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\author{nsz\_genius}
\pdfinfo{
  /Title (infections-of-the-oral-cavity.pdf)
  /Creator (Cheatography)
  /Author (nsz\_genius)
  /Subject (Infections of the Oral Cavity Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Infections of the Oral Cavity Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{nsz\_genius} via \textcolor{DarkBackground}{\uline{cheatography.com/59310/cs/15724/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}nsz\_genius \\
  \uline{cheatography.com/nsz-genius} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 7th May, 2018.\\
   Updated 7th May, 2018.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{{\bf{Diphtheria}}}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{Name- Corynebacterium diphtheria} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Lesion}}}} - {\bf{Psedomembranous lesion}}, tightly adhered to the underlying tissue, does not produce any secretions} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Toxin}}}}- may or may not produce  a toxin- laboratory investigations are hence essential. The toxin attacks cardiac myocytes and prevents protein synthesis within these cells causing infected people to die of cardiac failure} \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Vaccine}}}}- toxoid vaccine which produces no infection but effective due to inflammatory response generated by host (Infection control measure)} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Treatment}}}}- Antibiotic(Penicillin G)+Antitoxin} \tn 
% Row Count 14 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Location}}}}- upper respiratory tract (if occurs on the vocal cords, it will obstruct the air pathway and can cause death due to asphyxation)} \tn 
% Row Count 17 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\emph{scraping or dislodging of the lesion can damage the underlying tissue or cause bleeding  \newline }}unvaccinated people are usually affected}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{{\bf{Otitis Media}}}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{Caused by Pseudomonas aeruginosa} \tn 
% Row Count 1 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{{\bf{Pharyngotonsillitis}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Etiology}}}}: 80\% idiopathic; 80\% of the remaining 20\% is caused by viral manifestation and the remaining 20\% is caused by bacteria} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{{\emph{Bacterial cause}}}}: usually {\bf{Group A Streptococci (Streptococcus pyogenes)}}.} \tn 
% Row Count 5 (+ 2)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Manifestations of Group A Strep}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Streptococcus Pyogenes (group A strep) can have 2 manifestations when they enter a host:} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
1. Infectious Diseases & Scarlet fever, Erysipelas, Necrotizing fasciitis (tissue necrosis) \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
2. Post Infectious Diseases / Inflammatory diseases & Rheumatic Fever, Post infection Glomerulonephritis \tn 
% Row Count 9 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Scarlett Fever}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525726998_SF.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{Streptococcus Pyogenes (group A strep) is a common bacterial cause for pharyngitis or pharyngotonsillitis. Infestation of this bacteria can either cause ordinary pharyngitis or manifest as {\bf{{\emph{scarlett fever}}}} due to some strains of Streptococcus pyogenes being able to produce {\bf{erythrogenic toxins}} .  \newline {\bf{Clinical presentation:}}  rash (typicaly appearing on the head and neck first then body; more intense in skin folds called Pastia lines), perioral pallor, strawberry tongue}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Erysipela}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525727306_erysipela.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Diabetic patient -\textgreater{} skin infection -\textgreater{} bacterial infestation -\textgreater{} release of erthrogenic toxins -\textgreater{} Erysipela}  \tn 
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\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fungal Oral Infections}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Candida}}  \tn
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Structure}}: it is a type of a unicellular yeast which reproduces by budding \newline  \newline  {\bf{Risk factors:}}  \newline Extreme of ages \newline Diabetes Mellitus \newline Antibiotics  \newline Immunosuppression \newline Corticosteroids (including inhalers) \newline  \newline {\bf{Treatment:}} {\bf{{\emph{Azoles}}}} are the drug of choice because they target ergosteroles (cell wall of fungi)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Gram positive bacteria lab algorithm}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525695377_bacteria.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Group A streptococcus is : \newline beta-hemolytic  \newline Bacitracin sensitive}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Streptococci}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525694806_streptococci.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The oral cavity has billions of Group A streptococci and they are the most common cause of pharyngitis in humans}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Post Infection Diseases due to Group A strep}}  \tn
% Row 0
\SetRowColor{LightBackground}
1. Rheumatic Fever & permanent condition and eventually requires valve replacement \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
Mechanism: & Molecular Mimicry \tn 
% Row Count 5 (+ 1)
% Row 2
\SetRowColor{LightBackground}
2. Poststreptococcal Glomerulonephritis & temporary and resolves without long lasting damage \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
Mechanism: & Complement Activation \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Rheumatic Fever {\bf{(Molecular Mimicry)}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{M protein is a sequence of amino acids present on the bacteria and also present on the cells of the heart. This bacterial M protein is the target of the host immune system. however \textasciitilde{}20 days post infection, the host's immune cells attack their own body i.e the M cells of the heart. This is called {\bf{molecular mimicry}} and involves {\bf{cross reactive antibodies}} (attack foreign and later self).} \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
Molecular mimicry often leads to post-infection manifestations such as Rheumatic Fever & Rheumatic fever is an example of a post-infectious disease (due to the response of the inflammatory cells on self) that can develop as a complication of inadequately treated strep throat or scarlet fever. \tn 
% Row Count 19 (+ 11)
% Row 2
\SetRowColor{LightBackground}
Rheumatic Fever is characterised by {\bf{transient arthiritis}} & It damages the heart valves and increases the rigidity of chorda tendinae causing mitral insufficiency \tn 
% Row Count 25 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Post Streptococcal Glomerulonephritis}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{({\bf{Complement Activation}})} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{this disorder produces proteins that have affinity for sites in the glomerulus. As soon as binding occurs to the glomerulus, complememtn is activated. Activation of complement causes generation of inflammatory mediators. Immune complexes are trapped in a subepithelial pattern.} \tn 
% Row Count 7 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Post Infection sequelae}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{If blood culture involves {\bf{Anti Streptolysin O and Anti DNAase B}} then antibodies should be checked again and again as the child is suspecte of having a streptococcus infection  which may lead to greater complications} \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Arcanobacterium Haemolyticum}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{If culture for Group A,C and G is negative for a case of repetitive/recurring pharyngotonsillitis wherein the patient presents with fever, this bacteria must be considered because it has serious implications} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\seqsplit{Manifestations:} & pharyngitis, osteomyelitis, sepsis, invasive infections \tn 
% Row Count 7 (+ 2)
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\begin{tabularx}{5.377cm}{p{0.64701 cm} x{4.32999 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Streptococcal Shock Syndrome}}  \tn
% Row 0
\SetRowColor{LightBackground}
Cause & due to use of internal tampons \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\seqsplit{Signs:} & Hypotension, Fever \textgreater{}38.5, Rash, Renal Impairment, Coagulopathy /DIC Alteration liver enzymes, Acute Respiratory Distress Syndrome (ARDS), Tissue necrosis (necrotizing fasciitis) \tn 
% Row Count 7 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fungal Oral Infections}}  \tn
% Row 0
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\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Angular Cheillitis (Perleche)}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525729903_angle.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{This condition is called angular chellitis (Perleche) which is inflammation of the corners of the mouth usually in those elderly who wear dentures. if present, most likely candida will also be present  \newline Candida is very common in elderly people who wear dentures and also due to the fact that they commonly have xerostomia (dry mouth) which is an excellent growth factor for the fungi}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diphtheria}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525688876_diphtheria vc.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Manifestation of diphtheria on the vocal cords which can dislodge and move in the respiratory tract causing asphyxation}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diphtheria}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525688955_diphtheria.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Pseudomembranous lesion of diphtheria in the oral cavity}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Pharyngotonsillitis}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525689063_viral vs bacterial.png}}} \tn 
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\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Viral vs Bacterial manifestation}} \newline {\emph{Pharyngitis accompanied by rhinitis, conjunctivits, diarrhoea,etc is most likely \newline  {\bf{}}viral}}{\emph{ \newline }}Pharyngitis accompanied by fever, headache, tender cervical lymph nodes is most likely \newline  {\bf{{\emph{bacterial}}}} \newline *Throat culture and rapid screening is standard for diagnosis as they are highly sensitive for Group A streptococcus}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Rheumatic Fever}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525712398_RF.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Aschoff bodies (granulomatous lesion) present in the myocardium in Rheumatic Fever}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Post Streptococcal Glomerulonephritis}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525725920_AGN.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Acute poststreptococcal glomerulonephritis.  The glomerulus of a patient who developed glomerulonephritis after a streptococcal infection is hypercellular because of the proliferation of endothelial and mesangial cells and infiltration by neutrophils.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Parovirus B19}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525727181_slapped cheek or fifth disease.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Fifth disease (slapped cheek rash) is an acute viral disease characterized by mild symptoms and a blotchy rash beginning on the cheeks and spreading to the extremities. \newline {\bf{Caused by :}} Parvovirus B19}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{p{0.4977 cm} p{0.4977 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Fungal Oral Infections}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{} \tn 
% Row Count 0 (+ 0)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Vincet's Angina}}  \tn
% Row 0
\SetRowColor{LightBackground}
Clinical presentation & unilateral sore throat that increases in intensity over several days with earache, a bad taste and  fetid  breath \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
Pathology & necrotising infection of pharynx \tn 
% Row Count 7 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Cause & combination of {\bf{{\emph{Fusiform bacteria}}}} and {\bf{{\emph{Spirochetes}}}} \tn 
% Row Count 10 (+ 3)
% Row 3
\SetRowColor{white}
\seqsplit{Manifestation} & deep well circumscribed unilateral ulcer of one tonsil. The base of the ulcer is gray and bleeds easily when scraped with a swab.  There may be submandibular lymphadenopathy. \tn 
% Row Count 17 (+ 7)
% Row 4
\SetRowColor{LightBackground}
Treatment & Penicillin or Clindamycin and surgical debridement \tn 
% Row Count 19 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Vincent's Angina}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/nsz-genius_1525730795_VA.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{deep well circumscribed unilateral ulcer of one tonsil. The base of the ulcer is gray and bleeds easily when scraped with a swab.  There may be submandibular lymphadenopathy}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}