _____ and ______ STD caused by _____

syphilis is an INFECTIOUS and CONTAGIOUS STD caused by SPIROCHETE TREPONEMA PALLIDUM

tertiary syphilis can affect __________. most serious complications are _____, _____, and _____

tertiary syphilis can affect MULTIPLE ORGAN SYSTEMS. most serious complications are ANEURYSMS, VALULAR HEART DISEASE, AND NEUROSYPHILIS

what disease has strawberry tongue? which disease has strawberry gingiva ?

tongue = scarlet fever gingiva = granulomatosis w/polyangitis (wegener)

are syphilis pts still contagious during latency

yes

can syphilis bc completely cured

yes

how long does a chancre last

-disappears within a few weeks, whether pt is treated or not

cervicofacial actinomycosis is associated with...?

-Often associated with a carious or periodontally involved tooth. -Infection of bone perforates cortex

tx of cervicofacial actinomycosis

-Removal of source of infection (ie extraction) -Curettage and debridement -Long-term antibiotics

what takes place during the initial exposure of syphilis

-T pallidum penetrates intact mucosa -in hours, enters lymphatics and blood vessels -then get chancre

scarlet fever clinical features

-abrupt onset fever -headache -vomiting -malaise -sore throat -exanthem -enanthem

when does the syphilis latency stage occur

-after signs of secondary syphilis have disappeared

syphilis tx

-all stages of syphilis respond well to one or more injections of penicillin G

how is syphilis diagnosed

-challenging -first do blood test -serology is complex -disappearing lesions -nonspecific systemic symptoms

what are sulfur granules

-colonies of actinomyces with surrounding neutrophils (standard abscess but with yellow granules) in pus draining from actinomycotic sinus tracts -1 to 4 mm

manifestations of secondary syphilis

-cutaneous rash -no chancre -fever, lymphadenopathy, sore throat, patchy hair loss

syphilis reached an all time low in ___ and started to creep up again

2005

histology of cervicofacial actinomycosis

Eosinophilic masses of filamentous, branching gram-positive bacteria surrounded by a sea of neutrophils (an abscess)

NOMA is a _________ progressive ________ infection caused by _______ that become pathogenic during_______

NOMA is a RAPIDLY progressive POLYMICROBIAL OPPORTUNISTIC infection caused by NORMAL ORAL FLORA that become pathogenic during COMPROMISED IMMUNE STATUS

_____ can result in heart problems ____ later

RHEUMATIC FEVER can result in heart problems YEARS later

what is cervicofacial actinomycosis

Subacute or chronic bacterial infection

secondary syphilis skin lesions _____ and _____

appear and disappear

___________ are present in many cases of MRONJ

actinomyces colonies

actinomyces is found in _____

actinomyces is found in HEALTHY MOUTHS , IN THEIR -TONSILAR CRYPTS -PLAQUE -CALCULUS -NECROTIC PULPS

_____________ is the most common cause of actinomycosis

actinomyces israeli

actinomycosis induration can look _______ and you can often find ______

actinomycosis induration can look MULTINODULAR and you can often find A SINUS TRACT

rheumatic fever is an acute ____, _____ disease

acute multisystem inflammatory disease

which stages of syphilis have oral lesions associated with them

all except latency

exanthem vs enanthem

exanthem = rash on skin enanthem = rash on mucosa

key feature of NOMA

extensive ischemic necrosis

t/f exudate can be used to identify the organism causing tonsilitis and pharyngitis

false

t/f secondary syphilis condyloma lata appears only in the mouth

false -can appear in the genitals

t/f chancres of syphilis are accompanied by systemic symptoms

false no systemic symptoms or cutaneous eruptions

t/f cervicofacial actinomycosis is highly infectious

falso -not contagious