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Aim - to improve the methodology for collecting material from lesions of the oral mucosa for exfoliative cytological examination. A group of patients diagnosed with B37.0 Candida stomatitis was examined. To clarify the diagnosis, various methods of collecting biological material from the tongue of patients were used, namely, the method using a cytobrush with subsequent fixation of cytological material on a slide. The microbiota of the back of the tongue was analyzed in 12 patients with glossitis and 12 healthy subjects (the control group). The microscopic method of research was used - using an immersion microscope MICROmed@XS-3330, and the morphological and tinctorial properties of microorganisms were determined. In ten fields of view, the number of leukocytes, the nature of epithelial cells, and the presence of various microorganisms were detected and counted. A comparison of the quality of the use of the microscope method for the study of the tongue microbiota of patients with candidal glossitis was performed under the conditions of taking pathological material using a dental scalpel and an oral cytobrush. For a reasonable interpretation of the results and determination of their significance, a statistical analysis was performed to determine the frequency of detection of microorganisms in patients with glossitis and healthy subjects, depending on the nature of the material taken from the back of the tongue using a dental scalpel or cytobrush. The studies showed that the etiologic structure of glossitis pathogens was dominated by Candida yeast-like fungi, but cases of leptotrichosis aetiology were observed (16.7%). Monococci and gram-negative monobacteria were detected in all studied groups. An increase in the diversity of microorganisms was found when the material was taken with a cytobrush. The microbiota of all subjects differed depending on the type of instrument used for sampling. Thus, in the group of healthy individuals, the interdental brush helped to detect twice as many streptococci as a scalpel. In patients with candidiasis, a brush biopsy showed a 2.7-fold increase in gram-positive diplococci, twice as many streptococci and gram-positive bacilli, three times as many staphylococci, 2.25 times as many clusterforming gram-negative cocci, and 2.3 times as many gram-negative diplococci. A significant increase in the diversity of microorganisms was observed with the cytobrush compared to the use of a dental scalpel. In patients with glossitis, the accumulation of keratinized epithelial cells was significantly higher compared to the presence of young cells in healthy subjects, regardless of the method of sampling.

Rhodococcus equi infection in horses is common and is characterized by pyogranulomatous pneumonia and ulcerative enterocolitis. R. equi clinical disease in cattle, however, is rare and typically manifests as granulomatous lymphadenitis discovered in the abattoir. A 19-mo-old female Santa Gertrudis had a history of intermittent inappetence and weight loss for a 3-mo period before euthanasia. Gross and histologic examination revealed severe, chronic, ulcerative, and granulomatous inflammation in the tongue, pharynx, and small intestine. Also, the heifer had severe, granulomatous pharyngeal and mesenteric lymphadenitis. Bacterial cultures from the ileum, tongue, and liver yielded numerous-to-moderate numbers of R. equi . PCR analysis of the isolate detected the linear virulence plasmid vapN , which is often identified in bovine isolates ( traA - and vapN -positive). The bacteria also lack the circular plasmids vapA and vapB that are associated with virulence in horses and swine, respectively. We report herein an atypical and unusual clinical presentation of R. equi infection in cattle, which has zoonotic potential.

Five-day-old neonatal piglets presented with debilitation and ananastasia. At the necropsy of one piglet, the apex of the tongue was found to be discolored dark red, and disseminated white foci were found on the cut surface. Many white foci were also found in the lungs and on the serosa of the liver and spleen. Histopathological findings revealed multifocal necrotic glossitis and pneumonia with Gram-negative bacilli. The bacilli were identified as Actinobacillus suis through immunohistochemical, biochemical, and genetic tests, including 16S rRNA gene sequencing. Although A. suis usually causes inflammation in thoracic and abdominal organs, lesions were also found in the tongue in the present case. This study is the first report of glossitis caused by A. suis.

Diabetes mellitus (DM) is a metabolic disorder resulting with many different complications including soft tissue abnormalities in the oral cavity such as periodontitis and salivary and taste dysfunction. Previous studies also reported fungal and bacterial infections in oral cavity in these patients. This study aims to represent three dimentional morphologic ultrastructural changes of the diabetic rat tongue via scanning electron microscopy. Twenty-four (24) adult male Spraque-Dawley rats, (weight ranging between 200-250g) included in the study were randomly assigned into two groups: control rats were injected with intraperitoneally saline alone, experimental diabetes group received streptozotocin (STZ) (80mg/kg) administrated intraperitoneally. On month four, by the end of experimental period, all animals of each group were anesthetised. All tongues were dissected totally, postfixed in 2% osmium tetroxide and then dried by critical point drying before SEM analysis. Finally, superficial epithelial configurations of the lingual papillae in experimental diabetic rats were examined by scanning electron microscopy. Diabetes mellitus caused thickness, hyperceratosis and different epithelial changes, We observed yeast-like structures and bacterial colonisations on the papillar and epithelial structure of the tongue. The morphological atrophic changes of lingual mucosa and the median rhomboid glossitis (which is primary finding of candidal infection) are characteristic observations on the lingual mucosa of the streptozotocin treated rats., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: The purpose of this study was to clarify the species of Candida that are important for the development of atrophic glossitis in xerostomia patients., Methods: A total of 231 patients with subjective dry mouth were enrolled in the present study. Logistic regression analysis was performed to clarify the contribution of each Candida species and other variables to the development of atrophic glossitis. The dependent variable was the absence/presence of atrophic glossitis. The Candida colony-forming units (CFU) of C. albicans, C. glabrata, C. tropicalis, and C. krusei, as well as age, gender, resting (RSFR) and stimulated (SSFR) whole salivary flow rate, and denture-wearing status, were treated as explanatory variables., Results: Logistic regression analysis showed that two factors were closely associated with the presence of atrophic glossitis: an increase in C. albicans CFU and a decrease in the SSFR., Conclusions: C. albicans, but not non-albicans Candida, was associated with atrophic glossitis in xerostomia patients who had no systemic predisposing factors, indicating that C. albicans remains a treatment target for Candida-related atrophic glossitis.

Metarhizium (M.) granulomatis (formerly Chamaeleomyces granulomatis) invariably causes fatal fungal glossitis and systemic mycosis in veiled chameleons (Chamaeleo calyptratus). Isolation of M. granulomatis in other lizards thus far has not been described. The aim of this study therefore was to obtain information on the presence of M. granulomatis in reptiles kept as pets, and to examine whether there was an association between specific genotypes and clinical/pathological outcomes. Besides 18S ribosomal (r) DNA (SSU) and internal transcribed spacer1-5.8S (ITS1-5.8S) rDNA, a fragment of the large subunit of the 28S rDNA (LSU), including the domains 1 (D1) and D2, were sequenced for identification of the fungus and phylogenetic analysis. Metarhizium granulomatis was isolated from 23 veiled chameleons, two panther chameleons (Furcifer pardalis) and one central bearded dragon (Pogona vitticeps). Only the veiled chameleons revealed corresponding pathological findings in the form of glossal hemorrhage, granulomatous glossitis, pharyngitis, dermatitis and/or visceral mycosis. The infection site correlated to survival times of infected veiled chameleons. Combined long-term treatment with terbinafine and nystatin based on susceptibility testing may be helpful for prevention of disease and visceral spreading of the fungus, but elimination of the fungal pathogen or successful treatment of diseased veiled chameleons have not been achieved yet. Sequencing of the ribosomal genes yielded five different genotypes, with genotype A being strongly correlated with dermatitis, and remaining genotypes with pharyngitis and glossitis. However, disseminated visceral mycosis developed irrespective of the genotypes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Post mortem examination of a young fallow deer (Dama dama) revealed a severe purulent and necrotizing glossitis as well as a multifocal necrotizing and ulcerative rumenitis and typhlitis. The animal was cachectic. Mannheimia (M.) sp. was isolated from the tongue lesions and identified as M. granulomatis by MALDI-TOF MS and 16S rRNA sequencing. Mycosis and BVDV infection were excluded. Few publications are dealing with similar macroscopic findings associated with the isolation of M. granulomatis in cattle and roe deer. Therefore, M. granulomatis should also be taken into consideration when such lesions occur in other ruminants. Based on our findings in case of gross pathological lesions of the tongue of ruminants a Mannheimia granulomatis-infection should be investigated as well as the possible role of Fusobacterium necrophorum, Actinobacillus lignieresii or Actinomyces bovis.

Purpose: This study aimed to identify factors associated with atrophic tongue in patients with dry mouth., Methods: Discriminant analysis was performed in 1265 patients with dry mouth to identify factors that might influence the risk of developing atrophic tongue. The dependent variable was the presence of atrophic tongue, while patient age, resting saliva flow rate, stimulated saliva flow rate and Candida colony-forming units (CFU) were used as the independent variables., Results: The standardised linear discriminant coefficients showed that Candida CFU, stimulated saliva flow rate and age were significantly associated with the presence of atrophic tongue. The following linear discriminant function was obtained: z = 0.024 × age - 0.63 × (resting saliva flow rate) - 0.81 × (stimulated saliva flow rate) + 0.002 × Candida CFU - 0.611., Conclusion: High Candida CFU, low stimulated saliva flow rate and advanced age were identified as closely associated factors for the risk of development of atrophic tongue., (© 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.)

In comparison to the range of antibiotics used in medicine, the spectrum of antifungal and antiviral drugs used in primary dental care is relatively limited. In practical terms, there are only three antifungal agents and two antiviral agents that have a role. This paper will describe the clinical presentation of orofacial candidal and viral infections and the use of antimicrobial drugs in their management.

Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations., (© 2012 John Wiley & Sons A/S.)

The article presents data on the clinical and microbiological short and long term efficacy of treatment of the oral mucosa diseases in patients with Helicobacter pylori associated and not associated chronic gastritis depending on the chosen treatment regimen.

Disseminated histoplasmosis caused by Histoplasma capsulatum, a zoonotic fungal organism, is an important disease in animals and humans, particularly those with compromised immune systems. Reports of disseminated histoplasmosis in an avian species are not available within the current literature. Candida albicans, another fungal agent with zoonotic importance, is a commensal of the avian digestive tract that is often associated with opportunistic infections particularly in young or immunocompromised birds. This report describes a case of concomitant histoplasmosis and candidiasis in an Eclectus parrot (Eclectus roratus) characterized by severe granulomatous glossitis, blepharitis and osteomyelitis with numerous intrahistiocytic and extracellular yeasts (H. capsulatum) as well as intralesional hyphae, pseudohyphae and conidia (C. albicans). To our knowledge, co-infection with H. capsulatum and C. albicans has not been reported in an avian species.

In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12% chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4%) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47%), Candida albicans (35.3%), Klebsiella pneumoniae (5.9%), enteropathogenic Escherichia coli (5.9%), and Stenotrophomonas maltophilia (5.9%). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80%) when compared with patients with normal oral mucosa (33.3%). In conclusion, the results of the present study suggest that the prophylactic use of 0.12% chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition, the present findings suggest a possible relationship between coagulase-negative staphylococci and the development of oral mucositis.

Oral candidosis is the most common fungal infection encountered in general dental practice. It manifests in a variety of clinical presentations which may mimic more sinister diseases, and can occasionally be refractory to treatment requiring the attention of an oral medicine specialist. Management of oral candidosis should always include a thorough investigation of underlying predisposing conditions, as the disease often presents when the patient is systemically compromised. This update highlights the pathogenesis, clinical presentation, and management strategies of oral Candidal lesions commonly encountered in dental practice.

Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians. Recognition and diagnosis require a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Examination of tongue morphology and a careful assessment for lymphadenopathy are also important. Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment. Median rhomboid glossitis is usually associated with a candidal infection and responds to topical antifungals. Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, or niacin and resolves with correction of the underlying condition. Oral hairy leukoplakia, which can be a marker for underlying immunodeficiency, is caused by the Epstein-Barr virus and is treated with oral antivirals. Tongue growths usually require biopsy to differentiate benign lesions (e.g., granular cell tumors, fibromas, lymphoepithelial cysts) from premalignant leukoplakia or squamous cell carcinoma. Burning mouth syndrome often involves the tongue and has responded to treatment with alpha-lipoic acid, clonazepam, and cognitive behavior therapy in controlled trials. Several trials have also confirmed the effectiveness of surgical division of tongue-tie (ankyloglossia), in the context of optimizing the success of breastfeeding compared with education alone. Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology.

Unlabelled: The oral cavity has been considered a potential reservoir for Helicobacter pylori (H pylori) , from where the organism causes recurrent gastric infections., Aim: With this case-control study we tried to evaluate the role of H pylori in the etiology of mucosal inflammation, a condition that compounds the morbid state associated with oral submucous fibrosis (OSF)., Materials and Methods: Subjects ( n = 150) were selected following institutional regulations on sample collection and grouped into test cases and positive and negative controls based on the presence of mucosal fibrosis and inflammation. The negative controls had none of the clinical signs. All patients underwent an oral examination as well as tests to assess oral hygiene/periodontal disease status; a rapid urease test (RUT) of plaque samples was also done to estimate the H pylori bacterial load. We used univariate and mutivariate logistic regression for statistical analysis of the data and calculated the odds ratios to assess the risk posed by the different variables., Results: The RUT results differed significantly between the groups, reflecting the variations in the bacterial loads in each category. The test was positive in 52% in the positive controls (where nonspecific inflammation of oral mucosa was seen unassociated with fibrosis), in 46% of the test cases, and in 18% of the negative controls (healthy volunteers) (chi2 = 13.887; P < 0.01). A positive correlation was seen between the oral hygiene/periodontal disease indices and RUT reactivity in all the three groups., Conclusions: The contribution of the H pylori in dental plaque to mucosal inflammation and periodontal disease was significant. Logistic regression analysis showed gastrointestinal disease and poor oral hygiene as being the greatest risk factors for bacterial colonization, irrespective of the subject groups. A positive correlation exists between RUT reactivity and the frequency of mucosal inflammation.

Helicobacter pylori (H. pylori) is one of the frequently encountered micro-organisms in the aerodigestive tract. Although infections caused by H. pylori are this common, the exact mode of transmission has not been fully understood yet. Oral-oral, fecal-oral and gastrointestinal-oral routes are the possible modes of transmission. This infection is usually acquired in childhood and may persist for the whole life of the patient. However, about 80% of the infected humans are asymptomatic. Human stomach was considered to be the only reservoir of H. pylori until bacteria were discovered in human dental plaque, in oral lesions, in saliva, in tonsil and adenoid tissue. It is suggested that H. pylori enters the nasopharyngeal cavity by gastroesophageal reflux and colonize in the dental plaques, adenoid tissues and tonsils. From these localizations, the bacteria ascend to the middle ear and to the paranasal sinuses directly or by the reflux again and may trigger some diseases, including otitis, sinusitis, phyrangitis, laryngitis and glossitis. But still, the exact mechanism remains unclear.

Aim: This case report aims at describing an infection of the tongue as a manifestation of a Trichosporon asahii infection, its association with bronchial asthma and steroid administration, and to present a review of the literature pertaining to its antifungal susceptibility profile., Background: Trichosporon asahii has been reported to be associated with a wide spectrum of clinical manifestations, ranging from superficial infection to severe disseminated diseases, particularly in immunocompromised patients., Case Report: A 36-year-old male asthmatic patient with recurrent glossitis presented with a chief complaint of burning sensation and two red areas on the dorsum of the tongue of three months duration. The glossitis was associated with Trichosporon asahii, which had a reduced susceptibility to some azole antifungal agents., Summary: Trichosporon asahii is an emerging fungal pathogen which may cause a wide range of clinical manifestations. More reports on its various clinical presentations in the oral environment need to be made available in the literature. To date there is a paucity of data on its prevalence, pathogenesis, and antifungal resistance mechanism.

We report an unusual case of disseminated cutaneous sporotrichosis with oral mucous and tracheal involvement in a forty-year-old male with a history of heavy drinking and liver cirrhosis. We also review the literature and other similar published cases.

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudomembranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.

Background: Helicobacter pylori is a curved microaerophilic Gram-negative bacterium considered as a risk factor for gastric cancer. The aim of this study was to find an association between burning sensations, acid taste, halitosis, and lingual hyperplasia with the effect of H. pylori on the mouth., Materials and Methods: A total of 124 subjects with different gastric diseases were studied: 46 patients with burning, halitosis and lingual dorsum hyperplasia and 78 patients with other diseases., Results: The detection of H. pylori in the oral cavity by histopathologic diagnosis and molecular biology was confirmed in 40/46 (87%) patients with burning, halitosis, and lingual hyperplasia, and in 2/78 (2.6%) subjects with other diseases. Chi2: 91.26 (p < .001) Mantel-Haenszel., Conclusion: This trial showed an association between H. pylori and burning, halitosis, and lingual hyperplasia, and further considered this bacterium a risk factor for gastric infection.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual "V", appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by 2 - 5 mm. This paper reports a case of rhomboid glossitis in a 61-year-old man who consulted for a painless raised lesion on the dorsum of the tongue, in left paramedial (not medial) location. Histopathological findings were compatible with rhomboid glossitis. Other diagnoses considered but ruled out on the basis of the clinical and histopathological findings were haemangioma, pyogenic granuloma, amyloidosis, granular cell tumour, and squamous cell carcinoma. This case confirms that rhomboid glossitis may occur in paramedial locations.

Glossal abscess is infrequent in children. Anaerobic bacteria are rarely recovered from this infection and never have been reported in children or adolescents. A 15-year-old patient presented with a tongue abscess following trauma. Aspirate of the abscess yielded polymicrobial anaerobic flora: Prevotella melaninogenica, Fusobacterium nucleatum, and Peptostreptococcus micros. The patient recovered following incision and drainage and 14 days of antimicrobial therapy with clindamycin. This report illustrates the recovery of anaerobic bacteria from glossal abscess in an adolescent.

Oral candidosis is the most common opportunistic fungal infection encountered in dentistry. Normally a benign inhabitant of mucous membranes, the fungal organism, Candida albicans, may present serious, even life-threatening infection in specific patient populations. As an opportunistic organism, Candida albicans is extremely responsive to any process resulting in immunosuppression. The clinical manifestations of oral candidosis are variable, occasionally complicating the clinical diagnosis and management. Treatment is often initially rendered based on a provisional clinical diagnosis and supplemented with adjunctive laboratory tests. Specific therapeutic intervention should be tailored to the individual patient, based on the current health status of the patient and the clinical presentation and severity of the infection.

A 37-day-old male Japanese black calf showing marked salivation and leucocytosis died and was examined the tissues histologically. Histological lesions were characterized by severe focal necrotic glossitis on the ventral side of the root of the tongue. Immunohistochemically, Fusobacterium necrophorum subsp. necrophorum antigen was detected in the necrotic tissues and its distribution corresponded to that of the gram-negative, nonsporeforming, long filamentous organisms. Ultrastructural similarities between the organism and F. necrophorum subsp. necrophorum, but not subsp. funduliforme were observed. These findings clearly demonstrated that the fatal necrotic glossitis was caused by F. necrophorum subsp. necrophorum. This is the first report of bovine fatal necrotizing glossitis with leucocytosis caused by F. necrophorum subsp. necrophorum infection, and this organism may be an important fatal pathogen in calves with glossal lesions.

The role of microflora was studied in patients with diseases of the buccal mucosa (aphthous stomatitis, lichen planus, leukoplasia, desquamative glossitis, etc.). Quantitative and qualitative composition of the microflora and its sensitivity to antibiotics, antifungal agents, and bacteriophages were studied. The following changes in the microflora were distinguished: dysbiotic shift, dysbacteriosis of the I-II, III, and IV degree. Microbiological status of patients with diseases of the buccal mucosa is essential for the course, outcome, and prognosis of the underlying diseases.

Nested polymerase chain reaction (PCR) was performed to detect the presence of Helicobacter pylori in tongue mucosa in 268 patients divided into four groups according to their diagnosis: 87 with atrophic glossitis, 37 with benign migratory glossitis and 144 with burning mouth syndrome (BMS). The latter group was subdivided according to anatomic site of burning sensation: subgroup A (54 patients) with complaints limited to tongue and subgroup B (90 patients) with burning sensations in other parts of oral mucosa. H. pylori was found in 43 samples (16%). Bacteria were significantly less present in tongue mucosa affected with benign migratory glossitis compared with atrophic glossitis and BMS (P=0.025). This difference was more obvious when compared with atrophic glossitis only (P=0.006). Mucosal changes in these conditions might make the oral environment more acceptable for H. pylori colonization compared with normal mucosa, and this mechanism may play a role in its oro-oral transmission.

Actinomycosis is a suppurative infection usually due to a facultative anaerobic bacteria, actinomyces israelii. This rare infection has been reported in immunocompetent individuals, with buccal or pharyngeal mucosal erosions. Paradoxically, few cases have been observed after solid organ transplantation: 2 cases after lung, 1 case after heart-lung transplantation and 1 case after renal transplantation. We report on a renal transplant recipient who developed a tongue and oropharynx suppurative abscess, looking like an epithelioma. Histological examination showed granulomatous inflammation with an angiofibroblastic reaction; few colonies of actinomyces were also observed by the pathologist. This lesion disappeared easily and totally after tetracycline treatment.

The advent of the human immunodeficiency virus and the increasing prevalence of immunocompromised individuals in the community have resulted in a resurgence of opportunistic infections, including oral candidoses. Despite the availability of a number of effective antimycotics for the management of oral candidoses, therapeutic failure is not uncommon. Further, the presence of many clinical variants of oral candidosis, both new and old, may confound the unwary clinician and complicate its management. These problems have been partly circumvented by the introduction of the triazole group of antimycotics, which initially appeared to be highly effective. However, an alarming increase in organisms resistant to triazoles has been reported recently. In this paper we provide an overview of clinical variants of oral candidosis. A second paper will discuss recent advances in the usage of antimycotics in the management of this condition.

An unusual case of necrotic infection of the tongue and unilateral necrotic maxillar sinusitis, in a cow is reported. The prominent clinical findings were: a marked salivation, unilateral mucopurulent nasal discharge, diffuse necrotic lesions on the ventral side of the tongue and fetid breath. Clinico-pathological and pathological findings and abnormalities in the haemogram were probably caused by the toxins produced by the causative organism--Fusobacterium necrophorum like microorganism.

Recently, a number of reports have been published on recurrent herpetic infection of the oral mucosa. In most of these cases, the infected tissue is the fixed intraoral mucosa, such as the gingiva or hard palate. Infection of movable mucosa such as the tongue, which is reported in the present paper, has not been reported in detail previously. In each of the two cases reported in the present paper, intraoral lesions were diagnosed as recurrent herpes-glossitis after isolation of the herpes simplex virus (HSV).

A follow-up study included the oral examination of 39 persons known to be infected with the human immunodeficiency virus. In addition to the other human immunodeficiency virus-associated oral lesions, lesions clinically similar to the smooth form of median rhomboid glossitis, which is now believed to be erythematous candidiasis located in the dorsum of the tongue, were found in seven patients (18%). Patients with median rhomboid glossitis were classified in different stages of the Centers for Disease Control 1986 classification system and showed an average of CD+4 cell counts 397.5/mm3. Also the presence or the absence of anti-p24 antibodies in the serum and stimulated whole saliva of the patients with median rhomboid glossitis did not correlate with the stage of the disease or with low levels of CD+4 cell counts as in other forms of oral candidiasis. Therefore our results suggest that median rhomboid glossitis should be included as a distinct form of oral candidiasis in the classification of the oral manifestations of infection with the human immunodeficiency virus.

Changes in the oral microbial flora, some of which are related to mucosal disease, have been detected in the elderly, but the causes are not fully understood. This study has examined the possible role of micronutrient depletions in the reduced colonisation resistance and oral infection exhibited by some elderly subjects. The oral health, oral microbiology and micronutrient status of 37 geriatric patients aged 65-91 years (mean 81 years) were examined. Ten of the patients had no oral mucosal disease. Mucosal pathology in the remainder included erythema (27%), denture stomatitis (24%), angular cheilitis (16%) and atrophic glossitis (41%). Those with mucosal pathology had significantly lower serum iron concentrations (P = 0.02). Serum or plasma concentrations of zinc, copper, selenium, C-reactive protein, transferrin, caeruloplasmin, albumin, vitamin A and vitamin E were not significantly different between those with oral disease and those with healthy mouths. Similarly, activity of the selenium-containing enzyme, red cell glutathione peroxidase, did not differ significantly between the two groups. In both groups, plasma selenium concentrations (82%), red cell glutathione peroxidase activity (47%), plasma zinc concentrations (58%) and albumin concentrations (44%) tended to be below the lower limit of the reference interval. The influence of subclinical infection on these values is discussed.

Median rhomboid glossitis is an inflammatory lesion of the tongue, now believed to be secondary to candidiasis. We document a case of median rhomboid glossitis with heavy colonisation by Actinomyces in a 60-year-old male. We propose that Actinomyces, like Candida, induces pseudoepitheliomatous hyperplasia of the mucosa of the tongue and florid inflammatory hyperplasia of the underlying connective tissue, resulting in the characteristic elevated lesion. Actinomyces has not earlier been implicated as a cause of median rhomboid glossitis.

This article discusses changing theories concerning median rhomboid glossitis (MRG). MRG is an uncommon lesion and when improperly diagnosed may be confused with carcinoma.