Cause of oral ulcers in HIV-infected patients: a study of 19 cases.

OBJECTIVES: To study the cause and clinical aspects of oral ulcers in HIV-infected patients. STUDY DESIGN: Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus. RESULTS: Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful. CONCLUSIONS: Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.

Treatment of oral Kaposi's sarcoma with a sclerosing agent in AIDS patients. A preliminary study.

Presently oral Kaposi's sarcoma is primarily treated with systemic and intralesional chemotherapy, immunotherapy, radiation, and occasionally lasers. Each of these modalities achieves varying degrees of success. In patients with acquired immunodeficiency syndrome, the traditional treatments are frequently accompanied by local and generalized side effects that are detrimental to an already compromised immune system. Experience using sclerosing agents to treat other oral vascular lesions in healthy patients is known to produce excellent results. To evaluate the use of this treatment method in patients with acquired immunodeficiency syndrome, 15 oral lesions in 12 patients were injected with 3% sodium tetradecyl sulfate (Sotradecol). Thirteen lesions were located on hard palate; nine were nodular, three papular, and three macular. One week after treatment, some degree of ulceration occurred in all lesions with healing beginning by the middle of the second week. Six lesions required a second treatment to completely resolve. In one patient, healing was delayed, and the patient encountered a period of discomfort as a result of superficial bone sequestration. All other lesions healed uneventfully without the major side effects encountered with the other commonly used methods. Patients were followed for recurrence until they died or moved away. No recurrences were noted, with many followed for 18 months or longer. It is suggested that for lesions 2.6 cm or less in size, a sclerosing agent may be a better treatment modality than those now commonly used for oral Kaposi's sarcoma.

Treatment of refractory oral candidiasis with fluconazole. A case report.

We describe a patient with the acquired immunodeficiency syndrome who had persistent oral esophageal pseudomembranous candidiasis clinically refractory to nystatin, clotrimazole, and ketoconazole. In vitro resistance to clotrimazole was demonstrated as well. The patient received temporary relief with intravenous amphotericin B therapy, but this was associated with serious adverse effects, including transfusion-requiring anemia, azotemia, and severe thrombophlebitis. Despite two courses of intravenous amphotericin B therapy, the patient's highly symptomatic, recurrent oral and esophageal candidiasis continued. The patient was then treated with fluconazole and obtained immediate relief without associated adverse effects.

Effects of disinfectants on dimensional accuracy of impression materials.

There is a continuing concern over the potential for cross-contamination of viral infections such as AIDS by means of dental impressions. This investigation compared the effects of various viricidal agents on the accuracy of irreversible hydrocolloid and silicone impressions made of single-unit and full mandibular arch models. Measurements on casts made from the treated impressions were compared with the corresponding measurements on casts made from untreated impressions. The results of this study led to the conclusions that there was no preferred disinfectant with respect to dimensional stability for the irreversible hydrocolloid, condensation silicone, or vinyl polysiloxane impression materials tested, and there was no difference in the accuracy of the casts obtained either by spraying with or immersion in any of the disinfectants tested. Therefore using the disinfectants described with either the immersion or spray techniques will not significantly affect the dimensional accuracy of cats made from treated impressions.