Bacterial, Viral and Fungal Infections
Bacterial Infections
Scarlet Fever
Oral manifestations
During the first 2 days of the infection the dorsal surface of the tongue exhibits a white coat through which the fungiform papillae are visible. Such an appearance is referred to as ‘white strawberry tongue’. After about 4 days the white coat on the tongue desquamates to reveal an erythematous dorsal surface with hyperplastic fungiform papillae, which is referred to as ‘red strawberry tongue’.
Diphtheria
Tularemia (Rabbit Fever, Deer-fly Fever, Francis’ Disease, Tick-Borne Disease, Ohara’s Disease)
Clinical manifestations
Based on the type of the tularemia, specific clinical manifestations are seen (Table 1).
Table 1
Clinical manifestations and types of tularemia
Type of tularemia | Mode of transmission | Clinical features |
Ulceroglandular tularemia | Bite of infected insects and animals (ticks, rabbits) | Ulcers at the site of inoculation (fingers, hands, feet) Inflammation of the regional glands. Tender nodes |
Glandular tularemia | Similar features as that of the ulceroglandular variety except that there is no evidence of ulcer | |
Pneumonic tularemia | Inhaling of airborne bacteria from soil or inhalation of the bacteria by healthcare workers | Pneumonia is the characteristic feature. Other symptoms include dry cough, dyspnea, and pleuritic chest pain |
Oropharyngeal tularemia | Eating undercooked meat of an infected animal or drinking contaminated water | Vomiting, diarrhea and other digestive problems |
Oculo-glandular form | Occurs following exposure of the conjunctiva to infected blood | The affected eye is tender and erythematous. Occasionally purulent exudate may be seen along with inflamed regional glands |
Impetigo
Melioidosis
Meliodosis is a potentially fatal bacterial infection caused by exposure to soil or water contaminated with the bacterial species Burkholderia pseudomallei. The causative organism, Burkholderia pseudomallei, was thought to be a member of the Pseudomonas genus and was previously known as Pseudomonas pseudomallei.
Tetanus
Clinical features
Trismus or lockjaw is the initial presentation in 75% of cases. Facial muscle spasm may cause the classic sneering grin of risus sardonicus. Motor findings progress to involve the neck, trunk and extremities, eventually leading to abdominal rigidity and opisthotonus. The muscle spasms may be sustained or paroxysmal. In severe cases the spasm of intercostal, diaphragmatic and pharyngeal muscles leads to breathing difficulties which may eventually lead to death.
Actinomycosis
Noma (Cancrum Oris, Gangrenous or Necrotizing Stomatitis)
Botryomycosis (Bacterial Pseudomycosis)
Botryomycosis arises from chronic infections produced by low-virulence organisms in an altered host environment. Staphylococci have been the most common organisms implicated, but various other bacteria have also been identified in lesions of human botryomycosis.
Clinical types and features
Literature review reveals a few reports of botryomycosis affecting the orofacial region. Small and Kobernick (1967) reported a patient with botryomycosis of the tongue. Rawal and Rawal reported a patient with gingival botryomycosis and Alavandar (1979) reported botryomycosis affecting the mandible.
Rhinoscleroma (Respiratory Scleroma)
Rhinoscleroma is contracted by direct inhalation of droplets or contaminated material.
Diagnosis
The diagnosis of rhinoscleroma is made by the bacterial isolation by culture on blood or MacConkey agar. Histopathological specimens can be stained with periodic acid-Schiff, Giemsa and Warthin-Starry stain. The presence of Mikulicz cells (clear cytoplasm vacuolated histiocytes containing the bacillus) and degenerated plasmocytes in Russel bodies are diagnostic of rhinoscleroma.
Cat-Scratch Disease
Diagnosis
Management
The condition is self-limiting and usually resolves in about 6 months duration. Suppurative nodes may be aspirated to evacuate the pus. The recommended surgical procedure to evacuate the pus is to introduce the needle into the skin 1 to 2 cm away from the swelling and then burrow beneath the surface of the skin to reach the affected node. The technique helps to hasten the healing and prevent formation of a persistent sinus.
Other bacterial infections with oral manifestations such as tuberculosis, syphilis, leprosy and gonorrhea have been described in Chapters 8, 21 and 22.
Viral Infections
Infectious Mononucleosis (Monoglandular Fever, Kissing Disease)
Acute Lymphonodular Pharyngitis
Clinical features
Acute lymphonodular pharyngitis is usually seen in children and young adults. Clinically, the hyperplastic lymphoid aggregates are evident as discrete yellow to dark pink colored nodules or white to yellow papules surrounded by an erythematous ring, generally 1–5 in number. These lesions are typically found on the tonsillar pillars, uvula, soft palate and oropharynx.