Littérature scientifique sur le sujet « Infective oral lesion »

Aim of study: To demonstrate the virulence of a Mycobacterium bovis local pig isolate in order to contribute to a better understanding of the pathological and immunological consequences of M. bovis infection in previous sensitized animals. Area of study: Buenos Aires, Argentina Material and methods: One group of ten pigs received two oral doses of killed M. bovis suspension and a comparative intradermal tuberculin test (CIT) (multiple sensitized) and then was infected with the M. bovis strain. Another group only received the CIT (single sensitized) and the infective dose. Humoral immune response was followed monthly, and gross pathology, histopathological and bacteriological analysis were performed at necropsy 100 days after infection. Main results: M. bovis oral infection induced lesions and allowed bacterial growth in most of the animals. Previous sensitization with killed M. bovis suspension slightly raised the intensity of the response, as the multiple sensitized group showed higher lesion scores and humoral response. Research highlights: Although the differences in lesion scores were not statistically significant, oral route infection after sensitization can modify the course of infections towards a fast development of lesions with a higher fibrous component suggestive of increased resistance to infection in the right conditions.

Although Leishmania transmission in nature is associated with the bite of an infected sandfly vector, other possible transmission routes are speculated to occur, such as the oral route. We evaluated the possibility of infection by this route in golden hamsters (Mesocricetus auratus) using Leishmania braziliensis (Lb) and Leishmania infantum (Li). Hamsters were exposed to experimental oral or intragastrical infection with axenic promastigotes, besides oral ingestion of a suspension of cultivated macrophages infected with amastigotes, lesion-fed Lutzomyia longipalpis, skin lesion or infective spleen fragment. The parasite’s isolation, besides a positive PCR and IFAT, confirmed the intragastric infection by promastigote parasites. The oral ingestion of macrophages infected with L. braziliensis amastigotes was also infective. These results confirmed that Leishmania parasites could infect mammals by the intragastric route through the ingestion of promastigote forms (what can happen after a sandfly ingestion) and by the oral ingestion of infected macrophages (what can happen in nature in a predator–prey interaction). The better understanding of these alternative routes is essential to understand their transmission dynamics in nature. As far as we know, this is the first time that oral and intragastric Leishmania transmission has been experimentally demonstrated, constituting new infection routes, at least for L. infantum and L. braziliensis.

Introduction. Over half a century ago the process of prevention of infective endocarditis in patients with predisposed cardiac diseases was started. The application of prevention has been based on the fact that infective endocarditis is preceded by bacteraemia, which can be caused by some invasive diagnostic and therapeutic procedures, and whose development can be prevented by applying antibiotics before an intervention. According to the latest guidelines of the European Society of Cardiology published this year, prevention is recommended only in high risk patients with previous infective endocarditis, prosthetic valves, cyanotic congenital heart diseases without surgical repair or with residual defects, palliative shunts or conduits, congenital heart diseases with complete repair with prosthetic material up to six months after the procedure (surgery or percutaneous intervention), and when the residual defect persists at the site of implantation of a prosthetic material. In addition, antibiotic prophylaxis is limited to dental procedures with the manipulation of gingival or periapical region of the teeth or perforation of the oral mucosa. Objective. The aim of this testing was to confirm whether these novelties in recommendations were applicable in our environment. Methods. Fifty-seven patients (44 men and 13 women) with infective endocarditis were included in the testing. Infective endocarditis was diagnosed in 68% of patients based on two major criteria and in 32% based on one major and three minor criteria. Results. In 54.4% of patients the entry site of infection could be determined. Twenty-one percent of patients developed infection after a dental intervention, 17.5% of patients the infection occurred after a skin/soft tissue lesion, whereas urinary infection preceded infective endocarditis in 14% of patients and bowel diverticulosis was a possible cause in of 1.75% of patients. In all cases with infective endocarditis preceded by the dental intervention, antibiotic prophylaxis was not applied due to absent data of heart disease or negligence. Conclusion. In our country a high incidence of infective endocarditis following dental procedures has been observed. One of possible reasons is poor oral hygiene. Its improvement and a regular dental control, as well as the individual risk assessment of intervention and conditions under which the intervention is performed could determine risk reduction for the development of infective endocarditis.

Actinomycosis is a chronic suppurative infection primarily caused by anaerobic gram-positive filamentous bacteria, primarily of the genus Actinomyces. Oral-cervicofacial actinomycosis is the localization found most often, presenting as a soft tissue swelling, an abscess, a mass lesion, or sometimes an ulcerative lesion. Periodontitis-like lesions, however, are rare findings. This report describes the case of a 41-year-old healthy female patient (nonsmoker), who was referred to the clinic with dull and throbbing pain in the second quadrant. Tooth 25 showed increased mobility and probing pocket depths up to 10 mm, with profuse bleeding upon probing. Radiographically, considerable interproximal horizontal bone loss was found, and the diagnosis of periodontitis stage 3, grade C was made. The situation was initially stabilized with adhesive splinting and local anti-infective therapy. Two weeks later, the bone defect was treated with guided tissue regeneration (GTR) using a xenogenic filler material (BioOss Collagen) and a resorbable membrane (Bio-Gide). Due to a suspicious appearance of the excised granulation tissue, the collected fragments were sent for histopathological evaluation. This evaluation revealed a chronic granulomatous inflammation with the presence of filamentous bacterial colonies, consistent with Actinomyces. The patient was successfully treated. While there are only few reports in the literature, actinomycotic lesions represent a rare but possible finding in cases with localized periodontal destruction. In conclusion, systematic biopsy of the infrabony tissue in localized periodontal lesions may help to provide a more accurate counting of Actinomyces-associated lesions, thereby improving diagnosis, therapy, and prevention.

First described by Hullihen in 1844, Pyogenic granuloma (PG) is a benign, exophytic vascular tumor. It is not infective, purulent or granulomatous but a reactive inflammatory mass of blood vessels with few fibroblasts within the mucosa or skin. Without any general agreement, there exist a variety of treatment options (complete surgical resection, cryosurgery, curettage, lasers etc). However, recurrence has been frequently reported. Sclerotherapy in PG (a vascular tumor) is not as commonly reported as in cases of hemangioma.Herein, we present a case of twenty-eight years old female with a clinical diagnosis of PG, treated with intralesional sodium tetradecyl sulfate (STS). Intralesional injection of 0.2 ml of undiluted STS was given for three visits between 10th of January and 21st of February 2016. The lesion healed completely at the patient’s fourth visit and recurrence was not reported till the patient was followed up for one year, i.e February 2017.

Infective endocarditis (IE) is a heart disease of an infectious nature with a primary lesion of the endocardium, heart valves, ligaments, followed by dissemination of the process to various organs. Infective endocarditis still remains a disease that is difficult to diagnose and unpredictable in terms of outcomes; it is registered in all countries of the world. Despite all the advances in medicine, infective endocarditis remains an extremely dangerous disease, with a mortality rate of 10–30%. The most common causes of lethal outcome of IE are multiple complications: embolisms of various localization, including cerebral arteries, aneurysms, toxic lesions of the spleen, myocarditis and pericarditis, acute renal failure. Currently, in pediatric cardiology practice, the frequency of primary infective endocarditis, which occurs with a change in the clinical picture, its atypical variants, has increased. The awareness of doctors of all specialties about this problem, the correct and timely diagnosis of the disease allows prescribing adequate therapy earlier and thereby improves the prognosis. The aim of our work was to familiarize physicians with the clinical observation of a teenager with an atypical onset of primary infective endocarditis, occurring under the “mask” of acute cerebrovascular accident. Also, the peculiarity of this case was the primary diagnosis of hereditary thrombophilia in the patient and the possible debut of a demyelinating disease of the central nervous system during the examination, which certainly complicated the diagnostic search and affected the outcome of infective endocarditis. The significance of dental procedures preceding the disease in a child, unfortunately, was not properly appreciated by the parents, but it is the inflammatory process in the oral cavity that should be considered as a key etiological factor in the development of infective endocarditis in this case.

A man in his 80s with no known comorbidities presented with diffuse swelling on the dorsal aspect of his right forearm for 3 months. Clinical features were suggestive of soft tissue sarcoma of the right forearm. A high resolution CT scan of the thorax showed allergic bronchopulmonary aspergillosis associated with mild mediastinal lymphadenopathy. MRI of the right upper limb showed a suspicious neoplastic/infective aetiology. A core biopsy of the right arm swelling found a granuloma with no malignancy features so an incisional biopsy of the lesion was carried out. This indicated granulomatous inflammation with excessive giant cell reaction and focal panniculitis with the possibility of a mycotic lesion. Bronchoalveolar lavage was negative for tuberculosis and fungal infection. After a multidisciplinary team discussion, the patient was started on antifungal medication. There was a marked reduction in both the size and consistency of the swelling after several weeks of oral itraconazole and potassium iodide solution. The purpose of this report is to increase the awareness of this uncommon treatable condition which, if misdiagnosed, could result in an inappropriate intervention.

A 36-year-old Asian man presented with swelling over the left frontal region involving the upper eyelids, with associated erythema and tenderness for 1 month duration. Clinically he was diagnosed as a case of preseptal cellulitis, however, the lesion did not improve on broad-spectrum systemic antibiotics. CT showed superficial soft tissue swelling in the forehead extending till the superior part of orbit. Histopathological assessment of the lesion revealed clusters of epithelioid cells with multinucleate giant cells in the dermis along with perivascular and periadnexal lymphocytic infiltrates, suggestive of leprosy. The patient was started on oral steroids with multidrug therapy, following which the patient showed early resolution of the lesion within 10 days of treatment. Leprosy is endemic in India, leprosy with reactional episodes mimics other inflammatory and infective etiologies making diagnosis difficult. Leprosy should be present in an ophthalmologist’s diagnostic repertoire while dealing with periorbital swellings for early clinical diagnosis and favourable outcomes.

Background: Knowledge of central nervous system manifestation (CS) is crucial for clinical practitioners, which is why this study was conducted to identify the neurological manifestations in HIV patient is crucial problems with HIV and the difficulties in managing these patients.Methods: The present study was conducted on patients of HIV infection who were either admitted or being treated in OPD during study period. The cases were selected based seropositivity for HIV on two consecutive occasions by ELISA and presence of WHO surveillance definition criteria. Based on a detailed history account including high risk behaviour to HIV infection was obtained from patients or relatives. Then each patient was subjected to thorough physical examination with specific attention to any clinical evidence of immunosuppression viz oral thrush. Thorough neurological examination was done to localize the part of central nervous system affected. Patients were then categorized into various clinical neurological syndromes.Results: Commonest finding was single or multiple ring enhancing lesions seen in 21(35%) patients followed by basal exudates (21.6%). Hydrocephalus was seen in 5 patients (8.3%) and infarct due to vascular lesion in 4(7%) patients. Oral thrush was more commonly seen in patients with cryptococcal meningitis. CSF analysis was useful and revealed abnormalities in most of the patients with infective disorders.Conclusions: In conclusion, variety of neurologic manifestations occur and any part of nervous system can be affected in HIV infection and high index of euspicion is required to pick up the cases early in the course which may help to improve the quality and life span of these suspicion patients.

Background. Infective endocarditis caused by the dimorphic fungus Histoplasma capsulatum is extremely rare, occurring predominantly in individuals with prosthetic heart valves and HIV infection. To our knowledge, no case of H. capsulatum native valve endocarditis has been reported in Asia. Methodology. A descriptive study was carried out at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 2020. Results. A previously healthy 34-year-old man developed fever, umbilicated skin lesions, oral ulcers, hoarseness of voice, severe weight loss, and progressive dyspnea over the course of one week. Facial umbilicated papules, nodular ulcers in his tongue and palate, a diastolic rumbling murmur at the mitral valve, diffuse fine crackles in both lungs, and engorged neck veins were detected during the examination. Skin scraping of the facial lesion revealed both extracellular and intracellular yeasts with buddings, 2–4 μm in size on Wright’s stain. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 54 percent, severe rheumatic mitral stenosis, and multiple oscillating masses in the anterior mitral valve leaflet ranging in dimension from 1.5 to 2.4 cm. The HIV antibody test was negative. H. capsulatum endocarditis was diagnosed, and liposomal amphotericin B was administered. Due to cardiogenic shock, emergency open-heart surgery was conducted one day after admission. However, he died of multiorgan failure four days after the operation. The skin and vegetation cultures finally grew H. capsulatum after 1 week of incubation. Conclusions. To date, there has been handful of cases of H. capsulatum native valve endocarditis in non-HIV-infected patients. We report herein the first case in Thailand. Umbilicated skin lesions, especially combined with oral mucosal lesions, are a clinical clue that leads to the correct diagnosis of the causative organism.

Our study describes the relationship between periodontal disease and oral mucosal lesions. At first we analysed classification criteria of oral lesions in order to provide a point of reference for an adequate description. In a second time we started to describe periodontal disease, that is a common pathology all over the world with high costs for therapy and rehabilitations. Also classification of periodontal disease is important, because there are different types of disease, with various clinical aspects. We used the AAP (American Academy of Periodontology) classification of 1999, that reports: gingivitis, chronic periodontitis, aggressive periodontitis, periodontitis related to systemic diseases, necrotizing periodontitis, periodontal abscess, periodontitis associated to endodontic lesions, acquired and developed deformities and conditions. In the second part we described oral mucosal lesions, starting with infective diseases on the basis of etiologic agents: bacterial, viral (with viral neoplasms), fungal, parasitic and syphilitic lesions. In the third part we described autoimmune lesions, in particular the erythema multiform. In the fourth part we analysed the neoplastic and pre-neoplastic diseases, in particular squamous cell carcinoma and leukoplakia. Fifth section is dedicated to “border lesions”, because they are studied both in periodontology and oral medicine. These diseases are the desquamative gingivitis, lichen planus, pemphigoid, pemphigus, linear IgA disease, chronic ulcerative stomatitis and epulid.

Thesis (Mnutr)--University of Stellenbosch, 2003.
ENGLISH ABSTRACT: Problem Definition: In the context of HIV/AIDS malnutrition is almost universal among children, and of the adverse effects of Protein Energy Malnutrition, the most frequent seems to be the occurrence of opportunistic infections with micro-organisms such as oral Candida. Objective: The aim of this study was to determine the nutritional status of children with oral complications in relation to HIV/AIDS as well as the effects of the oral lesions on nutritional status. Subjects/setting: The subjects of study were 24 children co-infected with TB and HIV who were admitted consecutively to the paediatric ward of Brooklyn Chest Hospital in Cape Town, South Africa. The nutritional status of the children was assessed over a maximum period of six months by nutrient intake, anthropometric status, and by biochemical parameters and clinical and oral examination on admission and at discharge from hospital. Results: Children with HIVand TB infection presenting with or without oral lesions were similarly malnourished throughout the period of hospitalization. There was no improvement in the nutritional status as indicated by height and weight measurements. Throughout the time of hospitalization, 7% of the children had a combination of stunting, underweight and wasting. Average nutrient intake was not found to be higher than the Recommended Dietary Allowance (RDA) in any of the children. At the time of admission to hospital and at discharge, carbohydrate intake provided most of the daily energy (36% and 42%, the difference not being statistically significant). There was a significant increase in the intake of energy (p=O.04) and a decrease in total fat intake (p=O.03) at discharge. Although not significant, mean protein intake at admission was higher than at time of discharge. Selected sub-optimal biochemical values were prevalent among the children studied, with 45% and 41% showing low serum albumin values «2.9g/dL) at the time of admission and at discharge respectively. Both on admission and at discharge, 38% of the children had Haemoglobin levels below normal values. Serum ferritin levels below normal values were present in almost all the children and the trend was similar for the prevalence of low zinc values. Sub-normal plasma retinol was present in 79% of the children at time of admission, while only 21% had deficient values at time of discharge (p=O.03). On admission, 29% of the children had vitamin evalues below the normal range whereas at time of discharge 17% of the children had values below normal (p=O.04). A total of 29% children presented with oral complications on admission. These included oral herpes, oral thrush, reflux, bleeding gums and stomatitis/angular cheilosis. Two children were asymptomatically colonized with Candida of the oral cavity. Mean total protein intake was higher (p=O.057) among the children who were not diagnosed with oral complications. Conclusions: This study confirmed that malnutrition is not only a common and serious problem associated with HIVand AIDS, but also that nutritional problems cannot be dealt with in isolation where Opportunistic Infections are present. The severity of malnutrition depends on various factors including oral complications. Additionally, appropriate management and treatment of tuberculosis did not appear to affect the nutritional status significantly. Recommendations: On the basis of these findings, and because of the increased risk of growth failure and developmental delays, children should be referred for full nutritional evaluation as soon as possible after diagnosis of HIV -infection. In addition, there is a need for intervention programmes to identify the immediate underlying causes of malnutrition and the ways in which such causes interact, in order to ensure that such interventions increase the resistance of HIV infected infants and children to the disease.
AFRIKAANSE OPSOMMING: Probleemdefiniëring: Binne die konteks van MIVNIGS is wanvoeding bykans universeelonder kinders en van die nadelige effekte van proteïen energie wanvoeding is die voorkoms van opportunistiese infeksies (Ol) met mikro-organismes soos orale candida die algemeenste. Doelwit: Die doel van dié studie was om die voedingstatus van kinders met orale komplikasies in verhouding tot MIVNIGS en die effek van orale letsels op voedingstatus, te bepaal. Proefpersone/omgewing: 'n Groep van 24 kinders, met beide tuberkulose en MIVNIGSinfeksie, wat agtereenvolgend in die kindersaal van Brooklyn Bors-Hospitaal in Kaapstad, Suid- Afrika opgeneem is, is bestudeer. Vir 'n periode van ses maande is die kinders se voedingstatus geassesseer deur middel van voedingstofinname, antropometriese status en biochemiese parameters met opname in en ontslag uit die hospitaal. Kliniese en orale ondersoeke was op elke kind uitgevoer met opname sowel as ontslag. Resultate: Kindres met HIV en tuberkulose, met of sonder orale letsels, het soortgelyke wanvoeding tydens hospitalisering ervaar het. Volgens antropometriese metings was daar geen verbetering in die voedingstatus nie. 'n Kombinasie van belemmerde groei, ondergewig en uittering het in 7% van die kinders tydens hospitalisering voorgekom. Nie een van die gemiddeldes van die voedingstowwe was hoër as die Aanbevole daaglikse toelatings (ADT) in enige van die kinders wat bestudeer is nie. Met opname sowel as ontslag, was koolhidraatinname die grootste energieverskaffer met onderskeidelik 36% en 42% (alhoewel die verskil nie statisties beduidend was nie). Daar was 'n beduidende toename in energie-inname (p=O.04) en 'n afname in totale vetinname (p=O.03) met ontslag. Alhoewel nie beduidend nie, was die gemiddelde proteïeninname hoër met ontslag. Die voorkoms van geselekteerde sub-optimale biochemiese waardes met toelating en ontslag wys dat onderskeidelik 45% en 41% van die kinders lae serum albumienwaardes «2.9g/dL) getoon het. Subnormale plasma retinol het in 79% van die kinders met toelating voorgekom, terwyl slegs 21% gebrekkige waardes (p=O.03) met ontslag getoon het. Tydens opname, sowel as met ontslag, was 38% van die kinders se hemoglobienvlakke laer as die normale. Serum ferritienvlakke was amper by al die kinders laer as die normale vlakke te bespeur, met sinkvlakke wat op soortgelyke lae vlakke voorkom. Met toelating was 29% van die kinders se Vitamien C-waardes laer as normaal en met ontslag was sowat 17% se waardes steeds laer as die normaal (p=O.04). Met toelating het 29% van die kinders orale komplikasies getoon. Ingeslote hierby was orale herpes, orale sproei, refluks, bloeiende tandvleise en stomatis/ angulêre cheilose. Slegs twee kinders was asimptomaties met orale Candida van die mondholte gediagnoseer. Die gemiddelde proteïeninname was hoër (p=O.057) onder die kindres wat nie orale komplikasies getoon het nie. Gevolgtrekking: Hierdie studie bevestig dat wanvoeding me net 'n algemene en ernstige probleem is wat met MIV en VIGS geassosieer word nie, maar ook in die teenwoordigheid van opportunistiese infeksies, die voedingsprobleem nie in isolasie gehanteer kan word nie. Die graad van wanvoeding hang af van ander faktore, insluitende orale komplikasies. Voldoende behandeling van TB het ook nie 'n beduidende effek op voedingstatus gehad nie. Aanbevelings: Op hierdie bevindings gebaseer, en as gevolg van die verhoogde risiko VIr belemmerde groei en vertraagde ontwikkeling wat al die liggaamstelsels van MIV -positiewe kinders affekteer, moet kinders so gou as moontlik nadat die MIV-infeksie gediagnoseer is, vir volle voedingsevaluasies verwys word. Daarmee gepaardgaande is daar 'n behoefte aan programme wat die onmiddellike onderliggende oorsake van wanvoeding identifiseer, asook om interaksie van hierdie oorsake met HIV vas te stel, ten einde intervensies wat weerstand van HIVkinders en-babas verbeter, positieftoe te pas.

Toxoplasma gondii é um protozoário intracelular obrigatório que causa a toxoplasmose. Em modelo experimental, camundongos C57BL/6 infectados por via oral com 100 cistos de T. gondii, cepa ME-49, desenvolvem sérias lesões intestinais similares as observadas em doenças inflamatórias intestinais. Ao invadir as células epiteliais intestinais, o parasito induz uma resposta inflamatória de padrão T helper (Th) 1 elevada, ativada pela produção de quimiocinas e citocinas envolvidas na migração e ativação celular. Para que ocorra essa migração celular para o sítio de infecção é necessário a presença de receptores de quimiocinas. O receptor de quimiocinas CCR5 é muito importante para o recrutamento celular em algumas infecções e está envolvido com a migração de vários subtipos celulares como células dendríticas, células T e, em particular, células T reguladoras. CCR5 pode estar relacionado também a mecanismos independentes da migração celular, no qual a sinalização intracelular e ativação de NF-B podem levar a intensificação da resposta imunológica. Ainda não está claro o papel do receptor CCR5 no modelo de infecção oral por T. gondii. Dessa forma, animais C57BL/6 e deficientes em CCR5 foram infectados por via oral com 5 cistos de T. gondii, cepa ME-49, e alguns parâmetros imunológicos e bioquímicos foram avaliados no 8º dia de infecção. Os resultados mostraram que animais CCR5-/- apresentaram alta suscetibilidade à infecção oral por T. gondii, exibindo um intenso infiltrado inflamatório no íleo e regiões de ulceração epitelial, quando comparados com animais C57BL/6. Independentemente de serem deficientes ou não de CCR5, os camundongos apresentaram focos inflamatórios dispersos pelo parênquima do fígado, entretanto camundongos CCR5-/- apresentaram uma extensiva vacuolização dos hepatócitos, com excessivo acúmulo de lipídeos no órgão e elevada concentração sérica de triglicérides e de transaminases. A carga parasitária foi significativamente mais elevada no intestino delgado e no fígado dos animais CCR5-/- em comparação com animais C57BL/6. Foi observada também uma menor migração de células NK no intestino delgado, bem como um aumento na frequência de células T CD4+ neste órgão e uma menor concentração de IFN- e IL-12p40 no macerado do fígado dos animais CCR5-/- em comparação com C57BL/6. Análise de expressão gênica no fígado revelou redução na formação de transcritos para PPAR nos animais deficientes em CCR5, e quando os camundongos foram tratados com Gemfibrozil, um agonista de PPAR, houve reversão na vacuolização hepática e na concentração de triglicérides no soro dos animais CCR5-/-. Estes dados sugerem que a migração celular dependente de CCR5 é essencial para a modulação da resposta inflamatória induzida por T. gondii no intestino delgado. Além do mais, a ausência de CCR5 compromete a integridade hepática durante a infecção oral por T. gondii e os mecanismos moleculares envolvidos podem estar relacionados à expressão de PPAR.
T. gondii is an obligate intracellular protozoan parasite which is the causative agent of toxoplasmosis. In experimental model, C57BL/6 mice orally infected with a high parasitic load develop serious intestinal lesions, whose injuries are similar to those observed in Inflammatory Bowel Disease. This inflammation is caused due to parasite invasion of intestinal epithelial cells that elicit a robust Th1 type immune response. Moreover, chemokines produced by intestinal epithelial cells are involved in the migration and activation of inflammatory cells. In particular, the chemokine receptor CCR5 is important for cell recruitment in some infections and is involved with the migration of various cells subsets such as dendritic cells, T cells and, in particular regulatory T cells. CCR5 may also be related to mechanisms independent of cell migration, in which the intracellular signaling and activation of NF-B may lead to intensification of the immune response. The role of CCR5 has not been clear in the experimental oral T. gondii infection. Thus, wild type C57BL/6 mice and CCR5-/- littermates were infected with T. gondii by gavage and immune and biochemical parameters, were analyzed at day 8 after infection. The CCR5-/- mice showed to be highly susceptible to the parasite, with intense inflammatory infiltration in the ilea and regions of epithelial ulcerations in comparison with WT mice. Both strain of mice presented inflammatory foci scattered by parenchyma of the liver, however the CCR5-/- mice presented an extensive hepatocyte vacuolization with an excessive accumulation of lipids in the organ and elevated serum triglycerides and transaminases concentration. The parasite load was significantly higher on small intestine and liver samples of CCR5-/- in comparison with WT mice. There was also a minor migration of NK cells in the small intestine, as well as greater frequency of CD4+ T cells in this organ and a lower IFN- and IL-12p40 levels in liver homogenate samples in the CCR5-/- mice compared with WT mice. Gene expression analysis revealed a reduction in the formation of transcripts for PPAR in mice deficient in CCR5, and when the animals were treated with Gemfibrozil, a PPAR agonist, there was an improvement in the level of vacuolization and reduced triglycerides. These data suggest that a CCR5-dependent cell migration is essential for the modulation of T. gondii-induced inflammatory response in the small intestine. In addition, hepatic integrity during T. gondii oral infection is compromised in the absence of CCR5, and the molecular mechanisms involved can be related to PPAR expression.

Background Oral candidiasis is the most common infection of the oral mucosa of HIV-seropositive patients, although its frequency is rapidly decreasing with the advent of highly active antiretroviral therapy (HAART). Many questions regarding its complex pathogenesis remain unanswered. The diagnosis is usually established with non-invasive techniques such as mucosal smears. Oral lesions of HIV-associated Kaposi sarcoma (HIV-KS) are routinely biopsied and frequently show secondary infection with Candida albicans or other Candida species. Aims and objectives The aim of this investigation was to determine the frequency and histomorphology of secondary Candidal infection of the surface epithelium of oral HIV-associated KS lesions (HIV-KS), which are routinely biopsied in HIV infected patients. Materials and methods Haematoxylin and eosin (HE), and Periodic Acid-Schiff (PAS) stains of 133 cases of oral Kaposi sarcoma diagnosed between the period 2003 and 2007 within the Division of Oral Pathology were examined histologically for intensity and morphology of Candidal colonisation, depth of invasion, number of organisms, epithelial reactions and associated inflammatory response. The depth of Candidal invasion and severity of infection were correlated with the available CD4 T cell counts of HIV seropositive patients at the time of biopsy. Results Almost forty one percent (40.62%) of all oral HIV-KS cases were secondarily infected with Candida species. The intensity varied from an isolated single pseudohyphus to matted colonies of vegetative yeasts and psuedohyphae. Whilst in most cases the organisms did not invade beyond the parakeratin layer, pseudohyphae were noted extending into the stratum spinosum in 2 cases, and a single case showed a pseudohyphus within the lamina propria. A further 2 cases showed pseudohyphae growing in the pyogenic membrane. Neutrophilic permeation of the epithelium and Munro micro-abscess formation, features commonly associated with Candidal infection, were frequently present even in the absence of Candidal infection. Candidal organisms were often present in the absence of inflammation. Conclusion Oral lesions of HIV-KS are commonly secondarily infected with large numbers of Candidal organisms. The morphological characteristics of secondary Candidal infection within the surface epithelium of HIV-KS lesions suggest an altered pathogenetic pathway. Further studies are necessary in this regard.

Abstract The utilization of oral lesions as a screening tool for HIV is not well documented. Attendees at two primary health care facilities (Khutsong and Heidelberg) were assessed to determine the predictive value of group I oral lesions for HIV infection. The objectives were to investigate the: 1) HIV prevalence amongst attendees at PHC facilities, 2) Prevalence of HIV-related oral lesions and 3) Correlation between the oral lesions and the HIV status using the Likelihood Ratio test. Methods: All patients over 12 months of age presenting at the two facilities for a curative care consultation over a one-week period (in April 2005) were included. Consent was obtained by trained counselors who also conducted a brief interview and offered pre-test counseling to patients wishing to know their HIV status. Two calibrated dentists conducted a head, neck and oral examination and administered a rapid saliva HIV test (OraQuick HIV-1/2-Rapid HIV-1/2 Antibody Test). Results: A total of 654 attendees were surveyed in the 2 facilities. There was a 100% response. The mean age of the participants was 34 years (range: 1-94), and the majority (73%) were female. HIV prevalence rates were 34% at Khutsong and 36% at Heidelberg. The HIV prevalence peaked at 46% in the 16-45 age groups. Of the 228 who tested positive for HIV, 121 (53%) patients were diagnosed with 1 or more Group I oral lesion. Oral candidiasis (46%) and oral hairy leukoplakia (19%) were the two most common oral lesions diagnosed in the HIV positive cohort. The positive predictive values and specificity values for multiple lesions ranged between 96% and 100%. Most of the likelihood ratios for multiple lesions were greater than 10 which implied that the patients who presented with these lesions were extremely likely to test positive for HIV. The sensitivity values (1% to 37%) and negative predictive values (66% to 70%) remained relatively low. Conclusion: The HIV prevalence of patients attending PHC facilities was high (34%). Oral lesions are useful markers of HIV-infection and should alert clinicians to the presence of HIV infection. Multiple group I lesions were more predictive of HIV infection compared to single lesions.

This chapter covers cancer of the oral cavity and the oropharynx, which includes the base of the tongue, soft palate, tonsils, and back and side walls of the throat. Many important risk factors for oral and oropharyngeal cancer have been identified, and in 2007 the World Health Organization determined there was sufficient evidence to include human papilloma virus (HPV) type 16 as a cause of these cancers. Tobacco and alcohol remain important modifiable risk factors, but the increasing incidence of HPV-associated tumors is now evident. While these tumors are more amenable to treatment than HPV-negative tumors, they are still a source of considerable morbidity and mortality. Moreover, the lack of a precursor lesion and limited data on efficacy of the HPV vaccine in preventing oral HPV infection are barriers to primary and secondary prevention efforts. Dietary patterns high in fruits and vegetables and low in meats may confer some protection.

Contents. Bacterial infections of the mouth. Viral infections of the mouth. Oral candidosis (candidiasis). Recurrent aphthous stomatitis (ulcers). Vesiculo-bullous lesions—intraepithelial. Vesiculo-bullous lesions—subepithelial. White patches. Pigmented lesions of the mouth. Premalignant lesions. Oral cancer. Abnormalities of the lips and tongue. Salivary gland disease—1. Salivary gland disease—2. Drug-induced lesions of the mouth. Facial pain. Oral manifestations of skin disease. Oral manifestations of gastrointestinal disease. Oral manifestations of haematological disease. Oral manifestations of endocrine disease. Oral manifestations of neurological disease. Oral manifestations of HIV infection and AIDS. Cervico-facial lymphadenopathy. An approach to oral ulcers. Temporomandibular pain—dysfunction/facial arthromyalgia.

Human immunodeficiency virus (HIV) causes a complete depletion of the immune system; it has been a major health issue around the world since the 1980s, and due to the reduction of CD4+ T lymphocytes levels, it can trigger various opportunistic infections. Oral lesions are usually accurate indicators of immunosuppression because these oral manifestations may occur as a result of the compromised immune system caused by HIV infection; therefore, oral lesions might be initial and common clinical features in people living with HIV. So, it is necessary to evaluate and understand the mechanism, prevalence, and risk factors of oral lesions to avoid the increase morbidity among those with oral diseases.

Examination of the face and hands can identify significant skin diseases and also provide clues to the presence of underlying systemic disease. Many patients ignore even malignant skin tumours because they are often painless, subtle in appearance, and may be slow-growing. Dental healthcare professionals should be aware of how to recognize malig­nant skin tumours. If suspicious, but unsure of the nature of the lesion, the patient should be referred to their general medical practitioner for further evaluation. If malignancy is obvious, then an urgent referral to an appropriate specialist (dermatologist, plastic surgeon, or oral and max­illofacial surgeon) should be made using the ‘2-week wait’ (2WW) path­way (Chapter 1). Benign lesions and inflammatory diseases are more common and are important considerations in the differential diagnosis of head and neck skin abnormalities. It is important that the dental healthcare professional should be able to recognize common skin infections involving the oro-facial region. Some infections, such as erysipelas, can mimic cellulitis associated with a dental infection. When infection is diagnosed, it is vital to consider the underlying or predisposing factors, as these may be not only important diagnoses, but also may require treatment to achieve an effective clin­ical outcome. The adage ‘infection is the disease of the diseased’ is a useful reminder when dealing with patients presenting with infection. Direct inoculation of Streptococcus into skin through minor trauma is the most common initiating factor for erysipelas, which occurs in iso­lated cases. Infection involves the upper dermis and, characteristically, spreads to involve the dermal lymphatic vessels. Clinically, the disease starts as a red patch that extends to become a fiery red, tense, and indurated plaque. Erysipelas can be distinguished from cellulitis by its advancing, sharply defined borders and skin streaking due to lymphatic involvement. The infection is most common in children and the elderly, and whilst classically a disease affecting the face, in recent years it has more frequently involved the leg skin of elderly patients. Although a clinical diagnosis can be made without laboratory testing, and treat­ment is antibiotic therapy, when the diagnosis is suspected in dental practice, referral to a medical practitioner is recommended.

Kaposi sarcoma (KS) is an angioproliferative disease that requires human herpes virus 8 infection (HHV-8). The development of KS appears to depend on the viral homologs of human genes that are carried by HHV-8. Skin lesions such as angiomas, hematomas, pyogenic granuloma, and nevi should also be considered in the differential diagnosis. Biopsy of the lesion should be performed when possible. The diagnosis of KS is confirmed if the biopsy specimen shows the HHV-8 latency-associated nuclear antigen. The main treatment for AIDS-associated KS is combination antiretroviral therapy.

Cutaneous leishmaniasis (CL) may present as a disseminated infection (visceral) or with lesions involving the skin or oral or nasal mucosa. Leishmaniasis is transmitted by the bite of infected sand flies. Diagnosis of CL is made by histopathologic observation of the amastigote form of the parasite, by parasite cultures, or by molecular methods. In immunocompetent individuals, infection may resolve without treatment. Therapeutic options include cryotherapy, thermotherapy, and photodynamic therapy or topical paromomycin. Preventive strategies include individual protective measures such as minimizing exposed skin, using bed nets, applying insect repellents to bare skin, and wearing permethrin-treated clothing.

This chapter begins by discussing general surgical principles, such as informed consent, preventing thromboembolic disease, and preventing infection. It then describes anaesthesia and management of the medically compromised patient. The chapter then covers dentoalveolar surgery, odontogenic infections, and non-odontogenic infections. Biopsy, cysts, and intraoral benign tumours are described. Neoplastic and non-neoplastic bone disorders are then discussed, along with the classic radiographic appearances of jaw lesions. Neck lumps (including cervical lymph nodes, Lymphoma, midline neck swellings, and lateral swellings), facial palsy, and paranasal sinuses are all covered. The chapter ends with a section on osseointegrated implants.

Oral manifestations are among the earliest presentations of HIV infection. They appear during the course of HIV disease progression and immune deterioration and also in association with many sexually transmitted infections. In the era of effective retroviral therapies, HIV-related oral soft tissue lesions are seen in less frequently, and their presence may indicate undiagnosed HIV infection or treatment failure. Patients living with HIV and AIDS continue to experience salivary gland abnormalities, such as xerostomia, periodontal disease, and sexually transmitted human papilloma virus infection, which can increase their risk of developing oropharyngeal cancer. In addition to conventional adult gingivitis and periodontitis in persons living with HIV with immune recovery, unique features of severe periodontal disease can be associated with poorly controlled HIV.

Brain tumor cases make up a significant part of the neurosurgery Oral Board Exam. A multitude of brain tumors exist and can be intraaxial or extraaxial. When considering a differential diagnosis for a brain lesion, infection, hematomas, infarctions, thrombosed aneurysms, inflammation, and demyelinating disease must be considered in addition to tumors. Common adult brain tumors consist of gliomas, meningiomas, metastases, and pituitary tumors. Management of brain tumors consists of understanding preoperative care, indications for surgery, surgical approaches, interpretation of preoperative and postoperative imaging, intraoperative and postoperative complications, and the role of adjuvant therapy, including chemotherapy and radiotherapy. Reviewing these essential points for the most common brain tumor cases and mastering the current treatment recommendations for common tumors will also be helpful for the boards.