DR FAIZA HASSAN, SENIOR REGISTRAR ( ORAL PATHOLOGY DEPT), MIHS BDS (NISHTAR MEDICAL COLLEGE, MULTAN) M Phil ORAL

PATHOLOGY( ARMED FORCES INSTITUTE OF PATHOLOGY) UHS

ACTINOMYCOSIS, TUBERCULOSIS, LEPROSY, SYPHILIS, NOMA

EPITHELIAL CELLS OF ORAL MUCOSA

STRATIFIED SQUAMOUS EPITHELIUM

INFLAMMATORY CELLS

ACTINOMYCES
y Causative bacteria: filamentous, anaerobic y y

y y

gram positive Actinomyces israelii A part of normal oral flora present in dental caries Predisposing factors include trauma or surgical procedure allowing the bacteria to invade an anaerobic area Site of involvement: upper neck, jaws, perioral area CLINICAL FEATURES
y Deep suppurative abcess with draining sinuses y Purulent exudate containing sulphur granules

ACTINOMYCES
y Initially infection is acute

causing pain and swelling y Causes osteomyelitis in jaw bone y The soft tissue abcess drain through sinus tracts y The sulphur granules in the exudate is actually calcified bacterial colonies

ACTINOMYCES
y HISTOPATHOLOGY
y Central portion of abcess y y

y

y

contains purulent exudate Multiple calcified colonies of filamentous bacteria The central portion of colony is basophilic and periphery is eiosinophilic The bacterial filaments are arranged in a radiating pattern at the periphery of the colony Rosette pattern Sunburst pattern of arrangement

ACTINOMYCES
y TREATMENT
y Surgical debridement and drainage of sinus

TUBERCULOSIS
y Causative bacteria: Acid fast Mycobacterium

tuborculosis y Chronic granulomatous infection of lungs y 2 types of infection: primary and secondary y Oral lesions associated with secondary TB

TUBERCULOSIS
y MODE OF SPREAD

PRIMARY
Aerosole Lungs

MACROPHAGES
Phagocytosed Replication

Disemination
Lysis of infected cell Spread to organs

TUBERCULOSIS
y CLINICAL FEATURES
y Chronic ulcer with y y y y

indurated borders Tosillar swelling May involve bone Cervical lymph nodes May relate to osteomyelitis

TUBERCULOSIS
y HISTOPATHOLOGY
y Granulomatous inflammation y Granulomas are composed of a collection of

epitheloid cells y Langhan giant cells present y Central areas of granulomas show caseous necrosis y Long standing granulomas show fibroblast at periphery along with numerous lymphocytes

TUBERCULOSIS

TUBERCULOSIS
y TREATMENT
y Isoniazid y Rifampicin

LEPROSY
y Also known as HANSEN S

DISEASE y Caused by Mycobacterium leprae y Moderately contageious y Two forms of leprosy:
y Tuberculoid leprosy y Lepromatous leprosy

y Tuberculoid type is a limited

form constituting of erythematous skin eruptions along with peripheral nerve involvement leading to sensory loss

LEPROSY
y Lepromatous leprosy

produces severe disfigurement of face. It causes collapse of nasal bridge and disfigurement of hands y In oral cavity, ant maxilla, lip and tongue involved is seen y Maxillary damage can lead to breathing problems

LEPROSY
y HISTOPATHOLGY
y Granulomatous inflammation y Multinucleated giant cells and

macrophages seen y Inflammatory cells infiltrate the nerves y Bacteria present in the macrophages y TL shows well formed granulomas where as LL shows poor granuloma formation

LEPROSY
y Diagnosis depends upon history of contact with an

infected patient y TREATMENT
y Chemotherapeutic drugs including dapsone, rifampin

etc

SYPHILIS
y Traponema pallidium y Mode of transmission: sexual contact, infected

mother to child y Occur in four forms:
y Primary y Secondary y Tertiary y Congenital

PRIMARY SYPHILIS
y After 3_4 weeks of primary infection y Lip and tip of tongue

Firm nodule

Surface breaks down

Ulcer (chancre)

PRIMARY SYPHILIS
y Painless chancer

resembling a carcinoma clinically y Painless y Regional lymphadenopathy y Treatment most effective at this stage y After 8 to 9 weeks, healing occurs

SECONDARY SYPHILIS
y 1 to 4 months after infection y Mild systemic effects like fever, sore

throat etc y Initially a rash occurs, consisting of coppery macules y Usually give rise to flat ulcers covered by grayish membrane y Snail track ulcers or mucous patches y Discharge from ulcers containing spirochetes

TERTIARY SYPHILIS
y 3 or more years after infection y GUMMA is the characteristic

lesion y Palate, tongue and tonsil y Gumma begins as a swelling with yellowish centre, which undergoes necrosis leaving an indolent ulcer y Ulcer has punched out edges y Floor has a leathery appearance

TERTIARY SYPHILIS
y Gumma after undergoing

necrosis can cause scarring y If present in the palate ,it may distort the palate leading to its perforations in the palate

CONGENITAL SYPHILIS
y Due to transplacental infections y If severe, it can lead to death of infant y Less severe forms do not appear for 12 months y Initially a rash, leading to destruction of

bones,nerves. y Hutchinson triad consisting of blindness, deafness and dental anomalies y Screwdriver incisors, mulberry molars important dental anomalies

CONGENITAL SYPHILIS

SYPHILIS
y DIAGNOSIS:
y Screening tests like VENEREAL DISEASE RESEARCH

LABORATORY test, RAPID PLASMA ANTIGEN test most frequently used y FTA-ABS most effective y Immunoflorescent staining

y TREATMENT:
y Pencilline G benzathine

NOMA (CANCRUM ORIS)
y Noma means to devour y Rapidly progressive, opportunistic infection caused

by normal flora components including fusobacterium, provetella etc y PREDISPOSING FACTORS
y Poverty y Poor oral hygiene y Poor sanitation y Malnutrition y malignancy

NOMA (CANCRUM ORIS)
y Recent illness y Immunodeficiency disorder

y CLINICAL FEATURES:
y Children 1 to 10 yrs of age y Begins in gingiva as NUG y NUG extends either in bone or soft tissue causing NUM y Greyish to bluish black discolouration of overlying skin y Necrosis in theses areas y Fetid odour, pain, fever, malaise etc y Scalp, neck, face, ear and shoulders

NOMA (CANCRUM ORIS)

NOMA (CANCRUM ORIS)
y TEATMENT:
y Penicillin y Metronidazole

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