Oral manifestations

Erythematous palatal lesion in an HIV antibody-positive patient

*Erythematous candidiasis* smears taken from the lesion showed hyphae and spores consistent with candida. The lesion healed after 2-wk course of anti-fungal meds.

Oral manifestations related to HIV

*Oral conditions can be one of the early signs of HIV infection and risk for progression to AIDs* -Candidiasis -hairy leukoplakia -specific forms of periodontal disease (linear gingival erythema & NUP) -Bluish/purple lesions (Kaposi sarcoma) -non-Hodgkins lymphoma ^above are reported to be strongly associated with HIV infection *candidiasis is the most common oral manifestation of HIV infection*

Burkitt Lymphoma

EBV can cause *BURKITT LYMPHOMA,* a tumor of the jaw an face resulting from immortilization of B-cells. *co-infection with the malaria parasite, plasmodium falciparum* promote involvement with EBV (HHV-4) with Burkitt lymphoma.

Infectious mononucleosis

Epstein-Barr virus (HHV-4) causes *INFECTIOUS MONONUCLEOSIS* *CHARACTERIZED:* exudative pharyngitis, lymphadenopathy, hepatosplenomegaly, swollen liver, fever and malaise. complications are rare but can be serious. --> laryngeal obstruction --> neurologic disorders *epidemiology:* result from activation and proliferation of immune effector cells, particularly suppressor CD8 cells, which appear as atypical lymphocytes called *DOWNEY CELLS.* Shared by person-to-person contact through saliva, "kissing disease." Children can acquire from contaminated cups, toothbrushes and utensils. Disease in children is usually subclinical. --> can cause leukoplakia

Kaposi sarcoma on face of patient with AIDS

Kaposi sarcoma is a malignant tumor of endothelial cells caused by HHV-8. *Kaposi sarcoma that occurs in an HIV-infected patient is diagnostic of AIDS*

Necrotizing ulcerative gingivitis in a cigarette smoker

NUG relates to ulceration and necrosis of one or more interdental papillae with no loss of periodontal attachment

Necrotizing ulcerative periodontitis in HIV infected patient.

NUP consists of gingival ulceration and necrosis with attachment loss and does not respond to conventional periodontal therapy.

Pseudomembranous candidiasis associated with AIDS

Note white lesions on the oral mucosa

Oral Hairy Leukoplakia

Patients with HIV may develop Epstein-Barr Virus (HHV-4, human herpes virus-4)-induced lesion in the mouth called *ORAL HAIRY LEUKOPLANIA*. *CHARACTERIZED:* RAISED WHITE PATCHES USUALLY SEEN ON THE TONGUE that *cant be wiped off*

Pseudomembranous candidiasis associated with AIDS

White lesions on the palate in a patient with AIDS. The lesions could be scraped off with a tongue blade. The underlying mucosa was erythematous. Diagnosis of *pseudomembranous candidiasis*

Nasopahryngeal Carcinoma

can be caused by EBV (HHV-4), tumor cells are of epithelial origin. - this cancer is regularly found in *Asia* (specifically Southeast China) and seen in adults

squamous cell carcinoma of the tongue in a heavy cigarette smoker

carcinoma looks "angry"

Kaposi Sarcoma

caused by HHV-8 also known as Kaposi's Sarcoma Herpes Virus (KSHV). *CHARACTERIZED:* dark purple lesions and often occur on the skin, in the *oral cavity* and on the soles of the feet. *TRANSMISSION:* by saliva or sexually *Epidemiology:* infects preferentially B-cells *Tx:* Ganciclovir or foscarnet

Kaposi sarcoma on palatal mucosa

multiple larfe, flat, erythematous lesions involving the palatal mucosa. Biopsy of the lesions revealed *kaposi sarcoma* and the patient was eventually given a diagnosis of AIDS

Herpes Zoster (shingles)

occurs when VZV (AKA varicella or chicken box) is reactivated, with vesicular eruptions along a dermatome. 10-20% of infected population with VZV become infected with herpes zonster. *Epidemiology:* VZV is spread through respiratory droplets (90% of cases occure before age 10). The infection become latent in the dorsal root ganglia. Reactivated in patient with impaired immunity and migrated down the sensory nerve to the skin *Characterized:* preceeded by pain in sensory nerve. vesicular eruption involves a dermatome and is usually unilateral

Palate of patient diagnoses with AIDS and has Kaposi sarcoma

palatal lesion in patient with AIDS. biopsy revealed Kaposi sarcoma.

Angular cheilitis in patient with AIDS

patient responded to antifungal meds.

Cold sores

recurrent mucocutaneous HSV-1 infection result in cold sores *Transmission:* present in orolaryngeal secretions, person-to-person contact.

Gingivostomatitis (herpetic stomatitis)

sympotomatic primary HSV-1 present as gingivostomatitis. *transmission:* person-to-person contact