1
|
Patel C, Le P, Salman M, Cavalieri S, Kovar J. An Unusual Discovery of Multi-Opportunistic Organisms in Gastrointestinal Biopsies of a Patient With Acquired Immunodeficiency Syndrome and Infectious Colitis. Cureus 2023; 15:e50124. [PMID: 38186439 PMCID: PMC10771264 DOI: 10.7759/cureus.50124] [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] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Patients with acquired immunodeficiency syndrome (AIDS) have an increased risk of infectious colitis. While individual cases of infectious colitis are not rare, co-infections involving multiple opportunistic organisms are uncommon. Here, we present an AIDS patient with concurrent opportunistic gastrointestinal infections resulting in symptomatic infectious colitis. A 56-year-old woman with AIDS presented to the hospital with diarrhea, abdominal pain, and sepsis. Initial imagining revealed thickening of the colonic wall suggestive of colitis. The initial workup identified the presence of Campylobacter and Cryptosporidium through the GI Pathogen Multiplex Polymerase Chain Reaction Panel (bioMérieux BioFire®, Salt Lake City, USA), and stool parasite examination also confirmed the presence of Cryptosporidium. Despite treatment for these infections, the patient's diarrhea persisted. The patient had a sigmoidoscopy performed, and the biopsy results revealed the presence of Histoplasma capsulatum, cytomegalovirus (CMV), Herpes simplex virus (HSV), Cryptosporidium, and Campylobacter. The patient subsequently received appropriate treatment for each infection, leading to the resolution of both colitis and bacteremia. This case emphasizes the importance of considering multiple pathogens in the management of infectious colitis in patients with AIDS. The presence of one infectious agent does not preclude the presence of additional agents, and a thorough investigation can ensure a definitive diagnosis and optimal treatment for patients.
Collapse
Affiliation(s)
- Chirag Patel
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Patricia Le
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Malik Salman
- Pathology, Creighton University School of Medicine, Omaha, USA
| | | | - Joyce Kovar
- Pathology, Creighton University School of Medicine, Omaha, USA
| |
Collapse
|
2
|
Cavalcante RS, Souza BS, Duarte IX, Moraes MPT, Coelho KIR, Griva BL, Pereira BAS, Calvi SA, Betini M, Mendes RP. Herpes simplex Virus Pneumonitis in an Acute/Subacute Paracoccidioidomycosis Patient With Malabsorption Syndrome. Case-Report and Literature Review. FRONTIERS IN FUNGAL BIOLOGY 2022; 2:805502. [PMID: 37744114 PMCID: PMC10512208 DOI: 10.3389/ffunb.2021.805502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/29/2021] [Indexed: 09/26/2023]
Abstract
Paracoccidioides sp.-Herpes simplex virus (HSV) co-infection was not reported until now and malabsorption syndrome is a rare complication of the acute/subacute form (AF) of paracoccidioidomycosis (PCM), characterized by life-threatening abnormalities, such as fat and protein loss, lymphopenia, ascites, and intense immunosuppression. A 21-year-old woman presented the PCM AF with intense involvement of the abdominal and intestinal lymphoid organs, which leads to the malabsorption syndrome and severe immunosuppression. This patient developed a fatal-disseminated HSV infection associated with the paracoccidioidal disease. This case demonstrates that, in addition to the antigen-specific immunosuppression, some PCM patients can present a generalized cell-mediated immune depression and endogenous infection of latent microorganisms. On the best of our knowledge, this is the first report of an association between PCM and HSV infection.
Collapse
Affiliation(s)
- Ricardo S. Cavalcante
- Tropical Diseases Area, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Bruno S. Souza
- Tropical Diseases Area, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Iverson X. Duarte
- Department of Pathology, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Marcelo P. T. Moraes
- Department of Pathology, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Kunie I. R. Coelho
- Department of Pathology, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Beatriz L. Griva
- Nuclear Medicine Service, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Beatriz A. S. Pereira
- Tropical Diseases Area, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Sueli A. Calvi
- Tropical Diseases Area, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| | - Marluci Betini
- University Library, São Paulo State University–UNESP, Botucatu, Brazil
| | - Rinaldo P. Mendes
- Tropical Diseases Area, School of Medicine, São Paulo State University—UNESP, Botucatu, Brazil
| |
Collapse
|
3
|
Ferrisse TM, Rocha AFL, Miotto LN, de Almeida Lança ML, Massucato EMS, Bufalino A. Disseminated Histoplasmosis Infection in HIV-Negative Patients: Series Case and Literature Review. CURRENT FUNGAL INFECTION REPORTS 2021. [DOI: 10.1007/s12281-021-00414-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
4
|
Ito K, Okuno T, Sawada A, Sakai K, Kato Y, Muro K, Yanagita M, Teramoto Y, Yamasaki T, Inoue T, Ogawa O, Kobayashi T. Recurrent Aphthous Stomatitis Caused by Cytomegalovirus, Herpes Simplex Virus, and Candida Species in a Kidney Transplant Recipient: A Case Report. Transplant Proc 2019; 51:993-997. [PMID: 30979493 DOI: 10.1016/j.transproceed.2019.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/20/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Recipients of organ transplants are immunosuppressed and at high risk of oral infection. Oral diseases are often neglected compared with infections of other organs that typically confer higher morbidity. However, severe local symptoms hinder oral intake, decrease quality of life, and are sometimes lethal. Here we describe a case of a 57-year-old woman who developed recurrent aphthous stomatitis after kidney transplantation; the cause of the infection was complex and included cytomegalovirus, herpes simplex virus, and Candida species. Since misdiagnosis of oral diseases impairs patient quality of life and increases morbidity, clinicians should be aware of possible etiologies of oral infections in renal transplant recipients.
Collapse
Affiliation(s)
- K Ito
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - T Okuno
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - A Sawada
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - K Sakai
- Department of Nephrology, Kyoto University Hospital, Kyoto, Japan
| | - Y Kato
- Department of Nephrology, Kyoto University Hospital, Kyoto, Japan
| | - K Muro
- Department of Nephrology, Kyoto University Hospital, Kyoto, Japan
| | - M Yanagita
- Department of Nephrology, Kyoto University Hospital, Kyoto, Japan
| | - Y Teramoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - T Yamasaki
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - T Inoue
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| | - O Ogawa
- Department of Urology, Kyoto University Hospital, Kyoto, Japan.
| | - T Kobayashi
- Department of Urology, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
5
|
Histoplasma and Cytomegalovirus Coinfection of the Gastrointestinal Tract in a Patient with AIDS: A Case Report and Review of the Literature. Diseases 2017; 5:diseases5040030. [PMID: 29292712 PMCID: PMC5750541 DOI: 10.3390/diseases5040030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
Opportunistic infections of the gastrointestinal tract are well-documented complications of patients with acquired immunodeficiency syndrome (AIDS). However, concomitant infection by Histoplasma and cytomegalovirus has been described rarely. We present the case of an HIV patient with a CD4 count of 20 cells/uL who was admitted with odynophagia and weight loss. Endoscopic evaluation revealed ulcerations in the esophagus and colon, and a mass formation in cecum. Histology revealed budding yeasts in the cecum and a transverse colon consistent with Histoplasma. Urine Histoplasma antigen was positive. Esophageal tissue disclosed viral cytopathic changes. Immunostaining was positive for cytomegalovirus in the esophagus and transverse colon. The patient was started on appropriate antifungal and antiviral treatment with complete resolution of his symptoms. To our knowledge, this is the fifth case of Histoplasma and cytomegalovirus co-infection of the gastrointestinal tract in a patient with AIDS. We also review the literature for similar cases in regards to clinical presentation and the type of gastrointestinal involvement.
Collapse
|
6
|
Klein IP, Martins MAT, Martins MD, Carrard VC. Diagnosis of HIV infection on the basis of histoplasmosis-related oral ulceration. SPECIAL CARE IN DENTISTRY 2015; 36:99-103. [PMID: 26597996 DOI: 10.1111/scd.12147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Histoplasmosis is an endemic systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis generally occurs as an opportunistic disease, with dissemination to various organs. Cutaneous involvement is observed in 38% to 85% of cases, with oral mucosal involvement in 30% to 60% of cases. This article describes the case study of a 32-year-old woman who presented an extensive tongue ulcer due to histoplasmosis and had the HIV infection diagnosis based on laboratory tests requested by the dentist.
Collapse
Affiliation(s)
- Isadora Peres Klein
- Master's degree student, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marco Antonio Trevizani Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Vinicius Coelho Carrard
- Assistant professor, Department of Conservative Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
7
|
Mainville GN, Marsh WL, Allen CM. Oral ulceration associated with concurrent herpes simplex virus, cytomegalovirus, and Epstein-Barr virus infection in an immunocompromised patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e306-14. [PMID: 25544404 DOI: 10.1016/j.oooo.2014.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/18/2014] [Accepted: 10/28/2014] [Indexed: 12/01/2022]
Abstract
In immunocompromised patients, oral ulcerations are common and have a wide spectrum of causes, including herpesvirus infection. We report on a case in which an oral ulcer was simultaneously infected by herpes simplex (HSV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) in a kidney-pancreas transplant recipient. A 46-year-old woman presented with a clinically nonspecific dorsal tongue ulcer of 3 months duration. Histopathologic evaluation indicated keratinocytes exhibiting herpetic viral cytopathic effect. Nuclear and cytologic alterations suggestive of CMV infection were found in endothelial cells subjacent to the ulcer. Immunohistochemistry testing for HSV and CMV was positive in these cells. Large atypical mononuclear cells were also evident in the ulcer bed's inflammatory infiltrate, which had intense nuclear positivity for Epstein-Barr encoding region in situ hybridization. We believe this is the first well-documented report of the definitive concomitant presence of HSV, CMV, and EBV in an immunocompromised patient. Although the pathogenesis of coinfected ulcers remains unknown, a synergistic effect is possible.
Collapse
Affiliation(s)
- Gisele N Mainville
- Assistant Professor, Department of Stomatology, Faculté de Médicine Dentaire, Université de Montréal, Montreal, Quebec, Canada.
| | - William L Marsh
- Professor, Department of Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carl M Allen
- Emeritus Professor, Division of Oral and Maxillofacial Pathology and Radiology, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| |
Collapse
|
8
|
Doumas S, Vladikas A, Papagianni M, Kolokotronis A. Human cytomegalovirus-associated oral and maxillo-facial disease. Clin Microbiol Infect 2007; 13:557-9. [PMID: 17403133 DOI: 10.1111/j.1469-0691.2007.01714.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Human cytomegalovirus is a ubiquitous pathogen with protean clinical manifestations. After initial infection, the virus remains in a persistent state in the host. Immunity plays a pivotal role in counteracting its virulence, albeit intermittent virus shedding occurs in immunocompetent individuals. Should deficiencies in immunity occur, e.g., as a consequence of AIDS or iatrogenic immunosuppression, then virus replication and subsequent pathogenic manifestations ensue. In the oral and maxillo-facial region, the virus causes a wide variety of diseases, mainly atypical chronic ulcerations and sialadenitis. These morbidities are rarely reported and sometimes cause significant problems for clinicians.
Collapse
|
9
|
Abstract
OBJECTIVE This study describes the involvement and the histological alterations found in the tongues of 92 autopsied patients who died with AIDS. MATERIALS AND METHODS Sex, age, CD4 cell count and clinical history were obtained from the files of 92 patients who died with AIDS. All the tongues were examined for macroscopical alterations and stained using H&E, Gomori-Grocott, Ziehl-Neelsen, PAS, Brow-Hopps and Mucicarmine. Histological autopsy findings were grouped based on a protocol that was designed following the World Health Organization recommendations. RESULTS The mean age of the patients who died of AIDS and CD4 cell count were 36 years and 82 cells microL(-1), respectively. Histological alterations of the tongues were found in 75% of the cadavers. The most common lesions were hairy leukoplakia (HL) (42 cases), candidosis (31 cases) and non-specific chronic glossitis (29 cases), followed by concomitant lesions (28 cases), non-specific chronic ulceration (17 cases), melanotic pigmentation (13 cases), herpes simplex (10 cases), lymphoepithelial cysts (two cases), cryptococcosis (two cases), mycobacteriosis (one case), histoplasmosis (one case), cytomegalovirus infection (one case) and non-Hodgkin Lymphoma (one case). HL with oral candidosis (n = 13) were the most common concomitant lesions. CONCLUSION These findings indicate that the tongue is a favorite site to occurrence of reactive, infectious and concurrent lesions in the end-stage of AIDS patients.
Collapse
Affiliation(s)
- P R de Faria
- Department of Oral Pathology, Dental School of Piracicaba-UNICAMP, Piracicaba-SP, Brazil
| | | | | | | | | | | |
Collapse
|
10
|
Loeb I, Keiani-Motlagh K, Dargent JL, Hermans P, Van Reck J. [Histoplasmosis of the oral cavity]. ACTA ACUST UNITED AC 2004; 105:215-8. [PMID: 15510072 DOI: 10.1016/s0035-1768(04)72310-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Histoplasmosis is an endemic mycosis. Histoplasma capsulatum, and duboisiï are the pathogenic agents in humans. The disease is reported as endemic in more than 30 countries. Three clinical forms are distinguished; acute, chronic and disseminated. Oral lesions may take on different clinical aspects which are often associated with disseminated histoplasmosis. Disseminated histoplasmosis is frequently diagnosed in immunocompromised hosts. High risk of mortality dictates rapid diagnosis and treatment.
Collapse
Affiliation(s)
- I Loeb
- Service de stomatologie et chirurgie Maxillo-faciale, CHU Saint-Pierre, Bruxelles, Belgique
| | | | | | | | | |
Collapse
|
11
|
Ferreira OG, Cardoso SV, Borges AS, Ferreira MS, Loyola AM. Oral histoplasmosis in Brazil. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:654-9. [PMID: 12142871 DOI: 10.1067/moe.2002.122588] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil. STUDY DESIGN This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases. RESULTS Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence. CONCLUSION Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.
Collapse
|
12
|
Bonifaz A, Cansela R, Novales J, de Oca GM, Navarrete G, Romo J. Cutaneous histoplasmosis associated with acquired immunodeficiency syndrome (AIDS). Int J Dermatol 2000; 39:35-8. [PMID: 10651964 DOI: 10.1046/j.1365-4362.2000.00877.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A Bonifaz
- Dermatology Service and Mycology Department, General Hospital of Mexico, "Centro Dermatológico Pascua," and Infectology Service, General Hospital of Mexico, Mexico City, Mexico
| | | | | | | | | | | |
Collapse
|
13
|
Stanford TW, Rivera-Hidalgo F. Oral mucosal lesions caused by infective microorganisms. II. Fungi and parasites. Periodontol 2000 1999; 21:125-44. [PMID: 10551179 DOI: 10.1111/j.1600-0757.1999.tb00172.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T W Stanford
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA
| | | |
Collapse
|
14
|
|
15
|
Economopoulou P, Laskaris G, Kittas C. Oral histoplasmosis as an indicator of HIV infection. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1998; 86:203-6. [PMID: 9720097 DOI: 10.1016/s1079-2104(98)90126-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Histoplasmosis as a serious opportunistic infection in association with AIDS has assumed considerable importance. We have gathered 20 case reports from the literature of oral histoplasmosis in HIV-infected patients. In some cases, oral lesions appear to be the primary or only manifestation of disease. We report one such case of oral histoplasmosis in a bisexual man who was seen with ulcerations on the palate and proved to be infected by HIV.
Collapse
|
16
|
Angius AG, Viviani MA, Muratori S, Cusini M, Brignolo L, Alessi E. Disseminated histoplasmosis presenting with cutaneous lesions in a patient with acquired immunodeficiency syndrome. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00724.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Casariego Z, Kelly GR, Perez H, Cahn P, Guelfan L, Kaufman S, Scully C. Disseminated histoplasmosis with orofacial involvement in HIV-I-infected patients with AIDS: manifestations and treatment. Oral Dis 1997; 3:184-7. [PMID: 9467363 DOI: 10.1111/j.1601-0825.1997.tb00033.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Histoplasmosis is a deep mycosis which is increasingly seen in HIV disease. It has emerged as a relatively common infection in Argentina, mainly in HIV-infected and other immunocompromised persons, and is often disseminated (DH). OBJECTIVE The aim of this study was to describe 32 HIV-I-seropositive patients with AIDS who had DH, 21 of whom presented orofacial manifestations, and their treatment. SUBJECTS AND METHODS A retrospective study of 876 HIV-seropositive patients revealed 32 with a clinical diagnosis of DH confirmed by special stains on histopathologic specimens, or by culture. RESULTS Thirty-two HIV-infected patients had DH. Two-thirds (21 patients) had oral lesions of histoplasmosis, of which six presented with oral cavity (OC) lesions as the sole orofacial manifestation of disease, nine patients presented oral and facial (OF) lesions and six presented facial lesions only. A unique case of submandibular histoplasmosis is also reported. Antifungal therapy cleared more than 90% of the orofacial and disseminated lesions of histoplasmosis. Over the 7-year period there was a mortality of 85%. CONCLUSION DH should be considered as a possible diagnosis in HIV patients with chronic ulcerative or nodular orofacial or oral lesions. Itraconazole is an effective and acceptable therapy.
Collapse
Affiliation(s)
- Z Casariego
- Department of Infectology, Fernandez Hospital, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
18
|
Flaitz CM, Nichols CM, Hicks MJ. Herpesviridae-associated persistent mucocutaneous ulcers in acquired immunodeficiency syndrome. A clinicopathologic study. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:433-41. [PMID: 8705589 DOI: 10.1016/s1079-2104(96)80019-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Persistent mucocutaneous ulcers in AIDS represent a variety of disease entities. The purpose of this study was to characterize clinicopathologic features of persistent oral ulcers associated with cytomegalovirus and herpes simplex virus in AIDS. Forty-seven persons infected with HIV with persistent ulcers (mean, 2.4 ulcers/person) were included in this study. A biopsy specimen from a representative ulcer was taken from each patient. Hematoxylin-eosin, periodic acid-Schiff, cytomegalovirus, and herpes simplex virus immunocytochemical stains were performed on tissue sections. The most common sites of involvement were the buccal/labial mucosa (27%), tongue (25%), and gingiva (18%). Mean ulcer size was 1.8 cm with a mean duration of 5.6 weeks. The ulcerogenic viral agents were cytomegalovirus alone in 53% of cases, cytomegalovirus and herpes simplex virus coinfection in 28% of cases, and herpes simplex virus alone in 19% of cases. Treatment response to ganciclovir with or without topical steroids resulted in lesion resolution in the cytomegalovirus and cytomegalovirus/herpes simplex virus groups; however, recurrence/resistance was relatively high (23%). Herpes simplex virus/cytomegalovirus ulcers responded to oral acyclovir in combination with systemic ganciclovir. Increasing the oral acyclovir dosage resulted in resolution of herpes simplex virus-only ulcers in all but one case. Cytomegalovirus and herpes simplex virus are associated with persistent mucocutaneous ulcers in AIDS. These lesions responded to systemic antiviral therapy but are difficult to differentiate from other ulcerogenic diseases such as aphthous major, necrotizing stomatitis, and ulcerations not otherwise specified without biopsy and histopathologic examination.
Collapse
Affiliation(s)
- C M Flaitz
- University of Texas-Houston Health Science Center, Bering Service Foundation Dental Clinic, Baylor College of Medicine, Houston, USA
| | | | | |
Collapse
|
19
|
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
|
20
|
Regezi JA, Eversole LR, Barker BF, Rick GM, Silverman S. Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 81:55-62. [PMID: 8850485 DOI: 10.1016/s1079-2104(96)80149-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.
Collapse
Affiliation(s)
- J A Regezi
- School of Dentistry, University of California San Francisco, USA
| | | | | | | | | |
Collapse
|
21
|
Abstract
A 36-year-old man, who was an intravenous drug abuser, developed thoracic herpes zoster, paronychia, oral candidosis, necrotizing gingivitis and bilateral parotid salivary gland swelling. Granulomatous oral lesions and ulceration on the nose were shown to be due to disseminated histoplasmosis.
Collapse
Affiliation(s)
- F J Souza Filho
- Department of Oral Pathology, University of Campinas, Picacicaba-SP, Brazil
| | | | | | | |
Collapse
|
22
|
Krunic A, Calonje E, Jeftovic D, Berger S, Milinkovic M, Lausevic Z, Martinovic N, Kokai D. Primary localized cutaneous histoplasmosis in a patient with acquired immunodeficiency syndrome. Int J Dermatol 1995; 34:558-62. [PMID: 7591438 DOI: 10.1111/j.1365-4362.1995.tb02954.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Krunic
- Department of Dermatology, Medical School, University of Belgrade, Yugoslavia
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Chinn H, Chernoff DN, Migliorati CA, Silverman S, Green TL. Oral histoplasmosis in HIV-infected patients. A report of two cases. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1995; 79:710-4. [PMID: 7621028 DOI: 10.1016/s1079-2104(05)80305-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.
Collapse
Affiliation(s)
- H Chinn
- Division of Oral Medicine, UCSF, USA
| | | | | | | | | |
Collapse
|
24
|
Landry ML. Multiple viral infections in the immunocompromised host: recognition and interpretation. ACTA ACUST UNITED AC 1994; 2:313-21. [PMID: 15566777 DOI: 10.1016/0928-0197(94)90001-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/1993] [Revised: 02/22/1994] [Accepted: 03/02/1994] [Indexed: 11/17/2022]
Abstract
BACKGROUND During the past decade, diagnostic virology has become an integral part of patient management. Concurrent infection with multiple viruses occurs in both the healthy and immunocompromised host. Many common viruses result in latent infection with the potential for reactivation throughout the life of the host. Superimposed on this are transient infections with yet other viruses. OBJECTIVES To review multiple viral infections in immunocompromised hosts, focusing on laboratory recognition and interpretation of results. STUDY DESIGN A review of the literature, with case examples from the author's laboratory. RESULTS Viral infections are more likely to cause morbidity and mortality in immunodeficient hosts, and early recognition and treatment may be lifesaving. To detect two or more viruses shed concurrently from the same body site requires the use of multiple test modalities, which are now available in many clinical laboratories. Establishing the significance of a virus isolate is a complex process. Knowledge of the specimen source, virus quantitation and characteristics of the patient are helpful. Careful evaluation of the patient's clinical findings together with other laboratory test results, including histopathology, X-rays and the detection of other microorganisms, is also essential. CONCLUSIONS The recognition and interpretation of multiple virus infections requires heightened awareness as well as close cooperation and communication between the professionals in the laboratory and physicians at the bedside.
Collapse
Affiliation(s)
- M L Landry
- Clinical Virology Laboratory, Department of Laboratory Medicine, Yale University School of Medicine, New Haven CT, USA
| |
Collapse
|
25
|
Cleveland DB, Miller AS. DIAGNOSTIC LABORATORY AIDS IN ORAL AND MAXILLOFACIAL SURGICAL PATHOLOGY. Oral Maxillofac Surg Clin North Am 1994. [DOI: 10.1016/s1042-3699(20)30760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Porter S, Scully C. HIV: the surgeon's perspective. Part 2. Diagnosis and management of non-malignant oral manifestations. Br J Oral Maxillofac Surg 1994; 32:231-40. [PMID: 7947567 DOI: 10.1016/0266-4356(94)90208-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Porter
- Joint Department of Oral Medicine, Eastman Dental Institute, London
| | | |
Collapse
|
27
|
Rocha MM, Severo LC. Histoplasmose disseminada em pacientes com Síndrome de Imunodeficiência Adquirida (SIDA): estudo de 25 casos. Rev Inst Med Trop Sao Paulo 1994. [DOI: 10.1590/s0036-46651994000200013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
São apresentados 25 casos de histoplasmose disseminada em pacientes com SIDA. O envolvimento mucocutâneo estabeleceu o diagnóstico de histoplasmose disseminada em 68% dos casos. Destacamos a importância da histoplasmose como infecção oportunística em paciente HIV positivo.
Collapse
|
28
|
Itin PH, Lautenschlager S, Flückiger R, Rufli T. Oral manifestations in HIV-infected patients: diagnosis and management. J Am Acad Dermatol 1993; 29:749-60. [PMID: 8227548 DOI: 10.1016/0190-9622(93)70241-k] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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.
Collapse
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Angiomatosis, Bacillary/complications
- Angiomatosis, Bacillary/diagnosis
- Angiomatosis, Bacillary/therapy
- Candidiasis/complications
- Candidiasis/diagnosis
- Candidiasis/therapy
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/therapy
- Female
- Gingivitis/complications
- Gingivitis/diagnosis
- Gingivitis/therapy
- Humans
- Leukoplakia, Hairy/complications
- Leukoplakia, Hairy/diagnosis
- Leukoplakia, Hairy/therapy
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Mouth Diseases/complications
- Mouth Diseases/diagnosis
- Mouth Diseases/therapy
- Mouth Neoplasms/complications
- Mouth Neoplasms/diagnosis
- Mouth Neoplasms/therapy
- Papilloma/complications
- Papilloma/diagnosis
- Papilloma/therapy
- Periodontitis/complications
- Periodontitis/diagnosis
- Periodontitis/therapy
- Salivary Gland Diseases/complications
- Salivary Gland Diseases/diagnosis
- Salivary Gland Diseases/therapy
- Sarcoma, Kaposi/diagnosis
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/therapy
Collapse
Affiliation(s)
- P H Itin
- Department of Dermatology, University of Basel, Switzerland
| | | | | | | |
Collapse
|
29
|
Epstein J, Scully C. Cytomegalovirus: a virus of increasing relevance to oral medicine and pathology. J Oral Pathol Med 1993; 22:348-53. [PMID: 8283400 DOI: 10.1111/j.1600-0714.1993.tb01087.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Human cytomegalovirus (HCMV) is a ubiquitous herpesvirus, emerging as an opportunistic pathogen in immunocompromised persons, particularly those infected with human immunodeficiency viruses (HIV). Clinical syndromes caused by HCMV are usually not specifically identifiable without laboratory investigations. However, it is now apparent that HCMV may cause oral ulceration in immunocompromised persons and it may play a role in other diverse conditions in these and other patients.
Collapse
Affiliation(s)
- J Epstein
- British Columbia Cancer Agency, Division of Oral Medicine & Clinical Dentistry, University of British Columbia, Vancouver, Canada
| | | |
Collapse
|
30
|
Jones AC, Freedman PD, Phelan JA, Baughman RA, Kerpel SM. Cytomegalovirus infections of the oral cavity. A report of six cases and review of the literature. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:76-85. [PMID: 8380493 DOI: 10.1016/0030-4220(93)90410-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cytomegalovirus is responsible for a significant percentage of asymptomatic viral infections worldwide. Although virtually any cell or organ may be infected, involvement of the oral cavity is uncommon. Only nine well-documented examples of intraoral cytomegalovirus infections were found in a review of the English-language literature. We report six additional examples, five of which possessed unique clinical and histopathologic characteristics. The light and electron-microscopic features of cytomegalovirus are discussed, as well as diagnostic adjuncts such as immunohistochemistry and deoxyribonucleic acid in situ hybridization.
Collapse
Affiliation(s)
- A C Jones
- Department of Oral Diagnostic Sciences, University of Florida College of Dentistry, Gainesville
| | | | | | | | | |
Collapse
|