Inflammatory Disease. Part I. Infections

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1 Inflammatory Disease Part I Infections

2 Bacterial, Fungal and Viral Infections of the Head and Neck

3 Sexually Transmitted Diseases Lomaki, Middle Mesa Petroglyphs Northern Arizona Herpesviruses I, II Clamydia Treponema Gonococci Papillomavirus HIV Hepatitis B, C

4 Bacterial Infections Pulpitis, periapical infections, spread of infection Space infections, osteomyelitis Periodontitis Sialadenitis Specific infections Syphilis (Treponema) Tuberculosis (Mycobacterium) Actinomycosis (Actinomycetes) Cat Scratch fever (Rochinella) Rhinoscleroma (Klebsiella)

5 SYPHILIS PRIMARY Chancre 2-4 weeks SECONDARY Maculopapular rash, Mucous patches Split papules TERTIARY Gummatous necrosis, Neurosyphilis, Aneurysm

6 SYPHILIS Treponema pallidum Diagnostic Tests VDRL FTA TPI

7 Primary Syphilis - Chancre

8 Secondary Syphilis

9 Tertiary Syphilis

10 CONGENITAL SYPHILIS Saddle Nose Mental Retardation Blindness Short Stature Saber Shins

11 Saber Shins

12 HUTCHINSON S TRIAD DENTAL DEFECTS Notched Screwdriver Centrals Pegged Laterals Mulberry Molars BLINDNESS DEAFNESS

13 Congenital Syphilis Notched Centrals, Mulberry Molars

14 TUBERCULOSIS Mycobacterium tuberculosum Primary, Secondary, Miliary Metastatic, Scrofula, Lupus vulgaris Mycobacterium aviium intracellulare HIV nonpulmonary infection

15 Tuberculosis Scrofula Oral Granuloma

16 ACTINOMYCOSIS Actinomycetes, elongated rods Sulfur Granules aggregated colonies Cervicofacial form Osteomyelitis of the mandible Soft tissue abscess Periapical abscess

17 Actinomycosis PAS stain

18 CAT SCRATCH FEVER Feline Claws Rochinella bergdorfdi Lymphadenitis Necrotizing Granuloma

19 Cat Scratch Fever Necrotizing granuloma

20 Fungal Infections Superficial Candidiasis Geotrichosis Invasive Histoplasmosis Coccidioidomycosis Blastomycosis Mucormycosis Asperigillosis Rhinosporidiosis Allergic fungal sinusitis (Bipolaris fungi)

21 CANDIDIASIS Pseudomembranous Erythematous Angular Cheilitis Median Rhomboid Glossitis

22 Pseudomembranous Candidiasis

23 Erythematous Candidiasis

24 Angular Cheilitis

25 Median Rhomboid Glossitis Multinodular mass Midline posterior tongue Adult onset Surface colonized by Candida

26 MYCELIA PAS STAIN Parakeratin layer, biospy Cytologic smear

27 Antifungals Nystatin Pastilles or Vaginal Tabs Nystatin Cream or ointment Chlotrimazole (Mycelex) Troches Ketaconazole (Nizoral) 100 mg

28 DEEP INVASIVE FUNGI Granulomatous Inflammation Special Stains (PAS, GMS) Microorganisms Histoplasmosis* Coccidioidomycosis* Blastomycosis* Cryptococcosis Tissue Tropism Pulmonary* and nonpulmonary

29 DEEP INVASIVE FUNGI Clinical Giant Cells with Fungus

30 Histoplasmosis

31 MUCORMYCOSIS Zygomycosis, Phycomycosis Large Mycelia Antral Involvement Vascular Invasion and Ischemic Necrosis Debilitation Brittle IDDM Immunosuppression

32 Mucormycosis Radiograph Fungal organisms GMS PAS

33 ALLERGIC FUNGAL SINUSITIS Bipolaris Pleomorphic Fungi Aspergillosis may show similar features Sinusitis, Expansion, Bone Resorption Lesion due to Allergy not organism Eosinophilic Infiltrate Brown Sludge in Antrum

34 Allergic Fungal Sinusitis Radiograph Bipolaris Fungi

35 Viral Infections Human Papillomavirus Herpesvirus types I and II Varicella zoster Epstein Barr Enteroviruses Coxsackieviruses Mumps virus HIV and oral opportunists

36 Benign HPV Oral Papillary Tumors Verruca vulgaris - HPV 2,4 Squamous papilloma - HPV 6,11 solitary Condyloma acuminatum - HPV 6,11 multiple

37 Verruca vulgaris Clinical Histopath and DNA

38 Clinical, Gross Squamous Papilloma Histopathology

39 Condyloma Acuminatum Clinical Histopath & DNA HPV 6

40 Condyloma

41 Focal Epithelial Hyperplasia HPV 13 and 32 are viruses with a restricted tropism for oral mucosa Lesions evolve as multiple papules then progress to flattened nodules of the lips and buccal mucosa Children (more often seen in Amerindians) and HIV infected subjects Lesions persist for 6-12 months, then spontaneously regress Microscopic: Focal parakeratosis and nodular acanthosis, mitosoid bodies resembling mitotic figures are found in the mid spinous layer.

42 Focal Epithelial Hyperplasia HPV 13,32

43 Heck Disease (FEH) in HIV+ Patients

44 HERPES SIMPLEX 1,2 LYTIC INFECTION Keratinocytes LATENT INFECTION Ganglia

45

46 Primary Herpetic Gingivostomatitis

47 Herpes Labialis

48 Recurrent Intraoral Herpes

49 HSV Vesicle and Antigen

50 BALLOONING DEGENERATION

51 HERPETIC WHITLOW

52

53

54 Primary Varicella-Zoster (Chicken Pox)

55 Secondary VZV (Shingles)

56 Infectious Mononucleosis Epstein Barr Virus Malaise Lymphadenopathy Palatal Petechia Atypical Lymphocytes in Blood Other EBV associated diseases Oral Hairy Leukoplakia Burkitt s Lymphoma Nasopharyngeal Carcinoma

57 ENTEROVIRUSES ENTEROVIRUSES ECHOVIRUSES COXSACKIEVIRUSES POLIOVIRUSES

58 Hand, Foot & Mouth Disease

59 Herpangina

60 Lymphonodular Pharyngitis

61 Koplik Spots -Rubeola-

62 ENDEMIC PAROTITIS (MUMPS) Mumps virus Bilateral Painful Parotid Enlargement Pain on Salivation Fever Ten Day Course Orchitis Complication

63 MUMPS

64 HIV CD4 Lymphocyte Target CD4 and CCR5 Chemokine Receptor Latency of years AIDS = <200 CD4 Lymphocytes/mm3

65 HIV ASSOCIATED DISEASES Opportunistic Infections Pneumocystis pneumonia HSV, VZV, CMV Toxoplasmosis, Cryptosporidium Mycobacterium Aviium Intracellulare Candida, Histoplasmosis Neoplasms Kaposi s Sarcoma Malignant Lymphoma

66 HIV ORAL LESIONS CANDIDIASIS HAIRY LEUKOPLAKIA PAPILLOMAVIRUS LESIONS HIV GINGIVITIS HIV PERIODONTITIS HISTOPLASMOSIS, OTHER DEEP FUNGI KAPOSI S SARCOMA NON-HODGKIN S LYMPHOMA

67 Oral Opportunistic Infections Candidiasis Pneumocystis Herpes

68 Oral Hairy Leukoplakia EBV DNA

69 EBV virions Keratinocyte nucleus ultrastructure

70 HIV - Kaposi s Sarcoma Herpesvirus type 8

71 Epstein Barr Virus HIV - Lymphoma

72 HIV Periodontal Lesions HIV Gingivitis HIV Periodontitis

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