The infectious diseases caused by microbes are due to the – Fomites refers to inanimate objects that can carry

latter’s ability to affect disturbance in the state of health of
the patient. Microbes cause disease in the course of stealing
space, nutrients, and/or living tissue from their symbiotic
hosts (e.g., human being). To do this, microbes do most of
the following: – Gain access to the host (contamination) –
Adhere to the host (adherence) – Replicate on the host
(colonization) – Invade tissues (invasion) – Produce toxins or
other agent that cause harm to the host.
Microbial Diseases
and spread disease and infectious agents like clothes,
blankets, door handles etc.
– Vectors are living organisms that can transmit
infectious pathogens between humans, or from animals to
humans. (e.g. mosquitoes)
– Food and water
– Intermediate hosts is normally used by a parasite
in the course of its life cycle and in which it may multiply
asexually but not sexually (e.g. snails)

Introduction
CLINICAL RESPONSES TO INFECTION BY AN AGENT
1. Disease is a disturbance in the state of health
1. Inapparent infection – no clinical symptoms
2. Microbes cause disease in the course of stealing
generated
space, nutrients, and/or living tissue from their
symbiotic hosts (e.g., us) 2. Carrier state – usually no clinical symptoms but host
can transmit infection for long periods
3. To do this, microbes do most of the following:
3. Clinical symptoms
– Gain access to the host (contamination)
– Mild disease
– Adhere to the host (adherence)
– Severe disease
– Replicate on the host (colonization)
– Residual impairment
– Invade tissues (invasion)
– Death
– Produce toxins or other agents that cause host
harm (damage) 1. Manifestations may be local (eg, cellulitis, abscess)
or systemic, most often fever.
BIOLOGIC CHARACTERISTICS OF INFECTIOUS AGENTS
2. Manifestations may develop in multiple organ
1. Infectivity – the ability to infect a host
systems.
2. Pathogenicity – the ability to cause disease in the
3. Severe, generalized infections may have life-
host
threatening manifestations (eg, sepsis, septic shock.
3. Virulence – the ability to cause severe disease in the
4. Most manifestations resolve with successful
host
treatment of the underlying infection.
4. Immmunogenicity –the ability to induce an immune
response in the host
The oral cavity harbors a diverse microbial flora that under
normal conditions resides in homeostasis.
MODES OF TRANSMISSION
The imbalance of this flora or the colonization with new
1. Direct microorganisms from a viral, fungal, or bacterial origin can
infect the oral cavity and its mucosa.
– Droplet

– Aerosol
Bacteria
– Skin to skin
1. Bacteria are microorganisms that have circular
1. Indirect
double-stranded DNA and (except for mycoplasmas)
cell walls.
2. Most bacteria live extracellularly, but some
preferentially reside and replicate intracellularly.

3. Obligate intracellular pathogens are able to grow,

reproduce, and cause disease only within the cells of
the host.

4. Facultative intracellular pathogens are able to live

and reproduce either inside or outside of host cells.

5. Many bacteria are present in humans as normal

microbiota, often in large numbers and in many
areas (eg, in the gastrointestinal tract and skin). Only
a few bacterial species are human pathogens. Cholera

6. Bacteria are classified by their Gram stain 1. Caused by Vibrio cholera.

characteristics.
2. Transmitted by ingestion of food and water
7. Gram staining is the application of a crystal violet contaminated directly or indirectly by feces or
dye to a culture of bacteria. vomitus of infected persons.

1. Bacteria that retain the color of the dye are 3. It is an acute enteric diseases varying in severity.
called Gram positive; bacteria that don't are
4. It can cause massive diarrhea with depletion of
Gram negative.
water and electrolytes.
8. Primary bacterial infections of the oral mucosa
5. Diarrhea due to cholera often has a pale, milky
seldom arise because of the oral epithelium's
appearance that resembles water in which rice has
protective role over the underlying tissues, the
been rinsed (rice-water stool).
saliva's antibacterial characteristics, and the immune
responses of the phagocytes. 6. It can be fatal.
9. However, if the oral mucosa is disrupted due to poor 7. Diagnosis : stool culture
oral hygiene, trauma, smoking, alcohol misuse, or
any other stimuli, the risk of primary bacterial 8. Treatment is with electrolyte-containing solutions
infections goes up. (ORESOL); Ciprofloxacin

10. Immunocompromised patients such as those with

HIV, cancer, or undergoing prolonged corticosteroid
therapy are also at increased risk.
Leprosy (Hansen's disease)

1. Caused by Mycobacterium leprae.

2. Humans are the main natural reservoir for M. leprae.

3. Armadillos are the only confirmed source other than

humans, although other animal and environmental
sources may exist.

4. Leprosy is thought to be spread by passage from

person to person through nasal droplets and
secretions. 

5. Symptoms usually do not begin until > 1 yr after

infection (average 5 to 7 yr). Once symptoms begin,
they progress slowly.
 6. Leprosy affects mainly the skin and peripheral
nerves. Nerve involvement causes numbness and
weakness in areas controlled by the affected nerves.
7. The most severe complications result from the
peripheral neuropathy, which causes deterioration
of the sense of touch and a corresponding inability
to feel pain and temperature.
8. Patients may unknowingly burn, cut, or otherwise
harm themselves. Repeated damage may lead to loss
of digits.
9. Muscle weakness can result in deformities (eg,
clawing of the 4th and 5th fingers caused by ulnar
nerve involvement, foot drop caused by peroneal
nerve involvement).
10. Diagnosed by skin biopsy
11. Long-term, multidrug regimens
with dapsone, rifampin, and sometimes clofazimine
12. Sometimes lifelong maintenance antibiotics
Leptospirosis
1. Caused by Sprirochetes of the genus Leptospira.
2. Human infections are acquired by direct contact with
infected urine or tissue or indirectly by contact with
contaminated water or soil.
3. Outbreaks frequently follow exposure to
contaminated flood water.
4. Abraded skin and exposed mucous membranes
(conjunctival, nasal, oral) are the usual entry portals.
5. Leptospirosis can be an occupational disease (eg, of
farmers or sewer workers)
6. The incubation period ranges from 2 to 20 (usually 7
to 13) days. The disease is characteristically biphasic.
7. The septicemic phase starts abruptly, with
headache, severe muscular aches, chills, fever,
cough, pharyngitis, chest pain, and, in some patients,
hemoptysis. Conjunctival suffusion usually appears
on the 3rd or 4th day. Defervescence (abatement of
fever) follows.
8. The 2nd, or immune, phase occurs between the 6th
and 12th day of illness, correlating with appearance
of antibodies in serum. Fever and earlier symptoms
recur.
Weil syndrome (icteric leptospirosis) is a severe form
with jaundice and usually azotemia, anemia, diminished
consciousness, and continued fever.
Diagnosis : Blood cultures and serologic testing
Prevention :
1. Avoid flood waters
2. Use PPE
3. Prophylaxis : The recommended regimen for
pre‐exposure prophylaxis for non‐pregnant,
non‐lactating adults is: Doxycycline
(hydrochloride and hyclate) 200 mg once
weekly, to begin 1 to 2 days before exposure
and continued throughout the period of
exposure.
Treatment : Penicillin or Doxycycline
Weil syndrome
Ictarus (jaundice)
 Yellowing pf the eye globes
 Yellow epidermis
 Dark urine
Typhoid fever
1.   A systemic disease caused by Salmonella serotype
Typhi. 
• Typhoid bacilli are shed in stool of asymptomatic
carriers or in stool or urine of people with active
disease.
• Inadequate hygiene after defecation may
spread S. Typhi to community food or water
supplies.
Signs and symptoms include fever, rash, splenomegaly and
leukopenia, and sometimes intestinal bleeding or
perforation.
Cultures of blood, stool, and urine should be obtained.
Treatment : Ceftriaxone; sometimes a fluoroquinolone
or azithromycin.
Diphtheria
 1. Diphtheria is an acute pharyngeal or cutaneous
infection caused mainly by toxigenic strains
of Corynebacterium diphtheriae and rarely by other,
less common Corynebacterium  sp.
2. Symptoms are either nonspecific skin infections or
pseudomembranous pharyngitis.
3. If a toxigenic strain is involved, the characteristic
membrane appears in the tonsillar area. It may
initially appear as a white, glossy exudate but
typically becomes dirty gray, tough, fibrinous, and
adherent so that removal causes bleeding.
4. Local edema may cause a visibly swollen neck (bull
neck), hoarseness, stridor, and dyspnea. The
membrane may extend to the larynx, trachea, and
bronchi and may partially obstruct the airway or
suddenly detach, causing complete obstruction.
Diagnosis is clinical and confirmed by culture.
Treatment is with antitoxin and penicillin or erythromycin.
Childhood vaccination should be routine.
Pertussis
(WHOOPING COUGH)
1. Pertussis is a highly communicable disease occurring
mostly in children and adolescents and caused
by Bordetella pertussis.
2. Symptoms are initially those of nonspecific URI
followed by paroxysmal or spasmodic coughing that
usually ends in a prolonged, high-pitched, crowing
inspiration (the whoop).
3. Diagnosis is by nasopharyngeal culture, PCR, and
serologic assays.
4. Treatment is with macrolide antibiotics.
Tetanus (Lockjaw)
1. Tetanus is acute poisoning from a neurotoxin
produced by Clostridium tetani.
2. Tetanus may follow trivial or even inapparent
wounds.
3. Infection may also develop postpartum in the uterus
(maternal tetanus) and in a neonate's umbilicus
(tetanus neonatorum).
4. C. tetani spores usually enter through contaminated
wounds. Manifestations of tetanus are caused by an
exotoxin (tetanospasmin) produced by the
germinating spores.
5. The toxin may enter the CNS along the peripheral
motor nerves or may be bloodborne to nervous
tissue.
6. Most often, tetanus is generalized, affecting skeletal
muscles throughout the body. However, tetanus is
sometimes localized to muscles near an entry
wound.
1. The incubation period ranges from 2 to 50 days
(average, 5 to 10 days). Symptoms include
a. Jaw stiffness (most frequent)
b. Difficulty swallowing
c. Restlessness
d. Irritability
e. Stiff neck, arms, or legs
f. Headache
g. Sore throat
h. Tonic spasms (risus sardonicus)
2. Later, patients have difficulty opening their jaw
(trismus).
Treatment is with human tetanus immune globulin and
intensive support.
Syphilis
1. Syphilis is caused by a spirochete known
as Treponema pallidum that can be
sexually transmitted (vaginal, anal, or oral contact)
or passed through the placenta, causing congenital
syphilis. 
2. It has an incubation period of approximately 20 to 40
days. 
3. The host for T. pallidum is humans, and it has
no animal reservoir.
4. Approximately 4 to 12% of syphilis patients will
present with oral manifestations and are usually
diagnosed in the secondary phase of the disease. 
 5. The mean age of syphilis diagnosis is around 34 years
old, of which 51% are men.
6. The oral manifestation of syphilis is usually the first
sign of the disease.
7. The initial oral lesion characteristic of primary
syphilis, known as a chancre, appears at the site of
inoculation around two weeks after the exposure.
8. The most common locations are the buccal mucosa,
tongue, and lips.
1. Syphilis can be screened via nontreponemal
serological tests, such as the venereal disease
research laboratory (VDRL) and rapid plasma reagin
(RPR) tests. 
2. If these are positive, then further testing
is mandatory.
3. Additional specific treponemal tests are required to
rule out or confirm the diagnosis of syphilis, like the
fluorescent treponemal antibody absorption (FTA-
ABS) test or treponema pallidum
microhemagglutination assay (TP-MHA).

1. Secondary syphilis is a highly contagious stage that

appears 2 to 8 weeks after the primary chancre
Syphilis : Treatment
emerges. 
1. The chancre and oral lesions in primary syphilis are
2. In this period, oral lesions can be maculopapular or
self-limiting and heal without scar in three to six
mucosal patches.
weeks. 
3. The mucosal patches are more common,
2. A single dose of long-acting benzathine penicillin G
appearing as slightly raised or shallow oval ulcers
(2.4 million units) intramuscular is the drug of choice
surrounded by an erythematous border with a gray
if primary lesions persist and for secondary syphilis. 
pseudomembrane. 
3. Tertiary syphilis is also treated
4. Lesions on the tongue may appear as irregular
with intramuscular benzathine penicillin G once
fissures or pronounced ulcerations. 
weekly for three to four weeks. 
5. Unlike primary syphilis, oral lesions in the secondary
4. The duration of treatment depends on the stage
stage of the disease are multiple and
of the disease and its manifestations. 
painful. Patients also report sore throats.
5. Patients who are allergic to penicillin are
6. Systemic symptoms include fever and
alternatively treated with doxycycline, tetracycline,
lymphadenopathy.
or ceftriaxone. 
7. In the skin, a maculopapular rash involving the palms
6. Patients diagnosed with syphilis, even if receiving
and soles and alopecia may be found.
treatment, should abstain from any sexual activity to
8. Condylomata lata, a painless, smooth wart-like prevent the spread of the disease. 
lesion, can be observed on the genitals during this
7. In addition, the sexual partners of a syphilis patient
period.
should be notified, tested, and treated accordingly. 

Syphilis : Complications
1. Tertiary syphilis is a destructive stage that manifests
1. Untreated syphilis can lead to cardiovascular and
months or years after the initial infection in patients
neurological syphilis.
who have not received effective treatment during
the primary or secondary stages of the disease. 2. These complications are irreversible, as the
treatment of syphilis can prevent further damage
2. Oral manifestations of this phase include a chronic
but not repair the one that is already done.
granulomatous gumma usually located on the hard
palate, which may perforate into the nasal septum.  3. Patients with a high titer of secondary syphilis, who
are being treated with penicillin, can develop a
3. The tongue may present with leukoplakia dorsally or
Jarisch-Herxheimer reaction. 
appear atrophic and fissured.[

Syphilis : Diagnosis
 4. Jarisch Herxheimer reaction (JHR) is a transient
clinical phenomenon that occurs in patients infected
by spirochetes who undergo antibiotic treatment.
5. The reaction occurs within 24 hours of antibiotic
treatment of spirochete infections, including syphilis,
leptospirosis, Lyme disease, and relapsing fever.
6. JHR usually manifests as fever, chills, rigors, nausea
and vomiting, headache, tachycardia, hypotension,
hyperventilation, flushing, myalgia, and exacerbation
of skin lesions.
Scarlet fever
1. Scarlet fever is a bacterial infection that develops in
patients suffering from bacterial pharyngitis - strep
throat - and occasionally from streptococcal skin or
wound infections. 
2. The causative agent is Streptococcus pyogenes,
which belongs to the gram-positive A beta-hemolytic
streptococci group (GABHS).
3. Humans are the primary reservoir for this bacterium,
with approximately 2 to 5 days of incubation.
4. Scarlet fever, also known as scarlatina, can spread
directly from person to person via infected saliva or
nasal secretions.
5. There is a higher risk of transmission in crowded
conditions such as daycare centers and schools.
1. Scarlet fever can occur in all age groups, but it is
more prevalent amongst children between 5 to 15
years old.  generation cephalosporin is effective in reducing
2. Strep throat is responsible for 15 to 30% of all
pharyngitis in children and 5 to 15% in adults,
making the prevalence of scarlet fever higher in
children.
3. Scarlet fever is seen more in underdeveloped
countries due to crowded living circumstances.
1. Scarlet fever is typically associated with acute
pharyngitis with accompanying symptoms such as
sore throat, fever, odynophagia, cervical
adenopathy.
2. The skin presents with a papular-blanching rash,
covering most of the body. 
3. This rash is described as a "sandpaper rash" because
of the lesions' lack of confluence.
4. It develops on the face, trunk, underarms, and groin
first, spreading to the extremities later, sparing the
palms and soles. 
5. Scarlet fever has a common oral manifestation
known as "strawberry tongue" because of the
hyperplastic fungiform papillae and white coating; as
the white coating resolves, the remaining papules
give the tongue a red, bumpy appearance.
6. The throat may also appear erythematous along with
white or yellowish patches making swallowing
painful.
1. Scarlet fever is sometimes clinically diagnosed
through history and physical examination, although
this may be challenging because of its earlier stages'
wide variety in severity. 
2. Throat cultures and rapid strep tests can be
performed to identify group A strep (GAS). 
1. The first-line treatment for GAS infections is beta-
lactam antibiotics due to their clinical efficacy and
low cost.
2. Penicillins usually outperform cephalosporins and
macrolides.
3. If the patient is allergic to penicillin, the first-
morbidity and mortality.
4. Penicillin (V) is typically prescribed four times a day
for ten days, and other systemic symptoms may be
treated with acetaminophen or ibuprofen and fluid
replenishment.
5. The oral manifestations tend to resolve within two
weeks.
1. Untreated scarlet fever can lead to rheumatic fever,
which affects the heart, joints, skin, and brain. 
2. The risk of having these complications is higher in
children, and they usually develop 2 to 3 weeks after
the initial infection. 
 3. Scarlet fever can also lead to renal complications,
such as post-streptococcal glomerulonephritis; this is
also more common in children than adults and can
occur within a few weeks of throat infection or 3 to 6
weeks after GAS skin infection.
long time, sometimes for many years. Sometimes a
trigger (particularly immunosuppression) causes
reactivation.

Viral diseases

Viruses

1. Viruses are the smallest parasites, typically ranging

from 0.02 to 0.3 micrometer, although several very
large viruses up to 1 micrometer long (megavirus,
pandoravirus) have recently been discovered.

2. Viruses depend completely on cells (bacterial, plant,

or animal) to reproduce. Viruses have an outer cover
of protein and sometimes lipid, an RNA or DNA core,
and sometimes enzymes needed for the first steps of
viral replication.

3. Viruses are classified principally according to the

nature and structure of their genome and their
method of replication, not according to the diseases
Dengue
they cause.
(Breakbone fever)
4. Viral infections are often readily transmitted in saliva
and other body fluids, and where general hygiene is
low and there is close contact with other persons or
1. Dengue is a mosquito-borne disease (Aedes
their secretions, infections are common.
mosquito) caused by a flavivirus.
5. The consequences of viral infection vary
2. Dengue fever usually results in abrupt onset of high
considerably.
fever, headache, myalgias, arthralgias, and
6. Many infections cause acute illness after a brief lymphadenopathy, followed by a rash that appears
incubation period. with a 2nd temperature rise after an afebrile period.

7. Some remain in a latent state, and some cause 3. Respiratory symptoms, such as cough, sore throat,
chronic disease. and rhinorrhea, can occur.

8. In latent infection, viral RNA or DNA remains in host
cells but does not replicate or cause disease for a
long time, sometimes for many years. Sometimes a
trigger (particularly immunosuppression) causes
reactivation.
9. The consequences of viral infection vary
considerably.
4. Dengue can also cause potentially fatal hemorrhagic
fever with a bleeding tendency and shock.
5. Diagnosis involves serologic testing and PCR.
6. Treatment is symptomatic and, for dengue
hemorrhagic fever, includes meticulously adjusted
intravascular volume replacement.

10. Many infections cause acute illness after a brief

incubation period.

11. Some remain in a latent state, and some cause

chronic disease.

12. In latent infection, viral RNA or DNA remains in host

cells but does not replicate or cause disease for a

Herpes simplex virus (HSV)
1. 2 subtypes of HSV:
a. HSV-1 – more frequently causes oral lesions
b. HSV-2 – usually isolated from the genital
area
2. Both subtypes can cause both oral and genital
lesions
3. Acute Gingivostomatitis is the most common
manifestation in childhood.
4. The illness begins with fever and inflammation of the
oral mucosa.
5. Regional lymph nodes become tender.
6. Persistence should prompt an investigation for
immunodeficiency.
7. Gingivostomatitis can lead to dehydration as a result
of limitation of oral intake because of the painful
mouth lesions.
8. Treatment of HSV infections like gingivostomatitis is
supportive
9. Topical anesthetics and systemic analgesics provide
some relief from the pain.
10. Young children occasionally require intravenous
hydration.
Varicella zoster virus
1. Herpes virus Varicellae, the cause of both zoster
(shingles) and varicella (chickenpox) has a worldwide
distribution.
2. Transmission is by airborne droplets and direct
contact with infectious lesions.
3. The individual is considered contagious from 1 to 2
days before the eruption until all lesions are crusted
usually 6 to 7 days after eruption.
4. In contrast to varicella, zoster occurs predominantly
in adults.
5. Since reactivation of latent virus is the antecedent of
the eruption in zoster, an individual does not acquire
the disease from an exogenous source.
6. A mild 1 to 3 day prodrome of fever and malaise
frequently precedes the exanthem
7. The presence of the rash is often the first sign of
illness.
8. The lesions become pustular and then crust.
9. Lesions initially develop on the face and trunk and
erupt in successive crops; some macules appear just
as earlier crops begin to crust.
10. The eruption may be generalized (in severe cases) or
more limited but almost always involves the upper
trunk.
11. Oral lesions are characterized by small blister-like
manifestations that involve various areas of oral
mucosa. Oral lesions resemble vesicles of primary
HSV, but these lesions are not particularly an
important symptomatic, diagnostic, or management
problem. 
Zoster
1. In Zoster infection (shingles) fever may or may not
be present.
2. The infection is often preceded by neuralgia, which is
generally more sever in adults.
3. Lesions are confined to single dermatomal area
4. The appearance and evolution of lesions are the
same with varicella infection.
Varicella-Zoster Virus
1. The typical case of varicella or zoster is diagnosed on
the basis of clinical features.
2. Symptomatic treatment is provided in the form of
analgesics and antipruritics
3. Ocular involvement in cases of zoster needs the
attention of an Ophthalmologist.
 4. Aciclovir is considered by some the treatment of
choice.
Herpangina
1. It is characterized by sudden onset of fever with sore
throat, headache, anorexia, and frequently neck
pain.
2. Infants may vomit.
3. Within 2 days after onset, up to 20 (mean, 4 to 5) 1-
to 2-mm diameter grayish papules develop and
become vesicles with erythematous areolae.
4. They occur most frequently on the tonsillar pillars
but also on the soft palate, tonsils, uvula, or tongue.
5. During the next 24 h, the lesions become shallow
ulcers, seldom > 5 mm in diameter, and heal in 1 to 7
days.
6. Diagnosis is based on symptoms and characteristic
oral lesions.
7. Treatment is symptomatic.
Hand-foot-and-mouth disease
1. The disease is most common among young children.
The course is similar to that of herpangina.
2. Hand, foot, and mouth disease is caused by viruses
that belong to the Enterovirus genus (group),
including polioviruses, coxsackieviruses, echoviruses,
and enteroviruses.
3. Children have a sore throat or mouth pain and may
refuse to eat.
4. Fever is common.
5. Vesicles are distributed over the buccal mucosa and
tongue, the hands and feet, and, occasionally, the
buttocks or genitals; usually, the vesicles are benign
and short-lived.
6. The diagnosis of hand-foot-and-mouth disease is
usually made clinically.
7. Treatment is symptomatic.
Mumps
1. Paramyxovirus
2. Transmission is by direct contact or by contact with
droplets of saliva that contains several virus several
days before and up to 1 week after the swelling of
the Parotids appears.
3. After a 12- to 24-day incubation period, most people
develop headache, anorexia, malaise, and a low- to
moderate-grade fever.
4. The salivary glands become involved 12 to 24 h later,
with fever up to 39.5 to 40° C.
5. Fever persists 24 to 72 h.
6. Parotitis is usually bilateral but may be unilateral,
especially at the onset.
7. Pain while chewing or swallowing, especially while
swallowing acidic liquids such as vinegar or citrus
juice, is its earliest symptom.
8. It later causes swelling beyond the parotid in front of
and below the ear.
9. About 20% of postpubertal male patients develop
orchitis (testicular inflammation), usually unilateral,
with pain, tenderness, edema, erythema, and
warmth of the scrotum.
10. Some testicular atrophy may ensue, but
testosterone production and fertility are usually
preserved.
11. In females, oophoritis (gonadal involvement) is less
commonly recognized, is less painful, and does not
impair fertility.
12. Treatment of mumps and its complications is
supportive. The patient is isolated until glandular
swelling subsides.
13. A soft diet reduces pain caused by chewing.
14. Acidic substances (eg, citrus fruit juices) that cause
discomfort should be avoided.
15. For orchitis, bed rest and support of the scrotum in
cotton on an adhesive-tape bridge between the
thighs to minimize tension or use of ice packs often
relieves pain.
Measles
Measles (Rubeola)
1. Paramyxovirus
 2. Measles is spread mainly by secretions from the
nose, throat, and mouth during the prodromal or
early eruptive stage.
3. Communicability begins several days before and
continues until several days after the rash appears.
4. Measles is not communicable once the rash begins
to desquamate.
1. After a 7- to 14-day incubation period, measles
begins with a prodrome of fever, coryza, hacking
cough, and tarsal conjunctivitis.
2. Pathognomonic Koplik spots appear during the
prodrome, before the onset of rash, usually on the
oral mucosa opposite the 1st and 2nd upper molars.
3. The spots resemble grains of white sand surrounded
by red areolae. They may be extensive, producing
diffuse mottled erythema of the oral mucosa.
4. The rash appears 3 to 5 days after symptom onset,
usually 1 to 2 days after Koplik spots appear.
5. It begins on the face in front of and below the ears
and on the side of the neck as irregular macules,
soon mixed with papules.
6. Within 24 to 48 h, lesions spread to the trunk and
extremities (including the palms and soles) as they
begin to fade on the face.
7. Petechiae or ecchymoses may occur with severe
rashes.
8. During peak disease severity, a patient’s
temperature may exceed 40° C, with periorbital
edema, conjunctivitis, photophobia, a hacking cough,
extensive rash, prostration, and mild itching.
9. In 3 to 5 days, the fever falls, the patient feels more
comfortable, and the rash fades rapidly, leaving a
coppery brown discoloration followed by
desquamation.
10. Diagnosis is by identifying the clinical manifestations.
11. Treatment is supportive.
German measles (rubella)
1. Rubella is caused by an RNA virus, rubella virus,
which is spread by respiratory droplets through close
contact or through the air.
2. Immunity appears to be lifelong after natural
infection.
3. Many cases are mild. After a 14- to 21-day
incubation period, a 1- to 5-day prodrome, usually
consisting of low-grade fever, malaise, conjunctivitis,
and lymphadenopathy, occurs in adults but may be
minimal or absent in children.
4. Tender swelling of the suboccipital, postauricular,
and posterior cervical nodes is characteristic.
5. The rash is similar to that of measles but is less
extensive and more evanescent; it is often the first
sign in children.
6. It begins on the face and neck and quickly spreads to
the trunk and extremities.
7. On the 2nd day, the rash often becomes more
scarlatiniform (pinpoint) with a reddish flush.
8. Petechiae form on the soft palate (Forschheimer
spots), later coalescing into a red blush.
9. The rash lasts 3 to 5 days.
10. Constitutional symptoms in children are absent or
mild and may include malaise and occasional
arthralgias.
11. Adults usually have few or no constitutional
symptoms but occasionally have fever, malaise,
headache, stiff joints, transient arthritis, and mild
rhinitis.
12. Fever typically resolves by the 2nd day of the rash.
13. Rubella is suspected in patients with characteristic
adenopathy and rash. 
14. Treatment is symptomatic. 
Monkeypox
1. Monkeypox is a rare disease caused by infection with
the monkeypox virus. Monkeypox virus is part of the
same family of viruses as variola virus, the virus that
causes smallpox. Monkeypox symptoms are similar
to smallpox symptoms, but milder, and monkeypox
is rarely fatal. Monkeypox is not related to
chickenpox.
2. Monkeypox was discovered in 1958 when two
outbreaks of a pox-like disease occurred in colonies
of monkeys kept for research. Despite being named
“monkeypox,” the source of the disease remains
 unknown. However, African rodents and non-human
primates (like monkeys) might harbor the virus and
infect people.
3. The first human case of monkeypox was recorded in
1970.
Monkeypox : Symptoms
1. Symptoms of monkeypox can include:
a. Fever
b. Headache
c. Muscle aches and backache
d. Swollen lymph nodes
e. Chills
f. Exhaustion
2. A rash that can look like pimples or blisters that
appears on the face, inside the mouth, and on other
parts of the body, like the hands, feet, chest,
genitals, or anus.
3. The rash goes through different stages before
healing completely. The illness typically lasts 2-4
weeks. Sometimes, people get a rash first, followed
by other symptoms. Others only experience a rash.
Monkeypox : Transmission
1. Monkeypox spreads in different ways. The virus can
spread from person-to-person through:
a. direct contact with the infectious rash, scabs,
or body fluids
b. respiratory secretions during prolonged,
face-to-face contact, or during intimate
physical contact, such as kissing, cuddling, or
sex
c. touching items (such as clothing or linens)
that previously touched the infectious rash
or body fluids
d. pregnant people can spread the virus to
their fetus through the placenta
2. It’s also possible for people to get monkeypox from
infected animals, either by being scratched or bitten
by the animal or by preparing or eating meat or
using products from an infected animal.
3. Monkeypox can spread from the time symptoms
start until the rash has fully healed and a fresh layer
of skin has formed. The illness typically lasts 2-4
weeks. People who do not have monkeypox
symptoms cannot spread the virus to others.
Monkeypox : Prevention
1. Take the following steps to prevent getting
monkeypox:
a. Avoid close, skin-to-skin contact with people
who have a rash that looks like monkeypox.
b. Do not touch the rash or scabs of a person
with monkeypox.
c. Do not kiss, hug, cuddle or have sex with
someone with monkeypox.
d. Do not share eating utensils or cups with a
person with monkeypox.
e. Do not handle or touch the bedding, towels,
or clothing of a person with monkeypox.
f. Wash your hands often with soap and water
or use an alcohol-based hand sanitizer.
g. Vaccination
2. If you are sick with monkeypox:
a. Isolate at home
b. If you have an active rash or other
symptoms, stay in a separate room or area
away from people or pets you live with,
when possible.
Monkeypox : Treatment
1. There are no treatments specifically for monkeypox
virus infections.
2. However, monkeypox and smallpox viruses are
genetically similar, which means that antiviral drugs
and vaccines developed to protect against smallpox
may be used to prevent and treat monkeypox virus
infections.
COVID-19 Disease
1. COVID-19 is the disease caused by a new coronavirus
called SARS-CoV-2.  
 2. WHO first learned of this new virus on 31 December f. Sleep disorders,
2019, following a report of a cluster of cases of ‘viral
g. More severe and rare neurological
pneumonia’ in Wuhan, People’s Republic of China.
complications such as strokes, brain
inflammation, delirium and nerve damage.

COVID-19 Disease : Symptoms COVID-19 Disease : Testing

1. The most common symptoms of COVID-19 are 1. Anyone with symptoms should be tested, wherever
possible.
a. Fever
2. People who do not have symptoms but have had
b. Dry cough
close contact with someone who is, or may be,
c. Fatigue infected may also consider testing – contact your
local health guidelines and follow their guidance. 
2. Other symptoms that are less common and may
affect some patients include: 3. While a person is waiting for test results, they should
remain isolated from others. 
a. Loss of taste or smell,

b. Nasal congestion,
1. In most situations, a molecular test is used to detect
c. Conjunctivitis (also known as red eyes) SARS-CoV-2 and confirm infection. 
d. Sore throat, 2. Polymerase chain reaction (PCR) is the most
e. Headache, commonly used molecular test. Samples are
collected from the nose and/or throat with a swab.
f. Muscle or joint pain,
3. Molecular tests detect virus in the sample by
g. Different types of skin rash, amplifying viral genetic material to detectable levels.
h. Nausea or vomiting, For this reason, a molecular test is used to confirm
an active infection, usually within a few days of
i. Diarrhea, exposure and around the time that symptoms may
begin. 
j. Chills or dizziness.
4. Rapid antigen tests (sometimes known as a rapid
diagnostic test – RDT) detect viral proteins (known as
1. Symptoms of severe COVID‐19 disease include: antigens).

a. Shortness of breath, 5. Samples are collected from the nose and/or throat
with a swab.
b. Loss of appetite,
6. These tests are cheaper than PCR and will offer
c. Confusion,
results more quickly, although they are generally less
d. Persistent pain or pressure in the chest, accurate.

e. High temperature (above 38 °C). 7. These tests perform best when there is more virus
circulating in the community and when sampled
2. Other less common symptoms are: from an individual during the time they are most
a. Irritability, infectious. 

b. Confusion,

c. Reduced consciousness (sometimes Quarantine vs Isolation

associated with seizures), 1. Quarantine is used for anyone who is a contact of
d. Anxiety, someone infected with the SARS-CoV-2 virus, which
causes COVID-19, whether the infected person has
e. Depression, symptoms or not.
 2. Quarantine means that you remain separated from
others because you have been exposed to the virus
and you may be infected and can take place in a
designated facility or at home. For COVID-19, this
means staying in the facility or at home for 14 days.
3. Isolation is used for people with COVID-19
symptoms or who have tested positive for the virus.
4. Being in isolation means being separated from other
people, ideally in a medically facility where you can
receive clinical care.  seats, caps, bed linens, towels, hotel rugs, and locker
5. If isolation in a medical facility is not possible and
you are not in a high risk group of developing severe
disease, isolation can take place at home.
6. If you have symptoms, you should remain in isolation
for at least 10 days plus an additional 3 days without
symptoms.
7. If you are infected and do not develop symptoms,
you should remain in isolation for 10 days from the
time you test positive.  The frequency of oral mycosis has remarkably increased
COVID-19 Disease : Prevention
1. To prevent the spread of COVID-19:
a. Maintain a safe distance from others (at
least 1 metre), even if they don’t appear to
be sick.
b. Wear a mask in public, especially indoors or
when physical distancing is not possible.
c. Choose open, well-ventilated spaces over
closed ones. Open a window if indoors.
d. Clean your hands often. Use soap and water,
or an alcohol-based hand rub.
e. Get vaccinated when it’s your turn. Follow
local guidance about vaccination.
f. Cover your nose and mouth with your bent
elbow or a tissue when you cough or sneeze.
g. Stay home if you feel unwell.
Fungal infections
1. Fungal infections are often classified as opportunistic
or primary.
2. Opportunistic infections are those that develop
mainly in immunocompromised hosts; primary
infections can develop in immunocompetent hosts.
3. Fungal infections can be systemic or local.
4. Local fungal infections typically involve the skin,
mouth, and/or vagina and may occur in normal or
immunocompromised hosts.
Fungal infections are transmitted by:
1. Direct contact with infected host (human or animal).
2. Indirect contact with infected exfoliated skin or hair
in combs, hair brushes, clothing, furniture, theatre
room floors.
The majority of oral fungal infections (oral mycosis) are
resultant of opportunistic conditions.
Host resistance impairment allows for the initiation and
progression of pathogenic conditions through local
colonization in the oral cavity.
globally with the increased use of immunosuppressive drugs
and immunodeficiency viral infections.
Oral mycological conditions range from superficial to deep
fungal infections of the oral tissues.
The most frequently diagnosed and reported oral fungal
infections are the superficial type and candidiasis.
Dermatophytoses
1. Dermatophytes are molds that require keratin for
nutrition and must live on stratum corneum, hair, or
nails to survive.
2. Human infections are caused by
Epidermophyton, Microsporum, and Trichophyton sp
p.
3. These infections differ from candidiasis in that they
are rarely if ever invasive.
4. Transmission is person-to-person, animal-to-person,
and, rarely, soil-to-person.
5. Common dermatophytoses include tinea barbae,
tinea capitis, tinea corporis, tinea cruris and tinea
pedis,.
6. Symptoms and signs vary by site (skin, hair, nails).
7. Most often, there is little or no inflammation;
asymptomatic or mildly itching lesions with a scaling,
slightly raised border remit and recur intermittently.
 8. Tinea barbae (Barber’s itch) is a dermatophyte
infection of the beard area most often caused
by Trichophyton mentagrophytes or T. verrucosum.
Diagnosis is by examination of plucked hairs on
potassium hydroxide wet mount. Treatment is with
oral antifungals and sometimes prednisone.
9. Tinea capitis (Scalp Ringworm) is a dermatophyte
infection of the scalp. Diagnosis is by clinical
appearance and by examination of plucked hairs or
hairs and scale on potassium hydroxide wet mount.
Treatment involves oral antifungals.
10. Tinea corporis (Body Ringworm) is a dermatophyte
infection of the face, trunk, and extremities.
Diagnosis is by clinical appearance and by
examination of skin scrapings on potassium
hydroxide wet mount. Treatment involves topical or
oral antifungals.
11. Tinea cruris (Jock itch) is a dermatophyte infection of
the groin. Diagnosis is by clinical appearance and by
potassium hydroxide wet mount. Treatment is with
topical antifungals.
12. Tinea pedis is a dermatophyte infection of the feet.
Diagnosis is by clinical appearance and sometimes by
potassium hydroxide wet mount, particularly if the
infection manifests as hyperkeratotic, ulcerative, or
vesiculobullous or is not interdigital. Treatment is
with topical antifungals, occasionally oral
antifungals, moisture reduction, and drying agents.
13. Tinea versicolor is skin infection with Malassezia
furfur that manifests as multiple asymptomatic scaly
patches varying in color from white to tan to brown
to pink. Diagnosis is based on clinical appearance
and potassium hydroxide wet mount of skin
scrapings. Treatment is with topical or sometimes
oral antifungals. Recurrence is common.
14. Diagnosis is by clinical appearance and Potassium
hydroxide (KOH)wet mount.
15. Treatment:
1. Topical or oral antifungals
2. Sometimes corticosteroids
Candidiasis
1. Candida sp are commensal organisms that inhabit
the GI tract and sometimes the skin.
2. Several drugs are associated with the development
of Candidal infection.
3. The pharmacological action of these drugs may have
a suppressive effect on the normal gastrointestinal
and oral bacterial flora that naturally keeps
the Candidal population at check.
4. This means that there could be Candidal overgrowth
as a result of such drug effects.
5. Superficial invasion of the mucous membranes and
skin by Candida sp. is called thrush.
6. Mouth thrush most commonly occurs as white,
adherent plaque on the buccal mucosa.
7. Oral thrush is relatively painless except for fissuring
at the corners of the mouth (angular cheilitis), which
is usually painful.
8. Oral thrush can be treated with either Nystatin
suspension or Clotrimazole.
Infestations/ Parasites
1. Human parasites are organisms that live on or in a
person and derive nutrients from that person (its
host).
2. There are 3 types of parasites: protozoa, helminths
(worms), and ectoparasites such as scabies and lice.
3. Many parasitic infections are spread through fecal
contamination of food or water. They are most
frequent in areas where sanitation and hygiene are
poor.
Amoebiasis
1. Caused by Entamoeba histolytica.
2. Exist in 2 forms : Trophozoite and cyst
3. The motile trophozoites feed on bacteria and tissue,
reproduce, colonize the lumen and the mucosa of
the large intestine, and sometimes invade tissues
and organs.
4. Cysts predominate in formed stools and resist
destruction in the external environment. They may
spread directly from person to person or indirectly
via food or water. Amebiasis can also be sexually
transmitted by oral-anal contact.
5. Most infected people are asymptomatic but
chronically pass cysts in stools.
 6. Symptoms that occur with tissue invasion include
intermittent diarrhea and constipation, flatulence,
and cramping abdominal pain.
7. Diagnosed by microscopic examination.
8. Treatment :
1. Metronidazole or tinidazole initially
2. Iodoquinol, paromomycin, or diloxanide
furoate subsequently for cyst eradication
Giardiasis
1. Giardiasis is infection with the flagellated
protozoan Giardia intestinalis (lamblia).
2. Waterborne transmission is the major source of
giardiasis.
3. Transmission can also occur by ingestion of
contaminated food and by direct person-to-person
contact, especially in mental institutions and day
care centers or between sex partners.  1. Lymphatic filariasis is caused by threadlike adult
4. Giardia cysts remain viable in surface water and are
resistant to routine levels of chlorination. 
5. Symptoms of acute giardiasis usually appear 1 to 14
days (average 7 days) after infection.
6. They are usually mild and include watery
malodorous diarrhea, abdominal cramps and
distention, flatulence, eructation, intermittent
nausea, epigastric discomfort, and sometimes low-
grade malaise and anorexia.
7. Acute giardiasis usually lasts 1 to 3 wk.
8. Malabsorption of fat and sugars can lead to
significant weight loss in severe cases.  filariasis unless tested. A small percentage of persons
9. Diagnosis is by microscopic examination of stool.
10. Treatment : Tinidazole, metronidazole,
or nitazoxanide
Malaria
1. Caused by Plasmodium sp.
2. The Plasmodium species that infect humans are
3. P. falciparum
4. P. vivax
5. P. ovale
6. P. malariae
7. P. knowlesi
8. Concurrent infection with more than
one Plasmodium species is uncommon.
9. Manifestations common to all forms of malaria
include
1. Fever and rigor—the malarial paroxysm
2. Anemia
3. Jaundice
4. Splenomegaly
5. Hepatomegaly
10. Diagnosis is by Light microscopy of blood (thin and
thick smears)
11. Treatment : Antimalarial drugs
Bancroftian and Brugian Lymphatic Filariasis
filarial worms Wuchereria bancrofti, Brugia malayi,
and B. timori.
2. Bancroftian filariasis is present in tropical and
subtropical areas of Africa, Asia, the Pacific, and the
Americas, including Haiti.
3. Brugian filariasis is endemic in South and Southeast
Asia. Current estimates suggest that about 120
million people are infected.
4. Although the parasite damages the lymph system,
most infected people have no symptoms and will
never develop clinical symptoms.
5. These people do not know they have lymphatic
will develop lymphedema.
6. This is caused by fluid collection because of improper
functioning of the lymph system resulting in swelling.
7. This mostly affects the legs, but can also occur in the
arms, breasts, and genitalia. Most people develop
these symptoms years after being infected.
8. Treatment : Diethylcarbamazine (DEC) kills
microfilariae and a variable proportion of adult
worms.
Pinworm infestation (Enterobiasis;Oxyuriasis)
1. Enterobiasis is an intestinal infestation by the
pinworm Enterobius vermicularis, usually in children.
2. Its major symptom is perianal itching.
 3. Diagnosis is by visual inspection for threadlike worms
in the perianal area or the cellophane tape test for
ova.

4. Treatment is with mebendazole or albendazole.

Ascariasis

1. Ascariasis is infection with the round worm Ascaris

lumbricoides
Scabies
2. Light infections may be asymptomatic
1. Human scabies is caused by an infestation of the skin
3. Early symptoms are pulmonary (cough, wheezing)
by the human itch mite (Sarcoptes
4. Later symptoms are GI, with cramps or abdominal scabiei var.hominis).
pain from obstruction of GI lumina (intestines or
2. The microscopic scabies mite burrows into the upper
biliary or pancreatic ducts) by adult worms.
layer of the skin where it lives and lays its eggs.
5. Chronically infected children may develop
3. The most common symptoms of scabies are intense
malnutrition.
itching and a pimple-like skin rash.
6. Diagnosis is by identifying eggs or adult worms in
4. The scabies mite usually is spread by direct,
stool, adult worms that migrate from the nose or
prolonged, skin-to-skin contact with a person who
mouth, or larvae in sputum during the pulmonary
has scabies.
migration phase.
5. Products used to treat scabies are
7. Treatment is with albendazole, mebendazole or
called scabicides because they kill scabies mites;
pyrantel pamoate.
some also kill mite eggs.

6. Scabicides used to treat human scabies are available

Schistosomiasis only with a doctor’s prescription.

1. Schistosomiasis is infection with blood flukes of the
genus Schistosoma, which are acquired
transcutaneously by swimming or wading in
contaminated freshwater.
2. The organisms infect the vasculature of the GI or GU
system.
3. Acute symptoms are dermatitis, followed several
weeks later by fever, chills, nausea, abdominal pain,
diarrhea, malaise, and myalgia.
4. Chronic symptoms vary with species but include
bloody diarrhea (eg, with S. mansoni andS.
japonicum) or hematuria (eg, with S. haematobium).
7. Scabicide lotion or cream should be applied to all
areas of the body from the neck down to the feet
and toes.
8. Bedding, clothing, and towels used by infested
persons or their household, sexual, and close
contacts (as defined above) anytime during the three
days before treatment should be decontaminated by
washing in hot water and drying in a hot dryer, by
dry-cleaning, or by sealing in a plastic bag for at least
72 hours.
Lice (Pediculous)

5. Diagnosis is by identifying eggs in stool, urine, or 1. Lice are parasitic insects that can be found on
biopsy specimens. people's heads, and bodies, including the pubic area.

6. Serologic tests may be sensitive and specific but do 2. Human lice survive by feeding on human blood. Lice
not provide information about the worm burden or found on each area of the body are different from
clinical status. each other.

7. Treatment is with praziquantel. 3. The three types of lice that live on humans are:
 a. Pediculus humanus capitis (head louse),
b. Pediculus humanus corporis (body louse,
clothes louse), and
c. Pthirus pubis ("crab" louse, pubic louse).
4. Only the body louse is known to spread disease.
5. Lice infestations (pediculosis and pthiriasis) are
spread most commonly by close person-to-person
contact.
6. Dogs, cats, and other pets do not play a role in the
transmission of human lice.
1. Creutzfeldt-Jakob disease (CJD) is a sporadic,
familial, or acquired(iatrogenically) prion disease.
2. Variant CJD (vCJD) is the form acquired by eating
meat from cattle with bovine spongiform
encephalopathy (mad cow disease).
3. CJD symptoms include dementia, myoclonus, and
other CNS deficits; death occurs in 1 to 2 yr.
4. Transmission can be prevented by taking precautions
when handling infected tissues and using
appropriate techniques to clean contaminated
instruments.

7. Lice move by crawling; they cannot hop or fly. 5. Treatment is supportive.

8. Both over-the-counter and prescription medications

are available for treatment of lice infestations.

Prions

1. Prion diseases are progressive, fatal, and untreatable

degenerative brain disorders.

2. All prion diseases result from misfolding of a normal

cell-surface brain protein called prion protein (PrP),
whose exact function is unknown.

3. Accompanying pathologic changes include gliosis and

characteristic histologic vacuolar (spongiform)
changes, resulting in dementia and other neurologic
deficits. Symptoms and signs develop months to
years after exposure.

4. Prion diseases can be hereditary (familial)

5. Prion diseases can also be acquired, transmitted

from person to person (eg, as in kuru) or from
animals to humans (eg, as in variant Creutzfeldt-
Jakob disease).

6. Prion diseases should be considered in all patients

with dementia, especially if it progresses rapidly.

7. Treatment is symptomatic. Prions resist standard

disinfection techniques and pose risks to surgeons,
pathologists, and technicians who handle
contaminated tissues and instruments. Steam
autoclaving of materials at 132° C for 1 h or
immersion in 4% Na hydroxide or 10% Na
hypochlorite solution for 1 h is recommended.

Creutzfeldt-Jakob Disease (CJD)