Lymphangiomas: Rare presentations in oral cavity and scrotum in pediatric age group.

The incidence of lymphangioma is 1.2 to 2.8/1000 newborns. They present at birth/before 2 years, with predilection for the head and neck (50%-70%). The buccal mucosa is the second most common site reported (14 cases reported) after the anterior two-thirds of tongue. The scrotum is a rare site with less than 50 cases reported (till 2002). Involvement of vital structures, aesthetic, and functional requirements may necessitate treatments such as surgical excision, radiation, cryotherapy, electrocautery, sclerotherapy, embolization, ligation, and laser. Two rare cases - the first being primary, late-onset buccal lymphangioma, with vesicular presentation, and the second being genital lymphangioma involving the right side of scrotum, thigh, and groin with extension to the left groin - are highlighted.

Nonsegmental vitiligo follows Blaschko's lines and embryonic pigmentary segments.

BACKGROUND: Pathogenic mechanism that determines the localization of vitiligo patches and thus a patterned distribution in patients with nonsegmental vitiligo has remained poorly elucidated. A distributional similarity of the vitiligo patches with Blaschko's lines has been documented in patients with segmental vitiligo, both isolated segmental vitiligo and mixed vitiligo but never in cases of nonsegmental vitiligo. METHODS: Distribution of nonsegmental vitiligo patches on face and neck regions was assessed and compared with Blaschko's lines and also with embryonic pigmentary segments on the face. RESULTS: This study has documented distributional similarity of the nonsegmental vitiligo patches on face and neck with Blaschko's lines and the "embryonic pigmentary segments" among 154 (58.6%) cases. Patches around the palpebral and other fissures like periorbital, perinasal, perioral, and periaural were more common. In addition to the vitiligo patches, the spared areas were also found to respect the embryonic segmental outlines and follow the Blaschko's lines. CONCLUSION: Distributional pattern of the individual nonsegmental vitiligo patches along the Blaschko's lines and embryonic pigmentary segments suggests that mosaicism might control the susceptibility to the disease process in a patterned manner. LIMITATION: No genetic testing could be performed to confirm the hypothesis. Evaluation of nonsegmental vitiligo was done only on the face and neck areas.

Oro-facial manifestations in lepromatous leprosy patients in Central India: clinical findings from a cross-sectional study.

OBJECTIVES: To clinically evaluate the oro-facial manifestations in lepromatous leprosy patients undergoing multidrug therapy in Central India. MATERIALS AND METHODS: Two hundred patients from 2 leprosy treatment centers in Central India who satisfied the diagnostic criteria set by the WHO (2006-2010) committee on leprosy were included in the study. To avoid bias, only patients who started the multi-drug treatment regimen less than 1 year ago were included. All the patients were examined for the presence of oral and facial manifestations. To confirm that the oro-facial manifestations were not due to HIV co-infection, serological diagnostic tests including ELISA, Immunocomb, and Tri-dot were performed. RESULTS: Majority of the patients (n = 189) exhibited oral (n = 145) and/or facial (n = 147) manifestations. The most common oral lesions were found to be fissuring and depapillation of the tongue followed by fibrosis and loss of uvula. Among the facial manifestations, facial skin lesions and loss of eyebrows were most prevalent followed by sagging of facial skin and facies leonine. CONCLUSION: The facial manifestations of leprosy are quite common, readily recognizable, and relatively specific to the disease. Thus, the presence of facial manifestations, especially with co-existing oral lesions must prompt the clinician to mandate further investigations to confirm the diagnosis. CLINICAL RELEVANCE: As evidenced by the present study, facial manifestations and oral lesions are an integral part of leprosy. In addition to being a diagnostic parameter, facial manifestations and oral lesions could potentially be used to monitor the disease progression and treatment outcome.

Salud Dental en pacientes con Lepra / No disponible

La lepra conlleva una serie de efectos secundarios indeseables que condicionan la tolerancia y la calidad de vida del paciente. Así, dentro de la esfera orofacial, la boca puede ser asiento de lesiones que, pese a su accesibilidad, pueden por ignorancia pasar desapercibidas y dificultar el adecuado tratamiento de un proceso que hasta ese momento había producido pocas lesiones corporales. Para ello, realizamos una revisión bibliográfica para estudiar el daño dental que esta grave enfermedad puede llegar a causar en la cavidad oral, comparando distintas poblaciones hansenianas

Leprosy involves a series of undesirable side effects, which determine the patient’s tolerance and quality of life. The mouth can be the seat of injuries, which despite their accessibility, can be unnoticed and impede the suitable treatment of a process, which up to that moment, had produced few skin injuries. We performed a bibliographic review to study the dental damage that this serious disease can cause in the oral cavity, comparing different Hansenian populations

Oral lesions in leprosy revisited: a case report.

There is a scarcity of the histopathologically proven lesions of leprosy in the oral cavity, in the world literature. A 55-year-old man had come with a complaint of asymptomatic nodular lesions in the oral cavity. Cutaneous lesions and peripheral nerve examination were suggestive of lepromatous leprosy. Histopathologic examination of a nodule on the palate demonstrated diffuse macrophagic granulomas and acid-fast bacilli.

Lepra orofaríngea / Oropharyngeal leprosy

La lepra lepromatosa es una enfermedad infecciosa transmisible, casi erradicada en la actualidad, y crónica, que puede simular un cáncer. Las lesiones más precoces y frecuentes se localizan en piel, cavidades nasal y oral. Su diagnóstico y tratamiento oportuno evitan lesiones irreversibles…

The leprosy lepromatosa is an infectious transmissible disease, almost eradicated at present, and chronicle that can simulate a cancer. The most early and frequent injuries are located in skin, nasal and oral cavity. Its diagnosis and early treatment avoids irreversible injuries…

Toxicological assessment of Ricinus communis Linn root extracts.

Ricinus communis Linn (Euphorbiaceae) plant parts are claimed to be used as carminative, asthma, bronchitis, leprosy, anti-inflammatory, cathartic, and aphrodisiac. The toxicological study was carried out in the root part of the plant. The collected root was extracted with methanol and water. The extracts were vacuum-dried to yield the respective aqueous (AE) and methanol (ME) extracts. Toxicological assessment sought to determine the safety of Ricinus communis root extracts. The extracts were evaluated in the acute toxicity study (OECD-423 guidelines) and 90 days repeated dose toxicological assessment in Wistar albino rats. The acute oral toxicity of the aqueous (AE) and methanol (ME) extracts did not produce any toxic symptoms or mortality at the dose level of 2000 mg/kg in rats. In the 90 days (sub-chronic toxicity) repeated dose toxicity study the extracts (AE and ME) were administered 1000 mg/kg daily through oral route. The sub-chronic toxicity study demonstrated no significant changes in body weight, food, and water intake. Hematology parameters RBC, WBC, DLC, Hb, blood clotting time, and the biochemical parameters glucose, blood urea nitrogen, creatinine, total cholesterol, total protein, total bilirubin AST, ALT, and ALP were estimated. Histopathology observation of the major vital organs (liver, kidney, heart, spleen, lungs, ovary, testis, and brain) were tested. The hematology, biochemical and histopathology evaluations did not show any adverse effects in any of the organs tested. These results demonstrate the non-toxic nature of the root extracts AE and ME can be used for long-term usage in clinical practice.

Blue rubber bleb nevus syndrome: prominent oral findings.

Blue rubber bleb nevus syndrome is a rare disorder characterized by multiple cutaneous venous malformations in association with visceral lesions, most commonly affecting the gastrointestinal tract. Oral cavity lesions occur in 59 to 64% of cases. We report a unique presentation of this syndrome in a 25-year-old male patient with prominent oral findings. This is a sporadic case, started during early childhood, progressively increasing in number and size. Oral vascular lesions were part of gastrointestinal involvement. Associated cardiac abnormalities were also observed. An early diagnosis of this syndrome is required as it gets complicated with bleeding, anemia and other systemic complications.

[Protease activity of microflora in the oral cavity of patients with periodontitis].

Microbial spectrum and non-specific as well as specific IgA1 protease activity of isolated microorganisms were investigated in gingival liquid of patients with periodontitis. Microorganisms from the gingival liqud of these patients belonged to conditional-pathogenic obligate and facultatively anaerobic bacteria. 24 strains of microorganisms have been identified. Nonspecific proteolytic activity was found in the following microorganisms: Actinomyces israelii, Actinomyces naeslundii, Aerococcus viridans, Bifidobacterium longum, Neisseria subflave, Streptococcus parvulus, Eubacterium alactolyticum, Lactobaccilus catenoforme, Bacillus spp. Specific IgA1-protease activity and lack of proteolytic activity towards IgG was found in Streptococcus acidominimus, Streptococcus hansenii, Streptococcus salivarius, Leptotrychia buccalis, Staphylococcus haemolyticus and Neisseria sicca. No proteolytic activity was found in cultivation medium of Eubacterium alactolyticum (1 strain), Prevotella buccalis, Aerococcus viridans and Streptococcus sanguis.

Considerações sobre o envolvimento da cavidade bucal na hanseníase / Considerations on oral cavity involvement in leprosy

As lesões causadas pela proliferação do Mycobacterium leprae (M. leprae) foram significantemente reduzidas nos últimos anos com a detecção precoce de casos novos.Consequentemente, as lesões maxilofaciais e da mucosa bucal passaram ser cada vez menos relatadas. A despeito de ser menos evidente, a infecção da cavidade bucal pelo M. leprae pode revelar detalhes importantes a respeito da transmissibilidade e imunopatogenia da hanseníase.A associação entre a infecção da mucosa bucal e a perda óssea alveolar, bem como a participação da resposta imune local na proteção contra a doença, ainda são tópicos de pesquisa não explorados totalmente. Infelizmente, o tratamento da hanseníase não possibilitou a prevenção total de suas seqüelas, nem impediu transmissão dessa doença. As razões acima justificam rever algumas perguntas não respondidas do passado.

Lesions secondary to Mycobacterium leprae (M. leprae) proliferation have been significantly abbreviated in recent years due to early detection of new cases of leprosy. Consequently, oral and maxillofacial lesions have been each time less reported. In spite of been less evident, the infection of oral cavity by M. leprae may reveal important details regarding the transmission and immunopathology of leprosy. The association between oral mucosal infection and alveolar bone loss, as well as the role of local immune response in protection against this pathogen, are still not fully explored. Unfortunately, the treatment of leprosy did not allow the full prevention of sequels neither hindered the transmission of this disease. The reasons above justify reviewing some unanswered questions of the past.

First report of oral colonization by Debaryomyces nepalensis in a dog.

A stray, young male, wire-haired pointing griffon dog, found in a street of Perugia (Italy), was examined in order to check his health status. Two oropharyngeal swabs were collected in 24 h and streaked onto Sabouraud agar and after 6 days the yeasts colonies were transferred onto Malt agar. Ascospores were observed on Potato Dextrose Agar medium. The major ubiquinone of an isolated yeast was identified as ubiquinone-9 (Q-9), and genetical analyses were performed together with the type strains of Debaryomyces hansenii (var. hansenii and var. fabry), C. psychrophila and D. nepalensis type strain. The base sequences of ITS1 and ITS2, and D1/D2 domains of LSU rDNA completely coincided with those of D. nepalensis. From these results, the isolated yeast was identified as D. nepalensis. RAPD patterns between the two strains were found to be identical. The results indicate the first colonization of D. nepalensis in a dog.

Profile of systemic sclerosis in a tertiary care center in North India.

AIM: To study the clinical and immunological profile in patients of systemic sclerosis from North India and compare it with other ethnic groups. METHODS: Patients presenting to us between the years 2001 and 2004 and fulfilling the American Rheumatism Association (ARA) criteria for systemic sclerosis were included. There were 84 females and 16 males with the mean age of 32.5 +/-11.62 years and a mean duration of 6.49 +/- 4.34 years. All patients were admitted to the dermatology ward for detailed history and examination including Rodnan score. Investigations including hemogram, hepatic and renal functions, serum electrolytes, urine for albumin, sugar, microscopy and 24h urinary protein estimation, antinuclear antibody, chest X-ray, barium swallow, pulmonary function test, electrocardiogram and skin biopsy were done. RESULTS: The most common presenting symptoms were skin binding-down (98.5%), Raynaud's phenomenon 92.9%, pigmentary changes 91%, contracture of fingers 64.6%, fingertip ulcer 58.6%, restriction of mouth opening 55.5%, dyspnea 51.1%, joint complaints 36.7% and dysphagia in 35.2%. The mean Rodnan score was 25.81 +/- 10.04 and the mean mouth opening was 24.6 +/- 19.01 mm. The laboratory abnormalities included raised ESR in 87.8%, ANA positive in 89.1%, proteinuria in 6.0%, abnormal chest X-ray in 65.3%, abnormal barium swallow in 70.2% and reduced pulmonary function test in 85.8%. CONCLUSION: The clinical and immunological profile of systemic sclerosis in North India is similar to that of other ethnic groups except that pigmentary changes are commoner and renal involvement is relatively uncommon.

High oral prevalence of Candida krusei in leprosy patients in northern Thailand

Although Candida albicans is the most common human yeast pathogen, other Candida species such as C. krusei are now recognized as emerging agents, especially in patients with human immunodeficiency virus (HIV) disease. C. krusei is inherently resistant to the widely used triazole antifungal fluconazole and poses therapeutic problems, especially in systemic candidiasis. In a surveillance study of leprosy patients (with arrested or burnt-out disease) in a leprosarium in northern Thailand, we found a rate of oral carriage of C. krusei (36 per cent) significantly (P smaller 0.05) higher than that for a healthy control group (10 per cent). Among the Candida-positive patients, 16 of 35 (46 per cent) carried C. krusei, while C. albicans was the second most common isolate (12 of 35 patients; 34 per cent). The corresponding figures for the control group were 2 of 13 (15 per cent) and 6 of 13 (46 per cent), respectively. Studies of the antifungal resistance of the C. krusei isolates from patients indicated that all except one of the isolates were resistant to fluconazole, two isolates were resistant to ketoconazole, and all isolates were sensitive to amphotericin B. Evaluation of their genetic profiles by randomly amplified polymorphic DNA analysis with three different primers and subsequent analysis of the gel profiles by computerized cluster-derived dendrograms revealed that the C. krusei isolates from patients belonged to 10 disparate clusters, despite the origin from a single locale. These nascent findings indicate an alarmingly high prevalence of a Candida species resistant to a widely used antifungal in a part of the world where HIV disease is endemic.

Compromiso oral en dos casos de lepra lepromatosa / Oral compromise in two cases of lepromatous leprosy

Se publican 4 casos de acrodermatitis continua de Hallopeau,algunos de ellos seguidos durante mas de 20 años.Consideramos que la imagen histopatologica(pustula espongiforme)no autoriza a incluirla dentro de la psoriasis ya que son mas los puntos que las separan que los unen. Ellos son: manifestaciones cutaneas dolorosas,antecedentes,compromiso casi exclusivo de la extremidad distal del pulgar dejando en brotes sucesivos atrofia cutanea y esclerosis de tejidos blandos,afectacion temprana de la uña que puede conducir a la perdida de la lamina ungueal,respeto por la region central de palmas y plantas,compromiso oseo hasta severa mutilacion. No presenta lesiones tipicas de psoriasis vulgar en otros sitios,ni antecedentes familiares de ella ni HLA,B13,B17 yBW37

Compromiso oral en dos casos de lepra lepromatosa / Oral compromise in two cases of lepromatous leprosy

Se publican 4 casos de acrodermatitis continua de Hallopeau,algunos de ellos seguidos durante mas de 20 años.Consideramos que la imagen histopatologica(pustula espongiforme)no autoriza a incluirla dentro de la psoriasis ya que son mas los puntos que las separan que los unen. Ellos son: manifestaciones cutaneas dolorosas,antecedentes,compromiso casi exclusivo de la extremidad distal del pulgar dejando en brotes sucesivos atrofia cutanea y esclerosis de tejidos blandos,afectacion temprana de la uña que puede conducir a la perdida de la lamina ungueal,respeto por la region central de palmas y plantas,compromiso oseo hasta severa mutilacion. No presenta lesiones tipicas de psoriasis vulgar en otros sitios,ni antecedentes familiares de ella ni HLA,B13,B17 yBW37