Bacterial, Viral, And Fungal Infections In Mouth Pathology Question And Answers

Bacterial, Viral, and Fungal Infections in Mouth Question And Answers

Question 1. What is the other name of antibodies?
Answer. Immunoglobulins.

Question 1a. Name the different types of immunoglobulins.
Answer. IgG, IgM, IgA, IgD and IgE.

Read And Learn More: Oral Pathology Short Notes Question And Answers

Question 1b. Which immunoglobulin is transferred from mother to child for early immunity before the baby develops its own immune system?
Answer. IgM (maternal antibody).

Question1c. Which immunoglobulin is present mostly in the body secretions, e.g. milk, sweat, and saliva, etc.?
Answer. IgA (called secretory immunoglobulin) also present in blood.

Question1d. Which immunoglobulin is present in the body in maximum amount?
Answer. IgG.

Question 1e. Which immunoglobulin mediates type I hypercensitivity?
Answer. IgE.

Question 1f. Which immunoglobulin is present in the body in least amount?
Answer. IgD.

Question 1g. What is average concentration of individual antibodies in the blood?
Answer. IgG:80 percent, IgA:10-15 percent, IgM:5-10 percent, IgD:0.2 percent and IgE:0.1 percent.

Question 1h. Immunoglobulins are produced by which cells?
Answer. Plasma cells, which are the converted form of B lymphocytes.

Question 1i. What is a bacteria?
Answer. Bacteria constitute a large group of unicellular prokaryotic microorganisms; many of which are capable of causing disease. They are only few micrometres in length and have a wide range of shapes, ranging from spheres to rods and spirals, etc.

Question 1j. What is tuberculosis?
Answer. Tuberculosis is a very contagious, chronic bacterial infectious disease caused by Mycobacterium tuberculosis.

Question 2. What type of organism is Mycobacterium tuberculosis?
Answer. It is an aerobic, slender, non-motile, non-spore-forming, rod-shaped organism.

Question 3. How people get infected by the bacteria?
Answer. Most of the people make contact with the bacteria through airborne (droplet) infections.

Question 4. Which stain is used the detection of tuberculous bacilli?
Answer. Ziehl-Neelsen stain or acid fast stain.

Question 5. Name one disease in which tuberculosis often occurs as an opportunistic infection?
Answer. AIDS.

Question 6. What is the commonest site of infection of tuberculosis in the body?
Answer. Tuberculosis predominantly affects the lung and the condition is called ‘pulmonary tuberculosis.

Question 7. Which organ is most frequently affected in tuberculosis?
Answer. Lung is most frequently affected and the condition is called pulmonary tuberculosis.

Question 8. Name the extra-pulmonary organs where tuberculosis can occur.
Answer.

• Lymph node
• Oral cavity
• Central nervous system
• Kidney
• Intestine
• Skin.

Question 9. What is the primary reaction in the body after introduction of the tuberculous organism?
Answer. A transient inflmmatory reaction takes place in the lung upon introduction of the microorganism, this is usually followed by exudation and accumulation of PMN (polymorphonuclear neutrophils) and macrophages.

Question 10. Name the cell which causes phagocytosis of the bacilli in case of tuberculosis?
Answer. Macrophages.

Question 11. What are epitheloid cells in tuberculosis?
Answer. In tuberculosis the macrophage cells cause phagocytosis of the microorganism; after phagocytosis, tuberculous bacilli start to multiply within the macrophage itself and this results in change in the shape of the macrophage, which appear as an epithelial like cell,with ill-defied borders and hence are called epitheloid cells.

Question 12. What type of necrosis occurs in tuberculosis and how it occurs?
Answer. In tuberculosis the characteristic casseation necrosis occurs at the center of the infected
tissue and it results from hypersensitivity to tuberculoprotein (the bacillary antigen).

Question 13. Which type of giant cells are found in tuberculosis and how they are formed?
Answer. In tuberculosis Langhans type of giant cells are found with horse-shoe pattern of arrangement of nuclei; these giant cells form due to fusion of epitheloid cells.

Question 14. What is latent tuberculosis?
Answer. A person infected with tuberculous microorganism may remain asymptomatic for a long time and this condition is called latent tuberculosis.

Question 15. What is miliary tuberculosis?
Answer. In some cases, depressed host immunity may result in a wide spread disseminated infection in the lungs as well as in the extra pulmonary organs and this type of infection is known as milliary tuberculosis.

Question 15a. In miliary tuberculosis, how does the tuberculous bacilli spread widely in the body?
Answer. They spread through the blood.

Question 16. Name the general clinical manifestations of tuberculosis.
Answer. The tuberculosis patients commonly complain of gradual weight loss, evening rise of temperature, loss of energy, anorexia, persistent productive or unproductive cough,hemoptysis (coughing of blood), chest pain, malaise, night sweats and easy fatigability,etc.

Question 17. What is scrofula?
Answer. Tuberculous infection in the lymph node is called scrofula.

Question 18. What are the characteristics of the infected lymph nodes in case of tuberculosis?
Answer. The infected lymph nodes are often enlarged; they have a rubbery consistency and become matted in appearance.

Question 19. In tuberculosis, what does a cold abscess mean?
Answer. In untreated cases of tuberculosis, there may be abscess formation in the lymph node,which is known as cold abscess and it is characterized by pain, swelling and development of pus discharging sinus in the infected node.

Question 20. What is lupus vulgaris?
Answer. Primary tuberculosis of the skin is called lupus vulgaris.

Question 20a. What is the best laboratory test to diagnose lupus vulgaris?
Answer. Biopsy of the affected tissue.

Question 21. What are the manifestations of renal tuberculosis?
Answer. Renal tuberculosis occurs due to involvement of the kidney or the urinary bladder and this condition often produces hematuria or pyuria, etc.

Question 22. What is the most serious consequence of bone tuberculosis?
Answer. Development of tuberculous osteomyelitis.

Question 23. How intestinal tuberculosis develops and what are its features?
Answer. In severe cases of pulmonary infection, intestinal tuberculosis may occur due to swallowing of the sputum and it is characterized by ulceration of the intestinal mucosa with hypertrophy or adhesion of the walls.

Question 24. What is the most serious consequence in case of involvement of central nervous system by tuberculous infection?
Answer. Development of tuberculous meningitis.

Question 25. How oral tuberculosis develops?
Answer. Tuberculous lesions of the oral cavity mostly occur secondary to the pulmonary infections and are usually caused by the implantation of microorganisms in the oral mucosa during constant coughing.

Question 26. Name the important oral lesions of tuberculosis.
Answer.

• Tuberculous ulcers
• Tuberculous patches
• Tuberculous gingivitis
• Tuberculous osteomyelitis or simple bone radiolucency
• Tuberculosis of the salivary glands
• Tuberculosis of the lymph nodes
• Tuberculous tonsillitis.

Question 27. Which organ is more frequently affected in oral tuberculosis?
Answer. Tongue.

Question 27a. Describe the typical tuberculous ulcer of the oral cavity.
Answer. Tuberculous ulcers are well-defied, painful, fim and yellowish-grey in colour; they have a granulating flor with minimum induration. Moreover the surrounding mucosa appears inflmed and edematous.

Question 28. Describe the tuberculous gingivitis.
Answer. It is characterized by diffuse, hyperemic, nodular or papillary projections from the marginal gingiva with development of gingival hyperplasia.

Question 29. Describe the clinical features of salivary gland tuberculosis.
Answer. The tuberculous infection may involve either the salivary gland tissue itself or it may affect the intra or peri-glandular lymph nodes. There can be generalized glandular swelling or abscess formation along with pain, facial nerve palsy and fitulous tract formations, etc.

Question 30. In case of tuberculous osteomyelitis, how infection reaches the jawbones?
Answer. Chronic osteomyelitis of the maxilla and mandible may occur in case of tuberculosis and the infection reaches the bone via following routes:

• Bloodstream
• Root canals of tooth
• Extraction sockets
• Extensive gingival lesion
• Periapical lesion of tooth.

Question 31. Describe the clinical features of tuberculous osteomyelitis.
Answer. Tuberculous osteomyelitis of the jaw bones clinically produces pain, swelling, sinus or fitula formation, trismus, paresthesia and lymphadenopathy.

Question 32. Describe the histological features of tuberculosis.
Answer. Tuberculous lesions histologically reveal granulomatous tissue with central areas of caseous necrosis, surrounded by lymphocytes, epithelioid calls and occasional multinucleated Langhans type of giant cells.

Question 33. For differential diagnosis of tuberculosis, which lesions are often considered?
Answer.

• Squamous cell carcinoma
• Sarcoidosis
• Syphilis
• Aphthous ulcer
• Deep mycotic infections
• Traumatic ulcer
• Wegner’s granulomatosis.

Question 34. Name the investigations commonly done for the diagnosis of tuberculosis.
Answer.

• Staining of the smear prepared from sputum by Ziehl-Neelsen stain
  Chest radiograph
• Bacterial culture in Lowenstein-Jensen media (materials used for culture may be sputum, laryngeal swab, gastric lavage, urine, cerebrospinal flid and pus, etc.)
• Animal inoculation
• Histopathology of the infected tissue
• Tuberculin test
• Enzyme-linked immunosorbent assay (ELISA) test
• PCR (polymerase chain reaction).

Question 35. Name the common anti-tubercular drugs.
Answer. The common antitubercular drugs include—Rifampicin, Isoniazid, Streptomycin,Ethambutol, etc.

Question 36. What is syphilis?
Answer. Syphilis is a sexually transmitted disease (STD) caused by infection with a spirochete named Treponema pallidum.

Question 37. How many types of syphilis are generally seen?
Answer. The disease generally is of two types:

• Acquired syphilis
• Congenital syphilis.

Question 38. Name the stages of acquired syphilis.
Answer. The acquired syphilis manifests in three stages:

• Primary syphilis
• Secondary syphilis
• Tertiary (late) syphilis.

Question 39. Name the oral lesion of primary syphilis, when does it occur after the initial contact?
Answer. Oral lesion of primary syphilis is called chancre which generally occurs 3 weeks after the contact with the organism.

Question 40. Describe the appearance of a chancre.
Answer. The fully developed oral lesions of primary syphilis are called chancres; these are painless, rounded, ulcers with indurated margins and are often covered by a grayishwhite membrane.

Question 41. In which part of the mouth do oral chancres occur?
Answer. Most of the oral lesions occur on the lip; the other sites include tongue, palate, gingiva,uvula and tonsils, etc.

Question 42. For which lesion the oral chancre is often mistaken as?
Answer. Oral squamous cell carcinoma.

Question 43. What is condyloma lata?
Answer. In case of secondary syphilis, skin lesions may develop as nodular, flt or papillary growths; which often resemble viral papillomas and such lesions are called condyloma lata.

Question 44. Name the oral lesion of secondary syphilis, when does it occur?
Answer. The oral lesions in this stage are called mucous patches, these lesions usually occur 6 to 8 weeks after the primary infection.

Question 45. Mucous patches in secondary syphilis often develop in which areas of mouth?
Answer. These are commonly seen over the tongue, lips, buccal mucosa, gingiva, tonsils, larynx,pharynx, and palate, etc.

Question 46. Describe the typical appearance of mucous patches in secondary syphilis.
Answer. These patches are characterized by multiple, flt, irregular or circular, slightly raised,painless, white round erosions; which are covered by a thin yellowish grey (glistening)
slough and are surrounded by a painful erythematous halo.

Question 47. What is a snail track like ulcer in secondary syphilis?
Answer. It is an important fiding in secondary syphilis in which, multiple mucous patches in the oral cavity coalesce together and from irregularly linear ulcer, often known as snail track like ulcer.

Question 47a. Syphilitic ulcer is painful or painless?
Answer. Painless.

Question 47b. Name the common ulcers in the mouth which are painless.
Answer.

• Syphilis
• Granuloma inguinale
• R ecurrent herpetic ulcer
• Oral ulcer in leprosy
• Ulcer due to electrical burn.

Question 47c. Name the common ulcers in the mouth which are painful.
Answer.

• Tuberculous ulcer
• Traumatic ulcer
• Primary herpetic ulcer
• Aphthous ulcer
• Malignant ulcer
• ANUG.

Question 48. When does tertiary syphilis occur in comparison to primary syphilis?
Answer. Tertiary syphilis (third stage of the disease) usually occurs about 5–10 years after the primary infections.

Question 49. Name the organs commonly affected in tertiary syphilis.
Answer. Tertiary syphilis affects skin, mucous membrane, central nervous system (CNS) and cardiovascular systems. Besides this, muscles, bones and joints are also frequently affected.

Question 50. What is the typical oral lesion of tertiary syphilis?
Answer. Typical lesion of tertiary syphilis is called gumma, which is a localized, indurated, chronic granulomatous lesion; having either nodular or ulcerated surfaces.

Question 51. Name the consequence of tertiary syphilis during pregnancy.
Answer. Tertiary syphilis in a mother during pregnancy often results in development of congenital syphilis of the newborn.

Question 52. What type of scar develops in the skin in tertiary syphilis?
Answer. Skin lesions heal very slowly in tertiary syphilis and often they leave tissue paper-like scars.

Question 53. Name the most serious complications in tertiary syphilis.
Answer. The most serious complication, of tertiary syphilis is the destruction of the walls of large blood vessels, aneurysm of the arch of aorta, left ventricular hypertrophy and congestive
cardiac failure, etc.

Question 54. What is neurosyphilis?
Answer. Involvement of central nervous system in syphilis is called neurosyphilis and it results in generalized paresis, dementia and strokes, etc.

Question 55. Describe the clinical appearance of oral gumma in tertiary syphilis.
Answer. It presents a painless, deep, rounded ulcer with punched-out edges and a wash-leathery flor.

Question 56. What type of complication can occur in hard palate in patients with tertiary syphilis?
Answer. In tertiary syphilis, progressive necrosis and sloughing often leads to perforation of the hard palate with development of oro-nasal communication. This is a very characteristic
fiding in tertiary syphilis and patient often feels breathing and swallowing diffiulties.

Question 57. What type of complication can occur in soft palate in patients with tertiary syphilis?
Answer. Destruction of the soft palate and uvula in tertiary syphilis may result in obstruction of the nasopharyngeal airway in few cases.

Question 58. What is syphilitic glossitis?
Answer. In tertiary syphilis, there is often loss of filiform and fungiform papilla of tongue with the presence of superficial glossitis; which is called syphilitic glossitis.

Question 59. What is syphilitic leukoplakia?
Answer. In tertiary syphilis there is often presence of diffuse, large leukoplakic patches particularly in tongue and the condition is called syphilitic leukoplakia.

Question 60. Which stages of syphilis are contagious?
Answer. Both primary and secondary syphilis are contagious, but secondary syphilis is most risky.

Question 61. Which stage of syphilis is non-contagious?
Answer. Tertiary syphilis.

Question 62. In which stage of syphilis destruction of nasal tissue causes saddle nose?
Answer. In tertiary syphilis, destruction of the nasal septum and collapse of the nasal cartilage results in saddle nose.

Question 63. What is congenital syphilis?
Answer. Congenital syphilis is a rare entity that occurs in children born of a mother who had syphilitic infection during pregnancy. The condition occurs due to transplacental infection
with Treponema pallidum during fetal development.

Question 64. Name the clinical features of congenital syphilis.
Answer.

• Rhagades (fisuring and scarring of the corner of the mouth)
• Frontal bossae and saddle nose or bull dog nose (occurs due to destruction of the nasal spine)
• Short maxilla and high palatal arch and saber (pointed) shins
• Mulberry molars and screwdriver-shaped incisors
• Hutchinson’s (notched) incisors and peg laterals
• Delayed eruptions of teeth
• Hypodontia and enamel hypoplasia.

Question 64a. Name the conditions other than congenital syphilis, where peg-shaped incisors may be seen.
Answer.

• Ectodermal dysplasia
• Supernumerary teeth.

Question 64b. What are rhagades and these are seen in which disease?
Answer. Rhagades are fisures, cracks, or linear scars in the skin, especially at the angles of the mouth and nose (movable organs).These are associated with congenital syphilis.

Question 64c. What is saber shin?
Answer. It is a congenital malformation characterized by a sharp anterior bowing of the tibia; it is seen in congenital syphilis.

Question 64d. What is saddle nose?
Answer. Saddle nose is a condition characterized by a loss of height of the nose due to collapse of the nasal bridge. It is a common feature of congenital syphilis.

Question 64e. Name the other diseases besides congenital syphilis, where saddle nose may be present.
Answer.

• Nasal trauma
• Relapsing polychondritis
• Wegener’s granulomatosis
• Cocaine abuse
• Leprosy.

Question 65. What are the oral manifestations of congenital syphilis?
Answer.

• Short maxilla and high palatal arch
• Mulberry molars and screwdriver-shaped incisors
• Hutchinson’s (notched) incisors and peg laterals
• Delayed eruptions of teeth
• Hypodontia and enamel hypoplasia
• Rhagades (fisuring and scarring of the corner of the mouth).

Question 65a. What is Higoumenakis’ sign?
Answer. Higoumenakis’ sign refers to enlargement of the sternal end of the (right) clavicle, it is often seen in patients with late congenital syphilis.

Question 66. What is Hutchinson’s triad?
Answer. It is the pathognomonic feature of congenital syphilis and is characterized by:

• Hypoplasia of the incisor and molar teeth (Hutchinson’s teeth)
• Eighth nerve deafness
• Interstitial keratitis of the eye.

Question 67. Mulberry molars are characteristically seen in which disease?
Answer. Congenital syphilis.

Question 68. What are mulberry molars?
Answer. The mulberry molars (also known as Moon’s molars) are abnormally shaped molar teeth seen in congenital syphilis; these mulberry molars look dirty yellow in color which occurs
as a result of hypo calcification of these affected teeth.

Question 69. What are screwdriver-shaped incisors and in which disease it is generally seen?
Answer. Screwdriver-shaped incisors are important characteristic features of congenital syphilis; these teeth typically exhibit wide middle third of the crown with tapered incisal edges.

Question 69a. Painless perforation of palate is a manifestation of which disease?
Answer. Syphilis.

Question 70. Name the diagnostic procedures in syphilis.
Answer.

• Detection of bacteria in smear by dark ground illumination microscopy.
• Bacterial culture in artifiial media
• Serological tests like Washerman reaction, Kahn test, venereal disease research laboratory (VDRL) test, florescent treponemal antibody test (FTA), rapid plasma reagin (RPR) test, micro hemagglutination assay-T pallidum (MHA-TP) test.
• ELISA.
• Histopathology.

Question 71. What is the treatment of syphilis?
Answer. Treatment is done with high doses of penicillin.

Question 72. What is gonorrhea?
Answer. Gonorrhea is a sexually transmitted disease (STD) caused by Neisseria gonorrhea bacteria, the disease is often called the clap.

Question 73. Neisseria gonorrhe bacteria are often present in which parts of the body?
Answer. The microorganisms are often present in the moist part of the body e.g. vagina, penis,eyes, throat and rectum, etc.

Question 74. How gonorrhea affects an individual?
Answer. The disease affects both males and females and it spreads through all forms of sexual activity including oral, vaginal and anal sex.

Question 75. What are the general manifestations of gonorrhea in men?
Answer.

• Yellow, white or green pus-like discharge from the tip of penis
• Fever and vomiting
• Redness of the glans penis with swelling of the testicles
• Stinging (acute pain) during urination
• Frequent urinations and presence of blood in urine
• Swelling of the lymph nodes in the groin region.

Question 76. What are the general manifestations of gonorrhea in women?
Answer.

• Bleeding during intercourse and pain
• Fever and vomiting
• Abnormal intermenstrual bleeding
• Vaginal discharge
• Pain in the abdomen
• Burning or itching sensation during urination.

Question 77. In which parts of the oral cavity gonorrhea lesions often develop?
Answer. Oral lesions mostly occur due to fellatio and these mostly develop in the oropharynx,tonsils and uvula, etc.

Question 78. What are the oral manifestations of gonorrhea?
Answer.

• Diffuse erythema in the oropharynx with sore throat
• Erythema, edema and discharge of pus from one or both tonsils
• Cervical lymphadenopathy
• Vomiting tendency due to irritation and soreness in the throat
• Difficulty in swallowing.

Question 79. Name the different diagnostic methods in gonorrhea.
Answer.

• Neisseria gonorrheae can be demonstrated by gram staining and it appears as a gram – negative diplococcus under microscope
• Bacterial culture: From the samples obtained from the purulent discharge
• Sugar fermentation test
• Identifiation of bacterial DNA from the urine samples of the patient.

Question 80. What is actinomycosis?
Answer. Actinomycosis is a chronic granulomatous, suppurative and firosing infection; caused by fiamentous, Gram-positive, anaerobic actinomycotic group of organisms.

Question 81. Name the different actinomycotic group of organisms.
Answer.

• Actinomyces-israelii
• A naeslundii
• A bovis
• A odontolyticus
• A viscosus.

Question 82. What are the different types actinomycosis?
Answer. The disease mainly occurs in three forms:

• Cervicofacial actinomycosis
• Abdominal actinomycosis
• Pulmonary actinomycosis.

Question 83. Among the three forms of actinomycosis, which one is the most common?
Answer. The carvicofacial actinomycosis is the most common form (occur almost in 50% cases).

Question 83a. Which type of actinomycosis is the most serious one?
Answer. Abdominal actinomycosis.

Question 84. In which group of people actinomycosis predominantly occurs?
Answer. The disease often occurs among cultivators.

Question 85. Describe the clinical features of cervicofacial actinomycosis.
Answer.

• The disease starts with a painful, soft tissue swelling over the upper part of neck or below the ear, or near the angle of mandible
• The overlying skin appears dusky-red or bluish-red with induration
• Later on the swelling becomes flctuant at the centre and multiple pus discharging sinuses develop both intra-and extraorally
• The pus contains sulfur granules.

Question 85a. What is the chief clinical features of actinomycosis?
Answer. Hard swelling of the skin with multiple discharging sinus.

Question 86. How the skin lesion in actinomycosis is often described?
Answer. The skin lesion is often classically described as wooden indurated area of firosis.

Question 87. What are sulfur granules in actinomycosis?
Answer. In actinomycosis multiple pus discharging sinuses develop and the pus contains clinically visible, small, yellowish-green granules, often known as sulfur granules.

Question 88. What does the sulfur granules in actinomycosis actually represent?
Answer. Each granule represents a colony of actinomycotic organisms.

Question 89. Describe the histology of actinomycosis.
Answer.

• The disease shows formation of numerous abscesses, whose centers are typically occupied by the bacterial colonies
• The periphery of each colony shows club-shaped swellings; which produces a typical a ray fungus like appearance
• The pus inside the abscess often contains the so called sulfur granules.

Question 89a. A typical ray fungus like appearance is present in which disease?
Answer. Actinomycosis.

Question 90. What is scarlet fever (scarlet means a strong vivid red or reddish orange color)?
Answer. Scarlet fever is a rare specifi bacterial disease caused by streptococcus b-hemolyticus and it commonly occurs in children.

Question 90a. What type of toxin is released by the bacteria in scarlet fever?
Answer. Erythrogenic toxin.

Question 91. What are the skin changes in scarlet fever?
Answer. A diffuse, bright red skin rash often appears over the skin in scarlet fever, which occurs due to damage to the small superfiial blood vessels by erythrogenic toxins liberated by the causative bacteria.

Question 91a. When does the skin rash appear in scarlet fever?
Answer. The skin rash appears on the second or third day of the disease that starts on the chest and gradually spreads to the other body surfaces.

Question 92. How does the facial skin appears in scarlet fever?
Answer. Rash also develops in the facial skin and this rash typically appears as sunburn with goose pimples.

Question 93. The strawberry tongue develops in which disease?
Answer. Scarlet fever.

Question 93a. Hunter’s glossitis occurs in which disease?
Answer. Pernicious anemia.

Question 93b. Sandwith’s bald tongue is seen in which disease?
Answer. It is seen in pellagra; tongue is very smooth, swollen and red due to absence of fusiform papillae with associated severe inflmmation.

Question 93c. What is geometric glossitis?
Answer. It is a chronic painful tongue disease caused by herpes simplex virus (HSV) type I infection; characterized by a deep fisure in the midline of tongue with multiple branches.

Question 93d.What is the difference between geometric tongue and fisured tongue?
Answer. Geometric tongue is very painful and caused by herpes simplex virus; whereas fisured tongue is a developmental condition which doesn’t cause any pain.

Question 93e. A typical cobble-stone appearance of tongue is seen in which diseases?
Answer. Leprosy, Sjogren’s syndrome, vitamin B12 defiiency.

Question 94. Describe the appearance of strawberry tongue.
Answer. During the fist two days of scarlet fever, the tongue becomes covered with a white coat through which only the enlarged and reddened fungiform papillae project like small, red knobs. This phenomenon is called strawberry tongue.

Question 95. What is raspberry tongue in scarlet fever?
Answer. By the 4th or 5th day of scarlet fever, the initial white coating over the dorsum of the tongue is lost by desquamation; the tongue appears beefy red in color with many hyperplastic fungiform papillae and this condition is called, raspberry tongue.

Question 96. What is diphtheria?
Answer. Diphtheria is an acute contagious infection caused by Corynebacterium diphtheria and it commonly involves the children.

Question 97. How can person get infected with the bacteria?
Answer. Humans are sole reservoir of Corynebacterium diphtheria and the infection can be acquired through contact with an infected person.

Question 98. What are the constitutional symptoms in diphtheria?
Answer. The disease starts with low-grade fever, malaise, vomiting, anorexia, headache and lymphadenopathy, etc.

Question 99. What is the most important clinical characteristic of diphtheria?
Answer. Formation of a thick, firinous, grayish, pseudomembrane (diphtheric patch); over the tonsil, larynx, pharynx and uvula, etc, which may cause respiratory obstruction.

Question 99a. Fever, sore throat and formation of pseudomembrane are the features of which disease?
Answer. Diphtheria.

Question 100. What is sarcoidosis?
Answer. Sarcoidosis is a multi-system chronic granulomatous disease of unknown etiology; which resembles tuberculosis in many respects.

Question 101. Which organs of the body are often affected in sarcoidosis?
Answer. The body organs which are often involved in sarcoidosis include the lymph nodes, salivary glands, skin and bone, etc.

Question 102. What are the orofacial manifestations of sarcoidosis?
Answer.

• Unilateral or bilateral swelling of parotid gland along with facial nerve paralysis
• Swelling of intraoral minor salivary glands with xerostomia
• Multiple erythematous nodules over the cheek, labial mucosa and hard palate
• Involvement of the lacrimal glands may produce typical keratoconjunctivitis like symptoms.

Question 103. Describe the histopathological appearance of sarcoidosis.
Answer. Sarcoidosis microscopically exhibits multiple, non-caseating granulomas consisting of clustered epithelioid cells, lymphocytes and multiple multinucleated giant cells.
Often there is presence of star-shaped asteroid bodies or basophilic calcifid Schaumann bodies within the granuloma.

Question 104.What is the confimatory test in sarcoidosis?
Answer. In most of the cases, diagnosis of sarcoidosis is established by positive Kveim-Siltzbach skin test.

Question 105. What is leprosy?
Answer. Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves.

Question 105a. What is the other name of leprosy?
Answer. Hansen’s disease.

Question 106. What are the different types of leprosy?
Answer. The disease is broadly divided into four types:

• Tuberculoid leprosy
• Lepromatous leprosy
• Borderline leprosy
• Intermediate leprosy.

Question 107. Describe the oral manifestations of leprosy.
Answer.

• Development of tumor-like lesions called lepromas, in the oral cavity; which have a tendency to breakdown and ulcerate over time
• Repeated ulcerations in the mouth and attempted healing every time thereafter lead to ugly scarring and loss of tissue.
• Ulcerations and necrosis often causes perforation of the palate.
• There may be fiation of the soft palate with loss of uvula leading to diffiulty in swallowing and regurgitation.
• Erosive lesions over the tongue followed by formation of large lobules produce a typical ‘cobble-stone’ appearance with loss of taste sensation.
• Oral candidiasis, enamel hypoplasia of teeth with pinkish-red discoloration is also seen.

Question 107a. In leprosy, what are lepra cells?
Answer. The vacuolated macrophage cells seen in the histologic sections of leprosy are called lepra cells.

Question 108. What is tetanus?
Answer. Tetanus is a serious type of bacterial disease caused by clostridium tetani.

Question 109. How does Clostridium tetani appear?
Answer. Clostridium tetani is a Gram-positive, non-encapsulated, motile organism having terminally located spore, with a typical drumstick like appearance.

Question 110. In what type of environment Clostridium tetani is found?
Answer. Hot and damp climates with fertile soil rich in organic matter is favorable environment for the growth of this microorganism.

Question 111. What types of toxins are released by clostridium tetani?
Answer. The organism releases exotoxins namely the–tetanospasmin and tetanolysin.

Question 112. Tetanospasmin toxin released by clostridium tetani affects which parts of the body?
Answer. The tetanospasmin affects brain, sympathetic nervous system, the skeletal muscle motor end plates and the spinal cord, etc. The enzyme attacks the motor neurons and results in severe muscle spasms in these vital organs.

Question 113. Describe the clinical features of tetanus.
Answer.

• Severe pain and stiffness of the facial and neck muscles, resulting in trismus
• Risus sardonicus and opisthotonus
• Laryngospasm, increased body temperature and dysphagia
• Airway obstruction and gradual development of anoxia.

Question 114. What is risus sardonicus in tetanus?
Answer. In tetanus, rigidity and spasm of the facial muscles may produce a typical grinning expression of the face called risus sardonicus.

Question 115. What is opisthotonus in tetanus?
Answer. In few severe cases of tetanus, spasm of the entire body muscles produce opisthotonus (severe backward bending); it is a state of a severe hyperextension and spasticity in which an individual’s head, neck, and spinal column enter into a complete bridging or arching position.

Question 115a. Which cranial nerve is often paralyzed in tetanus?
Answer. Seventh cranial (facial) nerve.

Question 116. Why airway obstruction often occurs in tetanus?
Answer. Airway obstruction often occurs due to spasm of the pharyngeal, intercostal and diaphragmatic muscles.

Question 117. What is the treatment of tetanus?
Answer. Injection of tetanus antitoxin along with antibiotics, anticonvulsants and surgical wound care.

Question 118. What is midline lethal granuloma?
Answer. Midline lethal granuloma is a serious disease that involves the nasal cavity, maxilla,palate and nasopharynx, etc and is characterized by progressive destruction of the entire mid-face.

Question 119. How midline lethal granuloma starts?
Answer. Midline lethal granuloma begins with pain, stiffness in the nose and nonspecifi ulceration over the palate or upper respiratory tract.

Question 120. Describe the clinical appearance of fully developed midline lethal granuloma.
Answer. The disease progressively destroys the soft and hard palate and the nose by causing extensive necrosis with concomitant purulent exudation. There is perforation of the palate and development of granular, tumor-like lesions in the mouth and eventually the entire mid-face may be destroyed.

Question 121. What is the consequence of midline lethal granuloma?
Answer. The condition does not respond to any treatment and patients often die because of exhaustion, hemorrhage, malnutrition and cachexia, etc.

Question 122. What is Wegener’s granulomatosis?
Answer. Wegener’s granulomatosis is a rare disease characterized by necrotizing vasculitis of the larynx, trachea, salivary glands, palate, etc and is often associated with a fatal outcome.

Question 123. Describe the common clinical appearance of Wegener’s granulomatosis?
Answer. This potentially lethal disease often starts with rhinitis, sinusitis and nasal crusting, etc. with gradual destruction of the nasal septum. It often results in a saddle nose deformity.

Question123a. Where does oral lesions of Wegener’s granulomatosis most frequently develop?
Answer. Gingiva.

Question 124. What are the oral manifestations of Wegener’s granulomatosis?
Answer. Generalized severe proliferative or hyperplasic gingivitis and ulceration of the other mucosal surfaces. The gingival lesions produce dusky red or bright red swellings with a granular surface (strawberry gingiva).

Question 125. What is noma?
Answer. Noma is a rapidly spreading and extremely severe gangrenous infection of the orofacial tissues; characterized by perforation and destruction of large areas of the face.

Question 126. What are the causes of noma?
Answer.

• Protein-energy malnutrition due to extreme poverty
• Exanthematous diseases like typhoid fever, leukemia, etc.
• Stress
• Vitamin deficiency
• Poor oral and general hygiene
• Depressed immunity including AIDS
• Chemotherapy.

Question 127. Describe the clinical appearance of noma.
Answer. In noma, initially a painful, red, indurated papule develops over the gingiva followed by an ulcer, which spreads rapidly on both facial and lingual directions and exposes the underlying bone.
Within a few days a small, dark, reddish-purple area appears on the skin over the cheek, which rapidly undergoes gangrenous necrosis and creates a large hole of few inches size on the cheek due to sloughing of the tissue.

Question 127a. A malnourished child develops diffuse gingival ulceration with punched-out lesion and necrotic gingival margin; the condition will probably lead to?
Answer. Noma.

Question 128. What is pyogenic granuloma?
Answer. Pyogenic granuloma represents an over-exuberant tissue reaction to some known stimuli or injuries.

Question 128a. What is the most important initiating factor in pyogenic granuloma?
Answer. Local irritation.

Question 129. Why the term pyogenic granuloma is a misnomer?
Answer. The term pyogenic granuloma is somewhat a misnomer since the condition is not associated with pus formation.

Question 129a. What is the most frequent site of occurrence of pyogenic granuloma?
Answer. Gingiva.

Question 130. Describe the clinical appearance of pyogenic granuloma.
Answer. It presents a small, pedunculated or sessile, painless, soft, lobulated growth on the gingiva; with frequent surface ulceration and bleeding tendency.

Question 131. What is pregnancy tumor?
Answer. Sometimes a lesion similar to the pyogenic granuloma appears on the gingival tissue of pregnant women, which is known as pregnancy tumor. It occurs due to the combined effect of hormonal change in the body and local irritation from dental plaque.

Question 132. What is firoepithelial polyp?
Answer. If pyogenic gnanuloma is left untreated, the lesion undergoes firosis due to decreased vascularity and in such cases it appears as a small, fim lobulated mass with little tendency to bleed. This lesion is called firoepithelial polyp.

Question 133. Describe the histology of pyogenic granuloma.
Answer. Histologically, the lesion is composed of lobular masses of hyperplastic granulation tissue, containing multiple proliferating firoblasts, many blood capillaries and variable number of chronic inflmmatory cells.

Ulceration of the overlying epithelium, intercellular edema, hemorrhage and hemosiderin pigmentation of underlying connective tissue are common.

Question 134. What is a virus?
Answer. A virus is an obligatory intracellular parasite, which codes the host cell by contributing its own nucleic acids to produce a new generation of virions.

Question 134a. Which cells are responsible for humoral immunity in our body?
Answer. Mostly B-lymphocytes and sometimes T-lymphocytes.

Question 134b. From where the B-lymphocytes originate?
Answer. They originate from bone marrow and grow in the lymphatic tissue named Barsa of Fabricious.

Question 134c. Which cells are responsible for cell mediated immunity?
Answer. T-lymphocytes.

Question 134d. From which tissues the T-lymphocytes originate?
Answer. The cells originate from bone marrow and grow in the thymus gland.

Question 134e. What are the types of T-Lymphocytes?
Answer. Two types of T-lymphocytes effector cells and regulator cells.

Question 134f. What are effector T cells?
Answer. Effector cell directly kill the antigenic cells, hence also called cytotoxic cells.

Question 134g. What are the types of regulator T Lymphocytes?
Answer. Regulator cells are of two types: Helper T-cells and suppressor T-cells.

Question 134h. Which cells are called helper T-lymphocytes?
Answer. T4 lymphocytes are called helper cells and these cells help the B-lymphocytes to produce antibody.

Question 134i. What is the function of suppressor T-cells?
Answer. They suppress or prevent the autoimmune activity in the body.

Question 135. What is full-form AIDS?
Answer. Acquired immunodeficiency syndrome.

Question 136. Name the virus causing AIDS.
Answer. Human immunodeficiency virus (HIV).

Question 136a. Name the methods of cultivation of virus.
Answer. A virus can be cultivated in:

• Tissue culture
• Embryonated eggs
• Animals.

Question 137. What is a RNA virus?
Answer. An RNA virus is a virus that has RNA (ribonucleic acid) as its genetic material.

Question 137a. What is DNA virus?
Answer. A DNA virus is a virus that has DNA as its genetic material.

Question 137b. HIV is a RNA or DNA virus?
Answer. HIV is a RNA virus, which attacks the DNA of the host cell and then the viral RNA is copied into DNA by the process called transcription. The copied DNA then inserts into the chromosome of the host cell.

Question 137c. How many types of HIV viruses are seen?
Answer. HIV are two types: type-I and type-II.

Question 137d. What type of a virus is HIV?
Answer. HIV virus is a non-oncogenic lentivirus of the human retrovirus family.

Question 138. HIV virus primarily affects which cells of the body?
Answer. When HIV virus enters the body, it primarily infects the CD4+ T lymphocytes (the helper or inducer cells of the cell-mediated immune system) by binding on to the specific CD4+receptor site on these cell surfaces.

Question 138a. What is a helper T-lymphocyte?
Answer. T-helper cells (Th cells) are a sub-group of lymphocytes, which play an important role in the immune system.

Question138b. Describe the functions of T helper cells.
Answer.

• Activation of other immune cells by releasing T-cell cytokines.
• They are essential in B cell antibody class switching.
• Help in the activation and growth of cytotoxic T-cells
• Help in maximizing bactericidal activity of phagocytes, e.g. macrophages.

Question 138c. What are CD4+ T cells?
Answer. When mature Th helper cells express the surface protein CD4; these are called the CD4+ T cells.

Question 138d. What are cytotoxic T cells?
Answer. In case of infection, some T-helper cells produce toxic granules that contain powerful enzymes to kill the pathogen-infected cells and such cells are called cytotoxic T cells.

Question 138e. What is virus mediated transfer of host DNA from one cell to another called?
Answer. Transduction.

Question 138f. How does the enzyme reverse transcriptase helps in the activation of HIV virus?
Answer. This enzyme makes a double-stranded DNA copy from a single-stranded viral RNA template molecule.

Question 139. What are the modes of transmission of HIV?
Answer.

• Sexual transmission—both homosexuals and heterosexual
• Blood or blood products
• Injection drug users
• Occupational transmission for doctors, nurses and other related professionals
• Maternal-fetal/infant transmission
• Via other body flids.

Question 140. Name the different groups of diseases, which manifest during the entire clinical spectrum of AIDS.
Answer.

• Group-I: Acute infections (Infectious mononucleosis, hepatitis, meningitis and meningiencephalitis)
• Group-II: Chronic asymptomatic infections
• Group-III: Persistent generalized lymphadenopathy (PGL)
• Group-IV:
  • AIDS-related complex
  • Neurologic diseases
  • Opportunistic infections
  • Specified secondary neoplasms

Question 141. Name the diseases included in group IV.
Answer.

• Constitutional diseases (AIDS-related complex)
• Neurologic diseases
• Opportunistic infections
• Specified secondary neoplasms
• Others (encephalopathy, purpura, lupus erythematosus, Adisson’s disease and thrombocytopenia, etc.).

Question 142. What is AIDS-related complex?
Answer. It is an important characteristic of HIV infection and is manifested by prolonged unexplained pyrexia, chronic persistent diarrhea, weight loss more than 10% of the previous normal body weight.

Question 143. Classify the opportunistic infections in AIDS.
Answer.

• Pneumonia or sinusitis
  • Pneumocystis carinii pneumonia
  • Cryptococcosis
  • Mucormycosis
  • Toxoplasmosis
  • Pseudomonas aeruginosa
  • Tuberculosis
  • Staphylococcus aureus
  • Streptococcus pneumoniae
• Haemophilus inflenzae
• Gastrointestinal infections (diarrhea)
  • Cryptosporidiosis
  • Isosporiasis
• Mucocutaneneous infections
  • Herpes simplex
  • Herpes zoster
  • Candidosis
  • Staphylococcus aureus
  • Histoplasmosis
• Meningitis and encephalitis
  • JC-virus (Jamestown canyon virus)
  • Toxoplasmosis
• Disseminated infections
  • Atypical mycobacteriasis
  • Cryptococcosis
  • Histoplasmosis.

Question 144. Name the specified secondary neoplasms, which develop in AIDS.
Answer.

• Kaposi’s Sarcoma
• Lymphoma (immunoblastic)
• Burkitt’s lymphoma
• Squamous cell carcinoma of mouth, anus or rectum
• Leukemia.

Question 145. Classify the oral manifestations of AIDS.
Answer.
Oral manifestations of AIDS:

• Oral candidiasis
  • Erythematous, hyperplastic and pseudomembranous (the last one is most common among children)
  • Esophageal candidiasis
• Viral infection
  • Angular chelitis—viral infections of oral mucosa
  • Herpes simplex and herpes zoster causing atypical and chronic ulcers.
  • Epstein Barr virus causing hairy leukoplakia
  • Papilloma virus causing proliferative lesions
  • Cytomegalovirus infection
• Bacterial infections
  • Tuberculous ulcers
  • Osteomyelitis of the jaw
  • Submandibular cellulitis
• Deep fungal infections
  • Coccidoidomycosis
  • Histoplasmosis
  • Toxoplasmosis
• Hairy leukoplakia, gingivitis and periodontitis
  • HIV—gingivitis
  • HIV—rapidly progressive destructive periodontitis
  • Necrotizing ulcerative gingivitis
  • Exacerbation of atypical periodontitis
  • Halitosis
• Persistent generalized lymphadenopathy
• Tumors
  • Kaposi’s sarcoma: flt or nodular purplish lesion mostly on the palate
  • Non-Hodgkin’s lymphoma
  • Burkitt’s lymphoma
  • Squamous cell carcinoma
• Stomatitis
  • Progressive necrotizing ucerations of the oral mucosa
  • Recurrent major aphthous ulcers
  • Salivary gland disease
  • Parotitis and enlarged parotids
  • Sjogren’s syndrome
  • Xerostomia
  • Unilateral or bilateral swelling of other salivary glands
  • Cystic benign lymphoepithelial lesions
• Neurological disorders
  • Facial palsy
  • Trigeminal neuropathy
  • Paresthesia and hyperasthesia
• Autoimmune disease
  • Thrombocytopenic purpura
  • Systemic lupus erythematosus
• Miscellaneous diseases
  • Sinusitis
  • Vesiculobullous lesions
  • Bacillary angiomatosis
  • Adissonian pigmentations
  • Delayed wound healing.

Question 146a. Oral hairy leukoplakia in AIDS patients often develops in which part of the mouth?
Answer. Lateral borders of the tongue.

Question 146b. Name the important diagnostic methods in AIDS.
Answer.

• Clinical—according to WHO recommendations, existence of at least 2 major signs, e.g. chronic persistent diarrhea (more than one month), generalized pruritic dermatitis, recurrent herpes zoster, oesophageal candidiasis, chronic progressive and disseminated HSV infection, Kaposi’s sarcoma or cryptococcal meningitis suggests the diagnosis of AIDS
• Western Blot analysis
• Enzyme-linked immunosorbent assay (ELISA)
• Polymerase chain reaction (PCR)
• Detection of antibody to the virus in serum
• Reverse transcriptase PCR
• Detection of virus from the peripheral blood
• Reversal of normal ratio of T helper to T suppressor lymphocytes
• Viral culture
• P24 antigen detection
• Immunological tests—CD4+ T cell count, CD4+ T cell% and CD4/CD8 ratio tests
• Salivary tests to capture the HIV IgG antibody.

Question 146c. HIV can be detected and confimed by which test?
Answer. Reverse transcriptase PCR.

Question 146d. What happens to the platelet count in HIV infection?
Answer. Thrombocytopenia.

Question 147. Name the important members of herpes virus family.
Answer. Herpes virus family comprises of about 50 different DNA viruses and man is the host and exclusive reservoir of four important members of this group namely:

• Herpes simplex virus (HSV): type I and type II
• Varicella zoster virus
• Human cytomegalovirus
• Epstein-Barr virus.

Question 147a. Which type of tissue is often attacked in herpes simplex virus infection?
Answer. Ectodermal tissue.

Question 148. Name the diseases caused by herpes simplex virus type-I.
Answer.

• Acute herpetic gingivostomatitis
• Herpetic eczema
• Keratoconjunctivitis
• Meningoencephalitis
• Herpes labialis
• Genital herpes (occasional).

Question 149. Name the diseases caused by herpes simplex virus type-II
Answer. This virus is responsible for the following diseases:

• Genital herpes (very common)
• Neonatal herpes
• Uterocervical cancer
• Oral herpes (rare).

Question 150. Name the diseases caused Varicella Zoster virus?
Answer.

• Chickenpox
• Herpes zoster or shingles.

Question 151. Name the diseases caused by human cytomegalovirus.
Answer.

• Salivary gland disease
• Kaposi’s sarcoma.

Question 152. Name the diseases caused by Epstein-Barr virus?
Answer. This virus is responsible for a variety of conditions like:

• Infectious mononucleosis
• Burkitt’s lymphoma
• Nasopharyngeal carcinoma
• Hairy leukoplakia.

Question 153. What is the common age of occurrence of primary acute herpetic gingivostomatitis?
Answer. This acute infection of the oral cavity is caused by the HSV type I and the disease usually occurs during childhood, between 3–5 years of age.

Question 154. Why primary acute herpetic gingivostomatitis does not occur in children below 12 months of age?
Answer. The disease is not seen in children below 12 months of age due to passive immunity coming through the maternal antibodies.

Question 155. In primary acute herpetic gingivostomatitis, which areas of oral cavity are affected?
Answer. Both movable and attached mucosa can be affected and the common sites include the gingiva, hard palate, dorsum of the tongue, lips, vermillion border, perioral skin and nasopharynx, etc.

Question 156. Describe the clinical features of primary acute herpetic gingivostomatitis.
Answer. Initially there will be reddening of the oral mucosa followed by development of numerous small dome-shaped or pin-head type vesicles in the mouth. The associated symptoms include sore mouth, irritability, drooling, refusal of food, bilateral painful cervical lymphadenopathy and fever (103°–105° F), etc.

Question 157. Describe the clinical characteristics of vesicles found in primary acute herpetic gingivostomatitis?
Answer. The vesicles are dome-shaped or pin-head type and measure about 2 to 3 mm in diameter; which contain clear flid.

Question 158. In primary acute herpetic gingivostomatitis, what happens to the vesicles in the
later stages of the disease?
Answer. The vesicles rupture and leave multiple, small, painful, circular, shallow ulcers with sharply defied red margins and yellowish or greyish flor. Adjacent ulcers coalesce to form diffuse, large, whitish ulcers, surrounded by a red ring of inflmmation (halo).

Question 159. Describe how the gingiva appears in primary acute herpetic gingivostomatitis?
Answer. The gingival margins are particularly red, swollen and painful; occasionally there may be presence of punched-out erosions on the free gingival margin (mostly on the facial aspect).

Question 160. In primary acute herpetic gingivostomatitis, how the herpetic ulcers differ in an AIDS patient from that of a normal patient?
Answer. In case of HIV infection, the herpetic ulcers are larger, deeper, more painful and more persistent in nature.

Question 161. Describe the histological appearance of acute herpetic ulcer?
Answer. Ballooning degeneration of the prickle cells, intranuclear inclusion body and marginated chromatin. Multiple multinucleated syncytial giant cells are occasionally present in the lesion (these are formed by fusion of adjacent degenerated prickle cells).

Question161a. What are Lipschutz’s bodies?
Answer. These are intranuclear inclusion bodies found in the infected cells in herpes simplex virus infection.

Question 162. Name the lesions which clinically resemble primary acute herpetic gingivostomatitis?
Answer.

• Erythema multiforme
• Pemphigus
• Pemphigoid
• Chickenpox
• Allergic dermatitis.

Question 163. What happens to the HSV 1 virus after the spell of primary acute herpetic gingivostomatitis?
Answer. After the primary infection, the herpes virus retreats to the trigeminal ganglion where it lies dormant in a latent form.

Question 164. Name the conditions under which the virus can be reactivated.
Answer.

• Emotional stress
• Trauma
• Gastric upset
• Common cold
• Fever
• Menstrual cycle
• Immunosuppression
• Exposure to sunlight
• Radiations.

Question 165. What is the recurrent infection by HSV 1 virus?
Answer. Recurrent infection by HSV 1 is commonly known as herpes labialis or cold sores and it frequently affects the vermillion border of the lips or skin adjacent to the lips.

Question 165a. What is herpetic whitlow?
Answer. Herpetic whitlow is the recurrent lesion of the hands and figers by herpes virus infection.

Question 166. Name the commonest infection caused by HSV type II?
Answer. The virus often causes genital herpes and the disease produces vesicular lesions in the genital mucosa of both sexes along with fever and inguinal lymphadenopathy.

Question 167. Name the serious consequence of HSV 2 infection.
Answer. The disease can significantly increase the risk of development of utero-cervical cancer in females.

Question 167a. Name few diseases, where vesicles form in the oral cavity?
Answer.

• Herpes simplex
• Herpes zoster
• Pemphigus
• Pemphigoid.

Question 168. Name the diseases caused by Varicella-Zoster virus.
Answer. This virus produces two important diseases:

• Chickenpox
• Herpes zoster (shingles).

Question 169. What is chickenpox?
Answer. Chickenpox is the primary infection caused by varicella-zoster virus and it is a minor self-limiting disease, which usually affects children and on rare occasions, non-immune adults.

Question 169a. What is the incubation period of chickenpox?
Answer. Two weeks

Question 170. Describe the clinical characteristics of chickenpox.
Answer.

• The disease begins with fever, headache, anorexia, nausea, vomiting, myalgia, sore throat, etc.
• These are followed by a papular rash fist appearing over the trunk and then rapidly spreading to face and limbs
• After 3–4 days, unusual sequences of macules, vesicles, ulcerations and scabbing of the skin and oral mucosa are seen.

Question 171. How does an individual vesicle in chickenpox appears?
Answer. The individual vesicle appears as dew drop on rose petals and is often surrounded by a zone of erythema at the periphery.

Question 172. What is herpes zoster or shingles?
Answer. Herpes zoster is a recurrent regional infection caused by the Varicella-Zoster virus and it causes severe pain and burning sensations in the dermatome along the course of sensory nerve; (fifth cranial nerve is more frequently affected).

Question 173. What is the most important characteristic seen in this disease?
Answer. The disease is characterized by development of clusters of vesicles over the skin and oral mucosa on one side of the face up to the midline.

Question 173a. Name one important difference between herpes zoster and herpes simplex.
Answer. Lesions of herpes zoster are always unilateral.

Question 174. Which branch of the trigeminal nerve is most commonly affected in herpes zoster?
Answer. The first branch of the trigeminal nerve is most commonly affected.

Question 175. Name the other nerves, which can be affected in case of herpes zoster.
Answer. Herpes zoster while affecting the fist branch of trigeminal nerve, may also involve the following other branches:

• Nasociliary nerve—causing herpetic keratitis
• Ciliary nerve—causing Argyll-Roberston pupil
• Facial nerve—causing Ramsay-Hunt syndrome.

Question 176. In herpes zoster what type of ulcers develop after the vesicles rupture?
Answer. After the vesicles rupture there is formation of crateriform ulcers over the skin and the oral mucosa.

Question 177. Name another virus which has exactly the similar mode of action like herpes zoster?
Answer. Exactly a similar mode of action is seen in case of infections caused by the poliomyelitis virus.

Question 178. What is the basic difference between the herpes-zoster and the poliomyelitis virus infection?
Answer.

• Herpes-zoster virus—affects the sensory neurons
• Poliomyelitis virus—affects the motor neurons.

Question 178a. Ramsay-Hunt syndrome is related to which viral infection?
Answer. Herpes zoster virus infection.

Question 178b. Describe the symptoms of Ramsay-Hunt syndrome.
Answer.

• Red painful rash along with blisters in the ears or mouth.
• Unilateral facial paralysis
• Pain in the ear, hearing loss, dizziness (or vertigo), dry eye
• Altered taste sensation in the mouth.

Question 179. What are the oral manifestations of cytomegalovirus infection?
Answer.

• Painful swelling of the parotid and submandibular glands
• Sialadenitis and xerostomia
• Aphthus-like ulcers may develop in the mouth.

Question 180. What cytomegalovirus can do to AIDS patients?
Answer. The virus may produce Kaposi’s sarcoma in AIDS patients.

Question 181. Why the virus is named cytomegalovirus?
Answer. Because the virus-affected individual cells are often dramatically swollen (cytomegaly) with the presence of large intra-nuclear inclusion bodies.

Question 182. Name the diseases produced by Epstein-Barr virus?
Answer. The virus produces the following diseases:

• Infectious mononucleosis
• Burkitt’s lymphoma
• Nasopharyngeal carcinoma
• Besides the above diseases hairy leukoplakia is believed to be caused by the same virus.

Question 183. What is infectious mononucleosis?
Answer. Infectious mononucleosis or glandular fever is a self-limiting disease, which commonly involves the children and young adults.

Question 184. How the virus is usually transmitted?
Answer. The virus is mainly transmitted via saliva, during intimate kissing.

Question 185. What are the oral manifestations of Infectious mononucleosis?
Answer.

• Disease in the initial stage: manifests only in the oral cavity and produce gingivostomatitis, gingival bleeding and multiple pinpoint petechiae at the junction of the hard and soft palate.
• Disease in the later stage: produces acute necrotizing ulcerative gingivitis (ANUG) type of lesion.

Question 186. What is the common laboratory test done in Infectious mononucleosis?
Answer. Infectious mononucleosis is diagnosed by a heterophil antibody test called Paul-Bunnell test.

Question 187. Name the common oral disease produced by human papilloma virus.
Answer. The virus produces wart-like, self-regressing, multiple tumors in the oral mucosa.

Question 187a. Name the virus which can cause malignant disease in body.
Answer.

• Epstein-Barr virus
• Cytomegalovirus
• Hepatitis B virus.

Question 188. What is measles?
Answer. Measles is a catarrhal inflmmation of the skin, respiratory and oral epithelium; which is characterized by focal degeneration and exfoliation of the affected cells.

Question 189. What is the other name of measles?
Answer. Rubeola.

Question 189a. What is Rubella?
Answer. Rubella or German measles is also a viral infection.

Question 189b. What is the other name of Rubella or German measles?
Answer. 3-day measles.

Question 189c. What type of risk does the rubella infection poses during pregnancy?
Answer. May cause development of congenital anomalies in the new-born.

Question 190. Which virus causes measles?
Answer. The disease is caused by a RNA virus called paramyxovirus, the same virus which causes mumps too.

Question 191. What are Koplik’s spots?
Answer. It is an important feature of measles, which affects the oral mucosa.

Question 192. How koplik’s spots appear clinically?
Answer. Koplik’s spots consist of a cluster of white or white-yellow pinpoint papules on an inflmed, red background of the buccal mucosa, labial mucosa and soft palate, etc.

Question 193. Describe the skin rash that appears in measles.
Answer. In measles diffuse erythematous maculopapular skin rash develops in the skin; which starts in the facial skin and then spreads to the skin of the trunk and extremities.

Question 194. What is the signifiance of Koplik’s spots in measles?
Answer. The most important signifiance is that these Koplik’s spots are the fist sign of the disease; which are seen in the oral cavity itself. Therefore, oral examination can reveal the upcoming infection of measles before it actually appears in the skin.

Question 194a. What is the time gap between appearance of Koplik’s spots and appearance of skin rash in measles?
Answer. About 24 hours.

Question 195. What are the other oral lesions seen in measles besides koplik’s spots?
Answer.

• Presence of palatal petechiae
• Inflamed gingival or oral mucosa that resembles necrotizing stomatitis
• ANUG-like gingival lesions.

Question 196. What type of dental defect is seen in measles?
Answer. Severe measles during early childhood can disturb the normal tooth development and the affected teeth often exhibit ‘pitted enamel hypoplasia in the permanent dentition.

Question 197. What is mumps?
Answer. Mumps is an acute contagious, localized viral infection; characterized by unilateral or bilateral, non-suppurative enlargement of the parotid glands and sometimes other major salivary glands.

Question 198. Which virus causes mumps?
Answer. It is caused by the paramyxovirus, which primarily affects the salivary glands.

Question 199. Describe the most significant clinical manifestation of mumps.
Answer. Pain in the parotid region with subsequent unilateral or bilateral parotid swelling.

Question 200. What is the most important complication of mumps?
Answer. The most important complication is the occurrence of orchitis in adult males, which may sometimes lead to sterility.

• Fever, sore throat, dysphasia and malaise
• Vesicular eruptions in the palm of the hand, sole of the foot and mucosa of the anterior part of mouth
• Cough, rhinorrhea, diarrhea, nausea, vomiting, anorexia and lymphadenopathy, etc may be related

• Genetic factor
• Exaggerated response to trauma
• Immunosuppression
• Microbiologic factor
• Nutritional deficiency
• Certain systemic conditions
• Hormonal imbalance
• Allergy and asthma.

• Minor aphthous ulcers
• Major aphthous ulcers
• Herpetiform ulcers.

• Herpetic ulcers
• Traumatic ulcers
• Pemphigus vulgaris
• Cicatricial pemphigoid
• Ulcers due to neutropenia.

• C. tropicalis
• C. glabrata
• C. krusei
• C. pseudotropicalis.

• Poor oral hygiene
• Chronic denture wearing
• Heavy smoking dry mouth
• Acidic saliva
• Advanced malignancy, e.g. acute leukemia and squamous cell carcinoma.

• Immunologic immaturity in infants or in old aged persons
• Hormonal disturbances like diabetes mellitus, hypoparathyroidism, oral pills and
• pregnancy, etc.
• Long term local or systemic steroid therapy
• Xerostomia with Sjogren’s syndrome
• Anemia
• Malabsorption and malnutrition—iron, folic acid and other vitamin defiiencies
• Prolonged broad spectrum antibiotic therapy causing suppression of oral flra
• Immunosuppression (for example AIDS)
• Chemotherapy and radiotherapy
• Tricyclic antidepressant drug therapy
• Blood group ‘O’ individuals.

• Acute candidiasis
• Chronic candidiasis
• Systemic candidiasis
• Mucocutaneous candidiasis.

• Acute pseudomembranous type
• Acute atrophic type.

• Candidal endocarditis
• Candidal meningitis
• Candidal septicaemia.

• Localized type (oral cavity, face, nails, and scalp, etc)
• Familial type
• Syndrome-associated candidiasis.

• Candidal endocarditis
• Candidal meningitis
• Candidal septicemia.

• Hyperplastic epithelium with superficial necrotic and desquamating parakeranitized layer
• Hyperplastic epithelium is infitrated by candidal hyphae and yeast cells along with PMN
• The candidal hyphae often appear as a weakly basophilic thread-like structure
• Often there is separation between the superficial pseudomembrane and the deeper layers of epithelium.

• Histologically these lesions resemble oral thrush without the pseudomembrane
• Thin, atrophic, non-keratinized epithelium with occasional presence of candidal hyphae
• Chronic inflammatory cell infiltration is seen in the epithelium as well as in the lamina propria.

Hyperplastic, parakeratotic, acanthotic surface epithelium with intercellular edema and PMN infitrations. There can be occasional microabscess formation, invasion of candidal hyphae in the epithelium with development of epithelial dysplasia.

• Chemical burn
• Mucous patch of syphilis
• Traumatic ulcer
• Leukoplakia
• Lichen planus
• Discoid lupus erythematosus (DLE).

• Demonstration of mycelia and spores in the smear obtained by scraping of the lesion
• Demonstration of candidal hyphae in the histologic section of affected tissue.

• Topical and systemic administration of Nysta
• Systemic administration of amphotericin-B and flconazole in immunosuppressed
• patients
• Removal of primary etiological factors
• Improvement of oral hygiene.

• Coccidioidomycosis
• Histoplasmosis
• Cryptococcosis
• North American blastomycosis
• Bacterial, Viral and Fungal Infections in Mouth 255
• South American blastomycosis
• Mucormycosis.

• Flu-like illness characterized by fever, malaise, fatigue, headache, myalgia, cough and dyspnea, etc.
• Pulmonary lesions produce tuberculosis-like features e.g. chest pain, weight loss, persistent cough, and low-grade fever, etc.
• Granulomatous, verrucous or necrotic ulcers of the skin (more often on the facial skin).

• Granulomatous proliferation of oral mucosa with ulceration and induration
• Lymphadenopathy and occasional jaw swelling
• Healing of oral lesions with scar formation.

• Multiple focal granulomas contaning large number of macrophages, lymphocytes,plasma cells and multiple multinucleated giant cells
• Liquefaction necrosis and exudation at the margin of the lesion
• Epithelial hyperplasia with microabscess formation
• Large double contoured ‘spherules’ are seen with silver stain.

• Fever, malaise, non-productive cough, dyspnea, anorexia, headache, myalgia and chest pain (in case of pulmonary infections)
• Granulomatous lesions and cavitations in the lung
• Hepatosplenomegaly and lympadenopathy with involvement of kidney, skin and bone marrow in disseminated cases
• Calcification of the hilar lymph nodes.

• Formation of nodules over the gingiva, tongue, palate and buccal mucosa; which frequently undergoes ulceration
• The ulcers are painful with raised, rolled borders and induration
• Some lesions are non-ulcerated, verrucous or papillary or plaque-like
• Sore throat, pain during chewing, hoarseness of voice and dysphagia are common
• Oral lesions often cause destruction of the alveolar bone with loosening or exfoliation of teeth
• Oral histoplasmosis often occur in HIV-infected patients.

• Squamous cell carcinoma
• Tuberculosis
• Actinomycosis
• Leishmaniasis.

• Cough with mucoid expectoration, pleuritic pain and hemoptysis, etc.
• Pustular lesions may also occur which discharge pus-like material
• Papular, nodular or ulcerative lesions over the skin
• Brain infection results in meningo encephalitis with associated neurogenic symptoms.

• Encysted cryptococcal organisms can be seen in PAS stained sections.
• The infective form of the fungus is budding yeast that exhibits a thick, mucicarmine-positive capsule, which resembles a halo.