1
|
Abstract
Oral herpes virus infections (OHVIs) are among the most common mucosal disorders encountered by oral health care providers. These infections can affect individuals at any age, from infants to the elderly, and may cause significant pain and dysfunction. Immunosuppressed patients may be at increased risk for serious and potential life-threatening complications caused by OHVIs. Clinicians may have difficulty in diagnosing these infections because they can mimic other conditions of the oral mucosa. This article provides oral health care providers with clinically relevant information regarding etiopathogenesis, diagnosis, and management of OHVIs.
Collapse
Affiliation(s)
- Ramesh Balasubramaniam
- Orofacial Pain Clinic, School of Dentistry, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Perth Oral Medicine and Dental Sleep Centre, St John of God Hospital, Suite 311, 25 McCourt Street, Subiaco, Western Australia 6008, Australia
| | - Arthur S Kuperstein
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Room 207, Philadelphia, PA 19104, USA
| | - Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Room 206, Philadelphia, PA 19104, USA.
| |
Collapse
|
2
|
Jimenez-Acosta F, Penneys NS. Treatment of cutaneous complications of AIDS. J DERMATOL TREAT 2009. [DOI: 10.3109/09546638909086709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
3
|
Arduino PG, Porter SR. Herpes Simplex Virus Type 1 infection: overview on relevant clinico-pathological features. J Oral Pathol Med 2008; 37:107-21. [PMID: 18197856 DOI: 10.1111/j.1600-0714.2007.00586.x] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Herpes Simplex Virus Type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV-1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV-1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro-facial HSV infection is caused by HSV-1, infection by HSV-2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV-1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.
Collapse
Affiliation(s)
- Paolo G Arduino
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Turin, Italy.
| | | |
Collapse
|
4
|
Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management. Oral Dis 2006; 12:254-70. [PMID: 16700734 DOI: 10.1111/j.1601-0825.2006.01202.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) gives rise to a variety of clinical disorders and is a major cause of morbidity and mortality worldwide. HSV-1 infections are common in oral and perioral area. The aim of the present report was to critically examine the published literature to evaluate the advantages and limitations of therapy of HSV-1 infection in both immunocompetent and immunocompromised patients. Systemic antiviral therapy has been widely accepted as effective for primary herpetic gingivostomatitis. Aciclovir (ACV) 5% cream seems to be the accepted standard topical therapy for herpes labialis, being both effective and well tolerated, although penciclovir 1% cream has been proposed as a potentially useful treatment. Systemic ACV may be effective in reducing the duration of symptoms of recurrent HSV-1 infection, but the optimal timing and dose of the treatment are uncertain. Aciclovir and famciclovir may be of benefit in the acute treatment of severe HSV-1 disease in immunocompromised patients. There is also evidence that prophylactic oral ACV may reduce the frequency and severity of recurrent attack of herpetic infection in immunocompromised patients, but the optimal timing and duration of treatment is uncertain and can vary in different situations.
Collapse
Affiliation(s)
- P G Arduino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy.
| | | |
Collapse
|
5
|
Abstract
Oral herpes virus infections are commonly seen by the dental practitioner. Saliva is a reservoir for the herpes virus, and a variety of infections, both localized and systemic, may be induced by the virus. Patients who are immunocompromised may be at risk for serious and potentially life-threatening complications of herpes virus infections. This article highlights the basic virology and clinical manifestations of herpetic infections and the differential diagnosis and management of oral herpes virus infections.
Collapse
Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
6
|
Wald A, Ericsson M, Krantz E, Selke S, Corey L. Oral shedding of herpes simplex virus type 2. Sex Transm Infect 2004; 80:272-6. [PMID: 15295123 PMCID: PMC1744863 DOI: 10.1136/sti.2003.007823] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Herpes simplex virus (HSV) 1 and HSV-2 reactivate preferentially in the oral and genital area, respectively. We aimed to define frequency and characteristics associated with oral shedding of HSV-2. METHODS Demographic, clinical and laboratory data of patients with documented HSV-2 infection and at least one oral viral culture obtained were selected from the University of Washington Virology Research Clinic database. RESULTS Of 1388 people meeting the entry criteria, 44 (3.2%) had HSV-2 isolated at least once from their mouths. In comparison with the 1344 people who did not have HSV-2 isolated from their mouth, participants with oral HSV-2 were more likely to be male (OR = 1.9, 95% CI 1.0 to 3.7), HIV positive (OR = 2.9, 95% CI 1.4 to 6.0), and homosexual (OR = 2.2, 95% CI 1.1 to 4.2), and to have collected a larger number of oral specimens (median 32 v 4, p<0.001). Of the 58 days with oral HSV-2 isolation, 15 (25%) occurred during newly acquired HSV-2 infection, 12 (21%) during a recurrence with genital lesions, three (5%) during a recurrence with oral lesions, and three (5%) during a recurrence with oral and genital lesions; 25 (43%) occurred during asymptomatic shedding. Oral HSV-2 was found less frequently than oral HSV-1 (0.06% v 1%, p<0.001) in people with HSV-1 and HSV-2 antibody, and less frequently than genital HSV-2 (0.09% v 7%, p<0.001). CONCLUSIONS Oral reactivation of HSV-2 as defined by viral isolation is uncommon and usually occurs in the setting of first episode of genital HSV-2 or during genital recurrence of HSV-2.
Collapse
Affiliation(s)
- A Wald
- University of Washington Virology Research Clinic, 600 Broadway, Suite 400, Seattle, WA 98122, USA.
| | | | | | | | | |
Collapse
|
7
|
Abstract
Herpesviruses are responsible for many illnesses that affect the oral and maxillofacial region. The most common of these are primary or recurrent HSV infection, but knowledge of the manifestations of the eight herpesviruses that cause infections in humans will provide clinicians with a better understanding and basis for diagnosing and managing patients with these diseases. Immunocompromised patients are at greater risk for serious illness: therefore, clinicians treating transplant patients, patients receiving cancer chemotherapy, or HIV-infected individuals should be aware of the various clinical manifestations of infection with herpesviruses.
Collapse
Affiliation(s)
- Eric T Stoopler
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
| | | |
Collapse
|
8
|
Abstract
In immunocompetent patients, HSV is controlled rapidly by the human host's immune system, and recurrent lesions are small and short lived. When treated with antiviral agents, these patients rarely develop resistance to these drugs. In contrast immunocompromised patients might not be able to control HSV infection. Thus, frequent and severe reactivations are often seen and might lead to fatal herpetic encephalitis or disseminated HSV infection. Treatment in these patients is limited because immunocompromised hosts often develop severe herpes disease refractory to antiviral drug therapy. It is therefore imperative that physicians develop regimens to deal with both receptive and refractory HSV disease. The following treatment protocol (modified from Balfour and colleagues) might serve as a guide until further investigation of new drugs is performed. In all patients standard oral ACV therapy should be initiated at a dose of 200 mg orally, five times a day for the first 3 to 5 days. Prior to treatment, cultures the lesions should be obtained to verify HSV etiology. If the response is poor, the dose of oral ACV should be increased to 800 mg five times a day. If no response seen after 5 to 7 days, it is unlikely that the lesion will respond to intravenous ACV (or chemically and structurally related drugs such as VCV or famciclovir), so an alternative regimen must be assigned. First, repeat cultures for vital, fungal, and bacterial pathogens must be performed. In addition, ACV susceptibility studies should be ordered, if available. If the mucocutaneous lesion is accessible for topical treatment, TFT (as ophthalmic solution) should be applied to the area three to four times a day until the lesion is completely healed. If the lesion is inaccessible or if the response to TFT is poor, therapy with intravenous foscarnet should be given for 10 days or until complete resolution of the lesions. The dosage of foscarnet should be 40 milligrams per kilogram three times per day or 60 milligrams per kilogram twice daily. If foscarnet fails to achieve clinical clearing, consideration should be given to use of intravenous cidofovir (or application of compounded 1% to 3% topical cidofovir ointment). Vidarabine is reserved for situations in which all of these therapies fail. If lesions reoccur in the same location following clearing, the patient should started on high-dose oral ACV (800 mg, five times daily) or intravenous foscarnet (40 mg/kg tid or 60 mg/kg bid) as soon as possible. When lesions occur in a different location, the patient should be treated initially with standard doses of oral ACV (200 mg, five times daily) and the above protocol should be followed should there be clinical failure. In the future, new treatment options for patients with documented HSV resistance will be important in reducing the clinical impact of HSV.
Collapse
Affiliation(s)
- Suneel Chilukuri
- Department of Dermatology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA
| | | |
Collapse
|
9
|
Abstract
The purpose of this review is to describe current possibilities of management of selected fungal and viral oral opportunistic infections including oral candidiasis, herpes simplex type 1 and 2-related lesions (HSV1,2), oral hairy leukoplakia (OHL) and oral lesions associated with human papilloma viruses (HPV). Less common diseases such as cytomegalovirus infection or human herpes virus type 8 associated with Kaposi's sarcoma and others are not considered. In a number of instances lifelong therapy or prophylaxis has to be instituted. Antiretroviral combination therapy, also called highly active antiretroviral therapy (HAART), has considerably changed the frequency of oral lesions caused by opportunistic agents. A short description of the antiretroviral agents available including respective side-effects is presented.
Collapse
Affiliation(s)
- P A Reichart
- Abteilung für Oralchirurgie und Zahnärztliche Röntgenologie, Universitätsklinikum Charité, Medizinische Fakultät, Humboldt-Universität zu Berlin, Germany
| |
Collapse
|
10
|
White DK. Acute Viral Infections of the Oral Cavity and Parotid Gland. Oral Maxillofac Surg Clin North Am 1998. [DOI: 10.1016/s1042-3699(20)30343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
11
|
Abstract
Oral ulceration in HIV infection may be due to: (1) mycotic; (2) bacterial, protozoan; (3) and viral infections; (4) oral neoplasia; (5) aphthous ulceration/ulceration not otherwise specified (NOS); or (6) ulceration of iatrogenic origin. Of particular significance are oral ulcerations caused by viruses of the herpes virus group (HSV 1/2, CMV, VZV) and ulcerations of the aphthous type. It was shown recently that coinfection of viral ulcers occurs. The aetiopathogenesis of the aphthous type of ulcerations including the still debated ulceration NOS is not clear. Further basic and clinical research is necessary in order to better understand ulceration particularly in relation to immunoregulation, tissue breakdown and repair.
Collapse
Affiliation(s)
- P A Reichart
- Universitätsklinikum Charité, Medizinische Fakultät, Humboldt-Universität zu Berlin, Abteilung für Oralchirurgie und zahnärztliche Röntgenologie, Germany
| |
Collapse
|
12
|
Abstract
Few people with HIV infection fall to experience oral lesions during the course of their disease. Oral mucosal and salivary gland manifestations include several that were not seen before the AIDS epidemic, while others are more severe in this population. Oral lesions reflect HIV status and the stage of immunosuppression, are important elements in HIV staging and classification schemes, raise pertinent questions about mucosal aspect of immunosuppression, and provide therapeutic challenges. Their pervasive nature and biological significance emphasise the importance of a careful oral examination as part of the general clinical evaluation.
Collapse
Affiliation(s)
- D Greenspan
- Department of Stomatology, School of Dentistry, University of California San Francisco 94143-0422, USA
| | | |
Collapse
|
13
|
Piluso S, Ficarra G, Lucatorto FM, Orsi A, Dionisio D, Stendardi L, Eversole LR. Cause of oral ulcers in HIV-infected patients: a study of 19 cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:166-72. [PMID: 8863306 DOI: 10.1016/s1079-2104(96)80220-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- S Piluso
- Institute of Stomatology, University of Florence
| | | | | | | | | | | | | |
Collapse
|
14
|
Epstein JB, Ransier A, Sherlock CH, Spinelli JJ, Reece D. Acyclovir prophylaxis of oral herpes virus during bone marrow transplantation. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:158-62. [PMID: 8762872 DOI: 10.1016/0964-1955(95)00091-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Oropharyngeal shedding of herpes viruses (herpes simplex, cytomegalovirus) was assessed in patients on standard acyclovir prophylaxis during bone marrow transplantation (BMT) to determine the frequency of viral shedding and to assess possible oropharyngeal complications that may be associated with viral reactivation in these patients. We conducted a prospective assessment of 83 patients receiving BMT. Patients were evaluated weekly and oral surveillance cultures were completed. Shedding of herpes simplex virus (HSV) was detected in the oropharynx of 2.9% of seropositive patients on prophylactic acyclovir, and only one case of clinical oral herpetic infection was seen. Cytomegalovirus (CMV) was cultured from the oropharynx in 13.3% of CMV seropositive patients provided with prophylactic acyclovir, but no oropharyngeal lesions were attributed to CMV reactivation. No correlation was seen between HSV and CMV pretransplant serology and severity of oral mucositis and acute graft versus host disease. No effect on time to engraftment was detected. This study supports the continuing use of acyclovir prophylaxis in HSV seropositive patients receiving BMT. Acyclovir prophylaxis was effective in preventing viral shedding in all but 2.9% of patients, and only one case of clinical infection was diagnosed. The frequency of CMV shedding was approximately four times that of HSV; however, no oral lesions were attributed to CMV.
Collapse
Affiliation(s)
- J B Epstein
- Health Sciences Centre, Vancouver Hospital, British Columbia, Canada
| | | | | | | | | |
Collapse
|
15
|
Scully C. New aspects of oral viral diseases. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1996; 90:29-96. [PMID: 8791748 DOI: 10.1007/978-3-642-80169-3_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral HealthCare Sciences, University of London, England
| |
Collapse
|
16
|
MacPhail LA, Hilton JF, Heinic GS, Greenspan D. Direct immunofluorescence vs. culture for detecting HSV in oral ulcers: a comparison. J Am Dent Assoc 1995; 126:74-8. [PMID: 7822648 DOI: 10.14219/jada.archive.1995.0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diagnostic tests may be necessary to determine the cause of oral ulcers. Direct immunofluorescence staining of oral smears supplies results much more quickly than viral culture, the "gold standard" for diagnosing HSV lesions. This study compares the sensitivity and specificity of direct immunofluorescence staining vs. viral culture and evaluates the usefulness of the two techniques for the general dental practitioner.
Collapse
Affiliation(s)
- L A MacPhail
- Department of Stomatology, School of Dentistry, University of California, San Francisco 94143
| | | | | | | |
Collapse
|
17
|
Abstract
Periodontal diseases may be the first clinical sign of human immunodeficiency virus (HIV)-infection. Since the immunosuppression and subsequent susceptibility may alter the responses of the oral tissues as well as the microflora, both periodontal treatment and result of therapy may be modified. The periodontal diseases in HIV-seropositive patients include common as well as less conventional forms of gingivitis and periodontitis, and bacterial, mycotic and viral infections are seen. Neoplasias may also involve the periodontium; most common are Kaposi's sarcoma and non-Hodgkin's lymphoma. Recent studies of unselected groups of patients indicate that periodontal health in at least some groups of HIV-seropositive patients is better than previously reported.
Collapse
Affiliation(s)
- P Holmstrup
- Department of Periodontology, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark
| | | |
Collapse
|
18
|
Tateishi K, Toh Y, Minagawa H, Tashiro H. Detection of herpes simplex virus (HSV) in the saliva from 1,000 oral surgery outpatients by the polymerase chain reaction (PCR) and virus isolation. J Oral Pathol Med 1994; 23:80-4. [PMID: 8164158 DOI: 10.1111/j.1600-0714.1994.tb00261.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Herpes simplex virus (HSV) was detected by a polymerase chain reaction (PCR) in 47 (4.7%) out of 1,000 saliva samples from the outpatients of an oral and maxillofacial surgery department compared with 27 (2.7%) by conventional virus isolation. There were 20 PCR-positive, culture-negative cases but no culture-positive, PCR-negative cases. Patients younger than 10 years or older than 60 years secreted HSV more frequently than the others. Those with inflammatory diseases showed higher positivity for HSV than those with malignancy, trauma or other complaints. All 27 virus isolates were typed as HSV type 1 and none were resistant to acyclovir, arabinofuranosyl-adenine, iododeoxyuridine or phosphonoacetic acid.
Collapse
Affiliation(s)
- K Tateishi
- First Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
| | | | | | | |
Collapse
|
19
|
Heinic GS, Northfelt DW, Greenspan JS, MacPhail LA, Greenspan D. Concurrent oral cytomegalovirus and herpes simplex virus infection in association with HIV infection. A case report. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:488-94. [PMID: 8385304 DOI: 10.1016/0030-4220(93)90176-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.
Collapse
Affiliation(s)
- G S Heinic
- Department of Stomatology and Oral AIDS Center, University of California, San Francisco
| | | | | | | | | |
Collapse
|
20
|
Holliday RA. MANIFESTATIONS OF AIDS IN THE OROMAXILLOFACIAL REGION. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)02193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Jones AC, Migliorati CA, Baughman RA. The simultaneous occurrence of oral herpes simplex virus, cytomegalovirus, and histoplasmosis in an HIV-infected patient. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 74:334-9. [PMID: 1328984 DOI: 10.1016/0030-4220(92)90071-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Numerous publications have reviewed the oral manifestations of HIV infection and AIDS. Although uncommon, herpetic infections and histoplasmosis are among the diseases reported. The case that follows presents the first description of the simultaneous occurrence of oral herpes simplex virus, cytomegalovirus, and histoplasmosis in an HIV-infected person. These infections appeared as extensive oral ulcerations and were the only clinical manifestation of HIV infection. Eleven months after the initial presentation, the patient died of complications of AIDS.
Collapse
Affiliation(s)
- A C Jones
- Division of Oral Pathology, University of Florida College of Dentistry, Gainesville
| | | | | |
Collapse
|
22
|
Ficarra G, Shillitoe EJ. HIV-related infections of the oral cavity. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1992; 3:207-31. [PMID: 1571472 DOI: 10.1177/10454411920030030301] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- G Ficarra
- Institute of Odontology and Stomatology, University of Florence, Italy
| | | |
Collapse
|
23
|
Scully C, McCarthy G. Management of oral health in persons with HIV infection. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 73:215-25. [PMID: 1312692 DOI: 10.1016/0030-4220(92)90197-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prevention and treatment of oral disease is required to maintain quality of life and to improve prognosis of patients infected with the human immunodeficiency virus (HIV). Management requires a team approach, and close collaboration with the appropriate responsible physicians and other health care workers is necessary. Oral infection is frequent and usually opportunistic, and management is based on certain principles. Infections may disseminate and can be persistent and severe; multiple concurrent or consecutive infections with different microorganisms are frequent; fungal, viral, and parasitic infections are rarely curable; and long-term antimicrobial therapy may be required. This article reviews the management of oral candidiasis, hairy leukoplakia, and infections with herpes simplex virus, varicella-zoster virus, and cytomegalovirus. The management of Kaposi's sarcoma, lymphomas, aphthous ulceration, gangrenous stomatitis, bleeding, xerostomia, and adverse drug reactions is also described. Treatment should avoid further immunosuppression and inducement of xerostomia or caries, and should be designed to avoid adverse drug reactions and possible drug interactions.
Collapse
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/drug therapy
- Antifungal Agents/therapeutic use
- Antiviral Agents/adverse effects
- Candidiasis, Oral/complications
- Candidiasis, Oral/drug therapy
- Dental Care for Disabled
- HIV Infections/complications
- HIV Infections/drug therapy
- Herpesviridae Infections/complications
- Herpesviridae Infections/drug therapy
- Humans
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/radiotherapy
- Mouth Diseases/complications
- Mouth Diseases/drug therapy
- Mouth Neoplasms/etiology
- Mouth Neoplasms/therapy
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/radiotherapy
- Stomatitis, Aphthous/chemically induced
- Stomatitis, Aphthous/complications
- Stomatitis, Aphthous/drug therapy
- Tumor Virus Infections/complications
- Tumor Virus Infections/drug therapy
Collapse
Affiliation(s)
- C Scully
- University Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School, England
| | | |
Collapse
|
24
|
Eversole LR. Viral infections of the head and neck among HIV-seropositive patients. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 73:155-63. [PMID: 1312690 DOI: 10.1016/0030-4220(92)90188-v] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Many viruses cause opportunistic infections in HIV-positive patients. Those that cause oral lesions include herpes simplex, varicella zoster, Epstein-Barr virus, cytomegalovirus, and papillomavirus. Importantly, many of the herpes-group viruses are able to augment immunosuppression and some actually transactivate HIV replication-inducing genetic sequences. This article reviews the role of viral agents in the activation of HIV replication and details the features of the reported oral lesions that represent viral opportunistic infections.
Collapse
Affiliation(s)
- L R Eversole
- Section of Oral Diagnosis, Oral Medicine and Oral Pathology, School of Dentistry, UCLA Health Sciences Center 90024
| |
Collapse
|
25
|
Affiliation(s)
- S Syrjänen
- Department of Pathology, University of Kuopio, Finland
| |
Collapse
|
26
|
Abstract
AIDS and other expressions of HIV infection continue to present ever-increasing challenges to the health professions, including dentistry. Patients with oral manifestations of HIV disease present or are referred to dental practitioners for the diagnosis and treatment of their oral lesions. This review briefly summarizes the management approaches currently adopted at the Oral AIDS Center, University of California, San Francisco.
Collapse
Affiliation(s)
- D Greenspan
- Department of Stomatology, University of California, San Francisco 94143-0512
| | | |
Collapse
|
27
|
Berger TG, Greene I. Bacterial, Viral, Fungal, and Parasitic Infections in HIV Disease and AIDS. Dermatol Clin 1991. [DOI: 10.1016/s0733-8635(18)30396-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
|
29
|
Epstein JB, Scully C. Herpes simplex virus in immunocompromised patients: growing evidence of drug resistance. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 72:47-50. [PMID: 1653925 DOI: 10.1016/0030-4220(91)90188-i] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antiviral drugs have proven effective in treatment of herpesvirus infections and in prevention of reactivation of latent virus. The prototype drug is acyclovir. Herpes simplex virus (HSV) is susceptible to acyclovir. There is increasing evidence in immunocompromised patients of acyclovir-resistant HSV causing clinical disease. Mechanisms of HSV resistance to acyclovir are known. These findings have implications for the future development and clinical use of antiviral drugs.
Collapse
Affiliation(s)
- J B Epstein
- Cancer Control Agency of British Columbia, Vancouver, Canada
| | | |
Collapse
|
30
|
Miyasaki SH, Perrott DH, Kaban LB. Infections in Immunocompromised Patients. Oral Maxillofac Surg Clin North Am 1991. [DOI: 10.1016/s1042-3699(20)30507-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Stellbrink HJ, Albrecht H, Löning T, Greten H. Herpes simplex virus type-2 ulcers resistant to acyclovir in an AIDS patient--successful treatment with foscarnet. KLINISCHE WOCHENSCHRIFT 1991; 69:274-8. [PMID: 1828096 DOI: 10.1007/bf01666854] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The case of a 25-year-old homosexual man with large inguinal and perianal ulcers is reported. He had been pretreated extensively with acyclovir. Herpes simplex virus (HSV) was identified in the ulcer tissue by in-situ hybridization. No clinical improvement with acyclovir but a prompt response to foscarnet was noted. In a relapse after 11 weeks an acyclovir-resistant HSV type 2 was isolated. Again, a prompt response to foscarnet was noted. The case is presented in detail, and the clinical impact of resistance of HSV to acyclovir is discussed.
Collapse
Affiliation(s)
- H J Stellbrink
- Medizinische Kernklinik und Poliklinik, Universitätskrankenhaus Eppendorf, Hamburg
| | | | | | | |
Collapse
|
32
|
Scully C, Laskaris G, Pindborg J, Porter SR, Reichart P. Oral manifestations of HIV infection and their management. I. More common lesions. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 71:158-66. [PMID: 2003011 DOI: 10.1016/0030-4220(91)90459-p] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Oral lesions are common at all stages of HIV infection. This first of two articles reviews the clinical features and pathogenesis of common oral manifestations of HIV disease (candidiasis, hairy leukoplakia, Kaposi's sarcoma, and HIV-related periodontal disease) and considers current treatment measures.
Collapse
Affiliation(s)
- C Scully
- Department of Oral Medicine, Surgery and Pathology, Bristol Dental Hospital and School, U.K
| | | | | | | | | |
Collapse
|
33
|
Affiliation(s)
- T Berger
- Department of Dermatology, San Francisco General Hospital, California
| |
Collapse
|
34
|
Miller SM. Treatment of Opportunistic Infections Associated with Acquired Immune Deficiency Syndrome. Prim Care 1990. [DOI: 10.1016/s0095-4543(21)00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|