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Non-Plaque Induced Bacterial Infections Cheat Sheet by

dentistry

Cause of Increase in STD's

> Resistance to antibi­otics
> Promis­cuity
> New, emerging diseases - mainly viral
> "it won't happen to me" attitudes
> Multiple sexual partners
> Many are polymi­crobial
> Migrant labour and travel
> Mostly poor ethnic minority groups affected

Chlamydia tracho­matis:

Serotypes D-K
World-wide distri­bution
Associated with eye infections
Restricted to columnar and transi­tional epithelial cells
Lymp­hog­ran­uloma verereum/ inguin­ale:
> Serotypes L1,L2,L3
> Restricted to Africa, Central and South America, Caribbean and S-East Asia
> System­ically spread

Chlamydia Infection:

Symp­toms:
Prev­ent­ion:
Painless sores in the mouth
Use condom or barrier when performing oral sex on penis
Lesions similar to cold sores around the mouth
Use dental dam or cut open a condom top to make a square the use it as a barrier between the vagina or anus and mouth
Tonsilitis
Redness with white spots resembling strep throat
Scratchy dry throat
Trea­tme­nt:
doxycy­cline, erthomycin
Labo­ratory Diagno­sis:
> Throat swab
> Serology unreliable
> Growth in cell cultures
> Specimen suspended in fluid
> Centri­fuged onto monolayer of tissue culture cells pretreated with cycloh­eximide
> Contains glycogen so stain with iodine
> ELISA

Chlamydia tracho­matis

Gonorrhoea

Neisseria gonorrhoea
Symp­toms:
> Changing sexual practice and oral sex predis­poses the sex partners with involv­ement of oropha­rengeal regions
- Pharyn­gitis
 
- 50% asympt­omatic
Prev­ent­ion:
Contact tracing
Follow-ups

S.pyogenes tonsil­litis

- Natural reservoir: humans
- Asympt­omatic carriers rarely found
- Clinical syndromes: tonsil­litis and pharyn­gitis
- Common in school children and adoles­cents
- Less frequent in adults
 

Scarlet Fever:

> Combin­ation of strep sore throat and erythema
> Due to erytho­genic toxin coded for by a lysogenic phage
> Rash begins in the face and spreads to most of the body except palms and soles
> Rash fades after 1 wk followed by extensive desqua­mation
> Symptoms: headache, chills and muscle ache

Syphilis:

Transm­itted sexually or congen­itally
Occurs worldwide, no season
Causative organism: Treponema pallidum
Treatment: penici­llin, tetrac­ycline, doxycy­cline

Syphillis:

Prim­ary:
Seco­nda­ry:
Tert­iary:
- Lips, buccal mucosa, tongue & tonsils
- Most infectious
- Gummas (bone,­skin, tissues) Neuros­yph­yllis, cardio­vas­cular syphillis
- Site of inocul­ation: 3 wk after infection, papule breaks down to form an ulcer (chancre)
- secondary stage= after 6-8wks &lasts 2-10wks
- May develop after asympt­omatic period of a few years to decades
- Oral chancre: painless ulcer w/ smooth surface, raised borders & indurated margin
- Clinical features = Malaise, low grade fever, headache, lacrim­ation. sore throat, weight loss, myalgia, arthralgia & genera­lized lympha­den­opathy
- Non tender cervical lympha­den­opathy
- Sponta­neous healing

Gummas:

Develops in 15% of untreated cases within 1-10 years after infection
Highly destru­ctive tertiary syphillis lesions that usually occur in skin and bones but may also occur in other tissues
Slowly progre­ssive, painless, dull red nodule or plaque
Breakdown into ulcer with wash-l­eather floor
Regional Ln are enlarged
Not infectious

Congenital Syphillis:

- Acquired in 1st trimester
- Silent infection - not apparent till after about 2 years
- Teeth and bone malfor­mation (mulberry teeth)
- Fatal for foetus
-IgM Ab in infants
- Retested after 6 months
- Elevated levels remain
Labo­ratory Diagno­sis:
Dark field or phase contrast microscopy
Serology:
> Non-­spe­cific tests:
-venereal disease research laboratory (VDRL)
-rapid plasma reagin test (RPR)
-positive 4-6wk after infection (1-2wks post primary chancre)

>­Spe­cific Tests:
-trepo­nemal Ab test (TAT)
-fluor­escent treponemal Ab absorption (FTA-ABS)
-micro­hae­mag­glu­tin­ation assay (MHA-TP)
-positive in pt w/late syphillis
 

Chancroid (soft chancre):

> Caused by Haemo­philus ducreyi
> Symptoms appear 3-5 days after contact
> Painful irregu­larly shaped soft ulcers
> May be confused with genital herpes but usually larger and more ragged
> Self-l­imi­ting, easily cured
> Does not affect distant organs
> Common in Africa and Asia

Chancre vs. Chancroid:

Lab Diagno­sis:
- school fish appearance
- cultured on GC agar w/ 1-2% haemag­lobin, 5% foetal­-bovine serum, 10% vancomycin @ 33 degrees Centigrade
- in 5-10% Carbon dioxide

Trea­tme­nt:
> Azithr­omycin
>Ce­ftr­iaxone
>Er­yth­romycin
>Ci­pro­flo­xicin

Cheilitis:

Corners of the mouth
Malnut­rition
Medica­tions
Infect­ions: Candida or Staph. aureus

Impetigo:

Common in children and adults involved in contact sport
Appears as red spots which mature into blisters
Blisters burst yielding a clear fluid and develop a yellow­-brown crust
Accomp­anied by itching
Generally appears around nose and mouth (can occur anywhere)
Associated w/ insect bites, cuts or abrasions
Staph­yloccus aures (80% Strep­toc­occus pyogenes (20%)
Stap­hyl­ococcus Infect­ions:
Trea­tment
>mild cases heal on their own w/good hygiene
>Ca­rbu­ncles: incision and drainage
>Di­clo­xac­illin, cephalexin
>MR­SA-­tri­met­hop­rim­-su­lfa­met­hox­azole, clinda­mycin

Coryn­eba­cterium dipthe­riae:

Gram + bacillus
non-mo­tile, anerobe
Usually affects children and adoles­cents
Transm­itted by droplets
3 Biotypes: 1. C.gravis , 2 C.mitis, 3 C. interm­edius
Lab diagnosis: Elek agar (immun­ode­fus­ion), Tellurite, Blood agar
Albert's Stain = Metach­romatic granules
Gram Stain = Chinese lettering

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