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Doraiswamy M, Pesavento TE, Pandey D, Murali RD, Singh P. Rare oral lesions from cytomegalovirus in kidney transplant. Postgrad Med J 2021; 98:e32. [PMID: 37066583 PMCID: PMC8819655 DOI: 10.1136/postgradmedj-2021-140516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Mohankumar Doraiswamy
- Comprehensive Transplant Center, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Todd E Pesavento
- Comprehensive Transplant Center, Division of Nephrology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Deepali Pandey
- Division of Hematology and Oncology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | - Priyamvada Singh
- Comprehensive Transplant Center, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Nakamura M, Shigeishi H, Cheng-Yih SU, Sugiyama M, Ohta K. Oral human cytomegalovirus prevalence and its relationships with periodontitis and Porphyromonas gingivalis in Japanese adults: a cross-sectional study. J Appl Oral Sci 2020; 28:e20200501. [PMID: 33331391 PMCID: PMC7793530 DOI: 10.1590/1678-7757-2020-00501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to clarify the association between oral human cytomegalovirus (HCMV) and periodontitis in Japanese adults. METHODOLOGY In total, 190 patients (75 men and 115 women; mean age, 70.2 years) who visited Hiroshima University Hospital between March 2018 and May 2020 were included. Oral rinse samples were taken to examine the presence of HCMV DNA using real-time polymerase chain reaction (PCR). P. gingivalis was detected by semi-quantitative PCR analysis. RESULTS HCMV DNA was present in nine of 190 patients (4.7%). There were significant associations between HCMV presence and the presence of ≥4-mm-deep periodontal pockets with bleeding on probing (BOP) (P<0.01) and ≥6-mm-deep periodontal pockets with BOP (P=0.01). However, no significant relationship was observed between HCMV presence and periodontal epithelial surface area scores. Logistic regression analysis revealed that the presence of ≥4-mm-deep periodontal pockets with BOP was significantly associated with HCMV (odds ratio, 14.4; P=0.01). Propensity score matching was performed between patients presenting ≥4-mm-deep periodontal pockets with BOP (i.e., active periodontitis) and patients without ≥4-mm-deep periodontal pockets with BOP; 62 matched pairs were generated. Patients who had ≥4-mm-deep periodontal pockets with BOP showed a higher rate of HCMV presence (9.7%) than those who lacked ≥4-mm-deep periodontal pockets with BOP (0.0%). There was a significant relationship between HCMV presence and ≥4-mm-deep periodontal pockets with BOP (P=0.03). A significant relationship was found between HCMV/P. gingivalis DNA presence and ≥4-mm-deep periodontal pockets with BOP (P=0.03). CONCLUSIONS Coinfection of oral HCMV and P. gingivalis was significantly associated with active periodontitis. Moreover, interactions between oral HCMV and P. gingivalis may be related to the severity of periodontal disease.
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Affiliation(s)
- Mariko Nakamura
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Program of Oral Health Sciences, Department of Public Oral Health, Hiroshima, Japan
| | - Hideo Shigeishi
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Program of Oral Health Sciences, Department of Public Oral Health, Hiroshima, Japan
| | - S U Cheng-Yih
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Program of Oral Health Sciences, Department of Oral Health Management, Hiroshima, Japan
| | - Masaru Sugiyama
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Program of Oral Health Sciences, Department of Public Oral Health, Hiroshima, Japan
| | - Kouji Ohta
- Hiroshima University, Graduate School of Biomedical and Health Sciences, Program of Oral Health Sciences, Department of Public Oral Health, Hiroshima, Japan
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A Case of Cytomegalovirus-Induced Oral Ulcer in an Older Adult Patient with Nephrotic Syndrome due to Membranous Nephropathy. Case Rep Dent 2020; 2020:8843816. [PMID: 33062344 PMCID: PMC7542526 DOI: 10.1155/2020/8843816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/17/2020] [Indexed: 11/21/2022] Open
Abstract
We report a case of cytomegalovirus- (CMV-) induced buccal ulcer in a patient with nephrotic syndrome. An 82-year-old man with membranous nephropathy was on immunosuppressive therapy presented with an ulcer in the oral cavity and was hospitalized. Intraoral examination revealed an inflamed and painful ulcer on the left buccal mucosa. Blood test results showed CMV positivity, and histopathological examination confirmed the diagnosis. Anti-CMV therapy (ganciclovir) was initiated from the third day of hospitalization. However, he developed dyspnea on the 14th day. Computed tomography images of the chest revealed the presence of ground-glass opacities, and noninvasive positive pressure ventilation was initiated under the provisional diagnosis of pneumocystis pneumonia caused by ganciclovir-associated myelosuppression and/or steroid-induced immunocompromised state. The patient died of pneumocystis pneumonia on the 21st day. The patient had received immunosuppressive therapy for renal dysfunction. Immunocompromised patients with CMV infection should be treated with caution, as drugs for CMV may themselves cause myelosuppression, deteriorating the prognosis of the patient.
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Fitzpatrick SG, Cohen DM, Clark AN. Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review. Head Neck Pathol 2019; 13:91-102. [PMID: 30701449 PMCID: PMC6405793 DOI: 10.1007/s12105-018-0981-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 12/24/2022]
Abstract
Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.
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Affiliation(s)
- Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Ashley N Clark
- Department of Diagnostic and Biomedical Sciences, University of Texas at Houston Health Science Center School of Dentistry, Houston, TX, USA
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5
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Human Cytomegalovirus Productively Replicates In Vitro in Undifferentiated Oral Epithelial Cells. J Virol 2018; 92:JVI.00903-18. [PMID: 29848590 DOI: 10.1128/jvi.00903-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 12/12/2022] Open
Abstract
Human cytomegalovirus (HCMV) productive replication in vitro is most often studied in fibroblasts. In vivo, fibroblasts amplify viral titers, but transmission and pathogenesis require the infection of other cell types, most notably epithelial cells. In vitro, the study of HCMV infection of epithelial cells has been almost exclusively restricted to ocular epithelial cells. Here we present oral epithelial cells with relevance for viral interhost transmission as an in vitro model system to study HCMV infection. We discovered that HCMV productively replicates in normal oral keratinocytes (NOKs) and telomerase-immortalized gingival cells (hGETs). Our work introduces oral epithelial cells for the study of HCMV productive infection, drug screening, and vaccine development.IMPORTANCE The ocular epithelial cells currently used to study HCMV infections in vitro have historical significance based upon their role in retinitis, an HCMV disease most often seen in AIDS patients. However, with the successful implementation of highly active antiretroviral therapy (HAART) regimens, the incidence of HCMV retinitis has rapidly declined, and therefore, the relevance of studying ocular epithelial cell HCMV infection has decreased as well. Our introduction here of oral epithelial cells provides two alternative in vitro models for the study of HCMV infection that complement and extend the physiologic relevance of the ocular system currently in use.
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Brondani M, Chang S, Donnelly L. Assessing patients' attitudes to opt-out HIV rapid screening in community dental clinics: a cross-sectional Canadian experience. BMC Res Notes 2016; 9:264. [PMID: 27165490 PMCID: PMC4862228 DOI: 10.1186/s13104-016-2067-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/28/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND As a public health initiative, provided-initiated HIV screening test in dental settings has long been available in the U.S.; it was only in 2011 that such setting was used in Canada. The objective of this paper was to assess patients' response to, and attitudes towards, an opt-out rapid HIV screening test in a dental setting in Vancouver, Canada. METHODS A cross-sectional evaluation design using a self-complete survey questionnaire on self-perceived values and benefits of an opt-out rapid HIV screening was employed. An anonymous 10-item questionnaire was developed to explore reasons for accepting or declining the HIV rapid screening test, and barriers and facilitators for the HIV screening in dental settings. Eligible participants were male and female older than 19 years attending community dental clinics and who were offered the HIV screening test between June 2010 and February 2015. RESULTS From the 1552 age-eligible patients, 519 completed the survey and 155 (10 %) accepted the HIV screening due to its convenience, and/or free cost, and/or instant results. From the 458 respondents who did not accept the screening, 362 (79 %) were between the ages of 25 and 45 years; 246 (53.7 %) had identifiable risk factors for contracting HIV; and 189 (41.3 %) reported having been tested within the last 3 months. Those tested in less than 3 months had 3.5 times higher odds to decline the HIV screening compared to those who have been tested between 3 months and 1 year. CONCLUSIONS Convenience, cost-free and readily available results are factors influencing rapid HIV screening uptake. Although dental settings remain an alternative venue for HIV screening from the patients' perspectives, dental hygiene settings might offer a better option.
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Affiliation(s)
- Mario Brondani
- />Division of Preventive and Community Dentistry, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | | | - Leeann Donnelly
- />Department of Oral and Biomedical Sciences, Dental Hygiene Program, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3 Canada
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Slots J. Periodontal herpesviruses: prevalence, pathogenicity, systemic risk. Periodontol 2000 2015; 69:28-45. [DOI: 10.1111/prd.12085] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 12/13/2022]
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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.
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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
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McNamara KK, Pugalagiri P. Clinicopathologic conference case 4: painful nonhealing oral ulcerations. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:e94-8. [PMID: 25295345 DOI: 10.1016/j.oooo.2014.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bilodeau E, Alawi F, Costello BJ, Prasad JL. Molecular diagnostics for head and neck pathology. Oral Maxillofac Surg Clin North Am 2010; 22:183-94. [PMID: 20159486 DOI: 10.1016/j.coms.2009.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Molecular diagnostic techniques are quickly finding a role in the detection and diagnosis of tumors, and in predicting their behavior. They may also prove useful in developing new therapeutic approaches to head and neck cancer. The surgeon working in the craniomaxillofacial region should have an understanding of these technologies, their availability in various settings, and how they affect various aspects of treatment, particularly in the detection and treatment of malignancies. This article offers an overview of recent advances in molecular diagnostic techniques, with their implications for diagnosis and management of head and neck tumors.
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Affiliation(s)
- Elizabeth Bilodeau
- Department of Oral and Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine, 3501 Terrace Street, Pittsburgh, PA 15261, USA
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12
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López-Pintor R, Hernández G, de Arriba L, Morales J, Jiménez C, de Andrés A. Oral Ulcers During the Course of Cytomegalovirus Infection in Renal Transplant Recipients. Transplant Proc 2009; 41:2419-21. [DOI: 10.1016/j.transproceed.2009.06.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lerman MA, Laudenbach J, Marty FM, Baden LR, Treister NS. Management of oral infections in cancer patients. Dent Clin North Am 2008; 52:129-53, ix. [PMID: 18154868 DOI: 10.1016/j.cden.2007.10.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The myelosuppressive and mucosal-damaging consequences of cancer and cancer therapies place patients at high risk for developing infectious complications. Bacterial, fungal, and viral infections are all commonly encountered in the oral cavity, contributing to both morbidity and mortality in this patient population. Prevention, early and definitive diagnosis, and appropriate management are critical to ensure optimal treatment outcomes. With the majority of cancer patients treated as outpatients in the community setting, oral health care professionals play an important role in managing such infectious complications of cancer therapy.
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Affiliation(s)
- Mark A Lerman
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Epstein JB, Elad S, Eliav E, Jurevic R, Benoliel R. Orofacial pain in cancer: part II--clinical perspectives and management. J Dent Res 2007; 86:506-18. [PMID: 17525349 DOI: 10.1177/154405910708600605] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cancer-associated pain is extremely common and is associated with significant physical and psychological suffering. Unfortunately, pain associated with cancer or its treatment is frequently under-treated, probably due to several factors, including phobia of opioids, under-reporting by patients, and under-diagnosis by healthcare workers. The most common etiology of cancer pain is local tumor invasion (primary or metastatic), involving inflammatory and neuropathic mechanisms; these have been reviewed in Part I. As malignant disease advances, pain usually becomes more frequent and more intense. Additional expressions of orofacial cancer pain include distant tumor effects, involving paraneoplastic mechanisms. Pain secondary to cancer therapy varies with the treatment modalities used: Chemo-radiotherapy protocols are typically associated with painful mucositis and neurotoxicity. Surgical therapies often result in nerve and tissue damage, leading, in the long term, to myofascial and neuropathic pain syndromes. In the present article, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. As a presenting symptom of orofacial cancer, pain is often of low intensity and diagnostically unreliable. Diagnosis, treatment, and prevention of pain in cancer require knowledge of the presenting characteristics, factors, and mechanisms involved.
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Affiliation(s)
- J B Epstein
- Department of Oral Medicine and Diagnostic Sciences, MC-838, College of Dentistry, 801 S. Paulina St., Chicago, IL 60612, USA.
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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.
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Saygun I, Sahin S, Ozdemir A, Kurtiş B, Yapar M, Kubar A, Ozcan G. Detection of human viruses in patients with chronic periodontitis and the relationship between viruses and clinical parameters. J Periodontol 2002; 73:1437-43. [PMID: 12546093 DOI: 10.1902/jop.2002.73.12.1437] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent studies have demonstrated that various human viruses, especially cytomegalovirus (HCMV), Epstein-Barr virus type-1 (EBV-1), and herpes simplex virus (HSV), seem to play a part in the pathogenesis of human periodontitis. Little information is available on the relationship between these viruses and clinical periodontal parameters in patients with chronic periodontitis. This study examined the occurrence of HCMV, EBV-1, and HSV in patients with chronic periodontitis and the relationship between these viruses and clinical parameters. METHODS A nested polymerase chain reaction (PCR) method determined the presence of HCMV, EBV-1, and HSV. Subgingival plaque samples from 30 patients with chronic periodontitis and 21 randomly selected healthy controls were collected by paper points, and clinical measurements were recorded from both sampling sites and entire dentition. The following indices were measured: plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL). RESULTS HCMV was detected in 44.3% of chronic periodontitis patients and 14.3% of healthy persons (P < 0.05); EBV-1 in 16.7% of chronic periodontitis patients and 14.3% of healthy persons (P = 1.00); and HSV in 6.7% of chronic periodontitis patients and in no healthy persons. HCMV and EBV-1 detected and undetected sites in patients with periodontitis showed statistically significant differences in sampling clinical depth (SPD) and sampling clinical attachment loss (SCAL). Differences in the measurements of PI of entire dentition and GI of entire dentition between HSV detected and undetected sites were statistically significant. CONCLUSIONS Findings of the present study confirm the frequent presence of HCMV in crevicular samples of chronic periodontitis lesions, and suggest a strong relationship between the presence of HCMV and EBV-1 in subgingival areas and the measurements of probing depth and probing attachment loss.
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Affiliation(s)
- Işil Saygun
- Gülhane Military Medical Academy, Department of Periodontology, Ankara, Turkey
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Affiliation(s)
- G Laskaris
- Oral Medicine Clinic, University of Athens, A. Sygros Hospital for Skin Disease, Athens, Greece
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18
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Abstract
Oral lesions are important in the clinical spectrum of HIV/AIDS, arousing suspicion of acute seroconversion illness (aphthous ulceration and candidiasis), suggesting HIV infection in the undiagnosed individual (candidiasis, hairy leukoplakia, Kaposi's sarcoma, necrotizing ulcerative gingivitis), indicating clinical disease progression and predicting development of AIDS (candidiasis, hairy leukoplakia), and marking immune suppression in HIV-infected individuals (candidiasis, hairy leukoplakia, necrotizing periodontal disease, Kaposi's sarcoma, long-standing herpes infection, major aphthous ulcers). In addition, oral lesions are included in staging systems for HIV disease progression and as entry criteria or endpoints in clinical trials of antiretroviral drugs. Recognition and management of these oral conditions is important for the health and quality of life of the individual with HIV/AIDS. In keeping with this, the U.S. Department of Health Services Clinical Practice Guideline for Evaluation and Management of Early HIV Infection includes recommendations that an oral examination, emphasizing oral mucosal surfaces, be conducted by the primary care provider at each visit, a dental examination by a dentist should be done at least two times a year, and patients should be informed of the importance of oral care and educated about common HIV-related oral lesions and associated symptoms.
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Affiliation(s)
- L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, USA.
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Rivera-Hidalgo F, Stanford TW. Oral mucosal lesions caused by infective microorganisms. I. Viruses and bacteria. Periodontol 2000 1999; 21:106-24. [PMID: 10551178 DOI: 10.1111/j.1600-0757.1999.tb00171.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Rivera-Hidalgo
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University System, Dallas, USA
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Syrjänen S, Leimola-Virtanen R, Schmidt-Westhausen A, Reichart PA. Oral ulcers in AIDS patients frequently associated with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections. J Oral Pathol Med 1999; 28:204-9. [PMID: 10226942 DOI: 10.1111/j.1600-0714.1999.tb02025.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Oral ulcers are common in AIDS patients, with a wide spectrum of underlying causes, including different viruses. In the present study, the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV) and human herpesvirus-8 (HHV-8) DNA was analysed in 21 biopsies from oral ulcers of 17 male homosexual AIDS patients. The methods used were in situ hybridization (ISH) and the polymerase chain reaction (PCR) with subsequent non-radioactive Southern blot hybridization to confirm the specificity of PCR products. With ISH, 4 biopsies were CMV DNA-positive and 11 contained EBV-DNA. Using PCR, an additional 4 CMV- and 7 EBV-positive samples were detected, and HHV-8 DNA was present in three oral ulcers. Six of the patients (35%) had oral ulcers co-infected by two or three viruses. The overall figures for patients with the detectable EBV-, CMV-, and HHV-8 DNA were 82% (14/17), 35% (6/17) and 18% (3/17), respectively. This is the first study to show the frequent presence of EBV-DNA in oral ulcers of AIDS patients. Because ISH-positivity signifies active virus replication, these results implicate an etiological role of EBV in AIDS-associated oral ulcers. The causal role of HHV-8 has to be considered as well, because this virus was detected in three such ulcers, which were not associated with Kaposi's sarcoma. To conclude, three common members of the herpesvirus family (CMV, EBV, HHV-8) were detected in all but three ulcers in AIDS patients, warranting the inclusion of these viral analyses in the diagnosis of ulcerative lesions of the oral mucosa in all immunosuppressed individuals.
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Affiliation(s)
- S Syrjänen
- Department of Oral Pathology and Radiology, Faculty of Medicine, University of Turku, Finland
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22
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Barr CE, Glick M. Diagnosis and Management of Oral and Cutaneous Lesions in HIV-1 Disease. Oral Maxillofac Surg Clin North Am 1998. [DOI: 10.1016/s1042-3699(20)30340-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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]
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Mirowski GW, Bettencourt JD, Hood AF. Oral infections in the immunocompromised host. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 1997; 16:249-56. [PMID: 9421215 DOI: 10.1016/s1085-5629(97)80013-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The prevalence of infections in the immunocompromised host is increasing. The oral cavity is a primary or sole site in many cases. It is important for the practicing clinician to recognize the more common infections in this growing patient population. Oral examinations are an essential component of all physical examinations, especially when immunosuppression is known or suspected. We recommend that all patients starting immunosuppressive therapy receive a comprehensive oral examination before the institution of such therapy to eliminate potential sources of oral and odontogenic infections. The examination should include full mouth dental radiographs and a complete soft-tissue examination. Timely, accurate diagnoses may have important implications with regard to management, prognosis, cost, morbidity, and mortality.
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Affiliation(s)
- G W Mirowski
- Dept of Oral Surgery, Medicine and Pathology, Indiana University School of Dentistry, Indianapolis 46202-6267, USA
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Abstract
Specific pathologic processes, particularly oral, esophageal, and intestinal infections, are common in the alimentary tract of AIDS patients. Many of these diseases are adequately assessed only by biopsy with histologic examination. Most are rare or unreported in immunocompetent hosts and are easily missed by those not familiar with them. This article describes the gross or endoscopic and histologic appearances and the diagnostic criteria for enteric pathologic processes seen in HIV-infected individuals.
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26
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Abstract
This article includes the oral manifestations which have been reported to be associated with human immunodeficiency virus (HIV) infection. The clinical appearance, diagnostic criteria and treatment of fungal, viral and bacterial infections, neoplasms and lesions of uncertain etiology are described. Accurate diagnosis of the oral lesions is important in the management of patients infected with HIV. Identification of oral lesions may suggest the need for HIV testing or may be an indicator for preventive intervention. Early identification, diagnosis and treatment may prevent extensive tissue destruction and may improve the quality of life for HIV-infected patients.
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Affiliation(s)
- J A Phelan
- Department of Veterans Affairs Medical Center, Northport, New York, USA
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27
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Abstract
A prior investigation has demonstrated a higher prevalence of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) in subgingival specimens from periodontitis patients than from gingivitis patients. This study aimed to determine the frequency of HCMV, EBV-1, EBV-2, herpes simplex virus (HSV) and human immunodeficiency virus (HIV) in subgingival samples from 27 adults who each contributed both a periodontitis and a gingivitis site. Viral detection was performed using a nested-polymerase chain reaction method. Twenty-four subjects (89%) yielded at least one of the five test viruses from deep periodontal pockets, whereas only 15 (56%) showed viruses from shallow periodontal sites (P = 0.015; chi-square test). Viral co-infection occurred more frequently in deep than in shallow periodontal sites (P = 0.015). HCMV was detected with higher frequency in deep than in shallow periodontal sites (P = 0.023). The possible periodontopathogenic mechanisms of mammalian viruses in human periodontitis are discussed. The role and importance of HCMV and other mammalian viruses in the initiation and progression of destructive periodontal disease merits further investigation.
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Affiliation(s)
- A Contreras
- Department of Periodontology, School of Dentistry, University of Southern California, Los Angeles 90089-0641, USA
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28
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Abstract
Recurrent aphthous ulcers, or RAU--also called canker sores--are among the oral mucosal conditions that dentists and physicians see most commonly in their patients. Several systemic conditions are associated with oral aphthouslike ulcers, and aphthae themselves often are mistaken for recrudescent oral herpes simplex virus, or HSV, infections. This article will review RAU, describe systemic conditions associated with aphthous-like ulcerations and discuss the differences between RAU and recrudescent oral HSV infections.
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Affiliation(s)
- S B Woo
- Harvard School of Dental Medicine, Boston, USA
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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.
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Affiliation(s)
- S Piluso
- Institute of Stomatology, University of Florence
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30
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 14-1996. A 66-year-old woman with toxic epidermal necrolysis and a fatal course. N Engl J Med 1996; 334:1254-61. [PMID: 8606722 DOI: 10.1056/nejm199605093341908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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31
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Sun A, Chang JG, Kao CL, Liu BY, Wang JT, Chu CT, Yuan JH, Chiang CP. Human cytomegalovirus as a potential etiologic agent in recurrent aphthous ulcers and Behçet's disease. J Oral Pathol Med 1996; 25:212-8. [PMID: 8835817 DOI: 10.1111/j.1600-0714.1996.tb01374.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In a preliminary study on anti-human cytomegalovirus (HCMV) antibody (Ab) by ELISA, the serum anti-HCMV/IgG Ab concentrations in 22 patients with recurrent aphthous ulcers (RAU) in the remission stage were found to be significantly higher than in 22 control subjects (121 +/- 42 vs 100 +/- 27, P < 0.05) and in 39 patients with RAU in the active stage (121 +/- 42 vs 88 +/- 45, P < 0.01). Therefore, the potential of HCMV as an etiologic agent in RAU was proposed and studies using the polymerase chain reaction (PCR) and in situ hybridization (ISH) have been performed to investigate the possible presence of HCMV DNA in pre-ulcerative oral aphthous lesions in patients with RAU or Behçet's disease (BD) of the mucocutaneous type. For this purpose, formalin-fixed biopsy specimens were obtained from 13 pre-ulcerative oral aphthous lesions, 2 samples of normal oral mucosa and 1 ileal mucosal lesion from 9 RAU patients and 4 BD patients. Five specimens of normal oral mucosa from 5 normal control subjects and 12 specimens of oral erosive or ulcerative lesions from 12 patients with erosive lichen planus (ELP) were also included. By PCR, HCMV DNA was detected in 5 of the 13 (38.5%) pre-ulcerative oral aphthous lesions, 3 from RAU patients and 2 from BD patients. The ileal mucosa specimen was also HCMV DNA-positive, whereas HCMV DNA was not demonstrated in any of the 7 specimens of normal oral mucosa from RAU patients and normal control subjects; 12 specimens of oral lesions from ELP patients were similarly negative. ISH did not detect HCMV DNA in any of the biopsy specimens from RAU patients and control subjects. Our findings suggest that HCMV may be an etiologic agent in some cases of RAU and BD.
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Affiliation(s)
- A Sun
- School of Dentistry, National Taiwan University, Taipei, Taiwan, ROC
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32
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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.
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Affiliation(s)
- C M Flaitz
- University of Texas-Houston Health Science Center, Bering Service Foundation Dental Clinic, Baylor College of Medicine, Houston, USA
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33
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Abstract
Human herpesviruses and human papillomaviruses are ubiquitous and may cause an array of oral disease. Herpesviruses are unique because recurrent localized disease occurs after the primary infection. Human papillomaviruses are known for their ability to produce benign epithelial proliferations and increasingly are implicated in the development of oral cancer. This article reviews the pathogenesis of common oral lesions induced by these viruses.
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Affiliation(s)
- C S Miller
- Department of Oral Health Science, University of Kentucky College of Dentistry, Lexington, USA
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34
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Abstract
Oral lesions are common in HIV infection and may be the first sign of AIDS. This article reviews the oral fungal and viral infections commonly detected in HIV-infected patients, particularly candidiasis, deep fungal infections, herpes simplex virus infections, cytomegalovirus infections, and oral hairy leukoplakia. The neoplasms associated with AIDS such as oral Kaposi's sarcoma and lymphoma are related periodontal diseases. Each disorder is discussed by clinical appearance, diagnosis, and management. Recent advances in therapy are stressed.
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Affiliation(s)
- M S Greenberg
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, USA
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35
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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
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36
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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.
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Affiliation(s)
- J A Regezi
- School of Dentistry, University of California San Francisco, USA
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37
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Leimola-Virtanen R, Happonen RP, Syrjänen S. Cytomegalovirus (CMV) and Helicobacter pylori (HP) found in oral mucosal ulcers. J Oral Pathol Med 1995; 24:14-7. [PMID: 7722916 DOI: 10.1111/j.1600-0714.1995.tb01123.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The possible involvement of Cytomegalovirus (CMV) and Helicobacter pylori (HP) in oral mucosal ulcers is suggested by their role in the development of ulceration at other mucosal sites of the gastrointestinal tract. A series of 29 incisional biopsies from 29 consecutive and apparently immunocompetent patients attending the clinic for oral ulceration were examined by routine histopathology as well as by in situ hybridisation (ISH) with biotinylated CMV and HP DNA probes. In 14/29 biopsies, Giemsa staining disclosed spiral bacteria. Six (20.7%) of these 14 Giemsa-positive samples showed HP DNA on ISH and 3 ulcers (10.3%) contained CMV DNA. In none of the specimens were CMV and HP detected simultaneously. Two of the ulcers containing CMV DNA were found on the labial mucosa and one on the posterior palatal mucosa, whereas all HP DNA-positive ulcers were located on the buccal mucosa. The results indicate that CMV and HP DNA can be found in separate oral mucosal ulcers in apparently immunocompetent adults.
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38
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Firth NA, Rich AM, Reade PC. Oral mucosal ulceration due to cytomegalovirus associated with human immunodeficiency virus infection. Case report and brief review. Aust Dent J 1994; 39:273-5. [PMID: 7811201 DOI: 10.1111/j.1834-7819.1994.tb05560.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Reports of oral lesions associated with cytomegalovirus (CMV) infection in human immunodeficiency virus (HIV) infected patients are uncommon. In this article a case of CMV infection associated with oral mucosal ulceration and a brief review of the subject is presented. Establishing the cause of ulceration is important in determining a definitive diagnosis and prescribing appropriate therapy. It is important to recognize that CMV associated oral mucosal ulceration may be the initial manifestation of human immunodeficiency virus (HIV) infection.
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39
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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]
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40
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LeVeque FG, Ratanatharathorn V, Dan ME, Orville B, Coleman DN, Turner S. Oral cytomegalovirus infection in an unrelated bone marrow transplantation with possible mediation by graft-versus-host disease and the use of cyclosporin-A. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 77:248-53. [PMID: 8170655 DOI: 10.1016/0030-4220(94)90293-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Graft-versus-host disease remains as a significant sequela in allogeneic bone marrow transplantation patients. Reports of oral presentations of cytomegalovirus infection in this patient population are rare. Although the usual manifestation of oral cytomegalovirus is mucosal ulceration, we report a case that we believe reflects a dynamic among graft-versus-host disease, cytomegalovirus, and the use of cyclosporin A, commonly used as an immunosuppressive agent in bone marrow transplantation.
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41
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Flaitz CM, Hicks MJ, Nichols CM. Cytomegaloviral infection of the mandible in acquired immunodeficiency syndrome. J Oral Maxillofac Surg 1994; 52:305-8. [PMID: 8308632 DOI: 10.1016/0278-2391(94)90307-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C M Flaitz
- Department of Oral Diagnostic Sciences, University of Texas Health Science Center Dental Branch, Houston 77225-0068
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42
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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.
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Affiliation(s)
- J Epstein
- British Columbia Cancer Agency, Division of Oral Medicine & Clinical Dentistry, University of British Columbia, Vancouver, Canada
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