Demonstration of Epstein-Barr virus in scrape material of lateral border of tongue in heart transplant patients by negative staining electron microscopy

Oral Cancer and Oral Precancerous Lesions in Inflammatory Bowel Diseases: A Systematic Review

Oral cancer is historically linked to well-known behavioural risk factors such as tobacco smoking and alcohol consumption. Other risk factors include age over 40, male sex, several dietary factors, nutritional deficiencies, viruses, sexually transmitted infections, human papillomavirus, chronic irritation, and possibly genetic predisposition. Precancerous lesions in the oral cavity include leukoplakia, erythroplakia, and lichen planus. Histology of oral cancer varies widely but the great majority are squamous cell carcinomas.Epidemiological studies and cancer registries have shown a consistently increased risk of oral malignancies in kidney, bone marrow, heart, or liver transplantation, in graft vs host disease, and in patients with HIV infection. Because of the increasing use of immunosuppressive drugs in patients with inflammatory bowel disease, it is useful to more accurately delineate the consequences of chronic immunosuppression to the oral cavity. Oral cancer and precancerous oral lesions in patients with inflammatory bowel disease [IBD] have been scarcely reported and reviews on the topic are lacking.We conducted a literature search using the terms and variants of all cancerous and precancerous oral manifestations of inflammatory bowel diseases. By retrieving the existing literature, it is evident that patients with IBD belong to the high-risk group of developing these lesions, a phenomenon amplified by the increasing HPV prevalence. Education on modifiable risk behaviours in patients with oral cancer is the cornerstone of prevention.Oral screening should be performed for all IBD patients, especially those who are about to start an immunosuppressant or biological drug.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

OBJECTIVE

Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients.

METHODS

Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'.

RESULTS

Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness.

CONCLUSIONS

Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

Shedding dynamics of Epstein-Barr virus: A type 1 carcinogen

Epstein Barr virus (EBV) is one of the ubiquitous viral carcinogens found in humans and successfully infects more than 90% of the world population. The spectrum of EBV-related pathology ranges from asymptomatic primary infection to grave B- and T-cell malignancies. EBV triggers lymphoproliferative disorders after allogeneic stem cell transplantation, which contributes to higher mortality rates. Although the transmission of EBV primarily occurs from an infected host to a naive host through viral shedding from the oropharynx, increasing evidence points to considerable amount of shedding in other anatomical sites such as cervix, anal mucosa, breast milk and respiratory tract. It is impossible to eradicate the prevalence of EBV-related malignancies and other pathologies without preventing viral shedding. However, a detail analysis of the multifaceted nature of EBV shedding is not available in the literature. Thus, this review focuses on elucidating the key elements of the shedding dynamics of this carcinogenic virus.

[Oral hairy leukoplakia: histopathologic features of subclinical stage]

Oral hairy leukoplakia (OHL) is one of the most common oral manifestations of AIDS, with diagnostic and prognostic value. OHL is associated to the Epstein-Barr virus and presents clinical and histological defined characteristics. There have already been reports about a subclinical stage of OHL, although they lacked histopathologic characterization. The present study had the aim to describe the histopathological characteristics of subclinical hairy leukoplakia, as well as to carry out a comparative analysis between clinical and subclinical OHL. For that, 11 cases were analyzed--5 biopsies from patients who presented with the lesion and 6 samples from the borders of tongues obtained in necropsies. The histopathological findings in subclinical OHL were: absence of parakeratosis and papillomatosis, mild acanthosis, ballooning cells and nuclear alterations. In situ hybridization and immunostaining were positive for EBV in the nuclear alterations identified in the histopathological analysis. Based on the identification of EBV in the nuclear alterations, it was possible to conclude that subclinical OHL, similarly to the clinical lesion, presents histopathological features that are specific and sufficient to establish the definitive diagnosis, regardless of the identification of the virus.

Detection of Epstein-Barr virus (EBV) DNA and antigens in oral mucosa of renal transplant patients without clinical evidence of oral hairy leukoplakia (OHL)

The use of the polymerase chain reaction (PCR) to detect the presence of Epstein-Barr virus (EBV) DNA in oral mucosa in the absence of specific lesions gives rise to the problem of identifying the real viral replication sites. To verify whether the detection of EBV is due to salivary contamination or its true replicative capacity in oral mucosa, saliva samples and exfoliated cells from four different oral mucosa sites were taken from 40 renal transplant patients and 20 normal subjects for examination by PCR using two pairs of primers specific for the BamHI-L and BamHI-K genomic regions. EBV-specific sequences were detected in one or more of the oral mucosa samples from 29 transplant patients (72.5%) and six healthy controls (30%), and in the saliva samples of 16 transplant patients (40%) and three healthy controls (15%). A total of 89 oral mucosa smears from 29 transplant patients, and 13 from healthy subjects, were EBV-positive. The positive samples were also investigated by means of in situ hybridization in order to confirm the intracellular presence of the viral genome, and by means of immunofluorescence testing with monoclonal antibodies to assess the possible expression of viral antigens. Hybridization with the EBV-specific probe was observed in 40/ 89 and 2/13 samples, respectively. Latent antigens (with or without lytic antigens) were detected in only 23 of the 40 samples (collected from eight different transplant patients) that were positive by in situ hybridization. Our data show that EBV is more frequently present in the oral mucosa of immunodeficient patients (where it can efficiently replicate) than in normal subjects.

Different distribution of H1-H2 Epstein-Barr virus variant in oropharyngeal virus and in biopsies of Hodgkin's disease and in nasopharyngeal carcinoma from Algeria

In a previous study of Epstein-Barr virus (EBV) strains in North African nasopharyngeal carcinoma (N PC) biopsies, we have found that the viral strain present was of A/F/W'-I'/Xhol kept/H1-H2 type, while the strain associated with Chinese NPC was the A/"f"/W'I'/Xhol lost/H type. Using the restriction fragment length polymorphism (RFLP) and PCR-RFLP methods, the present study analyzed the H1-H2 variant in different clinical samples from Algeria, including the saliva of healthy EBV-positive individuals and patients with NPC or Hodgkin's disease (HD), as well as HD biopsies and lymphoblastoid cell lines (LCLs) established from the oropharyngeal virus-infected cells. Our results demonstrate that, in contrast to the H1-H2 variant found in NPC biopsies, the H genotype was dominant in HD biopsies. Moreover, H genotype was also dominant in the oropharynx of healthy EBV-positive individuals, of patients with NPC and with HD. Our results clearly indicate that in North Africa the EBV strain present of NPC biopsies is different from that shed in the oropharynx. This may suggest a specific distribution of the H1-H2 variant in the NPC epithelial tumor, whereas the H genotype is dominant in HD biopsies and in the oropharynx. The specific association of both viral strains with these 2 distinct diseases in North Africa may reflect a difference in tumorigenicity.

Oral hairy leukoplakia in a patient with multiple myeloma

The first case of oral hairy leukoplakia in an HIV-negative patient with multiple myeloma is reported. The patient is a 56-year old man who has had monoclonal gammopathy of undetermined significance since 1986 and has been treated for a symptomatic multiple myeloma since 1993. The clinical and histopathologic findings are typical for oral hairy leukoplakia, and Epstein-Barr virus was demonstrated with polymerase chain reaction technique. Although a relatively large number of cases of oral hairy leukoplakia has been reported in HIV-negative patients, both immunocompromised and immunocompetent, only a few of these patients have had a malignant hematologic disease.

Oral hairy leukoplakia in an HIV-negative woman with Behçet's syndrome

The first case of oral hairy leukoplakia in an HIV-negative patient with Behçet's syndrome is reported. The patient was a 47-year-old woman with bilateral lesions on the tongue. The clinic and histologic appearances were typical of hairy leukoplakia, and Epstein-Barr virus was demonstrated in the epithelial cells by DNA in situ hybridization. The patient had been on systemic steroid therapy for 15 years to control lesions of Behçet's syndrome. The literature now records 30 HIV-negative patients with hairy leukoplakia.

Oral hairy leukoplakia in a patient with ulcerative colitis

A 30-year-old man with ulcerative colitis developed oral hairy leukoplakia (OHL). Serological examination for human immunodeficiency virus (HIV)-1 and HIV-2 infection showed no abnormalities. Biopsy specimen of the lateral tongue showed ballooned prickle cells, and electron microscopy revealed herpes-type viruses. Immunologic investigation of the patient showed a marked decrease in T-helper cells as a result of immunosuppressive regimen. The present report appears to be the first well-documented case of OHL in an HIV-negative patient with ulcerative colitis. OHL may be a marker for severe immunosuppression but is not necessarily associated with HIV infection. Patients with iatrogenic immunosuppression should be monitored for OHL. Concerning the marked decrease in T-helper cells in this case, the presence of OHL may imply the examination of T-lymphocyte subsets in patients such as HIV-infected individuals or in organ transplant recipients.

Epstein-Barr virus in lingual epithelium of liver transplant patients

Thirty-three liver transplant patients and 20 controls were examined for the presence of EBV in epithelium of the lateral border of the tongue by negative staining electron microscopy. Five of the specimens (15%) showed particles typical of the herpes virus family, while all controls were negative for EBV. In 3 of the 5 patients moderate oral hairy leukoplakia was observed clinically. Our results indicate that EBV may be expressed at the lateral border of the tongue of liver transplant patients, who in some cases show oral hairy leukoplakia clinically.

Oral hairy leukoplakia in vertically and horizontally acquired HIV infection

Two boys aged 7 and 8 years, respectively, with oral hairy leukoplakia as the sole clinical sign indicative for HIV infection are reported.