Median rhomboid glossitis: not a misnomer. Review of the literature and histologic study of twenty-eight cases

A series of twenty-eight cases of median rhomboid glossitis were studied histologically. Of these twenty-eight cases, 85 percent showed fungal hyphae in the parakeratin layer. The literature is reviewed, and additional evidence is presented to support the theory the median rhomboid glossitis is not a developmental condition but the clinical expression of a localized chronic fungal infection.

Etiologic factors in denture sore mouth syndrome

A total of 24 patients, 19 women and 5 men, complaining of denture sore mouth was studied. In part I the following investigations were performed: (1) Mechanical factors were evaluated. (2) Temperature was measured beneath the prosthetic denture. (3) Yeast cultures were made. (4) Patch tests with possible allergens were performed on the buccal mucosa and on the skin of the back. In all these investigations there were no significant differences from the results obtained in a control group. In part II the connection between psychological factors and denture sore mouth was explored. Test results of the denture sore mouth group and a matched control group were compared. The obtained data suggest that complaining behavior concerning somatic symptoms in general, on a neurotic base, is a psychological characteristic of denture sore mouth patients.

Central papillary atrophy of the tongue and denture stomatitis

A retrospective study of the epidemiologic data of 4,417 subjects has been undertaken to study the possibility of a link existing between glossal central papillary atrophy (median rhomboid glossitis) and denture stomatitis. Neither the association between glossal central papillary atrophy and denture stomatitis nor the association between glossal central papillary atrophy and denture use was statistically significant. However, the correlation between wearing removable dental prostheses and finding candidal mycelia in smears from these tongue lesions was statistically highly significant. Debilitation caused by general age changes would not appear to predispose to atrophy of the pappillae of the middle portion of the tongue-dorsum.

Clinical aspects of Candida infection in denture wearers

Candida-induced denture stomatitis usually does not reflect any deep-seated, systemic abnormality, the dentures being the primary predisposing condition. However, infection with C albicans should be recognized as an extremely common complication to the wearing of dentures. Most cases are treated relatively easily, but recurrences are frequent and the infection often spreads to other parts of the oral mucosa. Therefore, preventive measures should be taken against colonization by Candida of the palatal mucosa and the dentures. In healthy persons, Candida-induced denture stomatitis is not serious; however, it should be considered a possible spearhead of systemic yeast infections in seriously ill patients, especially in those subjected to prolonged treatment with antibiotics, corticosteroids, or immunosuppressive drugs.

Pulmonary nocardiosis associated with primary nocardial infection of the oral cavity

A case of pulmonary nocardiosis associated with primary nocardial infection of the oral cavity in a compromised host is presented. Nocardia asteroides, an aerobic, gram-positive, branching, filamentous fungus, was demonstrated in the sputum and in pathologic specimens from gingival sulci stained by Gram's method and the acid-fast method Kinyoun. The organism was identified in cultures made on Sabouraud's glucose agar. Marked clinical improvement was noted when the patient received high dosage of sulfisoxazole diolamine (8 to 12 Gm. per day) for a prolonged period of time (9 to 12 months). Because of an apparent relative increase in the incidence of nocardiosis and a paucity of information on the subject in the dental literature, this article is timely.

Familial hypoparathyroidism with candidiasis and mental retardation

Five new cases of the syndrome of hypoparathyroidism, candidiasis, and mental retardation are described and the importance of the dental findings in contributing toward a definite diagnosis is stressed. The close consanguineous relationship of the parents, first cousins in all of these cases, makes imperative the consideration of the concept that the syndrome is a congenital defect, transmitted by a recessive gene.

Nutritional deficiency in oral candidosis

A retrospective study of 108 patients was carried out to investigate the possible relationship between infection of the mouth with Candida albicans and blood levels of iron, folic acid and vitamin B12. The patients were separated into two groups--those with hyperplastic and those with atrophic candidal lesions--and compared with separate control groups. Twenty-one patients had chronic hyperplastic candidosis and seven were iron deficient. Comparison with an age- and sex-matched control group showed the differences to be significant only at the p less than 0.1 level. Seven of the patients with hyperplastic lesions had folic acid deficiency and the difference between patients and controls was statistically significant (less than 0.05). However, no significant differences in iron or folic acid deficiency were noted between 87 patients with atrophic candidosis and 65 conttrols, and vitamin B12 deficiency was not statistically significant for either the hyperplastic or the atrophic group. It is concluded that deficiency of iron, folic acid or vitamin B12 alone does not promote growth of Candida albicans on the oral mucous membrane but that in some susceptible individuals, iron or folic deficiency may facilitate epithelial invasion by hyphae of Candida albicans.

A graded dose assessment of the efficacy of beclomethasone dipropionate aerosol for severe chronic asthma

In a 26-wk double-blind controlled study of 34 patients whose asthma had been poorly controlled despite oral steroids, valuable clinical and pulmonary function improvement was derived by adding beclomethasone aerosol to the prednisone regimen. The amount of improvement correlated linearly with beclomethasone dosage over the range 200 to 1,600 microng/day. These patients required relatively high dosage. Success in achieving asymptomatic status was only 26% with the conventional 400 microng/day and 60% at 1,600 microng/day. Oropharyngeal candidiasis was also dose-related but did not prohibit the use of high-dosage beclomethasone. Respiratory infections, physical signs, blood glucose, and electrolytes were unaffected by the drug. A dose-related suppression of cortisol secretion was demonstrated, but about 1/4 of the group had normal plasma cortisol even at 1,600 microng/day plus the oral prednisone. An individualized risk-benefit assessment seems a better basis for choosing an optimal beclomethasone regimen for each patient than adherence to a conventionalized fixed dosage of 400 microng/day. This requires definition of: (1) a specific goal of treatment in the individual patient and the beclomethasone dosage required to achieve it; (2) the adrenocortical functional response of that particular patient to the desired dose of beclomethasone; and (3) the presence and degree of any dose-limiting constraints such as preexisting complications of steroid use.

A prospective study of respiratory infection in asthmatic patients treated with beclomethasone dipropionate and sodium cromoglycate

A prospective study of forty adult asthmatic patients attending two chest clinics in the City of Liverpool was undertaken. All patients had reversible airways obstruction and were under treatment with either beclomethasone dipropionate or sodium cromoglycate. Satisfactory symptomatic control was achieved in both groups of patients on a subjective basis, but there was a statistically significant (P less than 0-001) reduction in the number of admissions to hospital in the treatment year compared to the preceding 12 months in the beclomethasone aerosol group. No increased incidence of lower respiratory tract infections or non-specific sore throats was found in either group studied. No cases of clinical oral Candida infection occurred in the beclomethasone aerosol treated patients. It is concluded that beclomethasone dipropionate in aerosol form is not only a safe and effective method for symptomatic control of adult bronchial asthma but is also economically worthwhile as a means of reducing hospital admissions in this vulnerable group of patients.

A case of chronic oropharyngo-esophageal candidiasis with immunological deficiency: successful treatment with miconazole

The case of a 38-year-old male patient with chronic recurrent oropharyngo-esophageal candidiasis since early childhood, resistant to topical therapy with nystatin, is reported. The disease had resulted in impressive oropharyngeal lesions and stricturing of the midesophagus. Extensive in vivo and in vitro immunological studies done before and after successful treatment with miconazole showed a persistent partial deficiency of the cell-mediated immune system, in particular that directed toward candida antigens. Miconazole, a new potent antifungal drug, proved effective in controlling the candidiasis, which had become resistant to conventional treatment.

Follow-up studies in oral leukoplakia

Follow-up examinations of 670 patients with oral leukoplakia during a 30-year-period showed cancer development in 40 cases, i.e. 6%. Dysplasia was observed in 24% of the histologically examined leukoplakia cases; 13% of the dysplasia cases subsequently showed development of carcinoma. The age distribution revealed the prevalence of leukoplakia in the age-group 51-60 years; that of carcinoma in the age-group of 61-70 years. The sex distribution showed a male-female ratio of 3.2 : 1 in the leukoplakia-group, and a 1.9 : 1 ratio in the carcinoma-group. The tongue and the lips were the site of predilection for malignant transformation and for dysplasia. Among aetiological factors, Candida albicans infection and the simultaneous existence of several aetiological factors seemed to play a role in malignant transformation. Erosive leukoplakia showed the highest risk, developing in 25.9% of the cases into cancer.

Denture sore mouth. Aetiological aspects and treatment

Seventy-four patients wearing full upper and lower dentures were examined in the study; 37 exhibited varying degrees of denture sore mouth (DSM) while the remaining 37 patients acted as controls. Denture trauma was more common in the DSM group. Candida was grown from 73 per cent of patients with DSM but only from 22 per cent of controls. Control patients had better denture hygiene than DSM patients. One year later 22 of the original DSM patients wearing newly made dentures were re-examined. Nine out of 22 still exhibited varying degrees of DSM. In the 9 cases persisting, a nystatin-chlorhexidine treatment plan was prescribed, resulting in resolution of 7 further cases. The cases that failed resolve were wearing unstable traumatogenic new dentures.

Treatment of oral candidiasis in debilitated patients with miconazole--a new potent antifungal drug

In 24 patients with advanced malignant diseases, mainly leukaemias and lymphomas, 35 episodes of oral candidiasis were treated with topical application of miconazole. Clinical cures were obtained in 100% of the episodes and mycological cures in 91% of the episodes after a mean treatment time of only 4.9 days, although most of the patients were severely granulocytopenic and were undergoing simultaneous treatment with cytostatics, prednisolone and antibiotics. Miconazole appears to be a remarkably fast-acting, reliable and non-toxic drug in the treatment of oral candidiasis.

Initiation and aggravation of denture stomatitis by sucrose rinses

The purpose of this study was to assess whether frequent exposure to sucrose would aggravate or initiate a palatal candidosis in denture wearers. Eight subjects with generalized simple or granular inflammation in the palate (inflammation group) and six with clinically healthy palatal mucosa (control group) carried out 1-min mouthrinses with 10 ml of a 25% sucrose solution four times daily for 15 d. In the inflammation group an aggravated palatal erythema was seen in two subjects after 7 d, and in another subject after 15 d. Among the controls a generalized simple inflammation had developed in the palate of one subject after 7 d, and in another one after 15 d. An increased number of yeast colonies on palatal and denture agar models and/or hyphae on palatal and denture smears was found in all subjects with clinical signs of aggravated or initiated denture stomatitis.

Clinical and physiological assessment of asthmatic children treated with beclomethasone dipropionate

Forty-two perennial asthmatic children were selected for a 12-wk study using beclomethasone dipropionate. The groups included 21 steroid-dependent children (Group I) and 21 patients (Group II) whose disease was of sufficient severity that corticosteroid therapy was contemplated. All children received the drug in a dose of 100 mug 4 times daily. During the study, oral prednisone was withdrawn from the steroid-dependent children while other therapy was essentially unchanged. Group II children underwent a double-blind trial, receiving beclomethasone for 6 wk and placebo for 6 wk. Objective assessment of adrenal and pulmonary function was obtained at regular intervals. For the latter, total lung capacity and its subdivisions, airways resistance, maximum expiratory flow volume, and oxygen tension, were measured in both groups. In Group II static elastic recoil was measured also. For most tests the results were statistically significant. In both groups, 18 of 21 patients demonstrated an excellent clinical response, no evidence of adrenal suppression, and improvement in pulmonary function. Forty of 42 patients were followed for another 12 wk, and 19 of each group did well. After 20-24 wk of therapy, 16% of patients harbored monilia in their oropharynx, and 1 patient had clinical monilial stomatitis. Within the limits of the time of the study, beclomethasone dipropionate appeared to provide adequate clinical control in many chronic, severe, steroid-dependent and nonsteroid-dependent asthmatic children.

[Fungal infections after renal transplantation (author's transl)]

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

Median rhomboid glossitis. Candidiasis and not a developmental anomaly

Infection by Candida Albicans was found in all biopsies taken from ten patients presenting with midline lesions of the tongue which clinically presented as median rhomboid glossitis.

Progressive and regressive changes in Hungarian oral leukoplakias in the course of longitudinal studies

Follow-up studies of 520 patients with leukoplakia during a 25-year period showed changes in the clinical type in 66 cases, i.e. 12.7%. Regressive changes occurred in 9%, progressive changes in 3.7%. The highest frequency of change in the clinical type was found in the group of erosive leukoplakias. The most frequent changing sites were the labial mucosa, commissures and buccal mucosa. Of the etiologic factors, smoking and Candida infection seemed to be correlated with the change of type. Oral leukoplakia should be considered a dynamic changing lesion of the oral mucosa.

Multicentric pigmented Bowen's disease of the perineum

Images

Candidiasis and multiple endocrinopathy. With oral squamous cell carcinoma complications

A 26-year-old man having multiple endocrinopathy (pernicious anemia, hypothyroidism, hypoadrenocorticism, gonadal failure, and diabetes mellitus) and chronic candidiasis developed several rapidly growing primary tumors on the oral mucosa. Histologically, the tumors appeared to be very well differentiated squamous cell carcinomas. Yet, in spite of all therapeutic attempts, the tumors rapidly progressed and within eight months resulted in disseminated carcinomatosis and death. At autopsy the patient was found to have had a miniscule dysplastic thymus. It is postulated that in chronic candidiasis and polyendocrinopathy a defect may exist in immunologic cellular surveillance for recognition and destruction of aberrant cells.