Head, Neck and Orofacial Infections

An Interdisciplinary Approach E-Book

James R. Hupp, Elie M. Ferneini

• Publisher: Elsevier Science
• Year: 2015
• ISBN:
  9780323289467
• Topic: Medicine
• Subtopic: Oral Health & Surgery

Use best practices in effectively treating infections of the head, neck, and orofacial complex! Head, Neck, and Orofacial Infections: An Interdisciplinary Approach is the only resource on the market with in-depth guidelines to the diagnosis and management of pathology due to severe infections. No longer do you have to search through journal articles and websites, as this comprehensive, full-color reference covers both cutting-edge and time-tested approaches to recognizing and handling infections. From well-known OMS educator James Hupp and oral surgeon Elie Ferneini, and with chapters written by expert contributors, this book is ideal for use in the classroom, as preparation for the NBDE and specialty exams, and as a clinical resource for patient care.

• UNIQUE! Comprehensive coverage of head, neck, and orofacial infections addresses the diagnosis and management of pathology due to infections of the head and neck and orofacial complex.
• Expert contributors are drawn from the disciplines of oral and maxillofacial surgery, head and neck surgery, plastic surgery, and otolaryngology, and they provide state-of-the-art guidance based on extensive experience with current techniques as well as technological advances in managing head, neck, and orofacial infections.
• Over 500 photographs, radiographs, and illustrations demonstrate pathologies, procedures, and outcomes.
• A logical organization addresses these topics: 1) issues that are common to all infections of the head and neck region, 2) infections of specific parts of the region, and 3) infections related to certain procedures, types of patients, unusual organisms, and medical-legal implications.

Key chapters include:

• Odontogenic Infections of the Fascial Spaces chapter focuses on the etiology, clinical manifestations, anatomic considerations, and treatment of odontogenic infections.
• Nasal and Para-Nasal Sinus Infections chapter discusses the pathophysiology and management of nasal and paranasal sinus infections.
• Microbiologic Considerations with Dental Implants chapter reviews the issues associated with the prevention of infection with surgical implant placement, including the factors that are known to cause infection, the putative bacteria involved and means to control infection once it occurs.

Part I

General Topics Related to Head, Neck, and Orofacial Infections

Outline

1. Immunobiology of Infectious Disease

2. Bacteriology of the Head and Neck Regions

3. Nonbacterial Microbiology of the Head, Neck, and Orofacial Region

4. Anatomy Relevant to Head, Neck, and Orofacial Infections

5. Introduction to the Laboratory Diagnosis of Infectious Diseases

6. Imaging for Head, Neck, and Orofacial Infections

7. Principles of Antimicrobial and Surgical Infection Management

8. Principles of Antibiotic Therapy for Head, Neck, and Orofacial Infections

9. Antimicrobial Pharmacology for Head, Neck, and Orofacial Nonbacterial Infections

1

Immunobiology of Infectious Disease

Joseph V. Califano, and Philip M. Preshaw

Introduction

The human immune system is a biologic marvel designed to identify and destroy or alter pathogens, foreign material, and abnormal cells that threaten an individual. This chapter presents a detailed discussion of the immune system as it relates to infectious pathogens.

Throughout our lives we are constantly encountering microorganisms capable of causing infectious disease. We have, through the evolutionary processes of natural selection, developed a complex and highly organized immune system composed of molecules, cells, and tissues that protect us from agents of infection. Although infections clearly do occur, most interactions with potentially pathogenic bacteria, viruses, or fungi do not result in a productive infection. For infection to occur, the inoculum and virulence of the organism must be of a magnitude sufficient to overwhelm the immune system.

Our immune system has been divided, based on our understanding of function, into innate immunity and adaptive immunity (Figure 1-1). It is important to note that these aspects of immune functioning do not operate in isolation; indeed, there is close functional integration between the innate and adaptive arms of the immune response.¹ Innate immunity serves to provide the first line of defense in preventing infection. It includes physical barriers such as the skin and mucosa, phagocytic cells (e.g., neutrophils, macrophages), specialized receptors that bind and detect classes of macromolecules associated with pathogens not found in eukaryotic cells (e.g., lipopolysaccharide, lipoteichoic acid, single-stranded DNA, double-stranded RNA [dsRNA]), and molecules that promote inflammation, chemotaxis, and opsonization (e.g., cytokines, complement, acute phase proteins, arachidonic acid metabolites). In most cases, infectious agents are eliminated by innate immunity. When the innate immunity is not sufficient to prevent infection, the invading microorganism is successful in replicating within the host, and a productive infection ensues. Once this occurs, many of the elements of innate immunity are still active, but an adaptive immune response occurs over time.² This response may be dominated by a humoral response in which opsonizing antibody specific to the pathogenic organism facilitates phagocytosis and clearance of the microorganism and its toxins (typical for extracellular pathogens such as bacteria), or it may be dominated by a cellular response in which cytokines, phagocytes, or cytolytic T cells eliminate infected host cells to clear the pathogen (typical response for intracellular pathogens like viruses and some bacteria, such as Mycobacterium tuberculosis). Innate immunity is constitutive; it does not require prior exposure to the microorganism to respond to it. Adaptive immunity, on initial exposure to a pathogen, requires 3 to 7 days for a response to occur. With multiple exposures to the pathogen over time, either naturally or through immunization, there is a decrease in the lag time and an increase in the magnitude and efficacy of the adaptive immune response.

Cells of the Immune System

The cells of the immune system are derived from pluripotent stem cells in the bone marrow. The stem cells then differentiate into lymphoid and myeloid progenitors.

The lymphoid progenitor ultimately differentiates into B lymphocytes (produced in the bone marrow), T lymphocytes (produced in the thymus), and natural killer (NK) cells. NK cells are involved in early immune responses, and they recognize virally infected cells and neoplastic cells. B lymphocytes, when activated further, differentiate into memory B cells and antibody-secreting plasma cells. T lymphocytes further differentiate into helper T cells, cytotoxic T cells, and regulatory T cells. These different subpopulations of T cells are distinguished from each other by the types of cytokines they produce and by the surface molecules that they display (Figure 1-2).

• Figure 1-1 Components and kinetics of innate and adaptive immunity. The mechanisms of innate immunity provide the initial defense against infections. Adaptive immune responses develop later and require the activation of lymphocytes. The kinetics of the innate and adaptive immune responses are approximations and vary in different infections. ILC, Innate lymphoid cell; NK, natural killer. (From Kumar V, Abbas AK, Aster JC: Robbins and Cotran pathologic basis of disease, ed 9, Philadelphia, 2015, Saunders.)

The myeloid precursor further differentiates into neutrophils (polymorphonuclear leukocytes), macrophage-monocytes, basophils, eosinophils, mast cells, and dendritic cells. It also can differentiate into an erythroblast from which red blood cells are derived, and a megakaryocyte from which platelets are derived (see Figure 1-2).

Polymorphonuclear leukocytes comprise the majority of the granulocytes circulating in the blood. Macrophages are also phagocytic cells, are derived from circulating monocytes, and are located in the tissues in readiness to encounter pathogens. Polymorphonuclear leukocytes and macrophages are the primary phagocytic cell...