Unit 24. Complication of oral infections.pdf

Microbiology Unit 24 Complications of oral infections Ve más allá 1 Dissemination routes of oral infections 1. Contiguity: to surrounding tissues 2. By Swallowing 3. By Aspiration: the lung 4. Trough the Blood (hematogenously) 1. Contiguity infections  Soft tissue infections spread through th...

Microbiology Unit 24 Complications of oral infections Ve más allá 1 Dissemination routes of oral infections 1. Contiguity: to surrounding tissues 2. By Swallowing 3. By Aspiration: the lung 4. Trough the Blood (hematogenously) 1. Contiguity infections  Soft tissue infections spread through the areas that offer less resistance.  The extension of the infection is limited by anatomical barriers: bone, muscle and fascia.  It is essential to know in detail the anatomical structures in order to know where the infection can spread and also where it can be drained surgically. 1. Contiguity infections Contiguity diseases  Cellulitis (infection of subcutaneous tissue)  Involvement of great vessels: • Jugular phlebitis (Lemierre’s disease) • Erosion of the carotid • Thrombotic sepsis of the cavernous sinus  Osteomyelitis of the mandible or maxilla (bone infection)  Maxillary sinusitis (sinus infection)  Ludwig's Angina 1. Contiguity infections Lemierre’s disease • It is a complicated tonsillitis • The infection (normally caused by Fusobacterium necrophorum) extends through the lateral pharyngeal space • Results in thrombophlebitis of the internal jugular vein, bacteremia and septic pulmonary metastasis Septic pulmonary metastasis: the abscess formed in the jugular releases framgents with bacteria that travel to the right heart and from there to the lung. 1. Contiguity infections Ludwig’s angina • Severe diffuse cellulitis • It originates from infections of the 2nd-3rd molar • It extends through the floor of the mouth via submandibular and sublingual spaces • Clinic: – bilateral submandibular painful swelling, elevation of the floor of the mouth and root of the tongue, intense odynophagia (pain during swallowing) – may progress to cause suffocation – fever and malaise 1. Contiguity infections Causative agents:  Group A streptococci  Streptococcus viridans  S. aureus  S. epidermidis  Peptostreptococcus spp,  Bacteroides spp,  E. coli  Borrelia vicentii Treatment: • Early treatment • Surgical debridement • Penicillin + clindamycin or metronidazole 2. Infections by aspiration  Usually as a result of loss of consciousness, dementia, impaired swallowing.  Aspiration pneumonia  Lung abscess  Bacteria from the oral microbiota are involved in these infections therefore they are polymicrobial and mixed. 3. Hematogenously Blood is the most rapid dissemination microorganisms to distant organs. route of  Transient or inapparent bacteremia: few microorganisms pass into the blood (<10 organisms / ml) for 15-30 min and do not produce symptoms. Bacteria are removed by macrophages.  Remote infections occur more easily if the body has any pre-existing disease (heart valves in endocarditis) or if the patient is immunocompromised. 3. Hematogenously Oral infections or procedures causing microbial dissemination 1. Infectious pulpitis 2. Periapical infection 3. Periodontitis 4. Dental procedures related with periodontitis (mos t common ca us e of ba cteremia ). 3. Hematogenously •Brushing: approximately a 12% of individuals with healthy gums suffer from transient bacteremia after brushing. •Dental extraction: the rotation of the tooth has a pumping action of bacteria into the bloodstream. It's more important if there's periodontitis. It is the one that causes most bacteremia. •Treatments of periodontitis (surgery or root planning) •Endodontic treatments: the risk of bacteremia is much lower than during dental extraction. •Any procedure: mechanical removal of the dental plaque, anesthesia…. Risk of transient bacteremia DENTAL PROCEDURE RISK (based on different studies) Dental extraction 10-100% Periodontal surgery 36-88% Root planing (periodontitis) 8-80% Dental cleaning (professional) Up to 40% Endodontics Up to 20% DAILY ACTIVITY Tooth brushing and flossing 20-68% Use of toothpicks 20-40% Chewing food 7-51% Pathogenesis of systemic lesion from an oral focus 1.-Systemic diffusion of microorganisms: • By blood • The most important complication is infectious endocarditis 2.-Distribution of toxins Pathogenesis of systemic lesion from an oral focus 1. Infectious endocarditis  microbial infection of the endocardium (epithelium lining the inner surface of the heart)  characteristic lesion: vegetations that settle in the valvular endocardium, a lthough they ca n a ls o a ffect the chorda e tendinea e, pa pilla ry mus cles or the m ura l endoca rdium  affects people with heart valve problems (children with birth defects, people with prosthetic heart valves, older people who suffered rheumatic fever in childhood)  1/3 of bacterial endocarditis are caused by the spread of bacteria from the oral cavity (mainly streptococci). 3. Hematogenously 2. Dissemination of toxins: a. Bacteria without invasive capability: exotoxins b. Endotoxin (Gram negative): • Untreated periodontitis: Tra ns ient recurrent gra mnega tive ba cteremia s • Endotoxin leads to platelet aggregation Several studies link periodontal disease and ischemic stroke or heart disease It has also been linked to increased cancer incidence THANKS FOR YOUR KIND ATTENTION! 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