Bacterial Infection

A B A C T E R I A L I N F E C T I O N I S T H E I N VA S I O N O F
B O DY T I S S U E S B Y D I S E A S E - C AU S I N G B A C T E R I A ,
T H E I R M U LT I P L I C AT I O N A N D T H E R E A C T I O N O F
B O DY T I S S U E S T O T H E S E M I C RO O RG A N I S M S A N D T O
T H E T OX I N S T H AT T H E Y P RO D U C E .
 Bacterial diseases

Leprosy
Tularemia
Botryomycosis
Actinomycosis
Syphilis
Gonorrhoea
Tuberculosis
Cat-Scratch Disease
Scarlet fever
Diphtheria
Meliodosis
Tetanus
Rhinoscleroma
Noma
 Leprosy

Also called as Hansens Disease.

Chronic granulomatous disease

Caused by Mycobacterium leprea.

Affects skin, peripheral nerves, upper respiratory tract, eyes,

testes, bones and joints.

It is unique in exhibiting dopa oxidase activity (enzyme that

oxidizes dopamine to melanin).

Staining smears taken from skin and nasal mucosa with ZN

method demonstrate the presence of the bacilli.
 Types
Tuberculoid Type
Lesions are characterised by
single or multiple macular,
erythematous eruptions.
Peripheral nerves are involved
with loss of sensation
accompanied by loss of
sweating of affected skin.
Lepramatous Type
These develop early
erythematous macules or
papules that lead to progressive
thickening of skin and
characteristic nodules.
Facial nerve paralysis occurs
due to facial nerve involvement.
 Histopathology

Well formed granulomatous

inflammation demonstrating
clusters of histiocytes and
macrophages
 Pathogenesis

Hosts defenses are crucial in determining patients

response to disease.

Tuberculoid type of leprosy is characterized by

strong CMI (cell mediated immunity), positive
lepromin test, granuloma formation, paucity of
bacilli.

Lepromatous type of leprosy is characterized by

suppressed CMI, negative lepromin test, no
granuloma formation and multiple bacilli.
 Diagnosis and Treatment

Tests for humoral responses are monoclonal antibodies,

ELISA, PCR, etc.

In children sweat function test is used.

MDT is used which includes rifampicin, dapsone and

clofazimine used for treatment.

Tuberculoid type rifampicin + dapsone for 6 months.

Lepramatous type rifampicin + dapsone + clofazimine
 Tularemia

Also called Rabbit Fever.

It is highly communicable and transmitted from

infected mammals to humans.

It occurs more frequently in adults.

 Clinical Features

Tularemia has 6 clinical types.

a). Ulceroglandular (most common), a skin ulcer that
forms at the site of infection, swollen painful lymph
glands, fever, chills, head ache and exhaustion.
b). Glandular same signs like ulceroglandular except
skin ulcers
c). Oropharyngeal caused by eating poorly cooked wild
animal meant. Fever, throat pain, mouth ulcers,
inflamed tonsils and swollen lymph nodes.
d).Pneumonic tularemia signs and symptoms are dry
cough, chest pain and difficulty in breathing.

e). Oculoglandular affects eyes. Signs are eye pain, eye

redness, swollen eye and discharge, ulcer on the inside
of eye lid, sensitivity to light.

f). Typhoidal is rare and serious form. Signs are high

fever, extreme exhaustion, vomiting and diarrhea,
enlarged spleen, enlarged liver and pneumonia.
 Treatment

Disease responds to antibiotic therapy.

Streptomycin is the drug of choice.

Also responds well to adequate doses of gentamicin

and tetracycline.
 Botryomycosis

It is a chronic granulomatous infection.

A number of common bacteria such as

staphylococcus, streptococcus, Escherichia,
pseudomonas and probably many others may serve
as etiologic agents of the disease.
Histopathology

Chronic granulomatous
nodules are
characterized by
presence of suppurative
foci containing granules
 Treatment

This condition may be caused by a variety of

different micro organisms of low virulence.
Therefore, pathogenesis may be related more to a
modified host resistance or tissue hypersensitivity
than to a specific micro organisms.
Treatment is non specific, however surgical
invention aids in cure.
 Actinomycosis

It is a chronic, granulomatous, suppurative and fibrosing disease

caused by anaerobic or microphilic gram positive, non acid fast,
branched filamentous bacteria.

They are a normal flora of oral cavity, colon and vagina.

It is characterized by formation of abscesses that tend to drain by

formation of sinus tracts.

They are classified according to the location of lesions as-

-cervicofacial
-abdominal
-pulmonary forms

It appears to be an endogenous infection and not communicable.

 Histopathology
Essentially a granulomatous one
showing central abscess formation
within which are seen colonies of
microorganisms.
peculiar appearance of colonies with
peripheral radiating filaments, so often
termed as ray fungus

Tongue lesions

Tonsil lesions
 Treatment and Prognosis

Long standing fibrosis cases are treated by draining the

abscess, excising the sinus tract with high doses of
antibiotics.

Surgical drainage of abscesses and excision of sinus tract is

necessary to accelerate healing.
 Syphilis

It is a veneral i.e. sexually transmitted disease caused

by spirocheates, treponema pallidum.
It is transmitted by following routes:
-Coitus
-Transfusion of infected blood
-Mother to foetal transmission
 Types

Acquired syphilis Congenital syphilis

Mainly contracted as a It is only transmitted

veneral disease. from infected mother to
It may also be acquired by
foetus only.
dentists while working on It is a very rare disease.
infected patients in a Morphological features
contagious state. are :
Its divided into 3 types
based on their appearance
a) Saddle nose
and type of lesions: b).Bony lesions,
a) Primary mucocutaneous lesions
b) Secondary c) High palatal arch
c) Tertiary d) Mulberry molar
Primary Phase

does not produce exudate

location is usually on genitalia

lesions heals without therapy

in 3-12 weeks, with little or
no scarring

Chancre, a chronic ulcer

at site of infection
Secondary Phase

if left untreated, begins

about 2-10 weeks

spirochetes are now

disseminated widely

inflammatory lesions may

occur in any organ during
this phase
Oral mucous patches
condyloma latum
maculopapular rash
Tertiary Phase

manifestations take
many years to appear &
can be profound

there is predilection for

cardiovascular system
+ CNS
Gummas (destructive ulcers)
central nervous system
cardiovascular diseases
Congenital Form

abnormal shape of molars/

incisors
deafness
ocular keratitis
skeletal defects
 Hutchinson's Triad

Hypoplasia of incisor and molar teeth.

8th nerve deafness and interstitial keratitis.

75% of congenital syphilis patients suffer from one

or more components of Hutchinson's triads.
 Diagnosis

Demonstration of
treponemas Serological test

Dark ground microscopy Non treponemal test

Direct flourescent
antibody staining for VDR RPR
T.pallidum. L
Treponemas in tissue by:
a). Silver impregnation Treponemal test
method
b). Immunoflourescent
TPI
staining TPH
A
 Histopathology

Chronic perivascular
infiltrate of plasma cells
and lymphocytes

Papillary epithelial
hyperplasia and heavy
plasmacytic infiltrate in
the connective tissue
 Prophylaxis

Peniclllin is the drug of choice for syphilis.

Early syphilis: Benzathine benzyl penicillin 24 lac
units I.M. in a single dose after sensitivity test.

Late syphilis: Benzathine benzyl penicillin 24

lacs units I.M. once weekly for 3 weeks.

Erythromycin or tetracycline is used if patient

is allergic to penicillin.
 Gonorrhoea

It is a veneral disease affecting the male and female

genitourinary tract.

It is caused by gram negative diplococci Neisseria

gonorrhoea.

The bacterium is a strict parasite and dies rapidly

outside the host in 1 to 2 hr in exudates and in 3 to
4 days in culture.
Clinical Features

no specific clinical signs have been consistently

associated with oral gonorrhea
multiple ulcerations
generalized erythema
chief complaint may be sore throat.
although many patients are asymptomatic
in the more common
pharyngeal gonococcal
infection, presenting signs
are usually
general erythema
associated ulcers
cervical lymphadenopathy
 Oral Manifestations

Extra genital infection of the oral cavity occurs as a result of

oral-genital contact or inoculation through infected hands.

Lips may develop acute painful ulceration, gingiva may

become erythematous with or without necrosis.

Tongue may present red, dry ulcerations or become glazed

or swollen with painful erosions.

Gonococcal pharyngitis and tonsilitis are also well

recognized.
 Diagnosis and Treatment

Diagnosis is established by bacteriological

examination of smear or culture.

Organism is sensitive to large doses of penicillin or

doxycycline.
 Tuberculosis

It is an infectious, granulomatous disease caused by

mycobacterium tuberculosis.

Primarily affects lungs but also affected are intestines,

bones, joints, meninges, lymph glands, skin and other
tissues.

The bacterium is a facultative intracellular parasite.

It causes pulmonary or generalized infection in

immunocompromised patients.
 Pathogenesis

Bacilli-host interaction: droplet nuclei inhaled by patient

Most bacilli are exhaled by ciliary reaction and 10% enters the alveoli
Initial stage is asymptomatic but 2 4 weeks after infection, specific
immunity develops and accumulation of a large number of activated
macrophages at the site of primary lesion.(granulomatus or
tubercles are formed).
Lesion consists of epithelioid cells, langerhans cells, plasma cells and
fibroblasts
Central part of the lesion contains caseous necrosis (dry cheesy,
granular and yellow in appearance).
Ranne complex necrotic material may undergo calcification(in lung
parenchyma or hilar lymph nodes.
Sometimes necrotic material may liquefy, discharging in the lungs leading
to cavity formation.
 Histopathology

Tuberculosis granulomas
demonstrated by ZN stain
 Oral Manifestations

Most commonly affected site is tongue. Others are

palate, lips, buccal mucosa, gingiva and frenula.
Usual presentation is irregular superficial or deep
painful ulcers which tend to increase in size slowly.
It may also involve the bone of the maxilla and
mandible.
Microorganisms may enter the pulp chamber and
root canal of the tooth with an open cavity.
 Treatment

Isoniazid (NPH) combined with rifampicin for 9

months
INH and rifampicin and pyrazinamide for 2
months followed by INH and rifampicin for 4
months.
Other drugs used are streptomycin and
ethambutol.
 Cat-Scratch Disease

It is a condition caused by Bartonella lenselae a

gram negative bacillus demonstrable with silver
stain.
It occurs at any age most commonly in children and
young adults by a traumatic break in the skin by
scratch or by household bite of cat, dog or monkeys.
 Histopathology

Lymph node necrosis

Swelling due to
inflammation
 Treatment and Prognosis

Prognosis is good since the disease is self limiting

and regresses within a period of weeks or months.
Incision and drainage of involved node may be
necessary.
Antibiotic therapy is ineffective
 Scarlet Fever

It is a highly contagious, systemic infection.

It occurs predominantly in children.
It is caused by -heamolytic streptococci, streptococcus
pyogens which produces a pyrogenic exotoxin
These organisms produce clear heamolysis around colonies
on blood agar plates.
Scarlet fever may reflect a hypersensitivity reaction
requiring prior exposure to the toxin.
 Histopathology

Necrotic conective tissue

 Oral Manifestation

Chief manifestations are termed as Stomatitis scarlatina.

Small, red macules may appear in the hard and soft palate and uvula which are
called Forchheimer spots.

Palate and throat is often fiery red.

Tonsils and faucial pillars are usually swollen and sometimes covered with a grayish
exudate.

In early course of the disease, tongue exhibits a white coating and the fungiform
pappila are edematous and hyperemic. This phenomenon has been described
clinically as strawberry tongue.

Later, the tongue coating is lost and appears red and glistening and smooth except
the pappliae this is called as raspberry tongue.
 Diptheria

It is an acute, life threatening infection and

communicable disease of skin and mucous membrane.

Caused by toxemic strains of corneybacterium diptheria.

Characterized by local inflammation and formation of a

graying adherent psuedomembrane which bleeds on
removal.

Also referred as The strangling angel of children.

 Clinical Features

Signs and symptoms arise 1 to 5 days after exposure.

Swelling of neck (Bull neck).

Onset is gradual.

Manifestations are fever, sore throat, weakness,

headache, change of voice.
 Classification

Of patients Of tonsils

Diptheria cases: On the basis of location of

Pseudomembrane present pseudomembrane:
a). Pharyngeal
Diptheria carriers: b). Laryngeal
Pseudomembrane absent c). Tracheal
d). Tonsillar
e). Nasal
f). Conjunctival
g). Cutaneous
h). Genital
 Oral Manifestations

Formation of Diptheric Membrane.

In oral cavity, appears as non specific ulcers.
Soft palate is temporarily paralysed.
Patients have peculiar nasal twang.

If infection spreads unchanged in repiratory tract:

a). Larynx becomes edematous, covered by pseudomembrane.

b). Husky voice
c). Suffocation if airways is not cleared.
 Meliodosis

Specific infection in man and animals.

Caused by burkholderia pseudomallei.

It is endemic in certain areas of far east including

Burma, India, Indo-china, malaysia and thialand.
 Diagnosis and Treatment

Diagnosed by culturing the organism from clinical and

throat sample.

Treatment involves:

Incision and drainage accompanied by massive antibiotic

therapy.
Tetracycline alone or in combination with chloremphenicol
is drug of choice.
 Clinical Features

Acute Chronic

Fever In those patients who

Diarrhoea have survived acute type.
Acute pulmonary
infection It is of granulomatous
Death as a result of type, characterized by
septicemia multiple, small, non
specific abscesses.
 Tetanus

Tetanus is an acute infection of the nervous system

characterized by intense activity of motor neurons and
resulting in severe muscle spasms.
It is caused by exotoxin of the anaerobic gram positive
bacillus clostridium tetani.
Most commonly occurs in non immunized, partially
immunized or even fully immunized people.
In infants were umbilical cord is cut with unsterile
instrument or in children with otorrhea.
After acute trauma.
 Pathogenesis

Suitable anaerobic conditions favour the spores of

clostridium to enter the wounds and germinate.

These produce tetanospasmin(potent neurotoxin)

It binds to the peripheral motor nerve terminals and enters

the axons cell body in the brain stem and spinal cord in
a retrograde direction.

Toxins migrate to the synapse where they block the

receptors of glycine and GABA which increases the resting
state of locomotor neurons thereby producin rigidity.
 Types

Generalized Tetanus Local Tetanus

Lock jaw due to the spasm of Spasm of muscle near the

masseter is the first symptom. wound is uncommon.

Dysphagia, stiffness or pain in Cephalic tetanus characterized

the neck, shoulder or back by spasm of muscle and facial
muscles occurs concurrently. palsy is rare.

Laryngeal spasm leading to Acute oral infection, trauma,

asphyxia. TMJ dysfunction and even
hysteria may be manifested.
 Prophylaxis

Wound debriment and booster doses of tetanus

toxoid.

For unimmunized indivisuals, anti-tetanus

serum(ATS) 1500 units or TIG 250 units should be
given.
 Rhinoscleroma

It is a chronic, slowly progressive, localized infectious,

granulomatous disease caused by bacillus klebsiella
rhinoscleromatus which is a gram negative, non motile
bacillus.
Mode of infection is through nasal exudates.
Granulomatous lesions are chiefly found in upper
respiratory tract involving nose, lacrymal glands, orbit, skin
and paranasal sinuses.
Oral lesions impair taste, anesthesia of the soft palate and
enlargement of the uvula and upper lip are described.
 Treatment

Administration of tetracycline or ciprofloxacin.

If left untreated, outcome is fatal.

 Noma

It means a rapidly spreading mutilating, gangrenous

stomatitis that occurs usually in debilitated or
nutritionally deficient persons.

Occurs chiefly in undernourished persons.

The condition is usually seen around the gingiva and

progressed to destruction of the mouth and the lower
lip.
results from oral contamination
by heavy infestation of
Bacteroidaceae

particularly Fusobacterium
necrophorum
consortium of other
microorganisms:

Borrelia vincentii

Staphylococcus aureus

Prevotella intermedia
these opportunistic pathogens
invade oral tissues whose
defense are weakened by:
malnutrition
acute necrotizing gingivitis
debilitating conditions
trauma
other oral mucosal ulcers
typically affects children
related disorder, noma
neonatorum, oocurs in low-
birth-weight infants
who suffer from debilitating
diseases
Clinical Features
initial lesion is a painful
ulceration
usually gingiva or
buccal mucosa
spreads rapidly + eventually
becomes necrotic
denudation of involved bone may follow leading to
necrosis + sequestration
teeth in affected area may become loose + exfoliate
penetration of organisms into
cheek
lip
palate
Clinical Features
 Treatment

The prognosis is considerably better if antibiotics are

administered before the patient reaches the final
stage.

Immediate treatment of any existing

malnourishment further improves the probability of
saving the patient.
Treatment
fluids
electrolytes
general nutrition are restored
along with antibiotics

clindamycin
piperacillin
aminoglycoside gentamicin
debridement of necrotic
tissue may also be
beneficial if destruction
is extensive
 References

1. Shafers textbook of oral pathology

2. Neville text book of oral pathology