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Mourad WF, Patel S, Young R, Khorsandi AS, Concert C, Shourbaji RA, Ciarrocca K, Bakst RL, Shasha D, Guha C, Garg MK, Hu KS, Kalnicki S, Harrison LB. Management algorithm for HIV-associated parotid lymphoepithelial cysts. Eur Arch Otorhinolaryngol 2016; 273:3355-62. [PMID: 26879995 DOI: 10.1007/s00405-016-3926-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
Abstract
We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control (p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control (p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands.
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Affiliation(s)
- Waleed F Mourad
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA. .,Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA.
| | - Shyamal Patel
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA.,Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Rebekah Young
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Azita S Khorsandi
- Department of Radiology, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Catherine Concert
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Rania A Shourbaji
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Katherine Ciarrocca
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Daniel Shasha
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Louis B Harrison
- Department of Radiation Oncology, Mount Sinai Beth Israel Medical Center, 10 Union Square East, Suite 4G, New York, NY, 10003, USA
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da Silva Rath IB, Beltrame APCA, Carvalho AP, Schaeffer MB, Almeida ICS. HIV-associated salivary gland disease--clinical or imaging diagnosis? Int J Paediatr Dent 2015; 25:233-8. [PMID: 25187268 DOI: 10.1111/ipd.12133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This work aimed at studying the salivary gland disease (SGD) as it relates to associated factors, such as persistent generalised lymphadenopathy (PGL), lymphocytic interstitial pneumonia (LIP), clinical and immunological features of AIDS, and salivary flow rate and pH, as well as at exploring the relationship between the clinical diagnosis and the imaging diagnosis by ultrasound (US) examination of the parotid glands. METHODS Information regarding the observation of parotid gland enlargement, PGL, LIP, and clinical and immunological features of AIDS was gathered from medical records, and a saliva sample for unstimulated salivary flow rate and pH measurement was collected from 142 children aged 3 through 10 years treated at the Department of Infectious Diseases of Joana de Gusmão Children's Hospital, Florianópolis, SC, Brazil. High-resolution ultrasonography was performed in 58 children. Pearson's chi-square test and t-test were used to evaluate the association between the variables. RESULTS A significant association was found between SGD and LIP. Ultrasound revealed a 50% higher incidence of SGD that was not reported in the patients' records. CONCLUSION US examination proved to be essential for the correct diagnosis and monitoring of the progression of HIV/SGD.
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Affiliation(s)
| | | | - Aroldo P Carvalho
- Department of Infectious Diseases, Joana de Gusmão Hospital for Children, Florianópolis, Brazil
| | | | - Izabel C S Almeida
- Department of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
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Syebele K, Munzhelele TI. Oral mucocele/ranula: Another human immunodeficiency virus-related salivary gland disease? Laryngoscope 2014; 125:1130-6. [PMID: 25446909 DOI: 10.1002/lary.25058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2014] [Accepted: 11/05/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe clinical characteristics of oral mucoceles/ranulas, with a focus on human immunodeficiency virus (HIV)-related salivary gland diseases. STUDY DESIGN A descriptive and clinical study, with review of patient data. MATERIAL AND METHODS We reviewed 113 referred cases of oral mucocele. The following anatomical sites were identified: lip, tongue, and floor of the mouth (simple ranulas), as well as plunging ranulas. The age and gender data of the patients with oral mucoceles were recorded. The HIV status of the patients and other information were reviewed. RESULTS There were 30 (26.5%) males and 83 (73.5%) females. Most patients were below 30 years of age, with the peak frequency in the first and second decade. Ranula (simple and plunging) represented 84.1% of the mucocele locations. Mucocele on the lips represented 10.6%. Seventy-two (63.7%) patients were HIV positive; and 97.2% of them had ranulas. Thirty-eight (33.6%) patients presented with plunging ranulas; and 92.1% of them were HIV positive, compared with two patients presenting with plunging ranulas in the HIV-negative group. These results strongly suggest that an HIV-positive patient is statistically (P < 0.001) more at risk of presenting with not only a simple, but also a plunging ranula type. CONCLUSION This study presents a different clinical picture of oral mucoceles/ranulas, as observed in HIV-positive patients. Additionally, it suggests a possible clinical link between the two pathologies. The authors strongly support the suggestion that oral mucocele/ranula is an HIV-related salivary gland disease. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Kabunda Syebele
- Department of Maxillo-Facial and Oral Surgery, University of Pretoria, South Africa
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Mourad WF, Hu KS, Shourbaji RA, Lin W, Harrison LB. Radiation therapy for benign lymphoepithelial cysts of parotid glands in HIV patients. Laryngoscope 2013; 123:1184-9. [DOI: 10.1002/lary.23878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Waleed F. Mourad
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Kenneth S. Hu
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Rania A. Shourbaji
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Wilson Lin
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
| | - Louis B. Harrison
- Department of Radiation Oncology; Beth Israel Medical Center; New York; New York; U.S.A
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Jeffers L, Webster-Cyriaque JY. Viruses and salivary gland disease (SGD): lessons from HIV SGD. Adv Dent Res 2011; 23:79-83. [PMID: 21441486 DOI: 10.1177/0022034510396882] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Viral infections are often associated with salivary gland pathology. Here we review the pathogenesis of HIV-associated salivary gland disease (HIV-SGD), a hallmark of diffuse infiltrative lymphocytosis syndrome. We investigate the presence and contributions of viral diseases to the pathogenesis of salivary gland diseases, particularly HIV-SGD. We have detected BK viral shedding in the saliva of HIV-SGD patients consistent with viral infection and replication, suggesting a role for oral transmission. For further investigation of BKV pathogenesis in salivary glands, an in vitro model of BKV infection is described. Submandibular (HSG) and parotid (HSY) gland salivary cell lines were capable of permissive BKV infection, as determined by BKV gene expression and replication. Analysis of these data collectively suggests the potential for a BKV oral route of transmission and salivary gland pathogenesis within HIV-SGD.
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Affiliation(s)
- L Jeffers
- School of Dentistry, Department of Dental Ecology, University of North Carolina at Chapel Hill, NC, USA.
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Krishnamurthy J, Manjula, Gowdanakatte MC, Gubanna MV. Lymphoepithelial cyst - A sign of unappreciated HIV infection. Indian J Sex Transm Dis AIDS 2011; 32:60-2. [PMID: 21799583 DOI: 10.4103/0253-7184.81263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Comparative study of the effect of antiretroviral therapy on benign lymphoepithelial cyst of parotid glands and ranulas in HIV-positive patients. ACTA ACUST UNITED AC 2011; 111:205-10. [DOI: 10.1016/j.tripleo.2010.09.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 01/08/2023]
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Abstract
The authors review the clinical presentation, diagnostic evaluation, and treatment modalities for salivary gland enlargement in an HIV-infected population. Because this can occasionally be the presenting clinical symptom of HIV infection, it is important for the oral/maxillofacial surgeon to diagnose and manage HIV salivary gland enlargement.
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Affiliation(s)
- Rabie M Shanti
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, 110 Bergen Street, Newark, NJ 07103, USA
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Leao JC, Ribeiro CMB, Carvalho AAT, Frezzini C, Porter S. Oral complications of HIV disease. Clinics (Sao Paulo) 2009; 64:459-70. [PMID: 19488613 PMCID: PMC2694251 DOI: 10.1590/s1807-59322009000500014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 02/18/2009] [Indexed: 12/13/2022] Open
Abstract
Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.
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Affiliation(s)
- Jair C Leao
- Departamento de Clinica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife, PE, Brazil.
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Abstract
HIV infection affects residents of all countries of the world, but the greater majority of affected individuals reside in the developing world. In the past decade there have been substantial changes in the management of HIV disease, particularly the introduction of highly active antiretroviral therapy (HAART). Such agents have reduced significantly the morbidity and mortality associated with HIV disease, however, they are not available for most HIV-infected individuals in the developing world. There is now considerable understanding of the molecular epidemiology, transmission and therapy of the common opportunistic oral infections of HIV disease, and as a consequence of improved anti-HIV strategies, the frequency and severity of oral disease associated with HIV infection have reduced considerably, although HAART may predispose to human papilloma virus infection of the mouth and potentially increase the risk of later oral squamous cell carcinoma. Despite advances in clinical care the majority of individuals with HIV disease worldwide will continue to develop oral disease, as they are resident in the developing world and do not have ready access to even simple therapies.
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Affiliation(s)
- Cristina Frezzini
- Oral Medicine Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, London, UK
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Walls T, Shingadia D. Bilateral parotid abscesses in an HIV-infected child caused by Streptococcus pneumoniae. J Paediatr Child Health 2004; 40:481-2. [PMID: 15265193 DOI: 10.1111/j.1440-1754.2004.00435.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- T Walls
- Academic Department of Child Health, Royal London Hospital, Whitechapel, England.
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Rivera H, Nikitakis NG, Castillo S, Siavash H, Papadimitriou JC, Sauk JJ. Histopathological analysis and demonstration of EBV and HIV p-24 antigen but not CMV expression in labial minor salivary glands of HIV patients affected by diffuse infiltrative lymphocytosis syndrome. J Oral Pathol Med 2003; 32:431-7. [PMID: 12846790 DOI: 10.1034/j.1600-0714.2003.00061.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The diffuse infiltrative lymphocytosis syndrome (DILS) in HIV patients is characterized by the persistence of CD8-circulating lymphocytes and lymphocytic infiltration, predominantly in salivary glands. METHODS We examined seven HIV-positive patients with bilateral parotid enlargement and sicca symptoms. Minor labial salivary gland biopsies were performed in all patients and submitted for histopathological analysis and immunohistochemistry for CD4, CD8, cytomegalovirus (CMV), LMP-EBV protein, and HIV p-24 protein. RESULTS In all cases, lymphocytic infiltration of the minor salivary glands, mainly periductal, was found. Acinar atrophy, ductal ectasia, and mild to moderate fibrosis were also observed. We noticed strong immunohistochemical reaction for LMP-EBV and p-24 proteins in ductal cells in all cases, while staining for CMV was consistently negative. The lymphocytes were positive for CD8, but consistently negative for CD4. CONCLUSIONS A role of Epstein-Barr virus (EBV) and HIV, but not CMV, in the pathogenesis of DILS, is suggested by our immunohistochemical findings.
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Affiliation(s)
- Helen Rivera
- Faculty of Dentistry, Central University of Venezuela, Venezuela
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Mandel L, Surattanont F. Regression of HIV parotid swellings after antiviral therapy: case reports with computed tomographic scan evidence. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:454-9. [PMID: 12374919 DOI: 10.1067/moe.2002.126025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Parotid swellings have been noted in approximately 5% to 10% of patients with HIV-1. These swellings are a result of lymphoproliferative activity or lymphoepithelial cyst formation in response to a viral parotid presence. Two patients with cosmetic concerns regarding parotid swellings are presented before and after antiviral therapy. Regression of the swellings after treatment is substantiated with clinical photographs and computerized tomographic scans. The successful outcome was a reflection of a diminution in viral load and some degree of immune restoration.
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Affiliation(s)
- Louis Mandel
- Salivary Gland Center, Columbia University School of Dental and Oral Surgery, New York, NY 10032, USA
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Capaccio P, Monforte AD, Moroni M, Ottaviani F. Salivary stone lithotripsy in the HIV patient. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:525-7. [PMID: 12075199 DOI: 10.1067/moe.2002.122343] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the use of shock-wave lithotripsy in the treatment of salivary gland disease in HIV-positive patients. STUDY DESIGN Four patients infected with human immunodeficiency virus with ultrasonographically confirmed sialolithiasis (three male patients, mean age 33.5 years, range 19-41 years) were treated with extracorporeal electromagnetic shock-wave lithotripsy. RESULTS All but one of the patients were successfully treated or experienced relief, with complete stone clearance demonstrated by ultrasonography 12 months after lithotripsy. CONCLUSION Extracorporeal shock-wave lithotripsy is a safe, effective and minimally invasive technique for the nonsurgical treatment of HIV-positive patients with sialolithiasis.
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Campisi G, Pizzo G, Milici ME, Mancuso S, Margiotta V. Candidal carriage in the oral cavity of human immunodeficiency virus-infected subjects. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:281-6. [PMID: 11925537 DOI: 10.1067/moe.2002.120804] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to assess asymptomatic oral carriage of Candida species and relative density in human immunodeficiency virus-infected (HIV+) subjects, as well as to determine whether yeast carriage is associated with CD4+ cell count, HIV-1 RNA quantity, gender, route of HIV transmission, antiretroviral therapy, or smoking. STUDY DESIGN A cross-sectional analysis of oral rinses from HIV+ and healthy subjects was undertaken. Oral candidal carriage and relative species were investigated in 42 HIV+ and 41 healthy individuals, all of whom were seen at the Palermo University Department of Oral Sciences, Italy. Data were managed and analyzed by means of the computer software package StatView 5.0.1. RESULTS Carriage rate was 61.9% and 29.3% (P =.003) among HIV+ and healthy subjects, respectively. Similarly, density carriage in the HIV+ group was found to be significantly higher than in the control group (P = .0002). Among HIV+ subjects, Candida carriage was significantly associated with smoking, whereas density was not. Oral candidal carriage and relative density were not significantly associated with the other 4 parameters evaluated. Candida albicans was the most frequently recovered species. CONCLUSIONS Asymptomatic candidal carriage and relative density were found to be significantly higher in the oral cavity of HIV+ subjects-but not associated with CD4+ counts or HIV-1 RNA quantities.
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Affiliation(s)
- Giuseppina Campisi
- Department of Oral Sciences, Section of Oral Medicine, University of Palermo, Italy.
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Mandel L, Surattanont F. Bilateral parotid swelling: a review. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:221-37. [PMID: 11925529 DOI: 10.1067/moe.2002.121163] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Louis Mandel
- Salivary Gland Center, Columbia University School of Dental and Oral Surgery, New York-Presbyterian Hospital, Columbia Campus, New York, NY 10032, USA
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Younai FS, Marcus M, Freed JR, Coulter ID, Cunningham W, Der-Martirosian C, Guzman-Bercerra N, Shapiro M. Self-reported oral dryness and HIV disease in a national sample of patients receiving medical care. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 92:629-36. [PMID: 11740480 DOI: 10.1067/moe.2001.117816] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to analyze the relationship between self-reported oral dryness and the demographic, enabling, behavioral, clinical, and treatment characteristics among human immunodeficiency virus (HIV)-positive patients in medical care. STUDY DESIGN The study group consisted of the HIV Cost and Services Utilization Study cohort, a nationally representative probability sample of HIV-infected adults receiving medical care in the contiguous United States. RESULTS It was estimated that 29% of adults (64,947 individuals) with HIV infection receiving medical care in the United States have a complaint of dry mouth. A multivariate logistic analysis was carried out to explore the association between several covariates and dry mouth. It was shown that compared with whites, individuals of Hispanic ethnic origin were 61% more likely to report dry mouth (OR, 1.61; 95% CI, 1.04-2.50; P =.04). Those who were unemployed were 55% more likely to report the symptom of dry mouth than were subjects who were employed (OR, 1.55; 95% CI, 1.22-1.98; P =.001). In comparison with nonsmokers, current smokers were 36% more likely to report dry mouth (OR, 1.36; 95% CI, 1.04-1.79;P =.03). The use of antidepressant drugs and antituberculosis/anti-Mycobacterium avium (anti-TB/anti-MAC) medications had the strongest association with dry mouth complaint. Those taking antidepressants were 55% more likely to report dry mouth (OR, 1.55; 95% CI, 1.23-1.97; P =.0001); compared with nonusers, patients receiving anti-TB/MAC drugs were 46% more likely to report dry mouth (OR, 1.46; 95% CI, 1.03-2.06; P =.04]. In comparison with those with undetectable viral load, individuals with a viral load of more than 100,000/mm(3) were 151% more likely to report dry mouth (OR, 2.51; 95% CI,1.58-3.96; P =.0001). CONCLUSIONS Our findings suggest that optimizing viral suppression, smoking cessation, and tailoring antidepressant and anti-TB/MAC medications may be promising interventions to decrease dry-mouth symptoms among HIV-infected individuals.
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Affiliation(s)
- F S Younai
- Section of Oral Biology and Medicine, School of Dentistry, University of California, Los Angeles 90095-1668, USA.
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Zeller V, Charlois C, Duvivier C, Bricaire F, Katlama C. Pseudo-Primary Infection Syndrome following Discontinuation of Antiretroviral Therapy. Antivir Ther 2001. [DOI: 10.1177/135965350100600305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a retroviral rebound syndrome associated with parotid gland enlargement in a chronically HIV-infected man.
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Affiliation(s)
- Valérie Zeller
- Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cécile Charlois
- Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claudine Duvivier
- Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France
| | - François Bricaire
- Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France
| | - Christine Katlama
- Département des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris, France
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Abstract
PURPOSE This study aimed to determine the role that ultrasound might play in evaluating parotid swellings in patients with human immunodeficiency virus (HIV)-1 disease. PATIENTS AND METHODS The parotid glands of 13 HIV-positive patients, who were previously diagnosed as seropositive and who were referred because they had unilateral or bilateral parotid gland swellings, were examined sonographically. RESULTS All patients showed multiple and varied parotid sonolucent areas bilaterally. These patterns reflected the presence of lymphoepithelial cysts, intraparotid lymphadenopathies, and parenchymal lymphoproliferation. CONCLUSION Because parotid swellings can represent early clinical evidence of HIV disease, comprehensive gland evaluation is mandatory. Ultrasound offers a simple, rapid imaging technique to ascertain the nature of the glandular pathology.
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Affiliation(s)
- L Mandel
- Salivary Gland Center, School of Dental and Oral Surgery, Columbia University, New York Presbyterian Hospital, NY 10032, USA
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McArthur CP, Subtil-DeOliveira A, Palmer D, Fiorella RM, Gustafson S, Tira D, Miranda RN. Characteristics of salivary diffuse infiltrative lymphocytosis syndrome in West Africa. Arch Pathol Lab Med 2000; 124:1773-9. [PMID: 11100056 DOI: 10.5858/2000-124-1773-cosdil] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence of diffuse infiltrative lymphocytosis syndrome (DILS) in the minor salivary glands of 30 African Cameroonian adults with the acquired immunodeficiency syndrome (AIDS). DESIGN Salivary gland tissue was analyzed using a modified classification system that was developed to aid the diagnosis of Sjögren syndrome. The advantages and disadvantages of this approach are discussed. MATERIALS AND METHODS Formalin-fixed, paraffin-embedded, hematoxylin-eosin-stained biopsy sections were prepared for 30 patients with AIDS, 26 healthy individuals who declined human immunodeficiency virus (HIV) testing, and 4 seronegative healthy controls. Tissues were immunostained for CD4/CD8+ lymphocytes and cytomegalovirus (CMV), and transmission electron microscopy was performed to locate viral particles. Patients were tested for HIV-1 and HIV-2 by the HIV/Chek System 3 or CAMSTIX-HIV-1 and HIV-2 assay. RESULTS Severe salivary ductal atypia (96%) was the feature most strongly associated with AIDS, and the lymphocytic focus score was the second histologic feature most strongly correlated with AIDS. Forty-eight percent of patients with HIV-1 infection had more than 1 lymphocytic focus in a minor salivary gland. These lymphocytes were primarily CD8+. We report, to the best of our knowledge, the first case of multinucleated salivary duct epithelial cells in minor salivary glands also containing enveloped virus particles. All cases were negative for CMV. CONCLUSIONS The prevalence of DILS in West Africans with AIDS appears higher than the prevalence reported in whites from the United States and Europe and in blacks from the United States, a group that has been reported to have a greater incidence of DILS than whites. This discrepancy may be related to differences in patient selection criteria. The determination of lymphocytic focus score, as used in the diagnosis of Sjögren syndrome, with the adjunct of ductal atypia is useful for assessing DILS. The impact of patient selection, drug therapy, and parasites on salivary gland pathology is discussed.
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Affiliation(s)
- C P McArthur
- Department of Pathology, Truman Medical Center, Kansas City, MO 64108, USA.
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Affiliation(s)
- J W Casiglia
- Harvard School of Dental Medicine, Boston, MA 02115, USA
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22
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Abstract
BACKGROUND Patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment.
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Affiliation(s)
- L Mandel
- Columbia University School of Dental and Oral Surgery, New York-Presbyterian Hospital, N.Y. 10032, USA
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23
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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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24
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Abstract
BACKGROUND An outstanding feature of the diffuse infiltrative lymphocytosis syndrome, or DILS, a subset of HIV-1 disease, is asymptomatic bilateral parotid swelling. Recognition of the entity is important because people with this disease will seek routine dental care. CASE DESCRIPTION The authors present a classic case of DILS. The patient exhibited bilateral parotid swellings caused by lymphoepithelial cysts, cervical lymphadenopathy, a CD8 circulating lymphocytosis and a CD8 lymphocytic infiltration into the labial salivary glands. A right superficial parotidectomy had been performed several years previously. However, no intervention was advised for the remaining left parotid because of its benign course. CLINICAL IMPLICATIONS Since patients with DILS can develop lymphomas, periodic observation is mandatory. Any change in the growth pattern requires that a fine-needle aspiration biopsy be performed.
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Affiliation(s)
- L Mandel
- Salivary Gland Center, Columbia University School of Dental and Oral Surgery, Columbia-Presbyterian Medical Center, New York, N.Y. 10032, USA
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