EnanthemEnanthem are medical terms for a rash (small spots) on the mucous membranes.Causes:1-local diseases. 2-systemic diseases 3-It can also indicate hypersensitivity

A 7-day-old infant develops white, cheesy patches on the tongue and buccal mucosa with mild inflammation of the mucosa. Which of the following organisms is most likely the cause of these oral lesions?

(A) Candida albicans(B) Listeria monocytogenes(C) Escherichia coli(D) group A streptococcus(E) group B streptococcus

(1)

(A) The findings described are typical of thrush (oral infection with C albicans), which is common in young infants. Although E coli, L monocytogenes, and group B streptococcus all are important pathogens in the neonatal period, they typically are not associated with pharyngeal infection or oral exudate. Group A streptococcus is a common cause of exudative tonsillitis in the older child but is an extremely rare pathogen in the newborn infant likely due to maternally acquired antibody. Additionally, the exudate noted with group A streptococcal infection would be in the area of the tonsils rather than on the buccal mucosa. (Behrman, 870, 1392; Brodsky, 204)

Causes;1-prolonged antibiotic ttt.2-malnutrition.3-T.cell immundef.4- neonatal .

An 18-month-old child presents to your officewith a 2-day history of fever. He is not eatingwell and the mother tells you that she thinkshis mouth hurts. On examination you see 3 mmvesicles on erythematous bases on the softpalate and tonsils. What is the most likely etiologyof this infection?

(A) streptococcal pharyngitis(B) herpangina(C) herpes simplex virus(D) human herpes virus 6(E) candida pharyngitis

(2)

-coxsackievirus.-<5yrs.-fever +refusal of feeding.-size< 5mm.-number <5.-subsided in 5days.

Herpangina

(B) Herpangina is a syndrome characterizedby small vesicles or punched-out ulcers on the tonsils and fauces, uvula, pharynx, and edge of soft palate. The remainder of the mouth and throat usually appear normal on examination. Infections caused by group Astreptococcus and candida do not present with vesicular lesions. Thevesicular lesions seen in HSV infection are generally limited to the anterior portion of the mouth in immunocompetent individuals. HHV-6 is the causative agent of roseola, which does not generally cause an enanthem. (Long, 201, 1151

The child in the above question also has smallvesicular lesions on his palms and soles. Yoususpect hand, foot, and mouth syndrome.What virus is the most likely causative agent ofthis disease?

(A) adenovirus(B) group A streptococcus(C) Arcanobacterium haemolyticum(D) coxsackievirus A16(E) herpes simplex virus

(3)

(D) Hand-foot-and-mouth syndrome is a specificsyndrome that can be caused by a variety of viral agents. It was originally described in associationwith coxsackievirus A16, but enterovirus 71 can cause an identical clinical picture. Group A streptococcus and Arcanobacterium haemolyticum cause similar manifestations of exudative pharyngitis. However the latter is a much less common cause of pharyngitis. Adenovirus does not typically cause enanthem. While HSV infection can cause oral as well as digital lesions, this is an atypical presentation with occurrence on both the palms and soles. (American Academy of Pediatrics, 284; Long, 1152)

(4)

Herpetic gingivostomatitis

Herpetic gingivostomatitis is the most common cause of stomatitis in children aged 1–3 years. There is often a high fever, fetor oris, refusal to eat, and irritability. The lesions are initially vesicular, and soon form ulcers ranging from 2 to 10 mm in diameter. The tongue, cheek, and gumsare usually involved, and there may be submaxillary Lymphadenitis

--Herpes simplex .--Fever+salivation+refusal of feeding.--Most common cause of stomatitis.--Last for 4-8 days.

Acute infection of oral cavity caused by herpes simplex virus.

(5)Eruptive gingivitis

--Difficult teething.--Bacterial invasion may responsible for fever+ irritability.

Eruptive gingivitis

acute necrotizing gingivostomatitis

(6)

A condition characterised by progressive necrosis of intraoral tissues and upper respiratory abscesses, which is seen in those with poor oral hygiene and suboptimal nutrition, often linked to herpes simplex and anaerobic flora—e.g., Fusobacterium spp, spirochetes.

Fever+ pseudomembrane over affected gingiva -fetor oris +cx LN +may extend to facecancrum oris

Ttt-Antibiotic+local antiseotic+analgisic

are painful ulcerations, which present as erythematous, indurated papules that erode to form circumscribed necrotic ulcers with gray fibrinous exudates and erythematous halo. They are 2–10 mm in diameter, heal spontaneously,often recure

(7)

Aphthous ulcerations (canker sores)

(8)Behçet syndrome

Behçet syndrome

is a multisystem disorder characterized by recurrent oral and genital ulceration, iritis or uveitis, as well as other

cutaneous, arthritic,neurologic, vascular,and gastrointestinal (GI) manifestations.

It is rare in children

(9)geographic tongue

geographic tongue--Benign condition.--Misdiagnosed.--Need no ttt.--Red patches with whitish margin.--Asymptomatic.--Persist for several weak and may recur.

Dental cyst

(10)

المحاضـــرة الطــبيــب اليوم

Treatment of DM+DKA. يدك. سامى د 3-30االحد Fever with rash. مناع. والء د 4-6االحد Autoimmune hepatitis. حمدى. خالد د 4-13االحدC.T. Brain. نبيله. د 4-20االحدAdvanced life support. .رضوان تامر 4-27االحد د