Serial no.

Learning Domain Level

Objectives

1. Clinical Effects Cognitive Must know

2. Types of Cognitive Must know

Infection
 Introduction
 Pathology of Infection
 Clinical effects of Infection
 Source & Spread of Infection
 Bacterial Infections
 Viral Infections
 Fungal Infections
 Summary
 References
 Infection is the invasion of an organisms body
tissues by disease causing agents, their
multiplication, and the reaction of host tissues to
these organisms and toxins they produce.

 Infectious disease, also known as transmissible

disease is illness resulting from an infection
 Infections cause Disease due to interaction of
microorganisms and defence mechanisms of body
 Depends on: number & virulence of organisms,
physiological & anatomical effects they
induce & effectiveness of bodys natural
defences
 Organisms act directly and/ or through their toxins
 Effects are generalized or specific
 • Fever, anorexia, • Weight loss & muscle
anemia, neutrophilia, wasting

Chronic
Acute

protein catabolism • Malnutrition

• Inflammation, tissue • Retardation of growth
damage, pain & intellect
• Convulsions( children) • Anaemia: iron
• Confusion( elderly ) sequestration & folate
• Shock deficiency
• Hemorrhage • Tissue destruction
• Organ failure • Post infective
syndrome
 • Rash • Erythematous rash
Allergic

Toxic
• Arthritis • Multisystem
• Pericarditis disturbances
• Encephalitis • Diarrhea
• Peripheral • Organ disturbance
neuropathy • Neurological
• Haemolytic
anaemia
• Nephritis
Sources Examples of Infection

Contact ( person to person) Staphylococci/ Streptococci,

scabies,wound infection
Air borne spread Measels, Rubella, Chickenpox

Faecal- oral spread Hepatitis A, cholera, E. coli

Transplacental Rubella, Cytomegalovirus ( CMV)

Medical and nursing procedures Pseudomonas, Tuberculosis

Tapeworm, Salmonellesis, E. coli,

Zoonoses(animal–person) Listerosis, brucellosis
Method of Spread Examples of Infection
Skin / mucous membrane via HIV, Tetanus, Leptospirosis
wounds & abrasions
Respiratory droplets or dust Scarlet fever, Mumps, Influenza
Water aerosols
Faecal contamination of food / drink Salmonella, bacillary & amoebic
dysentry
Maternal blood Toxoplasmosis, syphilis , HIV

Needles, ventilators, infusion fluid Hepatitis B , Staphylococal infection

Beef/ Pork, Poultry, Milk, Rats/ dogs, Rabies, hydatid disease, Psittacosis
Birds , Fish
 Spreads by person-person contact through respiratory
droplets or oral secretions

 Clinical symptoms: sore throat, dysphagia, tonsillar

hyperplasia, palatal petechiae and yellow tonsillar exudate

 Systemic symptoms: headache, malaise, anorexia,

abdominal pain and vomiting

 Treatment: resolves within 3-4 days

 Penicillin V or Amoxicillin
 Two patterns are seen-
 Nonbulous Impetigo: most frequent on legs & less
common on trunk, scalp or face
 Red macules or papules with development of fragile
vesicles
 Bullous Impetigo: frequently affects extrimities,
trunk & face
 Superficial vesicles that rapidly enlarge to form larger
flaccid bullae
 Treatment: 1) mupirocin or fusidic acid
2) Cephalexin, dicloxacillin
 Primary Syphilis: Solitary Chancres which begin as
papular lesion & develop central ulceration
 Oral lesions-mainly lips, also include buccal
mucosa,tongue,palate,gingiva & tonsils
 Secondary Syphilis: diffuse, painless, maculopapular
cutaneous rash affecting palmar, plantar areas
 Oral lesions- spongiosis of oral mucosa known as
mucous patches
 Tertiary Syphilis: Gumma
 Oral lesions- palate or tongue
 Congenital Syphilis: Hutchinsons triad along with
saddle nose deformity, high arched palate ,frontal
bossing , hydrocephalus & neurosyphilis
 Primary: unexposed people & always involve lungs
 Spreads through airborne droplets
 Under compromised host defenses reactivation of
organism goes into secondary tuberculosis
 Multiple small foci of infection resembling ‘ millet
seeds’ result in miliary tuberculosis
 Oral lesions: chronic ulcerations or swellings seen
 Chronic tongue ulcerations with mandibular swellings
 Treatment: DOTS therapy is standard regimen
 8 week of pyrazinamide,isoniazid,rifampicin &
ethambutol followed by 16 week of isoniazid &
rifampicin
 Tuberculoid leprosy: well circumscribed,
hypopigmented skin lesions with nerve involvement
 Lepromatous leprosy: ill defined, hypopigmented,
macules or papules that thicken with time causing
distorted facial appearance ( leonine facies )
 Sensory loss in extremities
 Nosebleeds, stufiness & loss of sense of smell
 Facies Leprosa & triad of lesions
 Treatment: Paucibacillary- rifampicin & dapsone
Multibacillary- rifampicin, clofazine &
dapsone
 Spread through air droplets or direct contact
 Maculopapular, cutaneous rash with few or no
vesicles,low fever for 4-6 days
 Rash on face and trunk progressing through stages of
erythema,vesicle, pustule and hardened crust
 Oral lesions: vermilion border & palate most involved
 white, opaque vesicles that rupture to form ulcerations
on hard palate
 Treatment: Acyclovir, Valacyclovir & famcyclovir
shown to reduce duration & severity of infection
 Varicella virus vaccine ( Varivax) developed
 Clinically evident Herpes zoster develops after
reactivation of virus
 Prodrome: characterized by pain as virus travels down
the nerves
 Acute phase: vesicles become pustular & ulcerate
with development of crusts
 Oral lesions: trigeminal nerve involvement, pulpitis,
pulpal necrosis, pulpal calcifications or root resorption
 Chronic phase: characterized by persistent pain after
resolution of rash
 Treatment: Acyclovir, Valacyclovir & famcyclovir
accelerate healing of lesions & reduce pain
 Highly contagious infection which spreads through
respiratory droplets involving lymph nodes, tonsils,
adenoids & Peyers patches
 First stage: coryza, cough & conjunctivitis along with
fever
 Oral manifestation: Koplik spots on buccal mucosa
 Second stage: maculopapular erythematous rash
begins from face to trunk
 Third stage: fever ends, rash begins to fade
 Treatment: fluids & nonaspirin antipyretics
vitamin A supplementation
Ribavirin & interferon
 Diffuse swelling of exocrine glands
 Spread by respiratory droplets, saliva and urine
 Prodromal symptoms: low grade fever, headache,
malaise & anorexia
 Swelling develops in lower half of external ear
extending down along posterior inferior border of
mandible
 Chewing increases pain
 Oral manifestations: redness & enlargement of
Whartons & Stensons duct openings
 Treatment: nonaspirin analgesics and antipyretics
 Avoid sour foods & drinks
 Acute phase: generalized lymphadenopathy, sore
throat, fever, maculopapular rash, headache, myalgia,
diarrhea, photophobia & neuropathies
 Oral changes include erythema & focal ulcerations
 Latency phase: several months to more than 15 years
Generalized lymphadenopathy persists
Overtime immune system fails and CD4+ cell count
declines resulting in AIDS
 Most patients express no symptoms or mild flulike
illness for 1-2 weeks
 Acute: Pulmonary infection due to high concentration
of spores causing fever, headache, myalgia,
nonproductive cough and anorexia.
 Chronic: affects older, immunocompromised patients
exhibiting cough, weight loss, fever, dyspnea, chest
pain & hemoptysis
 Disseminated: most oral lesions occur with this form
affecting tongue, palate and buccal mucosa.
 Treatment: IV administration of lipid preparations of
Amphotericin B
 Acquired by inhalation of spores where they reach
alveoli of lungs and grow as yeasts
 Male to female ratio-9:1
 Acute: resembles pneumonia with high fever, chest
pain, malaise and night sweats
 Chronic: mimics tuberculosis with low grade fever,
night sweats, weight loss & productive cough
 Oral lesions result from extrapulmonary
dissemination and resemble squamous cell carcinoma
 Treatment: Amphotericin B followed by 6-12 months
of Itraconazole
 Asymptomatic or flulike illness and pulmonary
symptoms
 Chronic progressive pulmonary: mimics
tuberculosis with persistent cough, hemoptysis, chest
pain and weight loss
 Disseminated: involves skin, lymph nodes, bone and
meninges
 Cutaneous lesions appear as papules, verrucous
plaques and granulomatous nodules
 Predilection to develop in areas of nasolabial folds
 Treatment: Fluconazole/ Itraconazole in high doses
 Affects mainly lungs with mild flulike illness
 Mostly associated with immune suppression
 Characterized by headache, fever, vomiting and
neck stiffness (initial signs )
 Skin of head and neck are involved seen as
erythematous papules or pustules that may
ulcerate
 Oral lesions are rare but appear as craterlike,
nonhealing ulcers tender on palpation
 Treatment: Amphotericin B with flucytosine for 2
weeks
 The current knowledge in today’s society regarding
infectious diseases in general and herpes, hepatitis
and acquired immune deficiency syndrome (HIV)
in particular dictates that all dental practices must
incorporate acceptable infection control
techniques.
 Textbook of Oral & Maxillofacial Pathology, 1st South Asia
Edition- Neville, Damm, Allen, Chii
 Shafers Textbook of Oral Pathology, 7th Edition
 Guyton & Hall Textbook of Medical Physiology, 2nd Edition
 Davidsons Essentials of Medicine, Alastair Innes, 3rd
Edition
 Robins Basic Pathology, 1st South Asia Edition-Kumar,
Abbas, Aster
 Annals of Internal Medicine 73(4), 537-544, 1970