Notes

Outline

Contagious Diseases I

Contagious Diseases I

"Contagious diseases are diseases that..." Contagious diseases are diseases that can be transmitted from person to person

Diagnosis and Tx cartoon

Visit to the dentist can give you AIDS

UNIVERSAL PRECAUTIONS We don’t use precautions only on patients that we can label as High Risk We use the identical precautions on ALL patients.

MAIN PURPOSE OF DENTAL EXAM Determine What Pathology Or Disease Conditions Exist

MAIN PURPOSE OF DENTAL EXAM And Make sure they are treated

Need to refer patient You may not do the treatment yourself but you need to know

Contagious Disease Lectures 1. Bacterial Diseases

Lab tests Various laboratory tests will be included to help you read and interpret a patient’s medical record

Scarlet Fever

SCARLET  FEVER STREP  THROAT due to Group A Beta Streptococci

GROUP A  BETA HEMOLYTIC STREPTOCOCCI Streptococcus pyogenes

Group A Beta Hemolytic Streptococci SYMPTOMS OF INFECTIONS Fever 93% Sore throat 90% Vomiting 62% Headache 59%

SCARLET  FEVER DISEASE STREP THROAT INFECTION + TOXEMIA Erythrogenic toxin causes Toxemia Erythrogenic toxin causes Skin Rash

Picture of finger with scarlet fever

SCARLET  FEVER ERYTHROGENIC TOXIN Not all strains of GpA strep produce the toxin Individuals who have had scarlet fever are immune to the toxin but not to the bacteria

SCARLET  FEVER ERYTHROGENIC TOXIN Infection with Toxin – strain Toxin + strain in immune person Only strep throat + fever of 100-103OF Petichiae may appear on the soft palate There is no skin rash

Picture of Strep throat

SCARLET  FEVER COURSE OF DISEASE Sore throat and fever Followed in a few days by a rash

SCARLET  FEVER COURSE OF DISEASE Rash Appears first on the trunk Later may appear on face and limbs The trunkè limb progression differentiates it from some viral rashes Usually doesn't appear on the lips nose or chin

SCARLET  FEVER COURSE OF DISEASE Fades after 3 or 4 days Skin may desquamate around the middle of the 2nd week Desquamation occurs in about 80% of cases

SCARLET  FEVER COURSE OF DISEASE The oral mucosa changes are similar to those in the skin but they appear earlier and are more marked The hard palate mucosa is red with punctiform mottling

SCARLET  FEVER COURSE OF DISEASE In 16% of cases the tongue is at first furred and looks like a STRAWBERRY

SCARLET  FEVER COURSE OF DISEASE As the furriness leaves, the tongue resembles a RASPBERRY

SCARLET  FEVER DIAGNOSIS Culture for Group A strep Immunological spot tests

SCARLET  FEVER ERYTHROGENIC TOXIN Schultz-Charlton Test

Picture of Schultz-Charlton

SCARLET  FEVER ERYTHROGENIC TOXIN Dick Test

Picture of Dick Test

GROUP A BETA STREP PERIOD OF COMMUNICABILITY Approximately 10 days without Penicillin 24 hours with Penicillin

GROUP A BETA STREP TREATMENT Penicillin 10 days

IMPETIGO  CONTAGIOSA (Bullous Impetigo)

IMPETIGO  CONTAGIOSA Staphylococcus aureus Group A b Hemolytic Streptococci

IMPETIGO  CONTAGIOSA DISEASE Superficial large blisters form They break easily and Release fluid which spreads

IMPETIGO  CONTAGIOSA DISEASE Can also enter lymphatics or blood vessels and be distributed throughout the body This causes severe damage to more vital tissues

Picture of Impetigo

IMPETIGO  CONTAGIOSA DIAGNOSIS Culturing S. aureus b strep

IMPETIGO  CONTAGIOSA PERIOD OF COMMUNICABILITY Throughout the time discharges are present

IMPETIGO  CONTAGIOSA TREATMENT Antibiotics are required

GONORRHEA Neisseria gonorrhoeae

GONORRHEA We are in the midst of an epidemic of gonorrhea In 2000 there were over 300,000 new cases diagnosed Not all cases are diagnosed

GONORRHEA OTHER NAMES The Drip The Strain The Clap

GONORRHEA DISEASE Primarily a genital infection A primary oral infection can occur via direct oral-genital contact via self inoculation from the fingers

GONORRHEA DISEASE More readily transmitted via the penis Mainly women and homosexual men get oral gonorrhea Also sexually abused children

GONORRHEA ORAL LESIONS Round Slightly elevated Gray-white spots Scattered over tongue, soft palate, cheeks, tonsils, oropharynx

GONORRHEA ORAL LESIONS Lesions become eroded Tongue becomes swollen, red, and dry Oral mucosa has an itching and burning sensation Foul breath

GONORRHEA ORAL LESIONS Pseudomembrane  may be present Possibly a temperature (102OF or higher) A gonococcal stomatitis may resemble lichen planus or herpetic stomatitis

Picture of Gonorrhea

GONORRHEA DIAGNOSIS Smears show Gram-negative intracellular diplococci Not diagnostic in the mouth

GONORRHEA PERIOD OF COMMUNICABILITY Communicable for years if untreated Effective therapy usually ends communicability within hours

GONORRHEA TREATMENT Treatment - generally Penicillin But Penicillinase Producing Neisseria gonorrhoeae (PPNG) are becoming common (almost 20% of cases) Tetracycline is second choice but PPNG strains are often resistant

GONORRHEA TREATMENT The PPNG strains are generally sensitive to spectinomycin But, in one study, pharyngeal strains were resistant to spectinomycin Therefor, for oral infections, antibiotic sensitivities must be determined

SYPHILIS Treponema pallidum

SYPHILIS DISEASE A venereal disease Primarily a genital infection Now commonly on tongue and other oral sites due to oral sex May be transmitted via blood

SYPHILIS DISEASE An acute and chronic relapsing disease

SYPHILIS DISEASE 3 stages of Syphilis Primary Syphilis Secondary Syphilis Tertiary Syphilis

SYPHILIS PRIMARY SYPHILIS DISEASE Lesion appears 2-6 weeks after infection Papule Erodes Chancre (sometimes)(painless) Heals in 2-4 weeks, even if untreated Person is highly infectious

SYPHILIS PRIMARY SYPHILIS DISEASE The lip is the most common extragenital site followed by the tongue and tonsillar area

SYPHILIS SECONDARY SYPHILIS DISEASE The primary lesion is followed 1- 4 weeks later by Secondary Syphilis a maculopapular rash involving skin and mucous membranes

SYPHILIS SECONDARY SYPHILIS DISEASE Oral lesions appear as mucous patches Multiple, grayish-white plaques Painless Highly infectious

SYPHILIS SECONDARY SYPHILIS DISEASE Skin lesions Last for a few weeks up to 1 year Periods of latency Sometimes a recurrence of the rash

SYPHILIS TERTIARY SYPHILIS DISEASE Sometimes, 3 or more years later, a third stage is seen-Tertiary Syphilis Lesions of skin, bone, viscera, CNS, cardiovascular system Probably a delayed hypersensitivity reaction

SYPHILIS TERTIARY SYPHILIS DISEASE Orally-leukoplakia of the tongue -gumma On the palate or in the heart, these gumma may cause a perforation

Picture of Primary Syphilis

Picture of Secondary Syphilis

Picture of Tertiary Syphilis

SYPHILIS DISEASE Oral Incidence Mainly women and homosexual men More readily transmitted via the penis

SYPHILIS DIAGNOSIS Darkfield microscopy Suggestive Not diagnostic for oral lesions

SYPHILIS DIAGNOSIS Serology may be useful for screening only or may be diagnostic depending on the test

SYPHILIS DIAGNOSIS Serology Reagin-Based = screening only VDRL Venereal Disease Research Laboratory

SYPHILIS DIAGNOSIS Serology Specific Antibody-Based Specific Identification FTA-ABS Fluorescent Treponemal Antibody Absorbed

SYPHILIS DIAGNOSIS Serology Serologic tests become positive 1-4 weeks after the  appearance of the chancre (approx. 4-7 weeks after infection)

SYPHILIS PERIOD OF COMMUNICABILITY Primary Infectious Secondary Infectious Tertiary Not infectious

SYPHILIS PERIOD OF COMMUNICABILITY For years if untreated Proper antibiotic treatment usually ends infectivity within 24-48 hours

SYPHILIS TREATMENT Penicillin Tetracycline or erythromycin if allergic to penicillin

TUBERCULOSIS Mycobacterium tuberculosis

TUBERCULOSIS DISEASE Infection usually occurs via inhalation of droplet nuclei containing M. tuberculosis The bacilli become established in the alveoli of the lungs and spread throughout the body

TUBERCULOSIS DISEASE 2-10 weeks after the initial infection Immune response usually limits further multiplication and spread

TUBERCULOSIS DISEASE Of those infected < 1% progress to clinical illness The rest do not have TB They have latent TB

TUBERCULOSIS DISEASE 5-10% develop illness after months, years, or decades due to the development of impaired immunity Seen most often in AIDS patients

Factors compromising the immune system HIV infection Transplant surgery Anti-inflammatory medications Advanced age

Number of Organ Transplants United States, 1982-1998

TUBERCULOSIS DISEASE TB most frequently attacks the lungs Secondary oral infections are rare Primary oral infections occur but are rare

TUBERCULOSIS DISEASE Oral disease most often occurs as an ulcer of the mucosa Occurs on Tongue Cheeks Gingiva Floor of the mouth Lips

TUBERCULOSIS DISEASE Lesion: Small yellowish nodule that breaks down and ulcerates Very painful if on tongue The tongue lesions have a history of continued mechanical irritation

Slide 88

TUBERCULOSIS DISEASE - SKIN Lupus Vulgaris The name for tuberculosis of the skin The face is the most commonly involved site

Lupus Vulgaris

TUBERCULOSIS DISEASE-Lymph nodes Scrofula TB of the cervical lymph nodes

Scrofula

Tuberculosis M. tuberculosis has also been isolated from gummas periapical and other abscesses osteitis gingivitis

TUBERCULOSIS DIAGNOSIS 1. Chest X-Ray 2. Recent serological conversion with the tuberculin test

TUBERCULOSIS DIAGNOSIS Tuberculin Test A Purified Protein Derivative (PPD) is injected intracutaneously A reaction 10 mm or larger in diameter is indicative of infection with M. tuberculosis This does NOT mean the person has the disease tuberculosis

TUBERCULOSIS DIAGNOSIS 3. Culturing the sputum takes 3-6 weeks

TUBERCULOSIS PERIOD OF COMMUNICABILITY As long as sputum is bacteriologically positive

TUBERCULOSIS TREATMENT A combination of INH (isoniazid) and one or more of the following: rifampin (RIF) streptomycin (SM) ethambutol (EMB) pyrazinamide (PZA) para-aminosalicillic acid (PAS)

TUBERCULOSIS TREATMENT Treatment for at least 9 months and often for 12

TUBERCULOSIS TREATMENT 1987 - first case in US of Multiply Drug Resistant TB (MDRTB)

End Part I