Lab Oral Infections

Dr. Rima Safadi

Primary herpetic gingivostomatitis

Mild circumoral crusting Ulcers on gingiva

Herpes Simplex Virus

Extraoral spread of infection: skin, fingers, nail bed, eyes

Herpetic whitlow

Multinucleated epithe. cells

Microscopic features Intraepithelial vesicle

Ballooning degeneration: swollen , eosinophilic cytoplasm, pale vesicular nuclei

Enlarged, multinucleated epithelial cells Tzanck cell: Access to nerve axons

Due to ruptured epithelial cells

Intraepithelial vesicle

 Balloon cell degeneration

Recurrent herpes infection

Small pinpointed vesicles/ulcers

Vesicles at vermilion border, junction with skin

Recurrent herpes infection

Small pinpointed vesicles/ulcers

Recurrent herpes labialis

Chicken pox

 Microscopic features: identical to HSV Prognosis for varicella is usually mild in children. vaccine is available. Acyclovir in immunocompro mised

Shingles

Unilateral vesicles and ulcers following trigeminal nerve branches

Infectious mononucleosis

pharyngitis
lymphadenopathy

petechei

Herpangina

Hand foot mouth disease

ANUG

Clinically Ulceration of interdental papilla and gingival margins Grey-green psuedomembrane Halitosis, salivation, lymphadenopathy

Actinomycosis

Actinomycosis
Etiology
filamentous branching Commensal organism Diagnosis
Culture, biopsy

Treatment
Long term high dose antibiotics Penicillin or tetracycline

Actinomycosis

neutrophils

Actinomyces colonies

Primary herpetic gingivostomatitis

Tzank cells

Syphilis

Clinical features
Primary
Chancre occurs at site of infection and is highly contagious

Syphilis
Clinical features
Secondary

Diffuse painless, maculopapular mucocutaneous rash 30% have grayish mucosal necrosis which are called mucous patches

Syphilis
Treponema pallidum Primary: chancre : shallow ulcer
Indurated base Associated with lymphadenopathy Heals spontanously

Syphilis
Mucous patch

6 weeks later
Secondary syphilis: skin rash and mucous patch Snail track ulcers, flat areas of ulceration that coalesced

Years later
Tertiary :

Gumma:
Necrosis and type IV hypersensitivity Perforation of palate

Atrophic glossitis:
due to endarteritis obliterance Followed by:

Syphilitic leukoplakia
Hyperkeratosis Followed by: Squamous cell carcinoma

Syphilis
Tertiary - Gumma on hard palate

Congenital Syphilis
Miscarriage, still birth or neonatal infection Collapse of nasal bridge Hutchinson triad: blindness, deafness, dental anomalies Hutchinson incisors (notched teeth)
Screw driver teeth

Peg shaped laterals Mulberry molars

Constricted atrophic cusps Globular masses of hard tissue

Classical TB ulcer:
Painless Undermind On the tongue

TB lymphadenitis and granulating gingival hyperplasia

Leprosy

Gonorrhoea
Neisseria gonorrhea Mainly tonsillar and soft palatal lesions Erythema, vesicles, ulcers, pain

Acute Pseudomembranous Candidosis (Thrush)

Pain or burning Predisposing:
xerostomia, antibiotics decreased host resistance 5 % of infants, 10% of elderly

White

plaques and red base

PAS stain

Acute Pseudomembranous Candidosis (Thrush)

Acute Pseudomembranous Candidosis (Thrush)

Acute Erythematous (Atrophic) Candidosis

(antibiotic sore tongue) Generalized pain, burning, erythema Prolonged corticosteroids or antibiotics Red and painful

Median Rhomboid glossitis

Chronic Atrophic Candidosis (Candidaassociated denture stomatitis)

Secondary infection by Candida in tissues modified by continual wearing of dentures Poor denture hygiene High carbohydrate diet May be asymptomatic Candida colonize the denture surface Minimal or no candidal invasion of mucosa

Chronic Hyperplastic Candidosis (Candidal Leukoplakia)

Persistent white patch Speckled/nodular Most frequent location: buccal mucosa at commissures Triangular Bilateral Associated with angular cheilities? Strong association with smoking
Local factors?

Chronic Hyperplastic Candidosis (Candidal Leukoplakia)

Chronic Hyperplastic Candidosis (Candidal Leukoplakia)

Neutrophils microabscess

PAS Stain

hyphae

Chronic Hyperplastic Candidosis (Candidal Leukoplakia)

Premalignant??????
Is candida a secondary infection of a pre existing leukoplakia?
Some lesions respond to antifungal therapyetiologic role

Angular Cheilitis
Fungal or bacterial or combined

Angular Cheilitis
Multifactorial disease of infectious origin
Candida or Staph aureus or Streptoccocci

Mainly in denture wearers

30% of patient with denture stomatitis have anguar cheilitis

Chronic mucocutanous candidosis

Persistent superficial infection of: skin, mucosa, nails Oral mucosa involved in most cases Orally: similar to candidal leukoplakia May be multifocal

Deep fungal infections

Non specific ulceration Or Granulomatous areas

Blastomycosis

Histoplasmosis

Zycomycosis

HIV infection and AIDS

Sero-conversion: detection of HIV antibodies in blood
in 3 months May have also acute symptoms

Sero-postitive for many years later on Persistent generalized lymphadenopathy AIDS related complex: persisitent pyrexia, lymphadenopathy, diarrhea, weight loss, fatigue and malaise Fully developed AIDS: opportunistic infections, Kaposi sarcoma, non Hodgekins lymphoma.

HIV-Gingivitis linear gingival erythema

Linear band of erythema free gingival margin

Not responsive to plaque control

Gingival hyperaemia due to release of vasoactive cytokines rather than inflammation Has been associated with C. albicans <10% of AIDS patietns

Necrotizing Ulcerative Periodontitis

Severe rapidly destructive process Necrosis of gingival and periodontal tissues Exposure of alveolar bone and sequestration Due to sever impairment of local defensive mechanisms like reduction in CD4 cells Defects usually localized Not responsive to conventional periodontal therapy

Acute Necrotizing Ulcerative Gingivitis

Hairy Leukoplakia
Vertical white folds on lateral border of the tongue, bilaterally White patch that can not be removed May have smooth flat surface May have candidal hyphae but as secondary

Hairy leukoplakia
Acanthosis Parakeratosis Finger like surface projections of parakeratin Absence of inflammatory cells in epithelium and lamina propria Swollen or balloon cells with prominent cell boundaries in pricke cell layer below parakeratin Perinuclear vaculization, small drak nuclei: koilocyte-like cells

parakeratin

Koilocyte like cells Superficial prickel cell layer

Kaposis Sarcoma

Kaposi sarcoma
Proliferating endothelial cells Cleft like vascular channels Extravasated RBC Inflammation Occasional atypical cells
Later stages more atypical cells Early stages difficult to differentiate it from other vascular lesions

Slit-like vessels

HIV associated HSV infection

HIV associated HZV infection

HIV thrombocytopenic purpura, autoimmune response

HIV oral ulceration

HIV lymphoma