The presence of Candida albicans in hereditary benign intraepithelial dyskeratosis. An ultrastructural observation

Keratin 13 deficiency causes white sponge nevus in mice

White sponge nevus (WSN) is a benign autosomal dominant disorder characterized by the formation of white spongy plaques in the oral mucosa. Keratin (KRT) 13 is highly expressed in the mucosa, and mutations in this gene have been commonly associated with WSN patients. However, it remains unknown whether there is a causal relationship between KRT13 mutations and WSN and what the underlying mechanisms might be. Here, we use mouse genetic models to demonstrate that Krt13 is crucial for the maintenance of epithelial integrity. Krt13 knockout mice show a WSN-like phenotype in several tissues, including the tongue, buccal mucosa, and esophagus. Transcriptome analyses uncover that Krt13 regulates a cohort of gene networks in tongue epithelial cells, including epithelial differentiation, immune responses, stress-activated kinase signaling, and metabolic processes. We also provide evidence that epithelial cells without Krt13 are susceptible to mechanical stresses experienced during postnatal life, resulting in unbalanced cell proliferation and differentiation. These data demonstrate that Krt13 is essential for maintaining epithelial homeostasis and loss of Krt13 causes the WSN-like phenotype in mice.

Oral infection by Staphylococcus aureus in patients affected by White Sponge Nevus: a description of two cases occurred in the same family

INTRODUCTION

White Sponge Nevus (WSN) is a rare pathology with a pathogenesis on genetic basis, a benign course and a localization affecting the mucosal keratin.WSN is usually a symptomless pathology: when pain is present, some authors reported reduction of symptoms by taking penicillin or oral tetracycline rinses, suggesting that a bacterial overinfection could be at the base of possible painful symptoms.

CASE REPORT

We describe 2 patients affected by WSN, father and son: they presented two different oral diseases associated with an infection by Staphylococcus aureus. So, we have performed a careful oral hygiene to reduce infection in the oral cavity. In the following days we prescribed 2 rinses a day with a mouthwash containing chlorhexidine digluconate at two different percentages.

DISCUSSION

Early diagnosis of this lesion is important, because it allows us to exclude other more serious diseases. In the most part of cases, WSN requires no treatment because of its benign and asymptomatic behaviour: up to now, no protocol of treatment for this condition was standardized. Even if WSN is a painless condition, sometime a correlated painful symptomatology was reported.

CONCLUSIONS

In our experience, we have achieved excellent results even with chlorhexidine digluconate rinses, considering that our treated cases were both infected by Staphylococcus aureus. We hypothesize that the corrugated plaques and the altered texture of the mucosa create the right conditions for the colonization and the development of microbial species such as saprophytic bacteria or fungal species.

Hereditary Benign Intra-Epithelial Dyskeratosis (HBID)

Hereditary Benign Intraepithelial Dyskeratosis (HBID) is a rare autosomal dominant recurring disorder of the oral and ocular mucosa first described in 1960 among Haliwa Native American Indians in North Carolina. A few cases have been reported also in other parts of the United States, South America and Europe. This report describes a case with clinical and histopathological features of HBID.

Clinical management of oral and perioral candidosis

Oral candidosis is a diagnosable and treatable mucosal disease that may be complicated by various other local or systemic disease conditions. Dependable diagnosis always should include a combination of clinical signs and symptoms suggestive of candidal disease as well as positive cytologic or direct culture results. The management of candidal infections should be individualized for each patient, with concern for interactions with current medications, immune status, other concurrent mucosal diseases, and exogenous infectious sources. In selecting the appropriate therapeutic agent(s) the clinician should consider patient health factors, location and severity of infection, and the probability of chronicity.

Short-term oral condidosis in rats, with special reference to the site of infection

Following a short-tem oral inoculation of Candida albicans in rats during tetracycline medication, the carriage of and infection by Candida organisms were investigated. After an initial high incidence, a rapid decline ws registered. Five weeks following the first inoculation 33% of the animals showed a positive swab and 67% demonstrated pseudohyphal penetration of the oral mucosa. The most frequent sites of infection were the margin of the gingivae, the buccal mucosa. the buccal and lingual sulci and the tongue accounting for 98.8% of all foci. The highly selective patterns of colonization is believed to be related to the surface characteristics of the epithelium and the nature of the keratin.