RESUMEN
OBJECTIVES: To study the cause and clinical aspects of oral ulcers in HIV-infected patients. STUDY DESIGN: Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. RESULTS: Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. CONCLUSIONS: Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.
Asunto(s)
Infecciones por VIH/complicaciones , Úlceras Bucales/etiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Recuento de Linfocito CD4 , Citomegalovirus/aislamiento & purificación , Femenino , Herpesvirus Humano 1/aislamiento & purificación , Herpesvirus Humano 2/aislamiento & purificación , Humanos , Linfoma Relacionado con SIDA/complicaciones , Masculino , Persona de Mediana Edad , Micosis/complicaciones , Micosis/etiología , Úlceras Bucales/microbiología , Úlceras Bucales/virología , Sífilis/complicaciones , Sífilis/etiologíaRESUMEN
BACKGROUND: HIV-infected individuals develop a large variety of oral manifestations. This study was designed to assess the prevalence and types of oral lesions among HIV-positive hemophiliacs. MATERIALS AND METHODS: A study population of 54 hemophiliacs was evaluated from February, 1987 to March, 1992 in order to analyze types, prevalence and relationships to clinical stages of HIV-related oral lesions. Thirty-six (67%) of the group of patients were HIV seropositive. The remaining 18 tested negative to HIV during the observation period. RESULTS: The majority of patients suffered from hemophilia A. One patient was also bisexual and two were also intravenous drug abusers. Analysis of patient stage revealed that half had a CD4+ T-lymphocyte count over 0.5 x 10(9)/L cells, 10 between 0.2 and 0.499 x 10(9)/L and 8 showed a count lower than 200 x 10(9)/L. Oral lesions were recorded in 18 (50%) HIV-seropositive hemophiliacs. No oral lesions were observed among the HIV-seronegative hemophiliacs. Advanced stage of immunosuppression and presence of oral lesions were significantly associated (p = 0.040). Candidiasis was the most common disturbance, followed by hairy leukoplakia. Oral herpes simplex infection, necrotizing gingivitis and facial herpes zoster were found in a small number of patients. Those with oral lesions showed a lower median CD4+ T lymphocyte count (0.209 x 10(9)/L cells; range 0.008 to 0.615) when compared to the ones without oral lesions (median CD4+ count was 0.539 x 10(9)/L cells; range 0.042 to 1.180; p = 0.002). CONCLUSIONS: HIV-seropositive hemophiliacs may develop oral lesions during the course of their disease. Candidiasis and hairy leukoplakia are among the most common manifestations. A careful oral examination should be included in the clinical evaluation of all HIV-infected hemophiliacs.
Asunto(s)
Seropositividad para VIH/complicaciones , Hemofilia A/complicaciones , Enfermedades de la Boca/complicaciones , Reacción a la Transfusión , Humanos , Masculino , Enfermedades de la Boca/epidemiología , Prevalencia , Estudios RetrospectivosRESUMEN
Patients with HIV infection are at greater risk of developing malignancies. We report two HIV-seropositive patients with primary oral manifestation of a B-cell non-Hodgkin lymphoma (NHL). Localisations of tumours were the palate, with an unusual bifocal origin, and the tongue which is rarely the primary site of NHL. Ulcerations and extensive tissue necrosis were observed. Histologically both cases were high grade malignant lymphomas, immunoblastic. Epstein-Barr virus DNA was detected with in situ hybridisation in 1 patient.
Asunto(s)
Seropositividad para VIH , Linfoma Relacionado con SIDA/patología , Neoplasias de la Boca/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Adulto , ADN Viral/análisis , Herpesvirus Humano 4/aislamiento & purificación , Homosexualidad Masculina , Humanos , Linfoma Relacionado con SIDA/virología , Masculino , Necrosis , Úlceras Bucales , Neoplasias Palatinas/patología , Neoplasias Palatinas/virología , Leucemia-Linfoma Linfoblástico de Células Precursoras/virología , Neoplasias de la Lengua/patología , Neoplasias de la Lengua/virologíaRESUMEN
We report on eight patients who developed white lichenoid lesions of the buccal mucosa during the course of human immunodeficiency virus infection. In five patients the lesions appeared after the administration of zidovudine, in two after the intake of both zidovudine and ketoconazole, and in one after ketoconazole. In the majority of cases, lesions presented as bilateral reticular keratosis or atrophic changes of the buccal mucosa. Three patients manifested lichenoid atrophic changes of the dorsum of the tongue. The histopathologic features were hyperkeratosis, epithelial atrophy, basal cell liquefaction, and the presence in the lamina propria of either a patchy or diffuse lymphocytic infiltrate. All specimens tested negative for Epstein-Barr virus and human papillomavirus. Our study suggests that lichenoid lesions of the buccal mucosa, similar to what has been described as lichenoid drug reactions or idiopathic lichen planus, can be observed during human immunodeficiency virus infection and that administration of zidovudine and ketoconazole should be considered as a possible cause.
Asunto(s)
Infecciones por VIH/complicaciones , Cetoconazol/efectos adversos , Liquen Plano Oral/inducido químicamente , Mucosa Bucal/efectos de los fármacos , Zidovudina/efectos adversos , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Liquen Plano Oral/complicaciones , Liquen Plano Oral/patología , MasculinoRESUMEN
This study examines the clinical aspects of HIV-associated periodontal lesions and the prevalence of periodontal pathogens. Subgingival plaque samples were taken from 55 subjects in six study groups: 1) HIV-seropositive patients with gingivitis, 2) necrotizing gingivitis, 3) periodontitis or 4) with health periodontium, 5) patients with rapidly progressive periodontitis or 6) periodontally healthy in whom there was no evidence of HIV infection. Among HIV-positive patients there was a majority (66%) of intravenous drug users. We detected more Bacteroides intermedius, B. buccae and B. oralis in HIV-infected patients with periodontal lesions and in HIV-negative subjects with rapidly progressive periodontitis than in the other groups. High levels of Spirochetes were recovered in both HIV associated necrotizing gingivitis and periodontitis. The results indicate that there is a similarity in the microbiological profile of HIV-associated gingivitis, necrotizing gingivitis, periodontitis and rapidly progressive periodontitis of HIV-negative subjects although significant differences in the clinical aspects of the lesions and in the immune status of the host have been observed.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/diagnóstico , VIH-1 , Enfermedades Periodontales/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Bacterias/aislamiento & purificación , Candida albicans/aislamiento & purificación , Femenino , Infecciones por VIH/microbiología , Seronegatividad para VIH , Seropositividad para VIH/diagnóstico , Seropositividad para VIH/microbiología , VIH-1/inmunología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Periodontales/microbiología , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
Oral features of Crohn's disease include ulcers, lip fissuring, cobblestone plaques, angular cheilitis, polypoid lesions, and perioral erythema. Pyostomatitis vegetans is a rare eruption of the oral mucosa characterized by tiny yellow pustules. It is considered a marker for inflammatory bowel disease. We describe a 45-year-old woman with a 6-month history of painful sores in her mouth, diarrhea, weight loss, and cutaneous lesions. Oral examination revealed cobblestone plaques and indentation on the tongue and friable vegetating pustules on the labial commissures. Staphylococcus simulans was isolated from the pustules. Laboratory studies revealed leucocytosis, eosinophilia, and low hemoglobin and zinc levels. Histologic study of the labial lesions revealed hyperplastic epithelium with intraepithelial clefts that contain eosinophils and neutrophils. Tongue lesions showed chronic inflammation with noncaseating granulomas. Later, colonoscopy and biopsy demonstrated Crohn's disease of the anorectal region. Pyostomatitis vegetans lesions regressed after oral zinc supplementation. Prednisone treatment resulted in healing of the tongue lesions. In our patient, pyostomatitis vegetans appeared to be related to zinc deficiency that may have been caused by malabsorption. The pathogenetic interrelationship between pyostomatitis vegetans and Crohn's disease is discussed.
Asunto(s)
Enfermedad de Crohn/complicaciones , Enfermedades Carenciales/complicaciones , Estomatitis/etiología , Zinc/deficiencia , Absceso/patología , Enfermedad de Crohn/patología , Femenino , Granuloma/patología , Humanos , Absorción Intestinal , Persona de Mediana Edad , Mucosa Bucal/patología , Estomatitis/tratamiento farmacológico , Estomatitis/patología , Úlcera/patología , Zinc/metabolismo , Zinc/uso terapéuticoRESUMEN
Oral hairy leukoplakia occurs mainly on the tongue of human immunodeficiency virus (HIV)-infected persons. An HIV-infected patient with hairy leukoplakia involving the tongue and buccal mucosa was studied by light and electron microscopic methods, in situ hybridization, and polymerase chain reaction. Our findings indicate that hairy leukoplakia may involve the buccal mucosa and should be considered in the differential diagnosis of white oral lesions in HIV-positive patients. Epstein-Barr virus particles were found in the epithelial cells of both buccal and tongue mucosa.
Asunto(s)
Leucoplasia Bucal/patología , Mucosa Bucal/patología , Lengua Vellosa/patología , Adulto , Mejilla , Diagnóstico Diferencial , Femenino , Seropositividad para VIH/complicaciones , VIH-1 , Humanos , Mucosa Bucal/ultraestructuraRESUMEN
We report on a HIV-positive patient presenting bilateral enlargement of the parotid gland. The ultrasound examination demonstrated multiple lesions with cystic aspect. A partial surgical excision of the parotid gland was performed, and histologic examination confirmed the diagnosis of a cystic benign lymphoepithelial lesion. The specimens which were tested for Epstein-Barr virus and cytomegalovirus by in situ hybridization proved negative. The clinical and pathologic features of this unusual salivary gland lesion which affects HIV-positive patients are discussed.
Asunto(s)
Infecciones por VIH/diagnóstico , VIH-1 , Linfocele/diagnóstico , Enfermedades de las Parótidas/diagnóstico , Adulto , Biopsia , Citomegalovirus/genética , ADN Viral/genética , Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Herpesvirus Humano 4/genética , Humanos , Linfocele/complicaciones , Linfocele/patología , Masculino , Hibridación de Ácido Nucleico , Enfermedades de las Parótidas/complicaciones , Enfermedades de las Parótidas/patología , Glándula Parótida/patologíaRESUMEN
Two cases of peripheral facial paralysis associated with infection by the human immunodeficiency virus in young intravenous drug abuser patients are reported. One patient manifested AIDS-related complex (ARC) and the other fulfilled the Center for Disease Control (CDC) criteria for AIDS. Clinical symptoms and signs occurred as facial paralysis and headache. One patient presented progressive motor slowing and the computerized tomography (CT) of the brain showed a wide hypodense lesion in the left temporal-anterior region and the involvement of the left basal ganglia. In this patient the impairment of the facial nerve was associated with a HIV-related encephalitis. In the second patient the CT did not show cerebral lesions and the etiology of the paralysis was unknown.