Oral manifestation of disseminated Mycobacterium avium intracellulare in a patient with AIDS

Palatial erosion caused by Mycobacterium Avium complex in a human immunodeficiency virus infected child

Oral manifestations of Mycobacterium Avium complex (MAC) are rare and have only been described in adults. Here we report a 10-year-old female with advanced human immunodeficiency virus infection, who presented with disseminated MAC and an erosive left palate defect.

Rare presentation of Mycobacterium avium-intracellulare infection

Mycobacterium avium-intracellulare causes clinical disease mainly in immunocompromised patients with long-standing pulmonary disease, the symptoms of which are identical to those of pulmonary tuberculosis. In patients with AIDS the infection is typically disseminated. Extrapulmonary infection by M. avium-intracellulare is seen in children aged 1-5 years as cervicofacial lymphadenitis. Other extrapulmonary sites are less common and include musculoskeletal, maxillary sinus, mastoid, breast, small bowel, genitourinary tract and cornea. Such infection of the hard palate is rare. We present an unusual case of infection of the palate by M. avium-intracellulare in a 53-year-old diabetic man. To our knowledge, this infection presenting as a palatal lump in a patient without HIV or pre-existing lung disease has not been previously reported.

Labial tuberculosis: a unique cause of lip swelling complicating HIV infection

BACKGROUND

HIV disease has many oral manifestations including tuberculosis, which most commonly presents as irregular ulceration of the tongue or the palate. We detail an HIV-infected patient found to have tuberculosis of the lip.

CONCLUSIONS

To our knowledge tuberculosis of the lips has never been reported in conjunction with HIV infection, and in this case establishing the oral diagnosis resulted in the diagnosis of disseminated disease.

Medication usage and dental caries outcome-related variables in HIV/AIDS patients

The purpose of this study was to access current medication usage by HIV/AIDS patients and its effects on dental caries and on unstimulated salivary flow rates. Thirty females and 127 males (mean age = 39.6 +/- 7.4 years), of whom 46% were White/Non-Hispanic, 39% African-American, and 15% Hispanic, were examined and interviewed at the Bering Dental Clinic, Houston, Texas. The mean time in years after seroconversion was 5.4 +/- 4.1. Calibrated examiners performed dental caries examination (DMFS) with dental explorers and bitewing radiographs. Interviews were carried out with pretested questionnaires, and medication usage was assessed by illustrative examples of HIV/AIDS medications. Salivary flow rates were determined gravimetrically (mL/min). Bivariate analysis and analysis of variance (ANOVA) were used to analyze the data. Because there were no race or gender effects on dental caries outcome variables or salivary flow rates, separate logistic regression models for medication usage were generated, which were adjusted for age and CD4+ cell counts. Patients who, currently, were receiving antiretroviral therapy (ART) had a lower occurrence of dental caries than patients not taking these medications. An unexpected finding in the lower caries rate group was a decrease in salivary flow rates, which was a probable oral side effect of ART. It appears from this cross-sectional study that systemic medication for the management of HIV disease has no significant detrimental effect on the dentition.

Prevalence of HIV-associated periodontitis and chronic periodontitis in a southeastern US study group

OBJECTIVES

This study estimates factors associated with the prevalence of HIV-associated periodontal diseases (HIV-P) and the severity and extent of periodontitis in HIV-infected adults from North Carolina (NC).

METHODS

Data are derived from a cross-sectional study of HIV-infected adults (total n = 326, dentate n = 316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV-P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3.

RESULTS

In addition to persons with HIV (non-AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range = 19-67); 78 percent were male and 60 percent were black. Sixty-two percent of persons had a probing pocket depth > or = 5 mm; 46% had recession > or = 3 mm, and 66 percent had attachment level > or = 5 mm in one or more sites. Cases of HIV-P (n = 15) were rare. Persons taking HIV-antiretroviral medication were one-fifth (OR = 0.20; 95% CI = 0.07, 0.63) as likely to have HIV-P as those not taking those medications, controlling for CD4+ cell counts.

CONCLUSIONS

HIV-infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV-P, which was attenuated by antiretroviral therapy.

Gastrointestinal pathology in HIV-infected patients

Specific pathologic processes, particularly oral, esophageal, and intestinal infections, are common in the alimentary tract of AIDS patients. Many of these diseases are adequately assessed only by biopsy with histologic examination. Most are rare or unreported in immunocompetent hosts and are easily missed by those not familiar with them. This article describes the gross or endoscopic and histologic appearances and the diagnostic criteria for enteric pathologic processes seen in HIV-infected individuals.

Cocaine-associated rapid gingival recession and dental erosion. A case report

This case report chronicles the clinical presentation and unusual response to treatment of a patient with rapid gingival recession and dental erosion secondary to local cocaine application. The initial clinical diagnosis was necrotizing ulcerative periodontitis; only after several years of therapy did the patient voluntarily inform one of the therapists that cocaine had been regularly applied to the affected gingival sites. This case illustrates the importance of including cocaine application to gingival tissues in a differential diagnosis in cases of rapid gingival recession and dental erosion of unknown etiology.

Oral lesions of HIV and AIDS in Asia: an overview

The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.

Oral manifestations of human immunodeficiency virus infection

This article includes the oral manifestations which have been reported to be associated with human immunodeficiency virus (HIV) infection. The clinical appearance, diagnostic criteria and treatment of fungal, viral and bacterial infections, neoplasms and lesions of uncertain etiology are described. Accurate diagnosis of the oral lesions is important in the management of patients infected with HIV. Identification of oral lesions may suggest the need for HIV testing or may be an indicator for preventive intervention. Early identification, diagnosis and treatment may prevent extensive tissue destruction and may improve the quality of life for HIV-infected patients.

Space-occupying and life-threatening infections of the head, neck, and thorax

Infections of the deep structures of the head and neck are polymicrobial, rapidly progressive, and frequently life-threatening. The bacteriology, clinical presentation, and the need for multidisciplinary management of these infections are stressed. In addition, this article discusses selected head and neck infections of immunocompromised hosts and postexposure prophylaxis for serious infections of the pharynx.

Mycobacterial complications of HIV infection

Tuberculosis is the most common opportunistic infection worldwide and is caused by the only readily transmissible pathogen among persons with HIV infection. If treatment is initiated promptly and is supervised appropriately, cure, fortunately, is highly likely. Isoniazid preventive therapy substantially reduces the risk of tuberculosis in persons with HIV infection. Of the nontuberculous mycobacteria, Mycobacterium avium complex (MAC) is the most frequent cause of disease; however, disseminated MAC disease usually is not seen until the CD4+ cell count is less than 50 cells/L. Newer agents, such as the macrolides and rifabutin, form the nucleus of treatment regimens and also are effective in preventing the disease.

Oral Mycobacterium avium complex infection in a patient with HIV-related disease. A case report

Mycobacterium avium complex infection is a common complication of the later stages of AIDS. Although a recognized cause of oral lesions, atypical mycobacteria are rarely detected in AIDS-related oral ulceration. Here we report a case of oral ulceration in a patient in the later stages of AIDS in which atypical mycobacteria were detected both histologically and microbiologically. The features of this case are similar to the one other case previously reported permitting some characterization and comparison of the clinical features of mycobacterium avium complex infection in AIDS.

Diagnostic and therapeutic management of atypical mycobacterial infections in children

A series of 12 children (9 girls, 3 boys) with non-tuberculous mycobacterial lymphadenitis was reviewed to define the most frequent presenting features, helpful diagnostic measures and optimal management. The mean age at diagnosis was 42 months and cervical nodes in the submandibular region were most commonly affected. In most of the children the diagnosis was made on the basis of a positive intradermal skin test with specific antigens for atypical mycobacteria. The diagnosis was confirmed in all but one case by histopathologic examination. Total excision of the affected gland was recommended as the therapy of choice in the patients treated.

Oral manifestations in HIV-infected patients: diagnosis and management

Oral lesions have been observed since the beginning of the AIDS epidemic. The number of HIV-infected patients is still increasing, especially in the heterosexual population. Oral diseases in HIV-infected patients are often more difficult to diagnose because the clinical presentations may differ from the same diseases in HIV-negative patients. HIV-associated oral lesions have diagnostic, prognostic, and therapeutic impact. Approximately 10% of the HIV-infected population will have oral manifestations as a first sign of their disease. In HIV-infected men oral hairy leukoplakia and oral candidiasis are useful markers for disease progression. This article summarizes the oral manifestations and the management of oral health in persons with HIV infection.

Complications of dental surgery in persons with HIV disease

Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.

Oral diseases in HIV-1 infection

HIV-associated oral lesions have been reported since the beginning of the AIDS epidemic, be they fungal, viral, bacterial, neoplastic, or non-specific in origin. The most common lesions are oral candidiasis (OC; noted in several forms) and oral hairy leukoplakia (OHL). OC appears to be directly related to levels of immunosuppression while OHL, a newly described lesion, is associated with the Epstein-Barr virus. Although prevalence data for all types of oral lesions are scarce, this review identifies and describes those reported most often. Lesions associated with HIV may appear on most oral mucosal surfaces and may differ from those seen on other body areas. The role of saliva in reducing the potential for transmission of the HIV virus appears to be significant. Physicians and dentists should cooperate in the management of the HIV patient who has oral disease.

HIV-related infections of the oral cavity

Oral infections are among the first manifestations of infection by the human immunodeficiency virus (HIV). They include fungal, viral, and bacterial infections and range from being essentially trivial, through troublesome to life threatening. Although some infections are due to overproliferation of the normal oral flora, others are due to organisms that normally are not found in the mouth. The clinical features of many of these infections have now been characterized, and clinical trials have indicated the optimal management. However, for many infections, the underlying processes are still not clear, and improvements in treatment are necessary.

Intraoral cytomegalovirus lesion and HIV-associated periodontitis in a patient with acquired immunodeficiency syndrome

Exposure to cytomegalovirus (CMV) is common in persons infected with the human immunodeficiency virus. Autopsy studies have documented the presence of CMV in multiple organs, but CMV is seldom indicated as the causative agent in specific diseases. Few reports have described localized CMV infection in the oral cavity. This may be due to the occult histopathologic appearance during oral mucosal CMV infections and to a lack of awareness of CMV infection as a potential etiologic agent in nonspecific oral ulcerations and other oral disease entities. This report describes an intraoral ulceration with documented presence of a localized CMV infection in association with human immunodeficiency virus-associated periodontitis in a patient with acquired immunodeficiency syndrome. A causative relationship between these two entities, however, cannot be established or excluded.

Periodontal disease in heterosexuals with acquired immunodeficiency syndrome

We studied the prevalence and severity of periodontal disease among 181 heterosexual men and women with AIDS. Included were 167 (92%) intravenous drug users (IVDU) and 14 sexual partners of persons at risk for AIDS. Periodontal disease was seen in 71 of 78 (91%) women compared to 75 of 103 (73%) men. Gingivitis was the most severe form of periodontal disease in 7 (9%) women and 15 (15%) men. Increased severity of periodontal disease was seen in women as compared with men (P less than .001); among subjects with periodontitis, 48 (75%) of 64 women had moderate to advanced disease compared to 32 (53%) of 60 men. For individuals with periodontitis, the extent of involvement was associated with severity; 90% of subjects with advanced periodontitis had all 4 quadrants affected. Concurrent oral manifestations of AIDS, including candidiasis, hairy leukoplakia, ulcers and Kaposi's sarcoma were present in 167 (92%) subjects. We conclude that HIV-associated gingivitis and HIV-associated periodontitis are common in heterosexual men and women with AIDS and are often accompanied by other oral manifestations of AIDS. The reason periodontal disease is more severe in women is not known. Clinicians should be aware that these disorders occur in heterosexuals as well as in homosexual men. Further study will be necessary to delineate the pathogenesis of these disorders.

Rosacea-like lesions due to familial Mycobacterium avium-intracellulare infection

Mycobacterium avium-intracellulare (MAI) is a non-tuberculous, nonlepromatous or "atypical" mycobacterium now seen frequently in patients with acquired immunodeficiency syndrome (AIDS). In the past decade, the incidence appears to have increased in non-AIDS patients. Although cutaneous involvement is rare, two brothers without detectable immune defects who both presented with cutaneous MAI infection are described; the older brother also has disseminated disease. The cutaneous presentation of MAI, as well as immune and genetic defects that may predispose to mycobacterial infection, are discussed.

Oral manifestations of HIV infection and their management. II. Less common lesions

This second of two articles reviews the many uncommon and rare oral lesions that have arisen in persons infected with human immunodeficiency virus (HIV). The various drug-related oral disorders of HIV disease are also considered.

Major aphthous-like ulcers in patients with AIDS

This report describes persistent, painful oral ulcers that occurred in nine patients with the acquired immunodeficiency syndrome (AIDS). These ulcers resembled major aphthous ulcers in clinical appearance and response to therapy. They occurred less frequently in patients with AIDS than those caused by herpes simplex and were found in 4 of 346 (1.1%) patients with AIDS at one medical center. Lesions were typically painful. Identification and treatment with topical tetracycline and steroids led to resolution with relief of symptoms. Further study is necessary to understand the etiology and pathogenesis of these ulcers.

Ectopic geographic tongue and AIDS

A 23-year-old man with AIDS developed a lesion with the clinical characteristics of an ectopic geographic tongue in the lower lip, near the right commissure.

The clinical and histologic appearance of HIV-associated gingivitis

Human immunodeficiency virus-associated gingivitis (HIV-G) has been described recently as a clinical entity in HIV-infected patients. However, little is known about the etiology and pathogenesis of this condition. We report a case of HIV-G in a 32-year-old man with acquired immunodeficiency syndrome (AIDS). The histology of the clinically involved gingiva revealed the absence of an inflammatory cell infiltrate. This report provides an initial description of the histologic changes occurring in HIV-G.

Endobronchial Mycobacterium avium-intracellulare infection in a patient with AIDS

The pulmonary manifestations of AIDS are well described in the medical literature; however, MAI infection presenting as an endobronchial lesion has not, to our knowledge, been reported in a patient with AIDS. We report a unique case of an AIDS patient who developed endobronchial polypoid lesions secondary to MAI infection. Complications resulting from these lesions included hemoptysis and later bronchiectasis.

Classification of oral lesions associated with HIV infection

This article proposes a classification for oral lesions associated with HIV infection. The lesions can be classified into those with fungal, bacterial, or viral origin whereas other subgroups include neoplasms, neurologic disturbances, and lesions of unknown cause. This proposal is neither final nor exhaustive and is forwarded as a basis for epidemiologic surveys.

AIDS and the surgeon

Several issues related to the AIDS virus concern the surgeon. This article discusses the common presentations of AIDS in each body system with special emphasis on conditions that require surgical intervention, alternatives to surgical procedures for diagnosis, and precautions for the handling of tissue and body secretions of individuals suspected of harboring the AIDS virus.

Oral manifestations of disseminated Cryptococcus neoformans in a patient with acquired immunodeficiency syndrome

A palatal lesion was the initial manifestation of disseminated cryptococcosis in a patient with acquired immunodeficiency syndrome (AIDS). The diagnosis was initially verified with cytologic smears in situ and later confirmed with pathologic findings from an excisional biopsy specimen. As cryptococcosis is one of the major opportunistic infections in persons with AIDS, an increased incidence of oral manifestations of cryptococcosis can be expected.

Oral findings in patients with acquired immunodeficiency syndrome

Oral examinations of 103 consecutive patients with acquired immunodeficiency syndrome (AIDS) were performed. Of these patients, 74 (72%) were heterosexuals and 29 (28%) were homosexual or bisexual men. Lesions that were identified on subsequent examination were recorded separately. Oral candidiasis was the most common finding, occurring in 94 patients. Other findings were herpes simplex ulceration (ten patients), exfoliative cheilitis (nine patients), xerostomia (ten patients), "hairy" leukoplakia (seven patients), and Kaposi's sarcoma (four patients). A patchy, depapillated tongue was seen in six patients, and ulcers with uncertain cause were seen in three patients. Gingival bleeding, perioral molluscum contagiosum, and brown hairy tongue each occurred in one patient. In this study, "hairy" leukoplakia and Kaposi's sarcoma occurred exclusively in homosexual and bisexual men with AIDS, and occurred significantly more frequently in this group than in heterosexual patients with AIDS. There was no significant difference between these groups in the frequency of occurrence of other findings.