GRANULOMATOUS BACTERIAL INFECTIONS

hi everyone this is dr. Missouri windiest conquer today I am going to discuss few important granulomatous bacterial infections that means these infections are associated with the granuloma formation they are like tuberculosis syphilis leprosy actinomycosis so before going into the bacterial infections usually human fetus is sterile but at colonization occurs at birth and within hours the oral cavity is accommodated with both alpha non hemolytic streptococcus so in when East are also present in the birth and when you see in the two months of the age the our oral cavities associated with Viana FPL and if you see at the six months of the age that oral cavity the predominant species are fuse of Actium and non-pigmented Prevotella species if you go into 12 months the oral cavity is predominant with cap no site of failure species first going into the tuberculosis this tuberculosis is mainly caused by Mycobacterium tuberculosis and these are the other species which are responsible for the tubercle tuberculosis formation mode of transmission includes whether it may be of inhalation or ingestion inoculation or a transplanted root there are two types of tuberculosis that is primary tuberculosis and secondary tuberculosis if if you go into the primary tuberculosis this occurs in the patient who has not not being previously infected or immunized and you have to remember one important thing about this primary - booktuber closes formation of gold's complex that is goals complex is associated with the primary tuberculosis and this bones complex will have a pulmonary component and a lymphatic vessel component so this is the gowns focus which is with primary tuberculosis and the fate of primary tuberculosis maybe a fibrosis or a calcification or a it made change into a progressive form or it may end up with Amelia reform that means including or associating with many organ service multi-organ involvement so it may end up with a calcification or a fibrosis even reactive lesions can be found like miliary tuberculosis which including the lungs liver and all the multi-organ involvement can be seen if you go into the secondary tuberculosis here the individual is previously infected or is sensitized and here the secondary tuberculosis we can see in the organs like tank lungs tonsils firings and small intestine and here the infection may be of endogenous or exogenous source and even this fate of secondary to you by closest maybe a fibrosis or a calcification on it may lead into a progress you pulmonary tuberculosis and finally it means up with the miliary tuberculosis with multi system or a multi organ involvement what are the clinical features of pulmonary tuberculosis this pulmonary tuberculosis is associated with prodromal symptoms like fever Vatican Palace and the important the point here is the patient may have in night sweats and along with that cough and that cough is with a black color or a blood street's put'em and even the in these patients they complains of a chest pain and because of pulmonary involvement you can see a track yawn deviation and you can hear the bronchial breath sounds which are very dull and extra pulmonary tuberculosis is nothing but these occurs in other systems other than the pulmonary system and the involvement of cervical and hilar nodes is called as rocks Rufina scrofula is nothing but a glandular swelling in front it means a female with full neck and if you bones and joints are involved it is called a supports disease and if the skin is involved it is Policy lupus vulgaris this is the important points with examination so we're coming into the oral manifestations if in primary tuberculosis we can see the most commonly involved thing is gingiva whereas in secondary tuberculosis the most commonly involved is tonguing palate and these oral manifestations we can see as a ulcer form or a modular form or a granulomas form that is granulomas nothing but a I mean excessive growth or a Clarke type of tissues so if it occurs on the tongue the most common sight is the lateral border you can see in the picture and other things that ulcer may be of it having undermined else which is an important point to note down right you can see here small granulomas or ulcerations in the palate or a floor of the mouth even the lips can show a granulating ulcers and even it can involve the bone in bone which may lead to the formation of cuba color osteomyelitis and even it can involve the major salivary glands like parotid gland followed by the submandibular gland and these are the investigations for the tuberculosis that this examination of sputum and here the OPG is important because in chronic cases we can see a soft tissue calcification or a soft tissue calcification of lymph nodes they are nothing but a dystrophy calcification even in the chest a gravy chest x-ray we can see the calcifications and these are the other tests diagnostic tests like FNAC PCR elisa these are the other investigations for the tuberculosis going into the treatment there are two line of trucks that is first line and second line and these are the drugs which are used as a first line or a first choice a mostly used I guess reform thing whereas the second line of these are the second line of drugs which are used in the treatment of tuberculosis and in the hueber Colossus we will use the multi drug regime and that is for a new cases or cases which again becomes mere positive and if you see a relapses or a failure in the treatment so these are the combination of the drugs used for the new cases these are the combination of the drugs used for the cases which have smear positive and and these are the drugs used for the relapses treatment failure and here you can note the shortcuts of this drugs which is a cheese isoniazid RS refampin e S is for streptomycin easy thumb butyl is a dis Pyrus in amide and T's Thea as it is own so ii going into the second granulomatous infection that is leprosy it is also called as a Hansen's disease it was given by Hansen and the causative organism is the Mycobacterium leprae mode of transmission may be whether a diet's contact or a maternal fetal transmission or even transmission from milk often leprosy patient if we go into the classification there are two types one is lepromatous type and cubicle R type and but now current classification we are using Posse bacillary and multi bacillary and these are the Ridley and shoppings classification there are seven types in this tubercle ID polar has a high resistance whereas lepromatous polar has a low resistance these are the difference between lepromatous leprosy and the tuberculoid leprosy whereas you can see a symmetrical lesions in the tuberculoid leprosy there is no clear zone in the tuberculoid leprosy and bass line the lepromatous leprosy or e-cigarettes in a pack whereas you when you compare with the see tubercle I'd refer to see it is a granular array beaded forms and again in lepre mean test is positive for tuberculosis II where it is negative for the lepre me leopard mattis leprosy and the reactions which you can see in the leprosy are of two types that is borderline reactions and erythema nodosum type of reactions and the current classification of passive are slurry and multi Becerra type inferencing as Larry it is nothing but the entire it resembles the tuberculin pattern of leprosy and here oral lesions are very rare then multi pass Larry leprosy here you can see few oral lesions and you can see the multiple macular or a growths or a papules type of structures on the skin and the faces which are seen in this multi basilar leprosy or leonine faces and hair including eyebrows and eyelashes often is lost in multi Valarie leprosy this coming to the oral manifestations usually only 19 to 60 percent of the cases will have only manifestations and in their oral manifestations the most Limon sight is hard palate along with this other site can also be in other side also you can see the manifestations and this affected soft issues will appear lo2 red and even in few cases there is a complete loss of EULA and there is really fixation of soft palate and this is an important point microglia it is nothing but infection of the lip which leads to Mac vigilia and faces leprosy if we will see that a trophy of the anterior nasal spine along with the a trophy of anterior minds in the annular Ridge and endonasal inflammatory changes all these things will convert into face she slept without any coming into the dental manifestations you will see the enamel hypoplasia of the teeth with short tapering roots and even the powerful infections and internal resorption and necrosis are also common in with this leprosy coming to the treatment the most commonly used drugs are rifampin and Dobson but in multi battle bacillary will use clover Zeeman along with this rifampin and dab zone if these patients are allergic to refampin we will use clover semen and minocycline and this thalidomide is important because it is used in the management of complication of leprosy therapies then the third infection is of syphilis it is also called as in Lewis what is the causative organism it is Treponema pallidum the mores of transmission may be through a sexual contact or from mother to fetus or glide transfusion accidental inoculation or puncture with contaminated instruments these are the mores of transmission of syphilis if you go into the history thief syphilis has different names in French it is termed as Napolitan each whereas in Russians call it as a Polish disease in Italian it is Modbus Calais and in real fennel he discovered or coined the term Lewis in the 16th century classification is of two types acquired and continental that is basic classification whereas aquarius of again three to four types that is primary secondary where you'll see a latency period then it turns into a tertiary infection and the last basic thing is congenital syphilis primary syphilis the most important characteristic feature is of canker for the primary syphilis and this KanCare occurs two to four weeks after exposure to the infection this canker is nothing but a initial it is a painless party that it undergoes a ulceration and develops into a canker and this because of this ulceration you will see a regional lymphadenitis secondary syphilis the characteristic manifestations of secondary syphilis are mucus patches you can see here in the picture mucus patches or a mucocutaneous lesions and one more thing is the candle oma later this mucus patches make me you can see and mouth fairies and even as a vagina and even a like it's under eyes skin eruptions where is condyloma later this is condyloma later it is nothing but it looks like a viral papillomas it mostly occurs in the dorsum of the tongue and even this prodromal symptoms are associated or followed by the necrotic oscillations which cue the terms Luis Molina so mucus patches condyloma later and Luis malignus associated with the secondary syphilis going into tertiary syphilis here the Lathan actually the patient after the secondary syphilis will go into a latent syphilis or a latency phase and this latency phase is remind for a one to thirty years then from latency period this patient will this patient will go into the tertiary syphilis so in the tertiary syphilis the entire multi organ system is involved and if you go into the baske it involves a vascular system or a central nervous system and the important oral manifestation is gamma it is nothing but it causes the perforation of the palate and other manifestations are industrial glossitis and lowest class sizes cutting nothing but syphilis involving the tongue is called a Zulu etic velocity source vertex traceability it is gamma in the seashell glossitis and you etic glossitis congenital syphilis here you can see the important manifestation is hutchinson triad it is nothing but a Hutchinson's teeth ocular in disguise in the seashell keratitis i8 now deafness this is important for the exam and Hutchinson's teeth are in that screwdriver shaped in sizes and mulberry molas these are these are the hats insults teeth this all are the diagnosis which we can do further examine which we can may be patient is have it ended stick to punch link or other alternative drugs are these are the other alternative to expected drug of choice is punched a pendulum then the fourth one is acting on my mices infection that is acronym is the causative factor or equality is of actual versus here the important form of this acronym is paralyzed rotation at you know my little and former man you can see the oral manifestations when it has been deck manifestations and here the organism enters through the mucous membrane right it strikes into the foundation soft tissues or to salivary glands where you can involve the voice and causes flooding and in today's market fish and even this serving may develop into one or more acid the important characteristic feature of this is liberating past sometimes harmful granules which is associated with acting oh my my process and you have to remember actinomycosis is not a fungal infection it is a bacterial infection and a granulomatous infection so here you can see the first generator with the sulfur canyons and here with the high doses of antibiotics that is mostly will use pencil in with a metal a visual combination and there should be the under abscess drainage and excision of the sinus tract so I hope it's these you have learned these things and these are the very important things and you have to remember all the discussed things are bacterial infections which are associated with granuloma formation and hence they are called as granulomatous infections and those are very very important for the me