[Chronic mucocutaneous candidiasis with STAT1 gain-of-function mutation associated with herpes virus and mycobacterial infections]. / Candidose cutanéo-muqueuse chronique avec mutation gain-de-fonction du gène STAT1 associée à des infections herpétiques et à mycobactérie.

INTRODUCTION: Chronic mucocutaneous candidiasis (CMC) is characterized by susceptibility to chronic or recurrent infections with yeasts of the genus Candida affecting the skin, nails and mucous membranes. We describe a Moroccan patient presenting CMC with heterozygous STAT1 gain-of-function (GOF) mutation. PATIENTS AND METHODS: A 5-year-old boy with no consanguinity presented recurrent episodes of oral thrush, chronic nail candidiasis and herpetic gingivostomatitis from the age of 8 months. He also had mycobacterial adenitis secondary to BCG vaccination and atypical rosacea. Genetic analysis revealed GOF mutation of the STAT1 gene. DISCUSSION: CMC was diagnosed in our patient despite poor clinical features. Sequencing of the genome revealed STAT1GOF mutation. This mutation affects production of IL-17, an important cytokine in mucocutaneous defense against Candida. The association with mycobacterial adenitis is rare and continues to be poorly understood. The presence of atypical rosacea in this setting is suggestive of this entity. Antifungal therapy and prevention of complications are necessary to reduce the morbidity and mortality associated with this condition. CONCLUSION: CMC due to STAT1GOF mutation is characterized by a broad clinical spectrum and should be considered in all cases of chronic or recurrent fungal infection, whether or not associated with other infections.

Recurrent Herpes Labialis in Adults: New Tricks for an Old Dog.

Herpes labialis remains a common worldwide affliction. Recent advances in understanding the basic pathogenesis have led to new therapeutic intervention, both on-label and off-label. Aside from reducing the duration and symptomatology of acute outbreaks, another goal of treatment is to decrease the frequency of future episodes. Oral and topical acyclovir and its analogues are the mainstay of both chronic suppressive and episodic therapy. A new muco-adhesive formulation of acyclovir provides a decrease in outbreaks, probably due to a diminution of herpesvirus load in all reservoir sites. Acyclovir-resistant strains are rare in immunocompetent hosts; parenteral foscarnet and cidofovir are administered in this situation. Parenteral acyclovir is the drug of choice for eczema herpeticum, which may begin as herpes labialis in an atopic dermatitis patient. Thermotherapy may be beneficial, and a certified device to deliver heat is available outside the United States.

J Drugs Dermatol. 2017;16(3 Suppl):s49-53.

What do Clinicians Perceive as a Successful "Trial of Fluids"?: A Secondary Assessment of a Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to explore physician perceptions of the amount of fluid that demonstrates a successful "trial of fluids" (adequate fluid intake) in the emergency department in children who have had insufficient fluid intake at home. METHODS: This is a secondary analysis of a randomized placebo-controlled trial of viscous lidocaine versus placebo in children aged 6 months to 8 years with acute infectious ulcerative mouth conditions (gingivostomatitis, ulcerative pharyngitis, or hand foot and mouth disease) and poor oral fluid intake. We measured the amount of fluid ingested in 60 minutes after administration of the intervention and related physician perception of adequate intake to measured intake. Given that there was little difference in oral intake between the treatment groups, the 2 arms were pooled for this analysis. RESULTS: One hundred participants were recruited (50 per treatment group), all of whom completed the 60-minute trial period. At baseline, 72% were mildly dehydrated, 21% were not dehydrated, and 5% were moderately dehydrated. The participants drank a median of 8.6 mL/kg (interquartile range [IQR], 3.7-14). Clinicians perceived 58% of the participants to have an adequate intake within the first hour after intervention. The median consumption of those whose oral intake was deemed as adequate was 12.6 mL/kg (IQR, 9.4-18.4); for those whose oral intake was not deemed adequate, the median consumption was 2.7 mL/kg (IQR, 0.7-5.3) (rank sum, P < 0.001). CONCLUSIONS: In children undergoing trial of fluids, we found that most clinicians perceived a fluid intake greater than 9 mL/kg as adequate and lower than 5 mL/kg as inadequate.

[Complex treatment of recurrent herpetic stomatitis with dysbiosis]. / Analiz kompleksnoi metodiki lecheniia retsidiviruiushchego gerpeticheskogo stomatita s disbakteriozom.

Research objective was to study the effectiveness of complex treatment of recurrent herpetic stomatitis with dysbiosis. The study included 147 patients aged from 18 to 45 years with recurrent herpetic stomatitis (RGS) and disbyosis divided in 3 groups. Group 1 received conventional antiviral and symptomatic treatment of RGS, in group 2 complex immunoglobulins (IgA (15-25%), IgM (15-25%) and Ig (50-70%)) were added to conventional therapy, group 3 received immunoglobulins only. Clinical and immunological efficiency was estimated by values of oral local immunity (SlgA, lysozyme), humoral immunity (IgE and IgG) and cellular immunity (RBTL with FGA, defined T-lymphocytes). Significant (p<0.05) increase of lisozyme and SlgA, RBTL with FGA, number of T-lymphocytes and IgG concentration was observed in group 2. The obtained data allow improving quality of treatment of recurrent herpetic stomatitis with related dysbiosis.

Clinical and cytologic features of antibiotic-resistant acute paronychia.

BACKGROUND: Acute paronychia usually is treated as a bacterial infection, but antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems. OBJECTIVE: We sought to describe the clinical, etiologic, cytologic, and therapeutic features of antibiotic-resistant acute paronychia. METHODS: A retrospective review of medical records and cytology was performed in 58 patients (age, 1 month-91 years; 36 children and adolescents [62%] and 22 adults [38%]) who had antibiotic-resistant acute paronychias. RESULTS: Causes of paronychia included bacteria (25 patients [43%]), viruses (21 patients [36%]), fungi (5 patients [9%]), drugs (3 patients [5%]), pemphigus vulgaris (3 patients [5%]), and trauma (1 patient [2%]). Diagnostic cytologic findings were noted in 54 patients (93%); no diagnostic cytologic findings were present with drug-induced (3 patients) or traumatic (1 patient) paronychia. The most common predisposing factors were the habits of finger- or thumb-sucking (14 patients [24%]) and nail-biting (11 patients [19%]). Complications included id reaction with erythema multiforme in 3 patients (5%). LIMITATIONS: Limitations include retrospective study design from 1 treatment center. CONCLUSION: Antibiotic-resistant acute paronychia may be infectious or noninfectious. Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage.

Metabolic acidosis mimicking diabetic ketoacidosis after use of calorie-free mineral water.

A previously healthy boy was admitted with fever, tachycardia, dyspnea, and was vomiting. A blood test showed a severe metabolic acidosis with pH 7.08 and an anion gap of 36 mmol/L. His urine had an odor of acetone. The serum glucose was 5.6 mmol/L, and no glucosuria was found. Diabetic ketoacidosis could therefore be eliminated. Lactate level was normal. Tests for the most common metabolic diseases were negative. Because of herpes stomatitis, the boy had lost appetite and only been drinking Diet Coke and water the last days. Diet Coke or Coca-Cola Light is sweetened with a blend containing cyclamates, aspartame, and acesulfame potassium, all free of calories. The etiology of the metabolic acidosis appeared to be a catabolic situation exaggerated by fasting with no intake of calories. The elevated anion gap was due to a severe starvation ketoacidosis, mimicking a diabetic ketoacidosis. Pediatricians should recommend carbohydrate/calorie-containing fluids for rehydration of children with acute fever, diarrhea, or illness.

Prevalence, incidence, and recurrence of oral lesions among HIV-infected patients on HAART in Alabama: a two-year longitudinal study.

OBJECTIVE: Our aim was to quantify prevalence, incidence, and recurrence of oral lesions (OL) among a population in the Southeast. METHODS: A retrospective study based on chart review was conducted among patients (n = 744) who were ≥19 years of age and initiated highly active antiretroviral therapy (HAART) between January 2000 and June 2006 at the University of Alabama at Birmingham (UAB) 1917 Clinic. Patients' laboratory data and oral conditions were recorded for 2 years after enrollment into the study. RESULTS: During 2 years of follow-up, the period prevalence of individuals experienced at least one OL was 35.6% (266/744). Among all of the 374 episodes of OL, 183 were new cases, while 57 were recurrences. The OL person-visit incidence rate was 0.02 per 100 person-visits. Oropharyngeal candidiasis (OPC) was the most frequent manifestation in terms of period prevalence (74.9%) with a person-visit incident rate of 0.01 per 100 person-visits. CONCLUSIONS: Patients undergoing HAART continue to be affected by HIV-related oral conditions, especially OPC. These results clearly indicate that OL during HIV infection are still highly prevalent in spite of the improvements in medical care and the availability of HAART.

[Massive alveolar hemorrhage due to cytomegalovirus (CMV) and HIV infection]. / Hemorragia alveolar masiva por citomegalovirus (CMV) e infección por VIH.

Alveolar hemorrhage may be a complication of diseases with local and systemic manifestations. Both share the same pathophysiological concept: damage to the alveolar microcirculation. It is a clinical entity that generates a diagnostic challenge for the physician. Early recognition favors aggressive treatment, which can improve the outcome. Despite the technological advances in its diagnosis and treatment, it is still a condition having high morbidity and mortality. We present the case of a 42-year old woman diagnosed of massive alveolar hemorrhage induced by cytomegalovirus (CMV) and HIV infection. Its presentation is atypical because most reported cases have occurred as a pneumonic process, episodes of massive hemorrhage being uncommon. The diagnosis was documented by bronchoscopy with bronchoalveolar lavage and etiological diagnosis with molecular techniques using reverse transcription polymerase chain reaction.

Presence of human papilloma virus, herpes simplex virus and Epstein-Barr virus DNA in oral biopsies from Sudanese patients with regard to toombak use.

Using PCR/DNA sequencing, we investigated the prevalence of human papillomavirus (HPV), herpes simplex virus (HSV) and Epstein-Barr virus (EBV) DNA in brush biopsies obtained from 150 users of Sudanese snuff (toombak) and 25 non-users of toombak in formalin-fixed paraffin-embedded tissue samples obtained from 31 patients with oral dysplasias (25 toombak users and 6 non-users), and from 217 patients with oral cancers (145 toombak users and 72 non-users). In the brush tissue samples from toombak users, HPV was detected in 60 (40%), HSV in 44 (29%) and EBV in 97 (65%) of the samples. The corresponding figures for the 25 samples from non-users were 17 (68%) positive for HPV, 6 (24%) positive for HSV and 21 (84%) for EBV. The formalin-fixed samples with oral dysplasias were all negative for HPV. In the 145 oral cancer samples from toombak users, HPV was detected in 39 (27%), HSV in 15 (10%) and EBV in 53 (37%) of the samples. The corresponding figures for the samples from non-users were 15 (21%) positive for HPV, 5 (7%) for HSV and 16 (22%) for EBV. These findings illustrate that prevalence of HSV, HPV and EBV infections are common and may influence oral health and cancer development. It is not obvious that cancer risk is increased in infected toombak users. These observations warrant further studies involving toombak-associated oral lesions, to uncover the possible mechanisms of these viral infections in the development of oral cancer, and the influence of toombak on these viruses.

Acute Oral Lesions.

A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.

Oral herpes simplex virus infection in pregnancy: what are the concerns?

Although epidemiologic data and the potentially serious effects of transmission of genital herpes from mother to infant during birth have been widely reported, published reports on oral herpes disease in pregnancy remain scarce and no clear management guidelines exist. Thus, questions remain about acquisition, transmission and outcome of infection, especially with respect to acute gingivostomatitis in pregnancy. In response to these questions, we summarize previous reports on herpes simplex virus 1 (HSV-1) oral disease in pregnancy and, briefly, present 2 cases of primary gingivostomatitis in the first trimester of pregnancy, resulting in a favourable outcome for both mother and infant. We also point out the most recent data on rare, potentially severe in outcome, but treatable, primary central nervous system HSV-1 infection in later stages of pregnancy. Finally, we emphasize a multidisciplinary approach to oral HSV disease in pregnancy, with dentist participation in the diagnosis and treatment.

Oral infections and their influence on medical rehabilitation in kidney transplant patients.

Infections seem to be the most common life-threatening complication of long-term immunosuppressive therapy following organ transplantation. Although sparse scientific evidence, potential oral infections are considered to contribute to these complications. The aim of this study was to examine whether there is an association between oral infections and rejections after kidney transplantation. A group of 46 kidney transplant candidates was enrolled. The patients were examined clinically and radiographically for dental caries, periodontal disease, mucosal lesions/infections, and general oral health problems. Examinations were conducted the day before transplantation, and one year post transplantation. Fifteen (32.6%) patients developed acute rejections during the first year. Six of these patients (40%) presented with oral opportunistic infections (candida or herpes infections of the oral mucosa). The number of dental infections and semi-impacted teeth were low. When rejections were related to probing pocket depths (PPDs) > or = 4 mm and apical lesions together, statistical significance was not reached (p=0.075, OR=3.17 [0.87; 11.55]). Similar results were obtained when PPDs > or = 4 mm, apical lesions, semi-impacted teeth, and opportunistic mucosal infections were compared to rejections. The results of the present study do not support that opportunistic oral mucosal infections or dental-related infections seem to increase the risk of rejection in kidney transplanted patients.

Staphylococcus aureus bacteremia complicating herpes simplex virus type 1 stomatitis: case report and review of the literature.

BACKGROUND: Gingivostomatitis is a common clinical manifestation of primary herpes simplex virus type 1 (HSV-1) infection in children. The most common complication of herpetic gingivostomatitis is dehydration; rarely, it may be complicated by secondary bacteremia, and Kingella kingae and group A Streptococcus infections have been reported to be responsible for such episodes. METHODS: We describe the clinical course of a 4.5-year-old girl several years after a liver transplantation, who presented with high fever, vesicular lesions in the buccal region, and cervical lymphadenopathy. RESULTS: Viral culture from the vesicles grew HSV-1, whereas blood culture and bacterial culture from the vesicles grew methicillin-sensitive Staphylococcus aureus with identical antibiogram. Serology against HSV-1 confirmed a recent infection. The child was treated with cephalexin and improved gradually. CONCLUSIONS: Herpetic lesions of the oral mucosa might serve as a port of entry for pathogens including Staphylococcus aureus. Pediatricians and dentists should be aware of bacterial complications in children with herpetic stomatitis.

Changes in the pattern of oral lesions associated with HIV infection: implications for dentists.

Broad access to better HIV treatment has resulted in a significant reduction in the prevalence of HIV-associated oral lesions in western industrialized countries. However, a possible increased prevalence of oral warts and a potential dissociation between CD4+ T-cell counts and oral manifestations of HIV require continued vigilance by oral health care providers. Head and neck and oral examination coupled with a careful consideration of the complications associated with hyposalivation remain essential components of a comprehensive oral health care program.

Treating patients with herpes simplex virus infections: dental and dental hygiene students' knowledge, attitudes, and professional behavior.

Dental and dental hygiene students frequently interact with patients with herpes simplex virus (HSV) infections, often simply referred to as cold sores. The objectives of this study were to assess dental and dental hygiene students' knowledge, attitudes, and professional behavior concerning the treatment of patients with HSV infections and to investigate the relationships among knowledge, attitudes, and professional behavior. Questionnaire data were collected from 337 dental and seventy-three dental hygiene students at regularly scheduled classes. Dental and dental hygiene students did not differ in their overall knowledge concerning HSV infections. Dental hygiene students were more apprehensive about treating patients with these infections, but used more appropriate professional behavior compared to dental students. Dental students' knowledge and appropriateness of professional behavior increased over the course of their education. Overall, it was found that an increase in student knowledge was associated with increased apprehension related to treating these patients. However, the more apprehensive they were, the more they engaged in appropriate professional behavior. Educating future health care providers about the treatment of patients with infectious and communicable diseases can potentially increase the students' apprehension/negative attitudes concerning providing care, while at the same time increasing appropriate professional behavior during their education. Addressing students' apprehensions might be a crucial moderator that will determine whether they will provide the best possible care for these patients in their future professional lives.

Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis.

Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow-grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings. Following resolution of the lesions, the virus travels through the nerve endings to the nerve cells serving the affected area, whereupon it enters a latent state. When the host becomes stressed, the virus replicates and migrates in skin, mucosae and, in rare instances, the central nervous system. A range of morbidities, or even mortality, may then occur, i.e., recurrent HSV infections, which are directly or indirectly associated with PHGS. These pathological entities range from the innocuous herpes labialis to life-threatening meningoencephalitis.

Complex oral manifestations of an HIV-seropositive patient.

A complex manifestation of characteristic oral lesions occurring simultaneously in an HIV-seropositive patient is presented. Necrotizing ulcerative gingivitis (NUG), necrotizing ulcerative periodontitis (NUP), oral-facial herpes infection, pseudomembranous candidiasis and atypical oral ulceration are discussed. In spite of extremely low CD4+ T-cell counts of 3 x 10(6)/L and lack of anti-retroviral therapy, an AIDS patient responded favourably to standard periodontal therapy. In the follow-up period of 3 months, no recurrence of any of the oral lesions initially present occurred and no special prophylactic regimes were needed to maintain oral health. This case illustrates that appropriate management of the oral manifestations contributes significantly to improvement of the quality of life of patients in the terminal stage of HIV-AIDS.

[Dysphagia in oral medicine]. / Disfagia in medicina orale.

Dysphagia, defined as a difficulty in swallowing of fluids and/or food, is one of the most frequent symptoms of oesophageal, gastrointestinal or ENT diseases. Interestingly, dysphagia can be also the initial or late symptom of several oral diseases: e.g. traumatic ulcerations, immunomediated or infectious lesions, malignant neoplastic disease or mucositis in chemio-radiotherapy. The presence of this frequent symptom, with or without oral evident lesions, can suggest the presence of oral or perioral diseases, promoving adequate diagnostic-therapeutic management. In this paper, authors describe aetiology, pathogenesis and clinical aspects of oral diseases, as being more frequently associated with dysphagia; moreover, they describe the most important clinical and epidemiological features of systemic diseases associated with dysphagia.

[Efficacy study of immunomodulator Gepon in treatment of oral membrane diseases in patients with complications in the form of filling material extrusion into mandibular canal].

Experience in new domestic immunomodulator Gepon application in practice of treatment of virus diseases and their manifestations in oral cavity of patients with complications in the form of filling material extrusion into mandibular canal is submitted. In a combination to traditional techniques of the treatment the preparation has shown high efficacy.