ORAL CAVITY LESIONS IN AIDS

1
ORAL CAVITY LESIONS IN AIDS

• Dr.SUJATHA. S.
• Senior Lecturer In ENT
• Medical College,Trivandrum

2

• One of the most common sites of head and neck
  involvement.
• Often the initial site of symptoms in HIV
  positive patients.

3

• PERIODONTITIS- 78.28
• CANDIDIASIS-65.65
• HAIRY LEUKOPLAKIA-16.5
• HERPES SIMPLEX-5.3

4
HERPES SIMPLEX

• HSV-1 -Common
• HSV-2 -Rare
• Painful, resistant ulcers
• Sites Buccal and labial mucosa(27)
• -Tongue (25)
• - Gingiva (18)
• HSVCMV- Long standing oral ulcers

5
Herpes simplex
6
(No Transcript)
7
DIAGNOSIS

• HE Stain
• PAS Stain
• CMV/HSV Immunocytochemistry

8
TREATMENT

• ACYCLOVIR
• FOSCARNET(FOSCAVIR)
• GANCICLOVIRTopical STEROIDS
• GANCICLOVIRACYCLOVIR

9
COLD SORES

• Occur in lips at the junction of vermillion and
  skin, oral cavity-palate and gingiva
• HSV 1 Recurrent
• Ulcer Big,can bleed, covered with yellowish
  pseudomembrane
• Virus latent in TRIGEMINAL ganglion

10
(No Transcript)
11
CANDIDIASIS

• Common with falling CD4 T cell count
• One of the early sign of HIV infection in a
  healthy high risk patient
• Burning mouth , change in taste
• Types-
• 1. Pseudomembranous (Thrush)
• 2. Hyperplastic erythematous
• 3. Angular chelitis

12
1. Pseudomembranous (Thrush)
13
(No Transcript)
14
2. Hyperplastic erythematous
15
3. Angular chelitis
16
HERPES ZOSTER

• Skin Oral lesion Unilateral
• Ulcer Usually affect gingiva and can present
  with tooth ache

17
(No Transcript)
18
HPV
19
HAIRY LEUKOPLAKIA

• Non-movable,corrugated/hairy white lesion on the
  lateral margin of tongue
• More in adults
• Occur in 20 asymptomatic HIV
• Occur when CD4 T cell counts falls
• Due to EBV

20
HAIRY LEUKOPLAKIA

• Useful to evaluate and treat HIV disease
• Hairy leukoplakia in HIV patients developed AIDS
  in
• - 47 within 2 years
• - 67 within 4 years

21
HAIRY LEUKOPLAKIA
22
(No Transcript)
23
PERIODONTAL DISEASE

• Common in asymptomatic and symptomatic HIV
• Two forms
• - Linear Gingival Erythema
• - Necrotising Ulcerative Periodontitis
• ( NUP)- severe with rapid progression

24
PERIODONTITIS
25
Periodontitis
26
Gingivitis
27
KAPOSI SARCOMA

• Common in MALES
• Intra-orally alone or with skin and disseminated
  lesions.
• Red / blue / purple
• Flat / Raised
• Solitary / Multiple

28
Sites

• Hard Palate commonest
• Gingiva
• Soft palate
• Buccal mucosa

29
KAPOSI SARCOMA
30
KAPOSI SARCOMA
31
DD of Kaposis Sarcoma

• Hematoma
• Hemangioma
• Pyogenic Granuloma
• Melanotic macular lesions

32
Treatment

• Based on number,size and location
• Small and circumscribed in gingiva and
  tongue-LASER excision
• Small lesion of palateGingiva Intralesional
  VINBLASTINE
• Large lesions- Local application of sclerosing
  agents
• Large,multiple - Radiation

33
LYMPHOMA

• Diffuse,undifferentiated Non-Hodgkins
• Mostly B Cell origin with EBV
• Firm,painless swelling- may ulcerate
• Underlying bone may be involved
• Anywhere in the oral cavity
• Biopsy

34
LYMPHOMA
35
LYMPHOMA
36
LYMPHOMA
37
RECURRENT APHTHOUS ULCER

• Common
• Aetiology- not known
• Minor- Solitary 5-10 mm
• - Herpetiform 1-2 mm,clusters
• Major Large,20-40mm,necrotic ulcers

38
(No Transcript)
39
LYMPHADENOPATHY
40
OTHER PRESENTATIONS

• ITP
• Xerostomia
• Parotid enlargement
• Granuloma - TB
• - M. avium intracellulare
• Histoplasmosis
• Cryptococcosis
• Geotrichosis

41
Parotid Enlargement
42
Histoplasmosis
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
Thank You