Oral Manifestations in Systemic Infections Oral manifestations can be observed in almost every generalized systemic infectious disease. Only the most characteristic ones are illustrated on this page. Measles produces a pathognomonic eruption of the mouth in the prodromal stage before any cutaneous lesions have become evident. About the second day after the first signs of the disease (coryza, conjunctivitis, and fever) become evident, the palate and fauces become intensely red, and the typical Koplik spots appear on the buccal or labial mucous membranes as isolated rose-red spots with a pale bluish white center. At the onset, the buccal mucosa is normal in color. Soon the eruptions become diffuse, with rose red predominating and the bluish spots more numerous, until the coalescence of all spots produces an even redness, with myriad white specks. The cutaneous rash, which is dull red and macular, follows the first Koplik spots by 2 to 3 days. The oral mucosa assumes its normal color before the skin rash has disappeared. The vesicular eruptions of chickenpox may be seen in the oral cavity before the skin eruptions appear, and they are mainly seen as isolated small vesicles on the soft palate. The thin vesicles, with a reddened halo, rupture quickly to form shallow erosions with gray tags of epithelial debris. Usually, the size is that of a pinhead, but it may be larger. It resembles a solitary aphtha but is generally not as painful. The oral symptoms of scarlet fever originate in the throat, which is red and swollen, as are the tonsils and palate and, occasionally, the gingivae. The tongue is next involved with a heavy, grayish, furry coating through which enlarged, red papillae are scattered. The edges of the tongue and its tip are vividly red. Within 3 or 4 days the dorsum has desquamated, with enlarged variously placed papillae, presenting the so-called strawberry tongue. Foot-and-mouth disease, or epizootic stomatitis, is an acute, highly contagious viral infection that can be transmitted to humans by the consumption of unsteril- ized milk or meat from cows suffering from the disease or by direct contact with the saliva of infected animals. The oral symptoms follow generalized fever and malaise with dry, swollen, reddened membranes. The tongue is coated and enlarged. Within days, yellow vesicles appear and rupture. Salivation and a fetid odor are prominent. The vesicles enlarge and then appear also on the hands and, occasionally, the toes. Fever and lymphadenopathy increase for 1 to 2 weeks, after which time they rapidly resolve. Infectious mononucleosis presents as a triad of fever, tonsillary pharyngitis, and lymphadenopathy as a result of infection with the Epstein-Barr virus between intimate contacts. In the early stage, usually with the onset of the fever, a reddened pharynx is seen with scattered petechiae of the buccal and labial mucosa and of the soft palate. The presence of palatal petechiae, splenomegaly, and cervical lymphadenopathy is highly suggestive of the infection. A heterophile antibody agglutination test (Paul-Bunnell reaction, sheep red blood cells; monospot, horse red blood cells) will establish the diagnosis. The primary lesion of syphilis is the chancre; 5% to 10% of lesions are extragenital, often around the oral cavity. Lip chancre is typically a sole lesion, the erosive e resembling a herpetic lesion with a tendency to crust and ooze. Lymphadenopathy is present and is unilateral, hard, movable, and slightly tender. The chancre contains numerous spirochetes. Chancre of the tongue presents as a circular lesion surrounded by indurated raised reddened tissue on the tongue tip; however, less typical chancres can develop on the gingiva, buccal mucosa, palate, and tonsils. By 4 to 6 weeks from the appearance of the chancre, the oral infection increases to include mucous patches on the tongue, buccal mucosa, pharynx, and lips, which contain numerous Treponema organisms. The tongue often has multiple gummas in the form of pea-size nodules on the dorsum. Ulceration and necrosis heal with stellate and grooved scars typical of leutic interstitial glossitis, or they may be extensive, causing macroglossia. Treatment with a penicillin-based antibiotic is very effective at the primary stage of the disease.