1. BACTERIAL
DISEASES
Prepared by:
Dr. Rea Corpuz

2. Bacterial Diseases
 (1) Syphillis
 (2) Tuberculosis
 (3) Leprosy
 (4) Actinomycosis
 (5) Cancrum Oris (NOMA)
 (6) Gonorrhea

3. (1) Syphillis
 sexually transmitted disease
 caused by spirochete Treponema
Pallidum
 acquired by sexual contact with
a partner with active lesions by:
 transfusion of infected blood
 transplacental inoculation
of fetus by infected mother

4. (1) Syphillis
 Pathogenesis
 when disease is spread
through direct contact
 a hard ulcer, or chancre
forms at site of spirochete
 later there is development
of painless, non-suppurative
regional lymphadenopathy

5. (1) Syphillis
 Pathogenesis
 chancre heals spontaneously
after several weeks without
treatment, leaving patient
with no apparent signs of
disease

6. (1) Syphillis
 Pathogenesis
 after a latent period of several
weeks, secondary syphilis
develops
• patients infected via
transfusion bypass primary
stage & begin with
secondary syphilis

7. (1) Syphillis
 Pathogenesis
 secondary syphilis
• fever
• flulike symptoms
• mucucutaneous lesions
• lymphadenopathy
• stage resolves spontaneously,
• patient enters latency period

8. (1) Syphillis
 Clinical Features
 Primary Phase
 Secondary Phase
 Tertiary Phase
 Congenital Phase

9. (1) Syphillis
 Clinical Features
 Primary Phase
• does not produce exudate
• location is usually on genitalia
• lesions heals without therapy
in 3-12 weeks, with little or
no scarring

10. (1) Syphillis
 Clinical Features
 Primary Phase
• Chancre, a chronic ulcer
at site of infection

11. (1) Syphillis
 Clinical Features
 Secondary Phase
• if left untreated, begins
about 2-10 weeks
• spirochetes are now
disseminated widely
• inflammatory lessions may
occur in any organ during this phase

12. (1) Syphillis
 Clinical Features
 Secondary Phase
• Oral mucous patches
• condyloma latum
• maculopapular rash

13. (1) Syphillis
 Clinical Features
 Tertiary Phase
• manifestations take many
years to appear & can be
profound
• there is predilection for
cardiovascular system
+ CNS

14. (1) Syphillis
 Clinical Features
 Tertiary Phase
• Gummas (destructive ulcers)
• central nervous system
• cardiovascular diseases

15. (1) Syphillis
 Clinical Features
 Congenital Form
• abnormal shape of molars/
incisors
• deafness
• ocular keratitis
• skeletal defects

16. (1) Syphillis
 Treatment
 drug of choice for treating
all stages of syphillis
is penicillin
 Treponema Pallidum is
sensitive to antibiotics such as:
• Penicillin
• Erythromycin
• Tetracycline

17. (2) Tuberculosis
 infects about 1/3 of world’s
population
 kills approximately 3 million
people per year
 most important cause of death
in the world

18. (2) Tuberculosis
 caused by aerobic, non-spore
forming bacillus Mycobacterium
Tuberculosis
 has thick, waxy coat
 does not react with Gram stains

19. (2) Tuberculosis
 Pathogenesis
 spread is through small
airborne droplets
• carry organism to
pulmonary air spaces

20. (2) Tuberculosis
 Clinical Features
 skin testing + chest radiograph
• provide only indicators
of infection

21. (2) Tuberculosis
 Clinical Features
 in reactivated disease,
• low-grade signs + symptoms
of fever
• night sweats
• malaise
• weight loss

22. (2) Tuberculosis
 Clinical Features
 with progression,
• cough
• hemoptysis
• chest pain (pleural involvement)

23. (2) Tuberculosis
 Clinical Features
 oral manifestations
• follow implantation of M.
tuberculosis from infected
sputum may appear on
any mucosal surface
• tongue + palate are favored
locations

24. (2) Tuberculosis
 Clinical Features
 oral manifestations
• typical lesion is indurated
chronic, nonhealing ulcer
that is usually painful
• bony involvement of maxilla
+ mandible may produce
tuberculosis osteomyelitis

25. (2) Tuberculosis
 Treatment
 First line drugs likely to
used fro treatment of TB
include
• isoniazid
• rifampin
• pyrazinamide
• exambuthol

26. (2) Tuberculosis
 Treatment
 drug combinations are often
used in 6, 9, or 12 month
treatment regimens
 may be extended as long
as 2 years.

27. (2) Tuberculosis
 Treatment
 Bacille Calmette Guerin
(BCG) vaccine is effective
in controlling childhood TB,
 but loses efficacy in adulthood

28. (3) Leprosy
 also known as Hansen’s disease
 chronic infectious disease
 caused by acid-fast bacillus,
Mycobacterium leprae
 moderately contagious

29. (3) Leprosy
 transmission of disease
requires frequent direct contact
with an infected individual
for a long period
 inoculation through respiratory
tract is also believed to be
a potential mode of transmission

30. (3) Leprosy
 Clinical Features
 there is clinical spectrum
of disease that ranges from
a limited form (tuberculoid
leprosy) to a generalized
form (lepromatous leprosy)
 latter has a more seriously
damaging course

31. (3) Leprosy
 Clinical Features
 skin + peripheral nerves
are affected
 organism grows best in
temperatures less than core
body temp of 37C

32. (3) Leprosy
 Clinical Features
 cutaneous lesions appear
as erythematous plaques
or nodules
• represents granulomatous
response to organism
 similar lesions may occur
intraorally or intranasally

33. (3) Leprosy
 Clinical Features
 in time, severe maxillofacial
deformaties can appear
• producing classic destruction
of anterior maxilla
• facies leprosa

34. (3) Leprosy
 Treatment
 chemotherapeutic approach
in which, several drugs are
used for protracted period,
typically years

35. (3) Leprosy
 Treatment
 commonly used drugs:
• dapsone
• rifampin
• clofazimine
• minocycline
• teratogen thalidomide
 useful to manage complications
of leprosy therapy

36. (4) Actinomycosis
 chronic bacterial disease
 exhibits some clinical + microscopic
features that are fungilike
 caused by Actinomyces israelii
 an anaerobic or microaerophilic
gram-positive bacterium
 not regarded as contagious because
infection cannot be transmitted from
one individual to another

37. (4) Actinomycosis
 infections usually appear after
 trauma
 surgery
 previous infection

38. (4) Actinomycosis
 Clinical Features
 most infections are seen:
• thorax usually preceded
• abdomen by trauma or direct
• head + neck extension of contagious
infectiom

39. (4) Actinomycosis
 Clinical Features
 when it occurs in head + neck
• condition is usually designated
cervicofacial actinomycosis
 swelling of mandible
 skin lesion are indurated
 having woody hard consistency
 results to osteomyelitis that
may drain through gingiva

40. (4) Actinomycosis
 Radiographic Feature
 radiolucency
 irregular + ill-defined margins

41. (4) Actinomycosis
 Treatment
 Long-term, high-dose
penicillin
 For sever cases, intravenous
penicillin followed by oral
penicillin
 Tetracycline + Erythromycin
can be used

42. (4) Actinomycosis
 Treatment
 drainage of abscess
 surgical excison of scar +
sinus tracts
• to enhance penetration
of antibiotics

43. (5) Cancrum Oris
(Noma)
 also known as gangrenous
stomatitis
 devastating disease of
malnourished children
 destructive process of orofacial
tissues

44. (5) Cancrum Oris
(Noma)
 results from oral contamination
by heavy infestation of
Bacteroidaceae
 particularly Fusobacterium
necrophorum

45. (5) Cancrum Oris
(Noma)
 consortium of other
microorganisms:
 Borrelia vincentii
 Staphylococcus aureus
 Prevotella intermedia

46. (5) Cancrum Oris
(Noma)
 these opportunistic pathogens
invade oral tissues whose
defense are weakened by:
 malnutrition
 acute necrotizing gingivitis
 debilitating conditions

47. (5) Cancrum Oris
(Noma)
 these opportunistic pathogens
invade oral tissues whose
defense are weakened by:
 trauma
 other oral mucosal ulcers

48. (5) Cancrum Oris
(Noma)
 Clinical Features
 typically affects children
 related disorder, noma
neonatorum, oocurs in low-
birth-weight infants
 who suffer from debilitating
diseases

49. (5) Cancrum Oris
(Noma)
 Clinical Features
 initial lesion is a painful
ulceration
 usually gingiva or
buccal mucosa
 spreads rapidly + eventually
becomes necrotic

50. (5) Cancrum Oris
(Noma)
 Clinical Features
 denudation of involved bone
may follow
 leading to necrosis +
sequestration

51. (5) Cancrum Oris
(Noma)
 Clinical Features
 teeth in affected area may
become loose + exfoliate
 penetration of organisms
into
• cheek
• lip
• palate

52. (5) Cancrum Oris
(Noma)
 Treatment
 fluids
 electrolytes
 general nutrition are
restored
 along with antibiotics
• clindamycin
• piperacillin
• aminoglycoside gentamicin

53. (5) Cancrum Oris
(Noma)
 Treatment
 fluids
 electrolytes
 general nutrition are
restored
 along with antibiotics
• clindamycin
• piperacillin
• aminoglycoside gentamicin

54. (5) Cancrum Oris
(Noma)
 Treatment
 debridement of necrotic
tissue may also be
beneficial if destruction
is extensive

55. (6) Gonorrhea
 one of the most prevalent
bacterial disease in humans
 caused by gram-negative
diplococcus Neisseria
gonorrhoeae
 infects columnar epithelium of
• lower genital tract
• rectum
• pharynx
• eyes

56. (6) Gonorrhea
 transmitted by direct sexual
contact with an infected
partner
 short incubation period of less
than 7 days
 absence of symptoms in many
individuals, especially females

57. (6) Gonorrhea
 genital infections may be
transmitted to oral or
pharyngeal mucous membranes
through orogenital contact
 transmission from an infected
patient to dental personnel
is regarded as highly unlikely

58. (6) Gonorrhea
 organism is very sensitive
to drying
 requires break in skin or
mucosa to establish an
infection
 gloves provide
 protective eyewear adequate protection
 mask from accidental
transmission

59. (6) Gonorrhea
 Clinical Features
 no specific clinical signs
have been consistently
associated with oral
gonorrhea
 multiple ulcerations
 generalized erythema

60. (6) Gonorrhea
 Clinical Features
 in the more common
pharyngeal gonococcal
infection, presenting signs
are usally
• general erythema
• associated ulcers
• cervical lymphadenopathy

61. (6) Gonorrhea
 Clinical Features
 chief complaint may be
sore throat,
 although many patients
are asymptomatic

62. (6) Gonorrhea
 Treatment
 uncomplicated gonorrhea
responds to single dose
of appropriately selected
antibiotic

63. References:
 Books
Neville, et. al: Oral and Maxillofacial Pathology
3rd Edition
• (pages 24-32)