Soluble LPS receptor CD14 is increased in saliva of patients with geographic tongue.

OBJECTIVES: The soluble bacterial pattern recognition receptor, sCD14 augments inflammatory responses in oral cavity. The aim of the study was to investigate whether patients with geographic tongue (GT) with and without fissured tongue (FT) have impaired inflammatory regulation, manifesting as increased levels of sCD14 in the saliva. MATERIAL AND METHODS: An enzyme-linked immunosorbent assay was used to measure the amount of sCD14 in whole and parotid saliva of patients diagnosed with GT (GT whole, n = 21; GT parotid, n = 23) and control subjects (GT whole, n = 25; GT parotid, n = 18). The levels of sCD14 were also evaluated according to our previous clinical assessment of GT based on the number of lesions detected on the tongue, as 'mild' (a single lesion), 'moderate' (2-5 lesions), or 'severe' (≥6 lesions). Diagnosis of FT was established when multiple grooves or fissures were observed on the dorsal and lateral surfaces of the tongue. RESULTS: GT patients had significantly higher sCD14 levels in whole (p<.05) and parotid saliva (p<.001), compared with controls. GT patients with FT had significantly increased sCD14 levels only in parotid saliva. A gradual increase in sCD14 levels in parotid and unstimulated saliva was seen in GT patients with multiple tongue lesions compared with single lesions. CONCLUSIONS: GT patients had increased sCD14 in both parotid and unstimulated saliva. sCD14 seems to increase local inflammatory responses, which suggests its involvement in the pathophysiology of GT.

Geographic tongue: What is this disease?

Geographic tongue or benign migratory glossitis, is a unique and peculiar tongue condition, producing a map-like appearance with filiform papillae atrophy, on different parts of the tongue. The lesions change in shape with time. The exact etiology remains unknown, although it has been suggested relating the lingual microbiota of a patient. The association between geographic tongue and psoriasis has long been pointed out, and histological similarities existed between both as well. Increasingly, recent findings suggest the involvement of certain oral bacteria. Here, we discuss these findings with an overview of the recent literature.

Psoriasis is associated with fissured tongue but not geographic tongue: a prospective, cross-sectional, case-control study.

BACKGROUND AND OBJECTIVES: It has been postulated that psoriasis is associated with tongue lesions and geographic tongue might be "oral psoriasis". However, reports are inconclusive, prevalence rates vary and data for Europe are sparse. In this prospective case-control study we investigated the point-prevalence of tongue conditions in an Austrian cohort. PATIENTS AND METHODS: Psoriasis patients and healthy volunteers were assessed regarding tongue and skin lesions, age, sex, smoking habits, allergies, onset of psoriasis, PASI scores and anti-psoriatic treatment. RESULTS: We included 173 psoriasis patients, 58 women, 115 men (median age: 50 [37-60] years), and 173 volunteers, 79 women, 94 men (median age: 54 [43-64] years). Overall, 95 subjects had allergies, 64 psoriasis patients and 50 volunteers were smokers. Median age at onset of psoriasis was 26 (12-40) years, the median PASI score was 2 (0-4.1), most patients received ustekinumab (n = 47). Fissured tongue was significantly associated with psoriasis (25 [14.4 %] psoriasis patients, 13 [7.5 %] volunteers; P = 0.04). Geographic tongue was present in four individuals of each group (2.3%) and associated with smoking (P = 0.01) but not with psoriasis. CONCLUSIONS: Overall, we found a low point-prevalence of tongue lesions in this Austrian cohort. Psoriasis was associated with fissured tongue but not with geographic tongue. Thus, we cannot corroborate the hypothesis that geographic tongue is an oral manifestation of psoriasis.

Prospective Evaluation of the Frequency and Severity of Symptoms in Lyme Disease Patients With Erythema Migrans Compared With Matched Controls at Baseline, 6 Months, and 12 Months.

BACKGROUND: Erythema migrans is the most common clinical manifestation of Lyme disease. Despite antibiotic therapy, typically at least 10% of adult patients with erythema migrans experience persistence of at least 1 subjective symptom for ≥6 months (posttreatment Lyme disease symptoms [PTLDS]). METHODS: This study was designed to determine whether the frequency and severity (based on a visual analogue scale) of 12 particular symptoms in patients with erythema migrans (n = 52) differed from matched control subjects (n = 104) followed prospectively for 12 months. RESULTS: At baseline, patients with Lyme disease were more likely than controls to have at least 1 symptom (P = .006). Among symptomatic subjects, Lyme disease patients had a higher mean number of symptoms (P < .001) and a higher mean total symptom severity score (P < .001). At both 6 and 12 months, however, there were no significant differences for these variables and no significant differences in the frequency or severity of any of the 12 individual symptoms assessed. However, 10 patients were clinically assessed as having possible PTLDS. CONCLUSIONS: Patients with erythema migrans were more likely than matched control subjects to be symptomatic at baseline with a greater symptom severity score, but this was not found at ≥6 months. Use of symptom survey data alone, however, was less likely to identify patients with possible PTLDS compared with individual clinical assessments. Because it is very challenging to be certain that the presence of long-term symptoms in a particular patient is correctly attributable to having had Lyme disease, an objective biomarker would be highly desirable.

Increased levels of calprotectin in the saliva of patients with geographic tongue.

OBJECTIVE: We investigated whether patients with geographic tongue have increased salivary levels of calprotectin and whether there is a correlation between the salivary levels of calprotectin and interleukin 8 (IL-8), which is another marker of inflammation. METHODS: Twenty-three patients diagnosed with geographic tongue and 32 control subjects without oral mucosal lesions were included in the study. The patients with geographic tongue were classified based on clinical appearance and number of oral lesions. ELISAs were used to determine the levels of calprotectin and IL-8 in whole saliva samples. RESULTS: There was a statistically significant increase in the salivary output of calprotectin in patients with geographic tongue compared with the healthy controls (62 ± 9,1 vs. 37,5 ± 4,7 µg/min; p = .0134). Furthermore, the levels of calprotectin correlated positively with the number of oral lesions in patients with geographic tongue. There was also a significant and positive correlation between the salivary levels of calprotectin and IL-8, both for the patients with geographic tongue and the controls. CONCLUSION: This study supports the notion that GT is an inflammatory disease, in which the activation of neutrophils and production of calprotectin in the saliva may play roles in its pathogenesis.

The prevalence of celiac disease in patients with geographic tongue.

BACKGROUND: Geographic tongue (GT) is a benign inflammatory condition usually involving the dorsal surface and lateral borders of the tongue. Numerous etiological factors of GT have been suggested, including immunological factors; genetic; atopic or allergic predisposition; emotional stress; and hormonal disturbances. GT may also coexist as one of the possible manifestations of celiac disease (CD). Therefore, the aim of this study was to investigate the prevalence of CD, positive serologic tests for CD screening, and HLA-DQ presence in patients with GT. METHODS: Tissue transglutaminase antibodies (anti-tTG), antibodies against gliadin (AGA), and human leukocyte antigen (HLA) typing were assessed for 60 GT patients and 60 healthy control subjects. The duodenal biopsy was performed in patients with positive serologic tests. RESULTS: We found that 9 (15%) GT patients were positive for IgA tTG, and in those patients histological changes consistent with CD were confirmed by duodenal biopsy. Only two of them reported the presence of gastrointestinal symptoms. There were statistically significant differences between the GT patients and control group for immunoglobulin (Ig) A tTG (P = 0.03), IgG tTG (P = 0.04), IgA AGA (P = 0.04), and IgG AGA (P = 0.02). CONCLUSION: The results of our study demonstrated the increased prevalence of CD in patients with GT. Therefore, the clinical oral examination should be considered a diagnostic tool, especially in atypical or silent forms of CD, since it may contribute to provide an early diagnosis.

[Multiple erythema migrans and facial nerve paralysis: clinical manifestations of early disseminated Lyme borreliosis]. / Multilokuläre Erythemata migrantia und Fazialisparese : Klinische Manifestationsformen der disseminierten Frühinfektion der Lyme-Borreliose.

Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks.

Characterization of lingual microbiota in pediatric geographic tongue.

BACKGROUND: Geographic tongue is an oral mucosal lesion affecting the tongue. The association between geographic tongue and the mucosal microbiota in children remains unclear. METHOD: To characterize the feature of lingual microbiota in pediatric geographic tongue, lingual swabs were collected from lesion sites and healthy sites of 25 patients with geographic tongue (14 males and 11 females; age 5.21 ±2.94 years) and 19 controls (10 males and 9 females; age 5.31±2.82 years). DNA was extracted and the 16S rRNA was amplificated, sequenced and analyzed. RESULTS: The lingual microbiota composition was significantly different between children with geographic tongue and the healthy cohort; Streptobacillus was reduced in geographic tongue, while Catonella, Bacillus and Oribacterium were overrepresented. When the lesions and the normal mucosa were compared, an increased abundance of Prevotella oris was observed. CONCLUSION: Our results provided new insight into the association between oral microbiota and pediatric geographic tongue.

Suspected early Lyme neuroborreliosis in patients with erythema migrans.

BACKGROUND: Our objective was to obtain data on patients with erythema migrans (EM) who have symptoms/signs suggesting nervous system involvement and to compare epidemiologic, clinical, and microbiologic findings in patients with and without cerebrospinal fluid (CSF) pleocytosis. METHODS: Adult patients with EM and suspected early Lyme neuroborreliosis were included in this study. RESULTS: Of 161 patients, 31 (19%) had elevated and 130 (81%) had normal CSF cell counts. In contrast to patients with normal CSF cell counts, those with pleocytosis (1) more often reported radicular pain and more often presented with meningeal signs but less frequently complained of malaise; (2) had larger EM skin lesions despite similar duration; (3) more commonly had Borrelia garinii isolated from EM skin lesions (odds ratio for pleocytosis was 31 times higher in patients with established B. garinii skin infection compared to patients with other Borrelia species isolated from their EM skin lesion) and from CSF; and (4) more frequently fulfilled microbiologic criteria for established borrelial infection of the central nervous system. The positive predictive value of pleocytosis for microbiologically proven borrelial infection of the central nervous system (defined by isolation of Borrelia from CSF and/or demonstration of intrathecal synthesis of borrelial antibodies) was 67.9%, whereas normal CSF white cell counts ruled out Lyme neuroborreliosis with a predictive value of 91.9%. CONCLUSIONS: Comparison of European patients with EM who had symptoms/signs suggesting early Lyme neuroborreliosis revealed several differences in the clinical presentation and in microbiologic test results according to CSF findings.

Lyme disease and human granulocytic anaplasmosis coinfection: impact of case definition on coinfection rates and illness severity.

BACKGROUND: Lyme disease is transmitted by the bite of the Ixodes scapularis tick, which can also transmit Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA). Conflicting data exist on the frequency of coinfection and on whether Lyme-HGA coinfected patients have more symptoms than patients with Lyme disease alone. METHODS: Blood culture and serology were used to detect HGA infection in patients with early Lyme disease who presented with erythema migrans. The rate of coinfection was determined using different definitions. The clinical and laboratory features of Lyme-HGA coinfection were compared with that of the individual infections. RESULTS: Among 311 patients with erythema migrans, the frequency of coinfection with HGA varied from 2.3% to 10.0%, depending on the definition used (P < .001). Only 1 of 4 groups with presumed coinfection had significantly more symptoms than patients with Lyme disease alone P < .05. High fever and cytopenia were less common in Lyme-HGA coinfection than in patients with HGA alone. CONCLUSION: The results of this study indicate that how HGA is defined in patients with early Lyme disease has an impact on the apparent rate of coinfection and the severity of illness. The findings also suggest that HGA may be less severe than is usually believed, suggesting the existence of referral bias in testing patients preferentially who present with high fever or cytopenia.

[Palpable arciforme migratory erythema]. / Erythema migrans arciforme et palpabile.

A 39-year-old man presented with an annular clearly palpable erythema on the décolleté. Based on clinical and histopathological findings, palpable migratory arciform erythema was diagnosed. This skin condition is classified as a rare type of T-cell pseudolymphoma. It is still a matter of debate whether palpable migratory arciform erythema is a specific entity or a clinical variant of lymphocytic infiltration of the skin (Jessner-Kanof). Topical corticosteroids or oral antibiotics are generally used. In our patient, UV-A1 therapy led to a complete regression of the lesions.

Clinical and serological features of patients with suspected Lyme borreliosis.

Serology is currently the method of choice for the laboratory diagnosis of Lyme Borreliosis, but it must be interpreted with caution. A total of 954 patients with suspected Lyme borreliosis were evaluated on the basis of clinical and serological data. The seroprevalence of Borrelia burgdorferi antibodies was 4.4% (42 of the 954 serum samples). The most frequent clinical manifestation was erythema migrans which occurred in 50% of the seropositive patients, followed by neuroborreliosis (16.6%) and arthritis (11.9%). Carditis was rare. Our findings suggest that for the diagnosis of Lyme borreliosis, serologic tests need to be combined with clinical signs and symptoms.