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Pinana M, Rapoport C, Champtiaux N, Lescaille G, Allenbach Y, Rochefort J. Cytomegalovirus-induced oral ulcers: A case report and literature review. Clin Case Rep 2023; 11:e7459. [PMID: 37305877 PMCID: PMC10248210 DOI: 10.1002/ccr3.7459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
Cytomegalovirus (CMV) ulcerations are rare clinical entities, but their occurrence is favored in immunocompromised patients who present a favorable environment for opportunistic infections. We describe the case of a patient treated for a systemic lupus erythematosus suffering from deep oral ulcerations. The case illustrates the complexity of establishing a precise etiological diagnosis of CMV lesions, as the diagnostic hypothesis can be varied: related to an immunodeficiency disorder or drug-induced toxidermia.
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Affiliation(s)
- Margaux Pinana
- Department of Oral Mucosal Pathology, AP‐HP Groupe Hospitalier Pitié‐SalpêtrièreUniversity of ParisParisFrance
| | - Camille Rapoport
- Department of Anatomopathology, AP‐HP Groupe Hospitalier Pitié‐SalpêtrièreSorbonne UniversityParisFrance
| | - Nicolas Champtiaux
- Department of Internal MedicineGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
| | - Géraldine Lescaille
- Department of Oral Mucosal Pathology, AP‐HP Groupe Hospitalier Pitié‐SalpêtrièreUniversity of ParisParisFrance
| | - Yves Allenbach
- Department of Internal MedicineGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
| | - Juliette Rochefort
- Department of Oral Mucosal Pathology, AP‐HP Groupe Hospitalier Pitié‐SalpêtrièreUniversity of ParisParisFrance
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Thakkar P, Banks JM, Rahat R, Brandini DA, Naqvi AR. Viruses of the oral cavity: Prevalence, pathobiology and association with oral diseases. Rev Med Virol 2021; 32:e2311. [PMID: 34854161 DOI: 10.1002/rmv.2311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
The human oral cavity contains a plethora of habitats and tissue environments, such as teeth, tongue, and gingiva, which are home to a rich microbial flora including bacteria, fungi, and viruses. Given the exposed nature of the mouth, oral tissues constantly encounter infectious agents, forming a complex ecological community. In the past, the discussion of microbiological aspects of oral disease has traditionally focused on bacteria and fungi, but viruses are attracting increasing attention as pathogens in oral inflammatory diseases. Therefore, understanding viral prevalence, pathogenicity, and preference regarding oral tissues is critical to understanding the holistic effects of viruses on oral infections. Recent investigations have demonstrated the abundance of certain viruses in oral inflammatory diseases, suggesting an association between viruses and disease. Human herpesviruses are the most extensively studied viruses in different oral inflammatory diseases. However, challenges in viral detection and the lack of reproducible in vitro and in vivo infection models have limited our progress in understanding viruses and their contribution to oral diseases. This review presents a summary of major mammalian viruses and associated diseases in the human oral cavity. The emergence of a recent pathogen SARS-CoV-2 and its tropism for salivary and periodontal tissues further highlights the relevance of the oral cavity in host-pathogen interaction. Understanding how these different viruses present clinically and influence oral health will advance our understanding of multifactorial oral diseases and their association with viruses.
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Affiliation(s)
- Pari Thakkar
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jonathan M Banks
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rani Rahat
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniela A Brandini
- Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil
| | - Afsar R Naqvi
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
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Abstract
The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.
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Affiliation(s)
- Corinne Légeret
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
| | - Raoul Furlano
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
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Clinical Manifestations and Epigenetic Regulation of Oral Herpesvirus Infections. Viruses 2021; 13:v13040681. [PMID: 33920978 PMCID: PMC8071331 DOI: 10.3390/v13040681] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
The oral cavity is often the first site where viruses interact with the human body. The oral epithelium is a major site of viral entry, replication and spread to other cell types, where chronic infection can be established. In addition, saliva has been shown as a primary route of person-to-person transmission for many viruses. From a clinical perspective, viral infection can lead to several oral manifestations, ranging from common intraoral lesions to tumors. Despite the clinical and biological relevance of initial oral infection, little is known about the mechanism of regulation of the viral life cycle in the oral cavity. Several viruses utilize host epigenetic machinery to promote their own life cycle. Importantly, viral hijacking of host chromatin-modifying enzymes can also lead to the dysregulation of host factors and in the case of oncogenic viruses may ultimately play a role in promoting tumorigenesis. Given the known roles of epigenetic regulation of viral infection, epigenetic-targeted antiviral therapy has been recently explored as a therapeutic option for chronic viral infection. In this review, we highlight three herpesviruses with known roles in oral infection, including herpes simplex virus type 1, Epstein–Barr virus and Kaposi’s sarcoma-associated herpesvirus. We focus on the respective oral clinical manifestations of these viruses and their epigenetic regulation, with a specific emphasis on the viral life cycle in the oral epithelium.
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Leite MGM, Freitas EDS, de Vasconcelos Ii AJA, Pinheiro TN. Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates. J Lasers Med Sci 2020; 11:348-354. [PMID: 32802297 DOI: 10.34172/jlms.2020.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.
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Affiliation(s)
- Milena Gomes Melo Leite
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | - Eliandro de Souza Freitas
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | | | - Tiago Novaes Pinheiro
- DDS, MSc, PhD, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
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Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
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Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
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Huang S, Delacroix I, Labrousse D. A rare case of cytomegalovirus induced oral ulcer in an immunocompromised patient. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Oral manifestations of cytomegalovirus are rare. Observation: We report the case of an atypical and persistent oral location of cytomegalovirus, in the form of ulcers, in a patient suffering from granulomatosis with polyangiitis and treated by rituximab. Discussion: In front of a chronic ulcer, a differential diagnosis must be made to exclude different etiologies, by order of severity, frequency or according to the clinical situation of the patient. The main differential diagnosis that must be excluded is a squamous-cell carcinoma. Conclusion: Cytomegalovirus ulcers are not specific and its etiology cannot be affirmed clinically. A pathological examination is essential to allow the quick establishing of a treatment in an immuno-compromised patient to prevent further complications.
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Naqvi AR, Shango J, Seal A, Shukla D, Nares S. Herpesviruses and MicroRNAs: New Pathogenesis Factors in Oral Infection and Disease? Front Immunol 2018; 9:2099. [PMID: 30319604 PMCID: PMC6170608 DOI: 10.3389/fimmu.2018.02099] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/24/2018] [Indexed: 12/28/2022] Open
Abstract
The oral cavity incessantly encounters a plethora of microorganisms. Effective and efficient oral innate and adaptive immune responses are incumbent to maintain healthy mucosa. A higher prevalence of Human Herpesviruses (HHV), a family of large enveloped DNA viruses, has been reported in multiple oral inflammatory diseases suggesting their involvement in disease progression. However, the viral components contributing to oral disease remain obscure. MicroRNAs (miRNA) are non-protein coding, single stranded ribonucleic acid (RNA) molecules that post-transcriptionally regulate diverse messenger RNAs. Thus, miRNAs can control large repertoire of biological processes. Changes in miRNA expression are associated with various oral infections and diseases. Cellular miRNAs can act as pro- or anti-viral factors and dysregulation of host miRNA expression occurs during herpesviruses infection. This strongly suggest a critical role of cellular miRNAs in host-herpesvirus interaction. Interestingly, HHV also encode multiple miRNAs (called viral miRNAs) that may play key role in host-pathogen interaction by modulating both host biological pathways and controlling viral life cycle. Recent studies from our laboratory have identified viral miRNAs (v-miRs) in diseased oral tissue biopsies and demonstrate their immunomodulatory roles. This review discusses the association of miRNAs (both host and viral) and herpesviruses in the pathogenesis of oral inflammatory diseases.
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Affiliation(s)
- Afsar R Naqvi
- Mucosal Immunology Lab, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Jennifer Shango
- Mucosal Immunology Lab, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Alexandra Seal
- Mucosal Immunology Lab, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
| | - Deepak Shukla
- Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, United States.,Department of Ophthalmology and Visual Sciences, University of Illinois Medical Center, Chicago, IL, United States
| | - Salvador Nares
- Mucosal Immunology Lab, College of Dentistry, University of Illinois at Chicago, Chicago, IL, United States
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Shedding of HSV-1, HSV-2, CMV, and EBV in the saliva of hematopoietic stem cell transplant recipients at Fundación HOMI - Hospital de la Misericordia, Bogotá, D.C. BIOMEDICA 2016; 36:201-10. [PMID: 27622810 DOI: 10.7705/biomedica.v36i0.2985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 03/22/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation in pediatric patients is an alternative treatment for different diseases. The conditioning regimen for transplant predisposes recipients to the development of infections. Viral infections by herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), human cytomegalovirus (CMV), and Epstein-Barr virus (EBV), are the most common, and the leading cause of morbidity and mortality among these patients. These viruses lie dormant in various cell types and the reactivation of latent infections may lead to asymptomatic viral shedding in saliva. The detection of these viruses in secretions may contribute to understand the behavioral dynamics of these viral infections in transplanted patients, and to the early diagnosis of reactivation. OBJECTIVE To assess HSV-1, HSV-2, CMV and EBV viral shedding in the saliva of patients admitted for hematopoietic stem cell transplantation at Fundación HOMI - Hospital de la Misericordia between January and November of 2012. MATERIALS AND METHODS We evaluated stimulated saliva samples of 17 hematopoietic stem cell transplantation recipients weekly. We performed DNA extraction from saliva, and we evaluated the presence of DNA for HSV-1, HSV-2, CMV, and EBV by PCR. RESULTS While we detected HSV-2 and CMV DNA in the saliva of four patients, EBV DNA was detected in nine patients with leukopenia. In contrast, we did not detect HSV-1 DNA in saliva. Additionally, four out of the 17 patients showed a simultaneous shedding of CMV and EBV. CONCLUSIONS By conventional PCR, we demonstrated asymptomatic HSV-2, CMV, and EBV viral shedding in saliva, associated with leukopenia.
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