Epidemiological characterization of oral focal epithelial hyperplasia in brown howler monkeys (Alouatta guariba clamitans).

BACKGROUND: Oral focal epithelial hyperplasia (FEH) is an uncommon infection affecting humans, chimpanzees, bonobos, and howler monkeys. This study describes 10 cases of free-ranging brown howler monkeys (Alouatta guariba clamitans) diagnosed with FEH and Alouatta guariba Papillomavirus 1 (AgPV 1). METHODS: We analyzed demographic characteristics, rescue conditions, clinical and pathological findings, and species-specific behavior factors in these cases. The study assessed the frequency of occurrence and potential contributing factors of FEH and AgPV 1 infection. RESULTS: The frequency of FEH was 8.13%. Most affected howlers were adult or geriatric males with comorbidities or stressful conditions. Clinical and pathological observations were consistent with AgPV 1 infection. Species-specific behaviors and environmental stressors were identified as contributing factors. CONCLUSIONS: FEH associated with AgPV 1 affected mainly adult or geriatric males with ongoing comorbidities or stressful conditions. Further research is needed to understand these factors for effective management.

HPV oral lesions in HIV-infected patients: the impact of long-term HAART.

BACKGROUND: Since the introduction of highly active antiretroviral therapy (HAART), an increase in the frequency of human papillomavirus-associated oral lesions (HPV-OL) has been observed. Thus, the aim of this study was to determine the prevalence and factors associated with HPV-OL in Mexican HIV-infected patients, as well as its genotyping, in the HAART era. METHODS: In a cross-sectional study developed at an HIV/AIDS referral center in Mexico City, HIV-infected patients were consecutively included from 2004 to 2011. An oral exam was performed; lymphocyte CD4(+) count, HIV-viral load, CDC-stage, and HAART use were recorded. HPV-OL samples were taken for routine histopathological analysis (H-E) and HPV-DNA amplification/sequencing. Logistic regression models were performed and the interactions tested using the STATA software. RESULTS: Among 787 HIV patients, 55 (6.9%) showed HPV-OL. HPV-OLs were independently associated with age (≥40 years) and with a longer time of HAART use (≥12 months). The most frequent lesion was squamous cell papilloma in 22 (40%) cases, followed by multifocal epithelial hyperplasia in 15 (27.3%) cases. Labial mucosa was the most common site involved (56.4%). Of the sequences obtained, 65.4% corresponded to low risk and 11.5% to high risk. Mixed high- and low-risk infection were identified in 7.7% of the cases. CONCLUSIONS: Human papillomavirus-associated oral lesions were associated with older age and longer HAART use. All lesions were benign in nature and most of the HPV sequences corresponded to low-risk types. The rise of HPV-OLs in HIV patients on HAART may be related with the longer life expectancy of individuals with an impaired immune system rather than a direct effect of HAART.

Prevalence of Oral Human Papillomavirus Infection Among Australian Indigenous Adults.

Importance: Human papillomavirus (HPV) infection is associated with oropharyngeal squamous cell carcinoma. International estimates suggest overall oral HPV prevalence is 7.5%, with prevalence of oral HPV types 16 and 18 being 1.6%; prior Australian estimates suggest oral HPV prevalence is 2.3%, with HPV-16 and HPV-18 being 1.3%. Objectives: To estimate the prevalence of oral HPV infection among Indigenous Australians and to report the prevalence of factors associated with high-risk HPV types (ie, HPV-16 and HPV-18) and HPV types linked with Heck disease (ie, HPV-13 and HPV-32). Design, Setting, and Participants: This cross-sectional study analyzed HPV screening results from saliva samples collected from 1011 Indigenous Australians between February 2018 and January 2019. Data were analyzed from May 2018 to May 2019. Recruitment occurred through Aboriginal Community Controlled Health Organisations in South Australia. Eligibility included identifying as Indigenous, residing in South Australia, and being aged 18 years or older. Main Outcomes and Measures: Saliva samples were collected, with microbial DNA for genotyping extracted. Sociodemographic parameters, health-related behaviors, and sexual history data were collected. Analyses were stratified by sex as well as by HPV types 13 and 32 (Heck disease) and 16 and 18 (high risk of oropharyngeal squamous cell carcinoma). Multivariable analyses were conducted to obtain adjusted odds ratios (ORs). Results: Data were obtained for 910 participants (median [interquartile range] age, 37 [27-51] years); 595 participants (65%) were female and 572 (63%) resided in nonmetropolitan locations. In all, 321 saliva samples (35.3%; 95% CI, 32.2%-38.4%) were positive for oral HPV (106 [33.7%] men; 215 [36.1%] women). The highest prevalence was found for HPV types 13 and 32 (207 [22.7%] total; 60 [19.0%] men; 147 [24.7%] women) followed by HPV types 16 and 18 (30 [3.3%] total; 9 [2.9%] men; 21 [3.5%] women). After multivariable analysis, risk factors associated with HPV types 13 and 32 included nonmetropolitan residential status (OR, 2.06; 95% CI, 1.10-3.88) and not having had a tonsillectomy (OR, 2.74; 95% CI, 1.05-7.16). Among women, having obtained a high school education or less was associated with lower odds of HPV-16 and HPV-18 infection (OR, 0.16; 95% CI, 0.03-0.97). Conclusions and Relevance: Prevalence of oral HPV infection in a large sample of Indigenous Australians was high, with one-third testing positive. The most prevalent HPV types were those associated with Heck disease. The prevalence of HPV types associated with oropharyngeal squamous cell carcinoma exceeded both Australian and international population-level estimates.

Molecular and serological evidence of the epidemiological association of HPV 13 with focal epithelial hyperplasia: a case-control study.

BACKGROUND: Focal epithelial hyperplasia is a benign proliferative condition that is more frequently found in children of certain ethnic groups. Human papillomavirus 13 and 32 DNA has been consistently detected in these lesions. OBJECTIVE: To demonstrate the epidemiological association of HPV 13 with FEH in the Emberá-Chamí community of Antioquia, Colombia. METHODS: A population-based, case-control study was conducted. One hundred and thirty-eight children were screened and 17 clinical and histologically-confirmed cases were sex and age-matched with 27 controls. Biopsies from FEH lesions and mouth washes from controls were obtained for DNA analysis. HPV 13 DNA was identified using a previously described type-specific PCR test. HPV 13 VLPs were produced by cloning of L1 from the HPV 13 cloned genome and seroreactivity against HPV 13 VLPs of sera from cases and controls were evaluated by ELISA. RESULTS: Among the whole population the prevalence of FEH was 13%. One-hundred-percent of the cases and 29.6% of the controls were HPV 13 positive. There was a significant difference in HPV DNA status between cases and controls (one-tailed Fisher exact test: P<0.0001). Antibodies against HPV 13 VLPs were found in 58.8% of cases and in 33.3% of controls, this difference was not statistically significant (P=0.089 Fisher exact test). However, the median of the ODs of the ELISA positive sera of the cases was 0.596 (interquartile range: 0.5075-0.8245) versus 0.452 (interquartile range: 0.337-0.479) in the controls and this was significantly different (P=0.0041 Man-Whitney test). CONCLUSIONS: We demonstrated a risk for association of FEH with infection with HPV 13. The higher level of antibodies against HPV 13 VLPs in cases may suggest the requirement of higher viral load or viral persistence for disease development.

Association of HLA-DR4 (DRB1*0404) with human papillomavirus infection in patients with focal epithelial hyperplasia.

OBJECTIVES: To determine gene frequencies of HLA-DR alleles in 22 Mexican patients with focal epithelial hyperplasia and compare them with those present in ethnically matched healthy subjects, as well as to determine the types of human papillomavirus present in the lesions. DESIGN: Prospective and retrospective observational study. SETTING: Dermatology outpatient clinic in a general hospital. PATIENTS: Twenty-two patients with clinically and histologically confirmed focal epithelial hyperplasia seen within a 10-year period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Results of high-resolution DNA typing for HLA-DR alleles and biopsy for viral typing. RESULTS: HLA-DR4 (DRB1*0404) was significantly increased (P<.001; odds ratio, 3.9; 95% confidence interval, 1.86-8.03). Seventeen (85%) of 20 patients had human papillomavirus subtype 13. The data on human papillomavirus differed from reports elsewhere that described association with human papillomavirus type 32. CONCLUSIONS: The HLA-DRB1*0404 allele suggests that Amerindian populations are at risk, and in this group, the Mexican population studied was affected only by human papillomavirus type 13.

The prevalence of oral mucosal lesions in U.S. adults: data from the Third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Most reports of oral lesion prevalence are based on studies of atypical populations. There are no published studies on oral mucosal lesion prevalence in U.S. adults that are based on a national probability sample. METHODS: The Third National Health and Nutrition Examination Survey, or NHANES III, employed a complex, multistage sample of 33,994 civilian, noninstitutionalized people from 19,528 households. Dentist examiners were trained to recognize, classify and record in a standardized manner the clinical characteristics of each of the 48 conditions of interest to include diagnosis, size, location, surface morphology, color consistency, pain, duration and history using procedures based on the World Health Organization's Guide to Epidemiology and Diagnosis of Oral Mucosal Diseases. RESULTS: Examinations were performed on 17,235 people aged 17 years and older, of whom 4,801 (27.9 percent) had a total of 6,003 lesions. Denture-related lesions (stomatitis, hyperplasia, ulcers, inflammation and angular cheilitis) composed 8.4 percent and tobacco-related lesions (smokeless tobacco-related and nicotinic stomatitis) composed 4.7 percent of all lesions. Discounting denture-related lesions, amalgam tattoos were the most prevalent lesions (3.30 percent), followed closely by cheek/lip bites (3.05 percent) and frictional white lesions (2.67 percent). Smokeless-tobacco users (odds ratio, or OR, = 3.90) and removable denture wearers (OR = 3.57) had the highest odds of having a lesion. CONCLUSION: Lesion prevalences differed significantly by age, sex, race/ethnicity, denture wearing and tobacco use. When lesion-specific prevalences are cited in the literature, they should be stratified by covariates known to be associated with them.

Focal epithelial hyperplasia (Heck's disease) in three Kenyan girls: case reports.

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

Sporadic cases of Heck disease in two Polish girls: association with human papillomavirus type 13.

Two sporadic cases of Heck disease in Polish girls were associated with human papillomavirus 13. No other children and nobody from their surroundings had similar lesions. The course of the disease was chronic in both patients. The lesions regressed spontaneously in one girl within several years after some of the papules were excised. The second girl's warts persist after eight years.

Multifocal papilloma virus epithelial hyperplasia.

Multifocal papilloma virus epithelial hyperplasia is an infection of the oral mucosa produced by human papilloma virus types 13 and 32, which primarily bilaterally affects lips, lateral borders of tongue, and buccal mucosa. The attached oral mucosa, floor of mouth, soft palate, and oropharynx are sites that appear not to be affected. This study comprises 110 patients with multifocal papilloma virus epithelial hyperplasia identified over a period of 3 years in Guatemala City and neighboring rural areas. All but four patients were younger than 18 years of age. More than one affected patient was observed in several families. All but three cases occurred in patients living in extreme poverty (annual family income less than $1,200 in U.S. dollars). Biopsies of 60 lesions demonstrated acanthosis and nuclear degeneration within the epithelium. We suggest that the eponym Heck's disease be abandoned because this disease was described in the Latin-American literature before the initial description in the American literature. We propose the term multifocal papilloma virus epithelial hyperplasia, which best describes the nature and multifocality of this disease.

Cross-sectional study of oral mucosal conditions among a central Amazonian Indian community, Brazil.

BACKGROUND: A cross-sectional study on the oral mucosal conditions among the Waimiri Atroari Indians from central Amazonia, Brazil, has been conducted. These Indians keep their traditional way of life and are free from habits such as smoking, alcohol drinking, and use of pacifiers. METHODS: Clinical examinations of a representative, randomly selected sample of patients during routine dental treatment, following ethical procedures recommended by Brazilian laws were made. RESULTS: Out of 922 individuals, 587 were examined, among which 52.57% of the children up to 12 years old and 73.44% of patients aged 13 years or older presented at least one oral mucosal condition. The conditions more frequently observed were, in decreasing order of prevalence: fissured tongue, focal epithelial hyperplasia (FEH), lesions of traumatic origin, geographic tongue, Fordyce's spots, and candidiasis. Only one case of leukoplakia was identified. CONCLUSIONS: Conditions observed among theses Indians were essentially the same that have been described in other populations around the world, except for FEH, which, as a characteristic lesion of Indians, had high prevalence (20.95%). The lesions observed were related to the way of life of this specific population.

Hiperplasia epitelial multifocal: estudio en un grupo de niños indígenas venezolanos / Multifocal epithelial hyperplasia in a group of Venezuelan indigenous children

La Hiperplasia Epitelial Multifocal (HEM) es una enfermedad caracterizada por múltiples pápulas en la mucosa bucal. Ha sido reportada en indígenas, así como en grupos de esquimales y su etiología se relaciona a la infección por VPH. Las lesiones afectan principalmente niños y son de carácter autolimitado y benigno. Se realizó un estudio en seis comunidades indígenas pertenecientes a la etnia Pemón en la Gran Sabana Estado Bolívar en Venezuela, con el objetivo de determinar la presencia de HEM, caracterizar dicha enfermedad y finalmente tratarla. 250 niños fueron evaluados clínicamente en un rango de edades entre 3 y 13 años, de los cuales 18 presentaban HEM (7.2 por ciento). La enfermedad se presentó con predilección 2:1 por el sexo femenino en un promedio de 8 años de edad. Las lesiones fueron más frecuentes en los labios, del mismo color de la mucosa, aunque algunas mostraron una superficie blanquecina, posiblemente producto del roce o mordedura. El estudio histopatológico mostró características de HEM en todos los casos, incluyendo características consistentes con infección por VPH. Las lesiones fueron tratadas exitosamente con criocirugía

Multifocal epithelial hyperplasia (MEH) is a disease characterised by multiple papules on the oral mucosal. MEH has been reported in American Indigenous, as well as in Eskimos and its aetiology has been related to HPV infection. Lesions typically appear in children and show a limited and benign course. The present study was carried out in six Venezuelan Indigenous communities of Gran Sabana, Bolivar State. The aim of the study was to determine the presence of MEH, describe it and eventually treat the disease. 250 children were evaluated and 18 showed HEM features (7.2%). A female predilection was observed (2:1) and the mean of age was 8 years old. Lesions were the same colour of the mucosa or slightly whiter, probably due to chewing or trauma. Lips were more frequently affected. All cases showed histopathological characteristics of MEH, including features consistent with HPV infection. Patients were successfully treated by cryosurgery.

Prevalencia de la hiperplasia epitelial focal en paciente de las etnias Sanema y Yekuana, estado Bolívar, Venezuela / Prevalence of focal epithelial hyperplasia in patients from the Sanema and Yekuana tribes, Bolivar State, Venezuela

El propósito de este estudio fue evaluar la prevalencia de Hiperplasia Epitelial Focal (HEF) en poblaciones indígenas de las tribus Sanema y Yekuana del Estado Bolívar - Venezuela. Se examinó un total de 862 pacientes de ambos sexos y en edades comprendidas entre 0 - 79 años, de los cuales 79 (9 por ciento) presentaron la patología a estudiar. El diagnóstico de la lesión fue realizada sobre la base de la historia y características clínicas de acuerdo a la guía para estudio epidemiológico de la Organización Mundial de la Salud (WHO, 1978). El número de pacientes con HEF fue de 79 (9 por ciento), de éstos, 45 (57 por ciento) pertenecían a la étnia Sanema y 34 (43 por ciento) a la étnia Yekuana. De acuerdo a los hábitos, se encontró que 13 pacientes (17 por ciento) presentaban el hábito de masticar tabaco. Con respecto a la frecuencia de HEF en relación a la muestra total, se pudo evidenciar que esta patología representa el 9 por ciento de la muestra estudiada en el período Septiembre 2003 - Julio 2004.

Multifocal epithelial hyperplasia, a rare oral infection in Asia: Report of twelve cases in Iran

Objectives: Multifocal epithelial hyperplasia (MEH) is benign, asymptomatic oral disease with viral etiology. The frequency of this disease varies widely from one geographic region to another, and can vary, from 0.002 to 35% depending on the population studied.Study design: Here we report the clinicopathological features of twelve cases of MEH referred to Oral Medicine Department of Mashhad Dental School for the first time in Iran. Records of patients with the diagnosis of MEH in our department during 7 years were analyzed and data were extracted. Results: Most of the patients were younger than 20-year-old (66%), and females were predominantly affected(7:12). The mean age of onset was 12.72±10.14 years and the mean duration was 52.54 ± 78.51 months. Patients had multiple, well circumscribed, soft, non tender, flattened papules, with a color similar to the adjacent mucosa,in different areas of the oral cavity but the most affected site was buccal mucosa. Familial history of such lesions was negative in all patients. Only three cases showed spontaneous regression.Conclusion: In spite of rare nature of this disease in Asia, it seems that it is not the case in Khorasan Province,southeast Iran (AU)

Hiperplasia epitelial focal. Una rara enfermedad en nuestro medio / Focal epithelial hyperplasia. A rare disease in our area

La hiperplasia epitelial focal es una afección benigna asintomática y de muy baja frecuencia en nuestro medio. Aparece como pápulas en labio inferior principalmente, aunque se pueden localizar en mucosa retrocomisural y lengua y con menos frecuencia en labio superior, encía y paladar. Presentamos un caso clínico de una niña de 9 años, saharaui con lesiones que clínica e histológicamente se corresponden con una hiperplasia epitelial focal

Focal epithelial hyperplasia is a benign, asymptomatic disease, occurring with very low frequency within our population. It appears as papules, principally on the lower lip, although it canalso be found on the retro-commissural mucosa and tongue, and less frequently on the upper lip, gingiva and palate. We present the clinical case of a 9-year-old Saharan girl with lesions that clinically and histologically corresponded to a focal epithelial hyperplasia

Prevalencia de hiperplasia epitelial focal de la comunidad indígena de Cristianía, Municipio de Jardín, Antioquia, 1998 / Prevalence of focal epithelial hyperplasia in schoolchildren from the indigenous community of Cristiania, Jardin, Antioquia, 1998

Se buscaron lesiones de hiperplasia epitelial focal en niños entre los cuatro y los catorce años de edad pertenecientes a la comunidad indígena emberá chamí de Cristianía, localidad del Municipio de Jardín, sudoeste antioqueño. Se examinaron 200 niños, y se encontró que la prevalencia de hiperplasia epitelial focal fue del 7.5 por ciento. En el 46.6 por ciento de los casos la edad estaba entre los cicno y los nueve años y no se encontraron diferencias significativas en cuanto a sexo. El 33 por ciento de los pacientes tenía. El 33 por ciento tenía algún grado de consanguinidad y antecedentes de la enfermedad en familiares. El 66 por ciento de los afectados relató que las lesiones se localizaron inicialmente en la mucosa yugal y el lagio inferior. Al examen clínico el 80 por ciento de los pacientes presentaban lesiones sésiles de bordes nítidos y asintomáticas, de tamaño entre 5 y 8 mm. y el 20.7 por ciento se encontró en la mucosa yugal. Los hallazgos histopatológicos fueron acantosis acantosis del epitelio, hiperqueratosis, papilomatosis, hiperplasia de células basales y presencia de coilocitos en las capas superiores. El 13.3 por ciento de los casos se encontró positivo para papiloma virus humano en pruebas inmunohistoquímicas. Todos fueron negativos para hibridización in situ de los serotipos 6, 11, 16 y 18