IMPROVEMENT OF THE METHODOLOGY OF BIOMATERIAL COLLECTION FOR THE DIAGNOSIS OF THE ORAL CAVITY MUCOSA DISEASES.

Aim - to improve the methodology for collecting material from lesions of the oral mucosa for exfoliative cytological examination. A group of patients diagnosed with B37.0 Candida stomatitis was examined. To clarify the diagnosis, various methods of collecting biological material from the tongue of patients were used, namely, the method using a cytobrush with subsequent fixation of cytological material on a slide. The microbiota of the back of the tongue was analyzed in 12 patients with glossitis and 12 healthy subjects (the control group). The microscopic method of research was used - using an immersion microscope MICROmed@XS-3330, and the morphological and tinctorial properties of microorganisms were determined. In ten fields of view, the number of leukocytes, the nature of epithelial cells, and the presence of various microorganisms were detected and counted. A comparison of the quality of the use of the microscope method for the study of the tongue microbiota of patients with candidal glossitis was performed under the conditions of taking pathological material using a dental scalpel and an oral cytobrush. For a reasonable interpretation of the results and determination of their significance, a statistical analysis was performed to determine the frequency of detection of microorganisms in patients with glossitis and healthy subjects, depending on the nature of the material taken from the back of the tongue using a dental scalpel or cytobrush. The studies showed that the etiologic structure of glossitis pathogens was dominated by Candida yeast-like fungi, but cases of leptotrichosis aetiology were observed (16.7%). Monococci and gram-negative monobacteria were detected in all studied groups. An increase in the diversity of microorganisms was found when the material was taken with a cytobrush. The microbiota of all subjects differed depending on the type of instrument used for sampling. Thus, in the group of healthy individuals, the interdental brush helped to detect twice as many streptococci as a scalpel. In patients with candidiasis, a brush biopsy showed a 2.7-fold increase in gram-positive diplococci, twice as many streptococci and gram-positive bacilli, three times as many staphylococci, 2.25 times as many clusterforming gram-negative cocci, and 2.3 times as many gram-negative diplococci. A significant increase in the diversity of microorganisms was observed with the cytobrush compared to the use of a dental scalpel. In patients with glossitis, the accumulation of keratinized epithelial cells was significantly higher compared to the presence of young cells in healthy subjects, regardless of the method of sampling.

Characteristics of lingual papillae in diabetic rats.

Diabetes mellitus (DM) is a metabolic disorder resulting with many different complications including soft tissue abnormalities in the oral cavity such as periodontitis and salivary and taste dysfunction. Previous studies also reported fungal and bacterial infections in oral cavity in these patients. This study aims to represent three dimentional morphologic ultrastructural changes of the diabetic rat tongue via scanning electron microscopy. Twenty-four (24) adult male Spraque-Dawley rats, (weight ranging between 200-250g) included in the study were randomly assigned into two groups: control rats were injected with intraperitoneally saline alone, experimental diabetes group received streptozotocin (STZ) (80mg/kg) administrated intraperitoneally. On month four, by the end of experimental period, all animals of each group were anesthetised. All tongues were dissected totally, postfixed in 2% osmium tetroxide and then dried by critical point drying before SEM analysis. Finally, superficial epithelial configurations of the lingual papillae in experimental diabetic rats were examined by scanning electron microscopy. Diabetes mellitus caused thickness, hyperceratosis and different epithelial changes, We observed yeast-like structures and bacterial colonisations on the papillar and epithelial structure of the tongue. The morphological atrophic changes of lingual mucosa and the median rhomboid glossitis (which is primary finding of candidal infection) are characteristic observations on the lingual mucosa of the streptozotocin treated rats.

The Candida species that are important for the development of atrophic glossitis in xerostomia patients.

BACKGROUND: The purpose of this study was to clarify the species of Candida that are important for the development of atrophic glossitis in xerostomia patients. METHODS: A total of 231 patients with subjective dry mouth were enrolled in the present study. Logistic regression analysis was performed to clarify the contribution of each Candida species and other variables to the development of atrophic glossitis. The dependent variable was the absence/presence of atrophic glossitis. The Candida colony-forming units (CFU) of C. albicans, C. glabrata, C. tropicalis, and C. krusei, as well as age, gender, resting (RSFR) and stimulated (SSFR) whole salivary flow rate, and denture-wearing status, were treated as explanatory variables. RESULTS: Logistic regression analysis showed that two factors were closely associated with the presence of atrophic glossitis: an increase in C. albicans CFU and a decrease in the SSFR. CONCLUSIONS: C. albicans, but not non-albicans Candida, was associated with atrophic glossitis in xerostomia patients who had no systemic predisposing factors, indicating that C. albicans remains a treatment target for Candida-related atrophic glossitis.

Factors associated with the presence of atrophic tongue in patients with dry mouth.

PURPOSE: This study aimed to identify factors associated with atrophic tongue in patients with dry mouth. METHODS: Discriminant analysis was performed in 1265 patients with dry mouth to identify factors that might influence the risk of developing atrophic tongue. The dependent variable was the presence of atrophic tongue, while patient age, resting saliva flow rate, stimulated saliva flow rate and Candida colony-forming units (CFU) were used as the independent variables. RESULTS: The standardised linear discriminant coefficients showed that Candida CFU, stimulated saliva flow rate and age were significantly associated with the presence of atrophic tongue. The following linear discriminant function was obtained: z = 0.024 × age - 0.63 × (resting saliva flow rate) - 0.81 × (stimulated saliva flow rate) + 0.002 × Candida CFU - 0.611. CONCLUSION: High Candida CFU, low stimulated saliva flow rate and advanced age were identified as closely associated factors for the risk of development of atrophic tongue.

Urban legends series: oral candidosis.

Candida species (spp) are commensal yeast that can only instigate oral infection (oral candidosis - OC) when there is an underlying predisposing condition in the host. We investigated four controversial topics on OC: (i) How can a microbiological determination of OC be made as Candida spp. are commensal yeasts and not all of them form hyphae or pseudohyphae during infection? (ii) Is median rhomboid glossitis (MRG) a manifestation of candidal infection? (iii) Can candidal infection cause palate papillary hyperplasia (PPH)? (iv) What is the best therapeutic treatment for denture-associated erythematous stomatitis (DAES)? Results from extensive literature searches, including a systematic review, suggested the following: (i) the diagnosis of OC merely on the basis of the presence of yeasts is an oversimplification of a complex process. No convincing evidence of a single test or method better able to discriminate the transition from candidal saprophytism to pathogenicity has been reported in the literature; (ii-iii) conclusive evidence of a direct aetiopathogenic relationship between MRG and PPH and candidal infection has not been found; and (iv) only limited evidence is available for any DAES treatment, thus making it impossible to make strong therapeutic recommendations.

[Integrated approach to the treatment of oral mucosa diseases in patients with chronic gastritis].

The article presents data on the clinical and microbiological short and long term efficacy of treatment of the oral mucosa diseases in patients with Helicobacter pylori associated and not associated chronic gastritis depending on the chosen treatment regimen.

Disseminated histoplasmosis with concurrent oral candidiasis in an Eclectus parrot (Eclectus roratus).

Disseminated histoplasmosis caused by Histoplasma capsulatum, a zoonotic fungal organism, is an important disease in animals and humans, particularly those with compromised immune systems. Reports of disseminated histoplasmosis in an avian species are not available within the current literature. Candida albicans, another fungal agent with zoonotic importance, is a commensal of the avian digestive tract that is often associated with opportunistic infections particularly in young or immunocompromised birds. This report describes a case of concomitant histoplasmosis and candidiasis in an Eclectus parrot (Eclectus roratus) characterized by severe granulomatous glossitis, blepharitis and osteomyelitis with numerous intrahistiocytic and extracellular yeasts (H. capsulatum) as well as intralesional hyphae, pseudohyphae and conidia (C. albicans). To our knowledge, co-infection with H. capsulatum and C. albicans has not been reported in an avian species.

Common tongue conditions in primary care.

Although easily examined, abnormalities of the tongue can present a diagnostic and therapeutic dilemma for physicians. Recognition and diagnosis require a thorough history, including onset and duration, antecedent symptoms, and tobacco and alcohol use. Examination of tongue morphology and a careful assessment for lymphadenopathy are also important. Geographic tongue, fissured tongue, and hairy tongue are the most common tongue problems and do not require treatment. Median rhomboid glossitis is usually associated with a candidal infection and responds to topical antifungals. Atrophic glossitis is often linked to an underlying nutritional deficiency of iron, folic acid, vitamin B12, riboflavin, or niacin and resolves with correction of the underlying condition. Oral hairy leukoplakia, which can be a marker for underlying immunodeficiency, is caused by the Epstein-Barr virus and is treated with oral antivirals. Tongue growths usually require biopsy to differentiate benign lesions (e.g., granular cell tumors, fibromas, lymphoepithelial cysts) from premalignant leukoplakia or squamous cell carcinoma. Burning mouth syndrome often involves the tongue and has responded to treatment with alpha-lipoic acid, clonazepam, and cognitive behavior therapy in controlled trials. Several trials have also confirmed the effectiveness of surgical division of tongue-tie (ankyloglossia), in the context of optimizing the success of breastfeeding compared with education alone. Tongue lesions of unclear etiology may require biopsy or referral to an oral and maxillofacial surgeon, head and neck surgeon, or a dentist experienced in oral pathology.

Ulcerative, granulomatous glossitis and enteritis caused by Rhodococcus equi in a heifer.

Rhodococcus equi infection in horses is common and is characterized by pyogranulomatous pneumonia and ulcerative enterocolitis. R. equi clinical disease in cattle, however, is rare and typically manifests as granulomatous lymphadenitis discovered in the abattoir. A 19-mo-old female Santa Gertrudis had a history of intermittent inappetence and weight loss for a 3-mo period before euthanasia. Gross and histologic examination revealed severe, chronic, ulcerative, and granulomatous inflammation in the tongue, pharynx, and small intestine. Also, the heifer had severe, granulomatous pharyngeal and mesenteric lymphadenitis. Bacterial cultures from the ileum, tongue, and liver yielded numerous-to-moderate numbers of R. equi. PCR analysis of the isolate detected the linear virulence plasmid vapN, which is often identified in bovine isolates (traA- and vapN-positive). The bacteria also lack the circular plasmids vapA and vapB that are associated with virulence in horses and swine, respectively. We report herein an atypical and unusual clinical presentation of R. equi infection in cattle, which has zoonotic potential.

Septicemic Actinobacillus suis infection in a neonatal piglet with multifocal necrotic glossitis.

Five-day-old neonatal piglets presented with debilitation and ananastasia. At the necropsy of one piglet, the apex of the tongue was found to be discolored dark red, and disseminated white foci were found on the cut surface. Many white foci were also found in the lungs and on the serosa of the liver and spleen. Histopathological findings revealed multifocal necrotic glossitis and pneumonia with Gram-negative bacilli. The bacilli were identified as Actinobacillus suis through immunohistochemical, biochemical, and genetic tests, including 16S rRNA gene sequencing. Although A. suis usually causes inflammation in thoracic and abdominal organs, lesions were also found in the tongue in the present case. This study is the first report of glossitis caused by A. suis.

Role of Helicobacter pylori in pathogenesis of upper respiratory system diseases.

Helicobacter pylori (H. pylori) is one of the frequently encountered micro-organisms in the aerodigestive tract. Although infections caused by H. pylori are this common, the exact mode of transmission has not been fully understood yet. Oral-oral, fecal-oral and gastrointestinal-oral routes are the possible modes of transmission. This infection is usually acquired in childhood and may persist for the whole life of the patient. However, about 80% of the infected humans are asymptomatic. Human stomach was considered to be the only reservoir of H. pylori until bacteria were discovered in human dental plaque, in oral lesions, in saliva, in tonsil and adenoid tissue. It is suggested that H. pylori enters the nasopharyngeal cavity by gastroesophageal reflux and colonize in the dental plaques, adenoid tissues and tonsils. From these localizations, the bacteria ascend to the middle ear and to the paranasal sinuses directly or by the reflux again and may trigger some diseases, including otitis, sinusitis, phyrangitis, laryngitis and glossitis. But still, the exact mechanism remains unclear.

Recurrent Trichosporon asahii glossitis: a case report.

AIM: This case report aims at describing an infection of the tongue as a manifestation of a Trichosporon asahii infection, its association with bronchial asthma and steroid administration, and to present a review of the literature pertaining to its antifungal susceptibility profile. BACKGROUND: Trichosporon asahii has been reported to be associated with a wide spectrum of clinical manifestations, ranging from superficial infection to severe disseminated diseases, particularly in immunocompromised patients. CASE REPORT: A 36-year-old male asthmatic patient with recurrent glossitis presented with a chief complaint of burning sensation and two red areas on the dorsum of the tongue of three months duration. The glossitis was associated with Trichosporon asahii, which had a reduced susceptibility to some azole antifungal agents. SUMMARY: Trichosporon asahii is an emerging fungal pathogen which may cause a wide range of clinical manifestations. More reports on its various clinical presentations in the oral environment need to be made available in the literature. To date there is a paucity of data on its prevalence, pathogenesis, and antifungal resistance mechanism.

Extracutaneous sporotrichosis in a patient with liver cirrhosis.

We report an unusual case of disseminated cutaneous sporotrichosis with oral mucous and tracheal involvement in a forty-year-old male with a history of heavy drinking and liver cirrhosis. We also review the literature and other similar published cases.

Fungal dermatitis, glossitis and disseminated visceral mycosis caused by different Metarhizium granulomatis genotypes in veiled chameleons (Chamaeleo calyptratus) and first isolation in healthy lizards.

Metarhizium (M.) granulomatis (formerly Chamaeleomyces granulomatis) invariably causes fatal fungal glossitis and systemic mycosis in veiled chameleons (Chamaeleo calyptratus). Isolation of M. granulomatis in other lizards thus far has not been described. The aim of this study therefore was to obtain information on the presence of M. granulomatis in reptiles kept as pets, and to examine whether there was an association between specific genotypes and clinical/pathological outcomes. Besides 18S ribosomal (r) DNA (SSU) and internal transcribed spacer1-5.8S (ITS1-5.8S) rDNA, a fragment of the large subunit of the 28S rDNA (LSU), including the domains 1 (D1) and D2, were sequenced for identification of the fungus and phylogenetic analysis. Metarhizium granulomatis was isolated from 23 veiled chameleons, two panther chameleons (Furcifer pardalis) and one central bearded dragon (Pogona vitticeps). Only the veiled chameleons revealed corresponding pathological findings in the form of glossal hemorrhage, granulomatous glossitis, pharyngitis, dermatitis and/or visceral mycosis. The infection site correlated to survival times of infected veiled chameleons. Combined long-term treatment with terbinafine and nystatin based on susceptibility testing may be helpful for prevention of disease and visceral spreading of the fungus, but elimination of the fungal pathogen or successful treatment of diseased veiled chameleons have not been achieved yet. Sequencing of the ribosomal genes yielded five different genotypes, with genotype A being strongly correlated with dermatitis, and remaining genotypes with pharyngitis and glossitis. However, disseminated visceral mycosis developed irrespective of the genotypes.

Oral candidiasis.

Oral candidiasis (OC) is a common fungal disease encountered in dermatology, most commonly caused by an overgrowth of Candida albicans in the mouth. Although thrush is a well-recognized presentation of OC, it behooves clinicians to be aware of the many other presentations of this disease and how to accurately diagnose and manage these cases. The clinical presentations of OC can be broadly classified as white or erythematous candidiasis, with various subtypes in each category. The treatments include appropriate oral hygiene, topical agents, and systemic medications. This review focuses on the various clinical presentations of OC and treatment options.

Septicemia caused by Capnocytophaga in a granulocytopenic patient with glossitis.

A patient receiving immunosuppressive treatment for multiple myeloma became granulocytopenic, and acute glossitis developed. Blood cultures were positive for Capnocytophaga, a fastidious Gram-negative bacillus that is known to be part of the normal oral flora and a pathogen for periodontitis. The infection responded to treatment with antibiotics, including penicillin G, to which the organism was sensitive. This is one of the first reports of Capnocytophaga septicemia, and suggests that this organism may be an important pathogen in immunosuppressed patients with oral mucosal lesions.

Oral candidosis and the therapeutic use of antifungal agents in dentistry.

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudomembranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.

Rhomboid glossitis in atypical location: case report and differential diagnosis.

Median rhomboid glossitis (MRG) is an uncommon benign abnormality of the tongue, most frequently affecting men. It is typically located around the midline of the dorsum of the tongue, anterior to the lingual "V", appearing as a reddish, rhomboid area, depapillated, flat maculate or mamillated and raised by 2 - 5 mm. This paper reports a case of rhomboid glossitis in a 61-year-old man who consulted for a painless raised lesion on the dorsum of the tongue, in left paramedial (not medial) location. Histopathological findings were compatible with rhomboid glossitis. Other diagnoses considered but ruled out on the basis of the clinical and histopathological findings were haemangioma, pyogenic granuloma, amyloidosis, granular cell tumour, and squamous cell carcinoma. This case confirms that rhomboid glossitis may occur in paramedial locations.