microbial infection that causes oral ulcers

1. Under supervision :
Professor Doctor : Tarek El-Sharkawy
Dr : Sayed Rashad

2. Bacterial tongueulcers

4. What is Syphilis?
Syphilis is an infective disease caused by the bacteria Treponema
pallidum spirochaets
.
What is treponema pallidum :
Long,helical bacterial ,seen by sliver, immunoflurescence or dark-
field microscope

5. Mode of infection :
ACQUIERED SYPHILIS
Venereal type: bacteria transmitted by sexual contact (most common)
Non venereal type: - touching syphilitic lesion
-blood transfusion from syphilitic donor
CONGENITAL SYPHILIS: transplacental transmission

6. Tissue reaction:
1-progressive end artritis oblitrans
2-chronic proliferative inflammatory reaction
(rich in plasma cells , poor in fluid exudate)
3-granulation tissue and fibrosis
4-considerable necrosis mainly in gummatous
leisions of the teriary stage

7. -extragenital : lip , tongue , nipple , anus
Types of syphilis:
1-venereal type:
A-primary syphilis(chancre)
-onset: lesions appears at the site of infection 2-6 W after infection
Sites of chancre:
-genitalia: penis, vulva , vagina ,cervix

8. pathology
- hard painless small papule, which
ulcerates.
-Infective stage
-Heals by minimal fibrosis then scar
-Enlargement of regional LNs

9. B-secondarysyphilis:(themostinfectivestage)
Onset:2Mafterthe1rystage

10. pathology
-Skin lesions:
1-skin rash
2-condyloma latum
3-loss of hair & leukodema
Mucous patches: develop in oropharyngeal , anal or vaginal mucosa-
Thepatches may ulcerate
Generalized LN enlargement-

11. C- Tertiary Syphilis :
Onset : 2-10 years after healing of secondery stag
.
Pathology : any organ may be affected and include
2 type
1- Gumma (localized Affection)
2- Diffuse Syphilic inflammation

13.  Aetiology:
Due to transplacental infection form a syphiitic
mother to her fetus .
Pathlolgic Featurs :
-The Placenta is enlarged and Pale. Microscopically
it show end arteritis and chorionic villitis
(characterized exudation of plasma cells and
lymphocytes)
-The clincal Possibilties include :
1- Abortion or Stillbirth
2- The baby survives and develops two groups of
lesions
A) Early Manifestations
B) Late Manifestations

14. A- Early Manifestations
 These develop during the first tow
years of life .
 These lesions largely resemble
those of the 2ry stage of acquired
syphilis .

15. B- Late Manifestations
 These develop from 2 to 30 year .
 1- Hutchinson's Teeth :
The permnent incisors are barrel-shaped: their
mesial and distal surfaces taper toward the incisal
edage raher than toward the cervical margin giving
a (screw-driver) appearance .
 The incisal edage usually have a central notch .
 The mesial and distal incisal angles are rounded off
.
 The incisors may show enamel hypolasia .

16. 2- Moon’s and Mulberry Molars
 The first permanent molars shows a
constricted occlusal surface and rounded
angles and is demo-shaped
 (Moon’s molars): or their occlusal surface
may be rough , pitted and exhibit multiple,
irregular tubercles replacing their normal
cuspal pattern (mulberry molars)

17. 3-Palatal perforation
4- dEafness :
Due to affection of 8th cranial nerve .
5-Sabre tibia :
The tibia is thickened and bent .
6- Neurosyphilis

18. Treatment
1- early stage :
single dose of intramuscular penicillin G ,
tetracycline are alternative choices for
those allergic to penicillin
2- late stage :
large doses of intravenous penicillin for a
minimum of 10 days , If a person is allergic,
ceftriaxone may be used .

19. Tuberculosis tongue ulcer
Tuberculosis

20. Tuberculosis :
Chronic infectious granulomatous disease caused by
Mycobecterium tuberculosis that can spread through
the lymphnodes and the blood stream to any organ in
the body , most often found in the lungs
Mode of infection:
Inhalation , swallowing or skin inoculation

21. Types of TB
Secondary TuberculosisPrimary Tuberculosis
Previosuly infected with TB
Spread of infection is less
Common
More marked
Very rapid
Innate , acquired immunity
and hypersensitivity
Infection for the first time
Spread of infection is more
common
Tissue destruction is less
marked
Tissue reaction is slow
Affected by innate
immunity

22. Secondary TBPrimary
TB

23. Clinical Features of TB

24. TB tongue ulcer
tuberculosis of the tongue always presents as a
chronic non healing ulcer that may resemble a
malignant
Lingual neoplasm clinically
TB Tongue ulcer is
.
Rare
phenomeno
n
Difficult in
Clinical
diagnosis

25. Tongue ulcer is a rare phenomenon
..???
the rarity of oral tuberculosis is due to :
1)to the continuous cleansing of the oral
mucosa by saliva
2)the presence of a variable normal flora in
addition to the presence of submucosal
antibodies which gives the buccal mucosa a
normal
resistance3) the tongue does not contain any significant
lymphoid tissue for which mycobacterium
tuberculosis organisms has a great affinity

26. Causes :
Such lesions are suspected to be caused by
implantation of infected sputum into a break
in the mucosal surface during coughing
episodes.

27. Differential Diagnosis :
The differential diagnosis of indurated tongue ulcers
includes: 1)oral cancer (squamous cell carcinoma),
lymphoma, salivary gland tumors .
2) Other non-neoplastic differentials are
traumatic ulcerations, aphthous ulcers and certain
infections (such as primary syphilis).
3) orofacial granulomatous conditions such as sarcoid,
Crohn’s disease, deep mycoses, foreign-body
reactions, and Melkersson-Rosenthal syndrome.
A detailed clinical history and examination are
important to make up the diagnosis, ancillary studies
including laboratory tests and radiological images are
helpful although the tissue biopsy remains the golden
standard for confirmation of the diagnosis.

28. Tuberculosis tongue ulcer
Diagnosis :
1) Medical history
History of productive prolonged cough of three
weeks or more
Cheast pain , hemoptysis
Production of sputum that starts out mucoid
then changes to purlent
2) Histopathological studies
Tissue biopsy
Sputum smear and culture ,

29. 3) Ancillary studies
PCR , Immunological tests , chest xRay
and CT

30. Treatment :
Antibiotics for at least six to nine mounth
Most common medications :
Isoniazid
Rifampin
Pyrazinamide

31. Case Report :
A 42-years old previously healthy Yemeni male presented at the
King Khalid University Hospital with a history of a persistent and
non-healing ulcer on the lateral aspect of his tongue and
extending to the lingual lip. The tongue tissue beneath the
described ulcer was irregular and nodular in shape. Chest X-ray
together with laboratory tests including complete blood count,
coagulation profile, urea and electrolytes, as well as renal and
liver function tests were reported to be within normal limits.
Serological tests for HBV, HCV, HIV and syphilis were negative.
Because the patient was a heavy smoker and an alcoholic in
addition to the presence of an ulcerated tongue mass lesion, an
initial clinical diagnosis of squamous cell carcinoma of the
tongue was made. A biopsy taken from the tip of the tongue was
reported as showing mucosal hyperkeratosis with nonspecific
chronic inflammatory changes possibly due to chronic irritation.
As there was a strong clinical suspicion of a squamous cell
carcinoma, a repeat biopsy from an area adjacent to the ulcer
was done and the second biopsy showed numerous caseating
epithelioid and giant cells granulomata, containing scanty acid
fast bacilli. A final histopathological diagnosis of tuberculous
glossitis was later made and was supported by a positive PPD
test and Mycobacterial culture from a sputum specimen. The

32. Conclusion :
In patients presenting with non-healing
tongue ulcers associated with a
nodular mass, the possibility of
tuberculous glossitis should be
included in the differential diagnosis
and confirmed by histopathological
examination of a representative and
"deep tissue" biopsy.

34. ACTINOMYCOSIS
Introduction
Actinomycosis is a chronic
granulomatous suppurative and
fibrosing infection caused by
actinomyces .
Actinomyces are filamentous
gram-positive
facultatively anaerobic
bacteria normally
present in body cavities.

35. They are opportunistic bacteria which
inter the tissues during trauma or
extraction

36. Predisposing factors
Bad oral hygiene
Immunocompromised patient

37. Pathogenesis and pathology
Actinomyces species are generally of low
pathogenicity and cause disease only in
cause of tissue or mucosal injury.
Then they inter through the wound and grow
in microscopic or macroscopic clusters of
tangled filaments that are surrounded by
polymorphonuclear nutroplils.
Sub acute chronic inflammation, granulation
tissue, extensive fibrosis, and sinuses tracts
are present in the surrounding tissues

38. Clinical presentation (cervicofacial
actinomycosis)
Age : 40 – 50 years , commonly in males
Site: soft tissue of submandibular area , jaw
bones, salivary glands and neck are most
commonly involved
Lesion: appear as firm, tender
swelling that eventually soften
and accompanied by formation
of pus which discharges
through multiple
sinuses on the skin surface

39. Isolation and diagnosis
Isolation is made by taking clinical
specimen and staining with gram stain

40. Sulfur granules:
consist of tangled filaments of
actinomyces
which becomes more apparent with
high
magnification power

41. Treatment
Antimicrobials including penicillin G,
chloramphenicol,the tetracyclines, erythromycin,
clindamycin, imipenem,streptomycin, and the
cephalosporins
The clinical experience with actinomycosis
has been extensive and supports the use of penicillin G
as the drug of choice for all clinical forms of the disease
Management
Mild(cervicofacial) infections may be adequately
managed with a 2- month course of peroral penicillin V
or one of the tetracyclines (e.g., doxycycline, 100 mg
given orally twice daily), without
surgical intervention

42. complicated forms of actinomycosis
parenteral penicillin G, every 6 hour should be
administered for 4–6 weeks,
followed by oral penicillin V every 6 hours, for 6–12
months
For penicillin-allergic patients:
a tetracycline, erythromycin, clindamycin, and
cephalosporins are suitable alternatives

43. Prevention
There are no specific measures for preventing
actinomycosis
however,
maintenance of good
personal orodental hygiene
removal of dental
plaque
may reduce the density if not the
incidence of colonization and low-grade
periodontal infection with Actinomyces

44. Presented by :
. Nada Mahmoud
. Mai Mohsen
. Ahmed Elsawy
. Ahmed Saad
. AbdElrahman Genedy