TOPOIC:Bacterial,Viral and

Mycotic Infections

Lectured by Yeong-Lei HUANG D.D.S.,M.S.

School of Dentistry,Kaohsiung Medical
University, Taiwan (Republic of China )

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.INTRODUCTION

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 A.The invasion of tissue by living
micro-organisms;disease is
produced by their subsequent
multiplication.
.Most micro-organisms are harmless:only a
few are pathogenic i.e. can cause disease.
.Bacteria and viruses are the most common.
.Fungi and other groups are less common.

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 B.Routes of entry of infecting
organisms
1.Through the skin or mucous membranes.
2.By ingestion
3.By inhalation

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 C.Factors influencing the
establishment of infection.
1.In the host
(1)Physical barries; skin
(2)Secretions; mucin
(3)Chemical action; Lysozymes (saliva) ,
IgA, non-specific inhibitory substances

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 C.Factors influencing the
establishment of infection.
2.In the micro-organism
Invasive capacity:
(1)Quantity of dose
(2)Virulence;
Capacity to resist phagocytosis
Capacity to produce enzyme
Capacity to produce toxins
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D.Factors influencing the course
of infection
1.Inflammation
2.Phagocytosis
3.The immune response
4.Interferon production

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.CONTENTS

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Common oral manifestation of
micro-organism infectious disease.

A.Bacterial infection
B.Viral infection
C.Fungal infections

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A.Bacterial infection
.ANUG
.Acute cellulits
.Pyogenic granuloma
.Tuberculosis
.Actinomycosis
.Syphilis
.Leprosy
.Sarcoidosis
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B.Viral infection

.Herpes simplex
.Primary herpetic stomatitis
.Secondary herpetic gingivostomatitis
.Recurrent apthous stomatitis
.Herpangina
.Hand,foot and mouth disease

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B.Viral infection

.Measles
.Molluscum contagiosum
.Condyloma acuminatum
.Herpes zoster
.Mumps
.Cytomegalic inclusion disease
.HIV disease arid AIDS
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C.Fungal infections

1.Deep fungal disease

* Clinically, infection often mimic T.B
.Histoplasmosis, Coccidioidomycosis,
.Blastomycosis, Cryptococcosis
2.Opportunistic fungal infections
.Phycomycosis
.Candidiasis
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A.Bacterial infection
.ANUG
.Acute cellulits
.Pyogenic granuloma
.Syphilis
.Tuberculosis
.Actinomycosis
.Leprosy
.Sarcoidosis
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Acute necrotizing ulcerative gnigivitis (ANUG)

1.Pathogen - fusiform baccilus and spirochete (Borrelia

vicentii)
2.Pathogenesis - synergistically multiply of two pathogen
3.Clinical features - painful hyperemia gingiva , and foul
odor sharply punched-out erosion of the interdental
papillae
4.Histopathology surface ulcerative with thickened fibrous
exudates , containing many polymorphonuclear
leukocytes and macrophages

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 Acute cellultis
1.Pathogen - streptococus pyogens , Bacteroid (anaerobes)
2.Pathogenesis - dental origin on the presence of unusually
virulent bacteria
*Ludwigs angina : involvement of submaxillary &
sublingual and backwards into the parapharyngeal space
3.Clinical features -
. brawny hardness of involved area , fever and malaise
.difficulty in breathing as a result of tongue being
pushed upward and backward into the airway
4.Histopathology - spread of exudate is separating &
destroyed muscle fibers,between which many neutrophils
can be seen
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 Pyogenic granuloma
1.Pathogennon-specific infection
2.Clinical featuresover exuberant connective
tissue reaction, are typically red. The ulcerated
lesion may become covered by yellow, fibrinous
membrane.
3.Histopathology
lobular masses of hyperplasic granulation tissue,
vast numbers of endothelium-lined vascular
spaces and proliferation of fibroblasts and budding
endothelial cells.

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 Syphilis

1.Pathogen- Treponema pallidum

2.Pathogenesis-Fig 1.
3.Clinical features
*1st stageHard Chancre
*2nd stageMucous patch
*Tertiary stageGummatous inflammation

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 Syphilis
4.Histopathology
* Proliferation of endothelial cell within arteries
* Plasma cells, along with lymphocytes and
macrophages, are found in a perivascular
distribution
* Necrosis and great numbers of macrophages,
resulting in a granulomatous lesion

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 Tuberculosis
1.PathogenMycobacterium tuberculosis
2.PathogenesisFig 2.
3.Clinical features
* Remarkably in conspicuous, easily fatigue and
malaise
* Scrofulatuberculosis lymphadenitis ; cervical
and submaxillary
* Irregular,superficial of deep painless ulcer which
tends to increase slowly in the oral mucosa
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 Tuberculosis

4.Histopathology
foci of caseous necrosis surrounded by
epitheloid cells, lymphocytes and
occasional multinucleated giants cells.

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 Actinomycosis
1.PathogenActinomyces israelii
2.Pathogenesisinfection usually appear after
trauma, surgery or previous infection
3.Clinical featuressimulate a pyogenic infection,
4.Histopathologygranulomatous inflammatory
response with central abscess formation, distinct
colonies of organisms (sulfur granules), radiating
from the center of colony are numerous filaments
with clubbed ends.

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 Leprosy

.PathogenMycobacterium leprae.
.Clinical featureserythematous plaques or
nodules, damage to peripheral nerves
resulting anesthesia
.Histopathologygranulomatous nodules, in
which macrophages and multinucleated
giant cells are usually seen

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 Sarcoidosis

1.Pathogen - unknown etiology

2.Pathogenesis - mycobacterial DNA and RNA can be
identified in the lesion
3.Clinical features - enlargement of salivary gland
4.Histology proliferation of noncaseous nodule , nest of
epitheloid cells with multinuclear giant cells in the
features of fibrous granlomatous nodule
*positive-response of kveim test

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B.Viral infection

.Herpes simplex
.Primary herpetic stomatitis
.Secondary herpetic gingivostomatitis
.Recurrent aphthous stomatitis
.Herpangina
.Hand,foot and mouth disease

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B.Viral infection

.Measles
.Molluscum contagiosum
.Condyloma acuminatum
.Herpes zoster
.Mumps
.Cytomegalic inclusion disease
.HIV disease and AIDS
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 Herpes simplex
.PathogenesisFig.3
.Clinical featuresPrimary: fever, malaise,
headache and cervical lymphoadenitis and
vesicular eruption in the oral mucosa.
* 2ndary;tingling,burning or pain in the site, short-
lived vesicle appear ulcerated.
.HistopathologyBallooning degenerated cells,
Lipschitz bodies, intranuclear inclusion.

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 Recurrent aphthous ulcer

.Precipitating factorsbacterial infection,

immunologic disorder
abnormalities, trauma, endocrine conditions,
psychic factors, allergic factors

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 Recurrent aphthous ulcer
.Classification
* recurrent aphthous minor
* recurrent aphthous major
* recurrent herpetiform ulcerations
* recurrent ulcers associated with Behcets
syndromes
.Histopathologyproliferation of mononuclear cells,
no specific microscopic diagnostic features.

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 Herpangina

.PathogenCoxsackie group A virus

.Clinical featuressmall ulcers exhibit in the
soft palate or fauces

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 Hand-foot and mouth disease

.PathogenCoxsackie A16
.Clinical featuresappearance of
maculopapular, and vesicular lesions
involving the hand, feet, legs and mouth.

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 Measles

.Pathogenparamyxovirus
.Clinical featuressymptoms of fever and
malaise, small, erythematous macules with
white necrotic centers appearing in the
buccal mucosa, know as Kopliks spots.

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 Molluscum Contagiosum

.Pathogendistincted pox virus

.Clinical featurespapilloma-like lesions
.Histopathologyeosinophilic intracytoplasmic
inclusion bodies (Henderson-Paterson) inclusion
or simple molluscum bodies.

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 Condyloma acuminatum
.Pathogenhuman papilloma virus
.Clinical featuressoft-pink nodules, which
proliferate and coalesce to form
papillomatous clusters of varying size.
.Histopathologymarked acanthosis with
papillomatous projection, intranuclear viral
inclusions in the epithelial cells of the
lesions.

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 Herpes zoster
.PathogenVaricella-zoster virus
.Clinical features
*Initially;fever, malaise . pain along the course of
the involved unilateral trigeminal sensory nerve,
either the branch of the trigeminal nerve
*Special form ; zoster infection of the geniculate
ganglion (James Ramsay Hunt Syndrome)
facial paralysis, and pain of the external auditory
meatus and pinna of the ear.

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 Mumps

.Pathogenparamyxovirus
.Clinical featuresheadache, chills, fever,
vomiting and pain below the area rubbery or
elastic swelling of the salivary gland.

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 Cytoegalic inclusion disease
.Pathogencytomegalovirus
.Clinical featuresfever,salivary gland
enlargement, hepatomegaly and
lymphocytosis, oral ulcer in HIV infected
patient
.HistopathogyIntranuclear and cytoplasmic
inclusion, swollen cells with large
basophilic nuclei

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 HIV Disease and AIDS

Pathogen - HIV -virus

Pathogenesis - HIV virus inoculated humane CD4
lymphocyte involved direct binding of the gp120 protein
.The C D4 cell and stabilization of the viral binding by the
CCR-5 cor-receptor

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C.Fungal infections

A.Deep fungal disease

*Clinically, infection often mimic T.B
.Histoplasmosis, Coccidioidomycosis,
Blastomycosis, Cryptococcosis
B.Opportunistic fungal infections
.Phycomycosis
.Candidiasis
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Deep fungal disease

Histoplasmosis,
Blastomycosis,
Cryptococcosis
Coccidioidomycosis

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 Histoplasmosis

1.Pathogen - Histoplasma capsulatun

2.Pathogenesis - mimic tuberculosis with granuloma ,
mainly 2nd to immunosuppression or AIDS
3.Clinical features -
. Main clinical forms are pulmonary
. Oral nodule with ulcerative surface
. Tissue destruction can be extensive and painful
4.Histology tuberculosis-like granulomatous lesion with
yeasts in macrophages

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Deep fungal disease

Histoplasmosis,
Coccidioidomycosis,
Blastomycosis,
Cryptococcosis

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 Coccidioidomycosis
1.Pathogen - coccidioides immitis
2.Pathogenesis - airborne inhaled with the lung of host
- 60% this group are asymptomatic
3. Clinical features
.Disseminated type following groups are particularly
susceptible
. High dose of corticosteroid
. Cancer chemotherapy
. End stage of HIV infection
4.Histology mimic tuberculosis-like grauulomatous lesions
with endospores in spherules
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Deep fungal disease

Histoplasmosis,
Coccidioidomycosis,
Blastomycosis,
Cryptococcosis

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 Blastomycosis

1.Pathogen - Blastomycesdermatitidis
2.Pathogenesis - prefer in rich moist soil where it grows as a
mold
3. Clinical features
.It mimic tuberculosis and squamous cell carcinoma .
.An irregular erythematous white intact surface or
ulcerative lesion with irregular rolled border can be noted
4.Histology tuberculosis-like granulomatous lesion with
yeasts in macrophages with budding yeasts

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Deep fungal disease

Histoplasmosis,
Coccidioidomycosis,
Blastomycosis,
Cryptococcosis

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 Cryptococcosis

1.Pathogen - cryptococcus neoformans

2.Pathogenesis - devastating to the immnocompromised
patient
3. Clinical features
. Primary infection to the lung is often asymptomatic
craterlike nonhealing ulcer
4.Histology mimic tuberculosis-like granulomatous lesions
with yeast with thick capsule

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B.Opportunistic fungal infections

Candidiasis
Phycomycosis

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 Candidiasis

.PathogenCandida albicans
.Clinical features
*Mucocutaneous candidiasis
*Systemic candidasis
*Table of Classification
.Histopathologypresence of yeast cells and
hyphae in the involved epithelium.
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 Phycomycosis

.PathogenPhycomycetes
.Clinical featuresTwo main type; superficial
and visceral
.Histopathogy
*various amount of necrosis
*large (6-30 um), non-septate hyphae with
branching at an obtuse angles.
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.CONCLUSION

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Suggested textbook

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Suggested textbook

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Suggested textbook

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