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Cutaneous, mucosal, and nail examination is the key to unveiling a plethora of systemic diseases. Mucocutaneous lesions directly related to human immunodeficiency virus (HIV) infection usually present as initial manifestations of immune deficiency, of which few lesions act as predictors of an immunocompromised state. Here, we report two cases who presented with onycho-mucocutaneous symptoms which raised the suspicion of and invariably led to the diagnosis of an underlying immunosuppression secondary to HIV infection.

Background: The oral cavity is a mirror of the body, entry point to food, antigens, and microorganisms. Oral cavity with mastication and speech, also have a role play in immunological defense. The Oral mucous membrane is in link with skin, oropharynx, and nasopharynx. The oral cavity and anterior two-thirds of the tongue are formed by the ectoderm and that is why from a dermatologist's viewpoint, an oral opening is especially imperative and involved in a range of systemic and skin disease, also affect teeth and gums. The body's natural protection is in good quality oral care. Oral problems when associated with skin conditions require oral care as it affects the quality of life and enable dermatologist and dentist in the identification and diagnosing of systemic disease. Oral illness can bring into being from infection, inflammation or neoplastic, immunological, benign, or malignant. Results: The oral cavity is a mirror to a variety of systemic and cutaneous diseases. Interpretation of the symptom and signs of systemic diseases help early diagnosis. However, while not correct oral hygiene, microorganisms will reach levels that may result in oral infections and decay. The health status of our oral cavity can give us a strong signal of the health of our bodies. It proceeds as a premature warning system. That's why the oral cavity should be examined in one piece from the buccal mucosa to the oropharynx. Conclusion: The mouth is a straightforwardly available window of the body. In contemplation with development, composition, and utility oral cavity is only one of its kind. It is a two-way road as systemic skin disease has oral manifestation. Interpretation of the symptom and signs help in identification and early diagnosis of systemic diseases. Oral illness can bring into being from infection, inflammation or neoplastic, immunological, benign, or malignant. That's why the oral cavity should be examined in one piece from buccal mucosa, lips, tongue, gum, teeth, palate to the oropharynx. Knowledge of systemic diseases is vital in day to day clinical practice, often oral manifestation is the most significant or first sign of systemic illness. So dermatologists and dental surgeons are conscious of oral complaints and their association with systemic disease.

Acute retroviral syndrome (ARS) refers to signs and symptoms present during acute human immunodeficiency virus (HIV) infection. Historically, ARS has been characterized as a mononucleosis-like illness. However, ARS may present with typical (i.e., mononucleosis-like) or atypical signs and symptoms. Here, we review typical and atypical ARS and discuss a 30-year-old man who first presented with a facial palsy and returned 2 years later with oral hairy leukoplakia, at which time he was found to have HIV and acquired immunodeficiency syndrome (AIDS). We suggest that facial palsies should pique clinical suspicion for HIV, especially in the context of recent or concurrent flu- or mononucleosis-like illness.

Background : Sexually transmitted infections (STIs) are commonly found in commercial sex workers (CSWs) due to lack of knowledge and bad behavior in sexual intercourse. STI does not only cause symptoms in the genital area but also lesions in the oral cavity. Method : This research was an analytical survey with cross sectional approach. Samples were 110 CSWs selected by simple random sampling. Chi-Square test was used to see the difference in the influence of the level of knowledge and sexual behavior on the incidence of oral cavity lesions. Result: Oral cavity lesions related to STIs were found in 44 cases, including suspect oral candidiasis, ulcers, suspect linear gingival erythematous (LGE), Suspect Kaposi Sarcoma and Oral Hairy Leukoplakia. Lesions were found in 43.9% respondents with low knowledge level and 37.7% in good knowledge level. Chi-Square test obtained p value of 0.328 (p> 0.05) showed that there was no difference between the knowledge level and the occurrence of lesions. Lesions were found 94.1% in respondents with bad sexual behavior and 15.8% in respondents with good sexual behaviour. Chi-Square test obtained p value of 0.00 (p> 0.05) which means that there are significant differences between good sexual behavior respondents and bad sexual behavior respondents towards the presence of lesions. Conclusion: The level of knowledge was not a risk factor for oral lesions, whereas bad sexual behavior was a risk factor for oral cavity lesions.

Hairy tongue is a benign pathology, characterized clinically by hyperkeratinized plaques on the dorsal surface of the tongue, hairlike, whose coloration ranges from unpigment, whitish, yellowish, green, brown to black. Diagnosis is clinical, and, in cases of whitish plaques, it may be difficult to differentiate between oral hairy leukoplakia, potentially malignant leukoplakia or squamous cell carcinoma. Thus, widefield optical fluorescence complementary examination may allow a better visualization of the local hairlike pattern of hyperkeratinization, typical of the hairy tongue, facilitating the diagnosis. In this work, a 57-year-old man was referred to the Dental Specialties Department of the Divinópolis Health Department (MG, Brazil) by a general dental practitioner, aiming a differential diagnosis of possible malignant lesion on the dorsal tongue surface. The complementary examination by wide-field optical fluorescence was performed. For this, it was employed a device with high-power light-emitting diode emitting light centered at a wavelength of (400±10) nm and maximum irradiance of (0.040±0.008) W/cm2 was used for fluorescence visualization. Fluorescence images showed projections of hairlike appearance in tongue dorsal surface with no aspects of malignancy. Hairlike appearance is the principal feature of hairy tongue. In this way, the final diagnosis was established. In conclusion, in this case, the use of widefield optical fluorescence in oral diagnostic routine provided a differential diagnosis, with no need of an incisional biopsy. Resumo A língua pilosa é uma patologia benigna, caracterizada clinicamente por placas hiperqueratinizadas na face dorsal da língua, semelhante a pelos, cuja coloração varia de despigmentada, esbranquiçada, amarelada, verde, acastanhada a preta. O diagnóstico é clínico, e em casos de placas esbranquiçadas, pode ser difícil diferenciar entre leucoplasia pilosa oral, leucoplasia potencialmente maligna ou carcinoma de células escamosas. Assim, o exame complementar de fluorescência óptica de campo amplo pode permitir uma melhor visualização do padrão local de hiperqueratinização semelhante à pelos, os quais são característicos de língua pilosa, facilitando o diagnóstico. Neste trabalho, um paciente do sexo masculino, 57 anos, foi encaminhado ao Departamento de Odontologia da Secretaria de Saúde de Divinópolis (Minas Gerais) por um clínico geral, visando o diagnóstico de uma possível lesão maligna na face dorsal da língua. O exame complementar por fluorescência óptica de campo amplo foi realizado. Para isso, foi empregado um dispositivo com diodo emissor de luz de alta potência, com luz centrada em um comprimento de onda de (400±10) nm e irradiância máxima de (0,04 ±0,008) W/cm2 para visualização de fluorescência. As imagens de fluorescência mostraram projeções de aparência semelhante à pelos na superfície dorsal da língua, sem aspectos de malignidade. A aparência similar à pelos é a principal característica da língua pilosa. Dessa maneira, o diagnóstico final foi estabelecido. Em conclusão, neste caso, o uso da fluorescência óptica de campo amplo permitiu um diagnóstico diferencial, sem a necessidade de uma biópsia incisional.

Treponema spp. are spirochaetes or spiral bacteria that cause congenital infections as well as sexually and non-sexually...

OBJECTIVE: To assess the prevalences and patterns of oral lesions occurring in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). METHODS: A cross-sectional study was conducted among 200 people living with HIV/AIDS (PlwHA) who regularly attended a counselling and treatment centre in Dar es Salaam Tanzania. A questionnaire-guided interview and clinical oral assessment were used. Strict confidentiality and adherence to ethical codes were observed. RESULTS: The mean age of participants was 38.91 years (standard deviation: 10.424; mode: 35 years; median: 37.0 years; range: 15-76 years). Most participants (58.5%) were aware of predispositions towards the occurrence of oral lesions such as oral candidiasis (60.0%) in HIV/AIDS and most of these (72.0%) were aware that the lesions are treatable. Some participants reported occurrences of oral thrush (22.5%) and lip ulcerations (28.5%) although only 47.0% of these had sought medical advice. Examinations revealed that 29.0% of participants had at least one oral lesion associated with HIV/AIDS. Prevalences of the various types of lesion were: 11.5% for herpes simplex; 7.5% for oral candidiasis; 4.0% for oral hairy leukoplakia; 3.5% for Kaposis sarcoma; 1.5% for dry mouth; 0.5% for angular cheilitis and 0.5% for acute necrotising ulcerative gingivitis. Herpes simplex and Kaposis sarcoma were more frequently observed in males (56.5% and 71.4% respectively) whereas oral candidiasis and dry mouth were observed more often in females (86.7% and 66.7% respectively) (chi(2) = 16.692 P = 0.016). CONCLUSIONS: Prevalences of oral lesions associated with HIV/AIDS in PlwHA and using antiretroviral therapy are persistent of moderate intensity and vary according to individual immune status. These patients level of awareness about oral lesions was satisfactory but formal medicodental lines of management were not prioritised. Contemporary protocol for the management of oral lesions should be understood and disseminated to the general public by dentists. (c) 2012 FDI World Dental Federation.

Human immunodeficiency virus (HIV) supresses immune system, primarily cell-mediated immunity. Cluster of differentiation 4 (CD4) cell count, viral load, and oral lesions are the most important laboratory parameters to evaluate the evolution of acquired immunodeficiency syndrome. The present study aims to determine the incidence of HIV-related oral lesions with CD4 cell count and viral load in Yunnan, China. A cross-sectional study was conducted from December 2007 to December 2009, in 1812 HIV positive patients from Department of Infectious Diseases in Kunming Third People's Hospital. CD4, CD8, and viral load data were collected and analyzed statistically using SPSS 11.3. Out of 1812 HIV positive patients, 929 (51.27%) were associated with 1 or more oral lesions. The most common oral lesions observed were Candida Pseudomembranous (13.75%), Candida erythematous (10.93%), Oral hairy leukoplakia (7.95%), Aphthous ulcer (6.18%), Herpes simplex infection (5.58%). In most patients with oral lesions, the CD4 cell count was 200/μL and with undetectable (P 500/μL (P

Author(s): Schander, Artur; Glickman, Andrew A.; Weber, Nancy; Rodgers, Brian; Carney, Michael B. | Abstract: Introduction: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses.Case Presentation: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative.Discussion: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.

Human cytomegalovirus (CMV) is a virus that can compromise the lungs and the liver and cause infection in the gastrointestinal tract. In addition, this virus can cause infectious mononucleosis syndrome, infection in the CNS, and retinitis. Moreover, it has been associated with the development of oral hairy leukoplakia and ulcers. Objective: To report two cases of patients with HIV with oral manifestations associated with CMV infection. Case Report: In the first case, the patient sought medical attention, with complaints of weakness, fever, cough, and weight loss. In the second case, the patient complained of weakness and blurred vision for about a week. Both patients were infected with HIV and made irregular use of antiretroviral therapy. Several ulcers were observed in the mouth that caused much discomfort. The diagnosis of CMV infection was defined by the following tests: enzyme immunoassay fluorescence-CMV IgG and PCR for CMV in real time. Ganciclovir has been used in the treatment of patients, and oral ulcerations received symptomatic treatment. Conclusion: The dentist must be aware that CMV may also be responsible for the development of ulcers in the oral cavity, especially in immunocompromised patients.

Made available in DSpace on 2020-12-12T02:24:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 We report a case of atypical oral hairy leukoplakia (OHL) in a 9-year-old immunocompetent girl treated with fluticasone propionate nasal spray for allergic rhinitis. The OHL in childhood is uncommon and should be included in a differential diagnosis of white lesions in the oral mucosa. Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (Unesp) Department of Stomatology Collective Health and Legal Dentistry Ribeirão Preto School of Dentistry University of São Paulo Department of Pathology and Forensic Medicine Ribeirão Preto Medical School University of São Paulo Department of Biosciences and Oral Diagnosis Institute of Science and Technology São Paulo State University (Unesp)

Well into the fourth decade of the HIV/AIDS pandemic, we can look back on the early years, the initial discoveries, and the broad sweep of the progress of our understanding of the nature, causes, and significance of the oral lesions seen in those infected with the virus. Prominent among these is oral hairy leukoplakia (HL), a previously unknown lesion of the mouth associated with Epstein-Barr virus (EBV) and initially seen only in people with AIDS, in the then-recognized risk groups, or those shown to be HIV positive. Subsequently, it became clear that the distribution of HL extends well beyond the HIV spectrum. In this brief review, we consider the clinical and histological features of HL, discuss how it was discovered, explore its cause, diagnosis, relationship with AIDS, pathogenesis, significance in EBV biology, options for management, and how it changes with HIV/AIDS therapy.

Aims and Objectives: Human immunodeficiency virus (HIV)-related oral lesions are often an early finding, and they reflect the underlying immunosuppression, and tuberculosis (TB) coinfection can have further deteriorating effect. Hence, a cross-sectional study was conducted to evaluate clinical and oral presentations of patients coinfected with HIV–TB, correlating with various parameters such as the type of TB with CD4 cell count, the type of TB with oral manifestations, site of the lesion, oral manifestations with CD4 cell counts, age, and gender. Materials and Methods: A cross-sectional study was conducted among selected 200 patients coinfected with HIV–TB, registered at Gandhi Medical College, Hyderabad, Telangana, India, and demographic data, CD4 count, diagnosis of TB, and clinical presentation of TB were correlated with site, age, gender, and the type of lesions in the oral cavity. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, (IBM SPSS), version 20 (Chicago, IL, USA), with the chi-square test, and the significant P value for all the parameters was considered as

Oral hairy leukoplakia (OHL), first described in 1984, is an Epstein-Barr virus lesion located laterally in the tongue and manifesting as a white, asymptomatic mucosal plaque which cannot be removed by scraping. OHL is more commonly observed in HIV-positive patients, in immunosuppressed patients after kidney, heart, liver and bone marrow transplantation, in hematological malignancies such as multiple myeloma, and in patients undergoing systemic or topical steroid therapy. OHL has rarely been reported in healthy patients who are not immunosuppressive. The case of an otherwise healthy, HIV-negative 24 year-old woman with OHL lesions in the buccal mucosa is presented here because of its rarity., İlk olarak 1984'te tanımlanan oral kıllı lökoplaki (OKL), sıklıkla dil lateralde yerleşen kazımakla çıkarılamayan beyaz renkli, asemptomatik mukozal plak olarak kendini gösteren bir Epstein-Barr virüsü lezyonudur. OKL daha çok HIV pozitif hastalarda bulunurken, böbrek, kalp, karaciğer ve kemik iliği transplantasyonu sonrası immünsüpresif hastalarda, multipl miyelom gibi hematolojik malignitelerde ve sistemik veya topikal steroid tedavisi altındaki hastalarda da tanımlanmıştır. Literatürde OKL, nadiren immünsüpresif olmayan sağlıklı hastalarda da bildirilmiştir. Burada, 24 yaşında diğer açılardan sağlıklı, HIV negatif, bukkal mukozada OKL lezyonu olan kadın hasta nadir görülmesi nedeniyle sunulmaktadır.

Objectives: The authors have conducted a systematic review of oral manifestations of HIV from studies conducted in Asia to establish the characteristics and prevalence of individual oral manifestations in Asia, and to assess the direction of future research studies on oral manifestations of HIV in Asia. Material and Methods: The electronic retrieval systems and databases searched for relevant articles were PubMed [MEDLINE], EBSCO, and EMBASE. The search was for limited articles published in English or with an English abstract and articles published during the period January 1995 to August 2014. The authors reached a final overall sample of 39 studies that were conducted in Asia. Results: The median population size among all studies was 312.7 patients. Oral candidiasis [OC] was the most common oral manifestation [37.7%] in studies conducted in Asia. The overall prevalence of oral hairy leukoplakia and melanotic hyperpigmentation was computed to be 10.1% and 22.8% respectively. Thailand and India are primarily countries with maximum research on oral manifestations. Conclusions: The research on oral manifestations of HIV in Asia has to upgrade to more interventional and therapeutic studies rather than the contemporary cross- sectional epidemiological descriptive studies. The authors have given suggestions and future directions for the implementation of clinical research of oral manifestations in HIV patients.

ObjectiveHerpesvirus shedding in the oral cavity was analyzed to determine if presence in the oral compartment correlates with systemic changes in HIV-associated immune deficiency as measured by CD4 cell counts, plasma HIV viral load and presence of AIDS-defining events.DesignA5254 is a multicenter, cross-sectional, single-visit study to evaluate oral complications of HIV/AIDS and determine the association between clinical appearance, herpesvirus shedding, and immune status as ascertained by CD4 cell count and HIV viral load. In total, 307 HIV-infected individuals were evaluated and throat wash collected.MethodsFisher's exact test and Kruskal-Wallis test were used to assess the association between presence of herpesviruses and the state of immunodeficiency as stratified by a combination of CD4 cell count and HIV viral load. Relationship between pathogens and HIV viral load in plasma was modeled by logistic regression.ResultsThe presence of cytomegalovirus (CMV) and herpes simplex virus-1 in throat wash was associated with decreased CD4 cell counts. By contrast, Kaposi sarcoma-associated herpesvirus and Epstein-Barr virus were similarly detectable across all levels of CD4 cell counts. One unit increase in log10 (HIV viral load) was associated with 1.31 times higher odds of detecting CMV in throat wash when controlling for oral candidiasis, CD4 cell count, and sites (95% confidence interval 1.04-1.65, P = 0.02).ConclusionOral CMV shedding was significantly higher in highly immunocompromised HIV participants. Our finding supports the recommendations to start antiretroviral therapy independent of CD4 cell count as this may have the added benefit to lower the risk of herpesvirus transmission among persons infected with HIV and their partners.

Summary Epstein–Barr virus (EBV) is known to be associated with the development of malignant lymphoma and lymphoproliferative disorders (LPDs) in immunocompromised patients. EBV, a B-lymphotropic gamma-herpesvirus, causes infectious mononucleosis and oral hairy leukoplakia, as well as various pathological types of lymphoid malignancy. Furthermore, EBV is associated with epithelial malignancies such as nasopharyngeal carcinoma (NPC), salivary gland tumor, gastric carcinoma and breast carcinoma. In terms of oral disease, there have been several reports of EBV-related oral squamous cell carcinoma (OSCC) worldwide. However, the role of EBV in tumorigenesis of human oral epithelial or lymphoid tissue is unclear. This review summarizes EBV-related epithelial and non-epithelial tumors or tumor-like lesions of the oral cavity. In addition, we describe EBV latent genes and their expression in normal epithelium, inflamed gingiva, epithelial dysplasia and SCC, as well as considering LPDs (MTX- and age-related) and DLBCLs of the oral cavity.

Background: The main aim of this study was to find out the ear, nose, and throat (ENT) manifestations in a selected regional population of 100 HIV infected patients, to identify the commoner ENT manifestations among them and to make these manifestations, a guide for regional ENT surgeons, to diagnose HIV/AIDS patients early and to treat them accordingly.Methods: The study was a prospective study which was conducted for a period of five years which included 100 HIV seropositive patients, among the patients attending the Outpatient Department of the Otorhinolaryngology and anti-retroviral therapy centre across Government Hospitals in Tamil Nadu according to our inclusion or exclusion criteria. Detailed ENT clinical examination as well as laboratory investigations were carried out to evaluate the nature of ENT presentations of HIV infection. Results: Out of the 100 HIV positive patients, who had some form of ENT symptoms, the most common ENT manifestation in HIV/AIDS was oral candidiasis (40%) followed by cervical lymphadenopathy (30%). Other common manifestations are oral herpes simplex and sensorineural hearing loss. Less common manifestations are chronic sinusitis, tuberculous laryngitis, chronic otitis media, oral hairy leukoplakia, nasal polyps and Kaposi’s sarcoma. Oral candidiasis, chronic/recurrent mucocutaneous herpes simplex, oral hairy leukoplakia and Kaposi’s sarcoma are the AIDS defining illnesses. Oral hairy leukoplakia, is pathognomonic of HIV infection.Conclusions: These manifestations help ENT surgeons, to recognize HIV/AIDS patients from the specific ENT lesions occurring in them, for early diagnosis and subsequent treatment.

Background/Aim: Oral lesions in human immunodeficiency virus (HIV) infections may serve as markers for immune deterioration and disease progression and sometimes be the first indication of the disease. The aim of this study was to assess the prevalence and pattern of HIV-related oral lesions (HIV-ROLs) in people living with the disease in Enugu, Southeast Nigeria. Materials and Methods: A questionnaire was used to obtain data from 208 HIV- infected persons accessing treatment from two centers for acquired immune-deficiency syndrome (AIDS) prevention. Data obtained were demographic details, duration of infection, current cluster of differentiated 4 (CD4) count, and oral complaints. Thereafter, the perioral and oral cavity of the respondents were inspected for HIV-ROLs using disposable items. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 17. Results: Eighty-four (40.4%) respondents had HIV-ROLs; 44 had more than one lesion yielding 128 combinations. Forty-four of the 84 lesions (52.4%) were seen in those diagnosed over 5 years ago, 28 (33.3%) in those with 2–5 years duration of infection (P = 0.05), and 27 (32.1%) in persons with CD4 counts

We report a case of hairy leukoplakia that developed in a patient undergoing anti-retroviral therapy. A 53-year old white male presented with mild erythema in the anterior maxillary gingiva and was managed with clobetasol gel, after excluding the possibility of candidiasis. Patient's medical history was significant for HIV, bipolar disorder, high blood pressure, high cholesterol, chronic bronchitis, smoking, and alcohol. His medications included Androgel, Axiron, atorvastatin, bupropion, clonazepam, finasteride, hydrochlorothiazide, lamotrigine, lisinopril, pantoprazole, Prezcobix, Trazadone, Truvada (200 mg emticitabine, 300 mg tenofovir), Ziprasidone, zolpidem, and baby aspirin. During one of multiple follow-up appointments, an asymptomatic white plaque was identified on right lateral tongue. Clinical differential diagnoses included hairy leukoplakia and hyperkeratosis secondary to trauma. Patient reported that his physician changed Truvada to Descovy (200 mg emticitabine, 25 mg tenofovir) since his last appointment. At the appointment six weeks later, the white plaque increased in size, and additional white plaques were found on the left dorso-lateral surface and dorsal tongue. Two biopsies were taken, one from the right lateral and the other from left dorso-lateral tongue. The biopsies showed similar histological features including hyperparakeratosis with shaggy surface and bacterial colonization. Intracellular edema and pyknotic nuclei were noted in the spinous cell layer. Upper spinous cell nuclei were enlarged and glassy appearing, without obvious nucleoli or nuclear beading. An Epstein-Barr encoding region (EBER) in-situ hybridization was performed, which demonstrated presence of EBV. Blood testing, taken five days after the biopsy, showed a CD4 count and viral load within normal limits. The patient's physician prescribed a course of acyclovir 800mg for treating oral hairy leukoplakia. The oral lesions reduced in size at the follow-up appointment three weeks after completion of acyclovir therapy. Further follow-up information also will be presented.

Objective An increase in head and neck cancer (HNC) in HIV-infected individuals has been described in several epidemiological studies, suggesting that immunosuppression, even in treated patients, may play a role in the development of HNC. A thorough oral examination is essential for the identification of potentially malignant lesions, particularly in individuals at high risk to develop cancer. Thus, we report two cases of oral potentially malignant disorders occurring in HIV individuals. Clinical Presentation Case 1. A 39-year-old male HIV+ since 2013. In 2015 presented an asymptomatic, slightly granular, red/white pediculate tumor on the left buccal mucosa, clinically compatible with multifocal epithelial hyperplasia with post-traumatic hyperkeratosis (251 cells/ml CD4+, undetectable viral load [VL]). Two weeks later, the lesion showed marked erosive/ulcerated areas, thus, a complete excision was done. The final diagnosis was in situ squamous cell carcinoma positive to HPV-16. Case 2. A 40-year-old male HIV+ since 2005, with histologically confirmed oral hairy leukoplakia, immunohistochemistry showed positive expression to EBV and negative to HPV. In 2015 presented a white well circumscribed homogeneous plaque, with a slightly rough surface and some satellite lesions, comparable with the previous hairy leukoplakia. The patient referred itching and burning sensation, so an excisional biopsy was done, showing hyper orthokeratosis with moderate dysplasia. The sample was negative for EBV and HPV. Both patients have remained asymptomatic, without signs of recurrence. Outcome The present cases evidence that some oral potentially malignant disorders may resemble other common lesions in HIV-patients that could be underdiagnosed, delaying an appropriate management and impacting prognosis. It is essential to highlight that HIV/AIDS patients should be closely monitored. Oral examination should be cautious even in the presence of lesions with a benign appearance.

Oral hairy leukoplakia occurs on the lateral surface of the tongue that clinically as an asymptomatic white lesion. It is mainly found in patient with human immunodeficiency virus infection. However, it rarely outbreak immunosuppressed patients after organ transplantation, or the patients taking steroids or immunosuppressants. It is the result of proliferating Epstein-Barr virus in the oral epithelium. Most of human immunodeficiency virus infected patients with oral hairy leukoplakia are highly contagious and possible to progress acquired immunodeficiency syndrome. Therefore, the early diagnosis of oral hairy leukoplakia is very important. Taking a thorough history and human immunodeficiency virus screening test is highly recommended in case oral hairy leukoplakia is detected. In this case, a 29-year-old man presented with whitish lesion on lateral border of tongue is diagnosed as oral hairy leukoplakia and human immunodeficiency virus infection.

Objectives To investigate the associations of CD4 count with chronic periodontitis and human immunodeficiency virus (HIV)-related oral lesions in pregnant HIV-infected Thai women. Study design Two hundred ninety-two HIV-infected pregnant women were interviewed for health information and examined for their periodontal condition and HIV-related oral lesions during weeks 16-34 of gestation. Logistic regression, t tests and Chi-squared tests were used to examine the associations of CD4 count with oral lesions and periodontal conditions. Results One hundred thirty-three women (45.6%) had at least 1 tooth with a periodontal pocket over 4 mm. Thirty-eight (17.76%) subjects had oral candidiasis and 53 subjects (24.77%) had oral hairy leukoplakia (OHL). Low CD4 count was significantly associated with periodontitis at odds ratio (OR) = 2.06 with 95% confidence interval (CI) = [1.00-4.27], P = .05. A significant association was found for low CD4 count with OHL with OR = 3.57, 95% CI = [1.34-9.46], P = .01. Conclusions Chronic periodontitis and OHL were associated with CD4 count lower than 200 cells/mm 3 in HIV-infected women.

Aim: The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. Methodology: A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearinghouse criteria. Results: A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39–13.36)]. Conclusion: These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.

We report the case of a 31-year-old woman with systemic lupus erythematosus who was found to have oral hairy leukoplakia (OHL). She was on immunosuppressive therapy but was human immunodeficiency virus (HIV)-negative. OHL has been previously reported in HIV-negative patients who were immunosuppressed for other reasons, such as solid organ or hematopoietic stem cell transplantation, hematologic malignancies, or systemic diseases. To the best of our knowledge, this is the first case of OHL in an HIV-negative patient reported in the otolaryngology literature. It adds to the growing list of cases of OHL in HIV-negative patients and serves as a reminder to physicians to include OHL in the differential diagnosis for oral cavity lesions in all immunosuppressed patients. The article also summarizes the current state of knowledge about the pathogenesis of OHL, its relation to the Epstein-Barr virus, and the treatment options.

Oral hairy leukoplakia (OHL) is caused by the Epstein-Barr virus (EBV), which has been related to HIV infection. In situ hybridization (ISH) is the gold-standard diagnosis of OHL, but some authors believe in the possibility of performing the diagnosis based on clinical basis. The aim of this study is diagnose incipient lesions of OHL by EBV ISH of HIV-infected patients and the possible correlations with clinical characteristics of the patients. Ninety-four patients were examined and those presenting with clinical lesions compatible to OHL were submitted to biopsy prior to EBV ISH. Twenty-eight patients had lesions clinically compatible to the diagnosis of OHL, but only 20 lesions were confirmed by EBV ISH. The patients with OHL had a mean age of 41.9 years and were HIV-infected for 11.2 years, on average, including CD4 count of 504.7 cells/mm3 and log10 viral load = 1.1. Among the quantitative variables, there was a statistically significant correlation with age only (P=0.030). In conclusion, the presence of OHL in patients with HIV/AIDS results in changes in the epidemiological characteristics of the disease, and this fact allied with subtle clinical-morphological features makes clinical diagnosis very difficult. Therefore, EBV ISH is important for a definitive diagnosis of OHL.

Author(s): Braz-Silva, Paulo Henrique; Schussel, Juliana Lucena; Lopez Ortega, Karen; Gallottini, Marina | Abstract: Background: Oral hairy leukoplakia (OHL) is a benign lesion caused by Epstein-Barr virus (EBV) replication in the oral epithelium affecting the borders of the tongue. It is strongly associated with immunosuppression, especially in HIV+ adults but is uncommon in pediatric population. The aim of the study is to show the importance of the correct diagnosis of OHL and its influence on HIV treatment.We report two cases of HIV+ adolescent patients that presented with leukoplakic lesions on the border of the tongue, suggestive of OHL. OHL diagnosis was confirmed in only one case through EBV in situ hybridization. After confirmation of the diagnosis, the patient with OHL was referred to an infectious disease specialist with the decision to start antiretroviral therapy. Conclusion: OHL definitive diagnosis can help clinical management of pediatric HIV+ patients.

Objective: To document the prevalence, age and gender distribution of oral lesions in HIV infected adults and the influence of highly active antiretroviral therapy and correlate them to the immune status of the patients. Materials and Methods: Oral lesions were diagnosed by a detailed physical examination by trained and calibrated examiners according to the case definitions established by the Oral HIV/AIDS research alliance. Demographic details, risk behavior patterns and oral symptoms and habits were collected by a questionnaire. Results: 81 patients; 54 men and 27 women aged between 20 ' 55 years participated in the study. A total of 49 patients; 60.5% had some oral lesion when examined. Oral candidiasis (21 %) and oral melanosis (21%) were the most common lesions, followed by linear gingival erythema, oral hairy leukoplakia, necrotizing ulcerative periodontitis/ gingivitis, herpes labialis, parotid gland enlargement and reccurent apthous ulcers. Oral hairy leukoplakia was exclusively seen in men (p=0.018). All six cases of herpes simplex lesion were seen in non - anti retro viral group (p=0.073) while oral candidiasis was commonly noted in the anti retro viral group (p=0.073). Lowering CD4 counts had the strongest association with the prevalence of oral candidasis (p=0.012), pseudomembranous candidiasis (p=0.014) and oral hairy leukoplakia (p= 0.065). Conclusion: This study shows a high prevalence of oral candidiasis, melanosis, linear gingival erythema and oral hairy leukoplakia in the patients.

Context: White lesions in the oral cavity may be benign, pre-malignant or malignant. There are no signs and symptoms which can reliably predict whether a leukoplakia will undergo malignant change or not. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction. Aim : The aim of the paper was to study the clinical and histopathological patterns of white lesions in the oral cavity presented at the study setting and to study the factors associated with the histopathological patterns of the lesions. Settings and Design: A hospital based cross-sectional study of patients with white lesions in the oral cavity attending the Department of Dermatology and Venereology, Medical College, Thiruvananthapuram was done. Materials and Methods: After taking a detailed history, microscopic examination of Potassium hydroxide smear and an oral biopsy with histopathologial examination was done. Results : Out of the 50 patients in the study, clinically the diagnoses made were Lichen planus (32 patients; 64%), Frictional Keratosis (4;8%), Dysplasia (2;4%), Oral Hairy Leukoplakia (1;2%), Pemphigus Vulgaris (2;4%), Cutaneous Lupus Erythematosus (1;2%), Oral Submucous fibrosis (3;6%) and Oral Candidiasis alone (5;10%). Out of the 45 patients who had undergone biopsy, 25 (55.6%) had Lichen planus, 9 (20%) had Frictional Keratosis and mild Dysplasia was found in 4 (8.9%) patients. Conclusion : The measure of agreement between the clinical and pathological diagnosis was only 32%. Older age, difficulty in opening the mouth, consumption of non-smoked tobacco, site of the lesion (gingival, floor of mouth or lingual vestibule) and presence of tenderness on the lesion were significantly associated with Dysplasia.