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Bacterial and fungal infectious diseases, affecting the oral mucosa.

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Presentation on theme: "Bacterial and fungal infectious diseases, affecting the oral mucosa."— Presentation transcript:

1 Bacterial and fungal infectious diseases, affecting the oral mucosa

2 Acute disease from the group of respiratory infections which characterized by fibrinous inflammation of mucous membranes of oral cavity, nasopharynx, larynx with toxic lesion of cardiovascular and nervous systems

3 Etiology Grampositive, nonmotile Don’t forms spores and capsules Coloured by Neisser in brown-yellow color Ru, Leffler, Clauberg mediums - blood agar with tellurium salts Cultural-biochemical types of C. diphtheriae - mitis, gravis, intermedius Production of very strong exotoxin (gene tox +) Structure of exotocin - dermanecrotoxin, hemolysin, neuraminidase, hyaluronidase Firm to low temperature, long save on a dry surfaces; high responsive to heating and desinfection solutions Corynebacterium diphtheriae ( Leffler rod )

4 Epidemiology Source – sick person or carrier (convalescent or health) of toxicogenic strains Ways of transmission - airborne, contact - household (occasionally) Sensibility is high, adults more often become sick (80 %) Case rate sporadic, outbreaks are possible Immunodefence antitoxic, postvaccine Seasonal character - autumn - winter

5 Diphtheria cases reported to World Health Organization between 1997 and 2007

6 Pathogenesis Penetration of the agent through entrance gate (mucous of upper respiratory tract, sometimes conjunctivas, skin) Production of exotoxin Local and systemic effects of the toxin: Dermonecrotoxin - necrosis of a surface epithelium, retardation of blood stream, rising of a permeability of vessels, their fragility, transuding of plasma in ambient tissues, formation of a fibrinous film, edema of tissues; downstroke of pain sensitivity

7 Pathogenesis Neuraminidase - replacement of cytochrome, blockage of cellular respiration, destruction of a cell, violation of a function of organs and tissues (central and peripheric nervous system, cardiovascular system, kidneys) Hyaluronidase - destruction of a stroma of a connecting tissue (rising of permeability of vessels, edema of tissues) Hemolysin - hemorrhagic set of symptoms

8 Clinical manifestation Incubation period – 2-10 days Phenomena of intoxication (high fever, malaise, general weakness, headache) Pharyngalgia - moderate Changes of a throat mucous - soft hyperemia, edema of tonsills, covers on their surface (grey colour, dense, hard to remove with bleeding, slime), spread out of tonsills limits (palatopharyngeal arches, uvula, soft palate) Augmentation and moderate morbidness of regional lymph nodes Edema of a hypodermic fat of a neck

9 Peculiarities of diphtheria covers ( Grey colour, dense, hard to remove with bleeding, slime), spread out of tonsills limits (on uvula, soft palate, palatopharyngeal archs)

10 Edema of a hypodermic tissues of a neck

11 Swollen neck in diphtheria

12 Features of diphtheria toxicosis (In wide-spread, combined, hypertoxical, hemorrhagic forms) toxicosis І, ІІ, ІІІ Edema of the neck hypodermic tissues Paleness of skin Cyanosis of lips Decreasing of arterial pressure Tachycardia Decreasing of a body temperature

13 Diphtheria of larynx Real croup (stenosis of a larynx) І degree (catarrhal) - labored inspiration, retraction of intercostal spaces, rasping “dog barking" cough, “horse” voice ІІ degree (stenosis) - noisy respiration, inspiratory dyspnea with an elongated inspiration, participation in respiration of auxiliary muscles, aphonia ІІІ degree (asphyxia) - acute oxygen insufficiency, sleepiness, cyanosis, cold sweat, cramps, paradoxical sphygmus

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15 Complications Infectious-toxic shock Intra vessels disseminated syndrome Myocarditis (early, late) Polyradiculoneuritis (early, late) Nephrosonephritis etc.

16 LABORATORY DIAGNOSTIC Detection of the agent in smears from a throat and nose (taking of material on border between effected area and normal mucous) Microscopy (colouring by Neisser) – typical locating of rods, grains of volutin in bacterias Sowing on convolute serum or telluric blood agar for allocation of clean culture and recognizing of toxigenisity Serological tests mirror a condition of immune defence (efficiency of vaccination)

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20 Treatment Immediate hospitalization Bed regimen (at localized forms - 10 days, at toxic - not less than days) Specific treatment - introducing of antitoxic antidiphtherial Serum (from thousand IU at the localized forms up to thousand IU at toxic, by Bezredka method) Glucocorticoids (in toxic forms and croup) Antibiotics (penicilini, tetracyclini, erythromycini) Strychninum (in toxic forms) In case of croup - inhalations, broncholitics, diuretics, glucocorticoids, antibiotics, antihistamine, lytic admixture; under the indications - intubation, tracheotomy

21 Conditions of discharging from a hospital Clinical convalescence 2 negative results of bacteriological research of smears from a throat and a nose with two-day interval For decret group - additional double bacteriological examination in polyclinic

22 Prophylaxis Plan immunization (vaccination in 3, 4, 5 months. With АPДT vaccine, revaccination in 18 months; 6, 11, 14, 18 years and adults every 10 years with АДT-М vaccine) In the focus – 7 days medical observation after contact persons Bacteriological examination Sanation of detected carriers Final disinfection Revaccination

23 Desinfection Aeration and ultra-violet lighting of puttings, wet cleaning with usage of 2/3-basic salt of perchloron, calcium of hypochlorite, 3 % of solution of chloraminum, 1 % of solution amfolan Sputum, the outwashes from a nasopharynx hash with double quantity of solutions, exposition 2 hours. The tableware is boiled in 2 % potassium solution 30 mines. Bed- clothes and clothes if necessary to decontaminate in desinfection camera

24 Differential diagnosis Tonsillitis, including Plaut-Vincent-Simanovsky Herpetic tonsillitis ARVI (adenoviral infection, false croup) Paratonsillar abscess Infectious mononucleosis Scarlet fever Pseudotuberculosis Tonsillo-bubonic form of tularemia Mycotic affection of tonsills Epidemic parotitis Typhoid fever Lues Hematological diseases (acute leukosis, agranulocytosis)

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30 Acute infection of respiratory tract, which is caused by meningococcous (Neisseria meningitidis) and clinically represents in the forms of nasopharyngitis, sepsis or meningitis

31 The source of disease: carriers (1 case per 2000 carriers) patients with meningococcal nasopharyngitis patients with generalized forms of infection

32 Mechanism of transmission – air-drop Seasonal occurrence – February-April Most of the patients are children under 10 Morbidity is sporadic, sometimes epidemic Immunity is type-specific, steady

33 Classification: I. Primarily localized forms: - meningococcal carrier state; - acute nasopharyngitis; II. Hematogenic generalized forms: - meningococcemia; - meningitis; - meningoencephalitis; III. Mixed forms (meningococcemia+meningitis); IV. Rare forms (endocarditis, arthritis, irideocyclitis, pneumonia). Complications: severe brain edema, infectious-toxic shock

34 Rashes peculiarities: haemorrhagic; localization on buttocks, thighs, shins, trunk; a lot of elements; different sizes of elements – from patechial to the spread hemorrhages; non correct form, often star-like; different coloring and brightness of elements; necrosis in place of considerable hemorrhages with formation of defects; often combination of hemorrhages with roseolla and papules.

35 Laboratory diagnostics 1. Revealing of infectious agent in smears from pharynx, blood, liquor - the material for stain should be taken without touching of mucous membrane of cheeks and tongue. Microscopy: gram-negative diplococci with intracellular localization 2. Serologic tests: in dynamic with interval 5- 7 days 3. Express-diagnosis: immunofluorescent method.

36 Treatment Generalized forms: - immediate hospitalization - antibiotics in large doses (benzylpenicilline – U/kg, levomycetini succinatis) - corticosteroids - dehydratation therapy (in case of meningitis) - desintoxication - treatment of disseminated intravessel coagulation (heparin, contrical, human plasma) Sanation of meningococcus carriers: - antibiotics in common doses (ampicillini, levomycetini, rifampicini) - local sanation (ultraviolet, ultrasonic) - desensibilisation therapy

37 HIV-Infection - viral disease of human, which is passed mainly by sexual and parenteral ways and characterized by long-term persistence. Defeat of the thymus gland’s system of immunity, causes clinically expressed form – syndrome of acquired immune deficiency (AIDS) with lymphadenopathy, intoxication, spreading of infectious diseases and oncological processes

38 Properties of Kaposhi sarcoma in patients with AIDS: - strike the persons of age young and middle - primary elements appear on a head and trunk - become purulent and varicosity - metastasizes in internal organs, has a malignant course - is marked by high lethality, patients more frequent does not exceed 1,5 year

39 Thanks for your Attention!


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