Arley Silva Junior

Prevalence of oral hairy leukoplakia in 120 pediatric patients infected with HIV-1

Oral hairy leukoplakia (OHL) is an EBV (Epstein-Barr virus) opportunistic infection found in HIV-infected patients. It is an asymptomatic lesion that has an important prognostic value in AIDS. Differently from what takes place with HIV adult patients, OHL has been described in the literature as having a very small prevalence in pediatric patients. Therefore, the aim of this study was to investigate the prevalence of OHL in HIV pediatric patients using cytopathology. The sample consisted of 120 patients who were submitted to oral examination and had material scraped from both sides of their tongues. The diagnostic criterion was based on the identification of nuclear alterations. Clinical OHL was identified in two (1.67%) patients. The cytopathology revealed twenty (16.7%) cases of subclinical OHL. Our results show that in pediatric patients the prevalence of OHL may be larger than that described in the literature.

Association between socioeconomic status and HIV-associated oral lesions in Rio de Janeiro from 1997 to 2004

The prevalence of HIV-related oral lesions may vary according to socioeconomic status and antiretroviral therapy, among other factors. This studys intent was to evaluate the association between socioeconomic indicators, CD4+ counts and HIV-related oral lesions in the city of Rio de Janeiro, RJ, Brazil. A retrospective epidemiological analysis was performed of the medical records of HIV-positive patients that attended the Federal University of Rio de Janeiro between 1997 and 2004. Gender, age, mode of HIV transmission, level of education, monthly familial income, CD4+ counts and HIV-related oral lesions were assessed. For statistical analysis, the Chi-square test was used with a level of significance of 5%. 254 medical records were reviewed: 83 women and 171 men. Monthly familial income below 2 minimum wages was associated with a higher prevalence of pseudomembranous candidiasis (p = 0.024), while income above 10 minimum wages was associated with a higher prevalence of salivary gland disease (p = 0.021). Lower socioeconomic status was associated with lower CD4+ counts (p = 0.017). In this study, an association was noted between socioeconomic status, immune suppression and prevalence of oral lesions. However, further studies are warranted using other socioeconomic variables in order to better assess this relationship.

Detection of sulphate-reducing bacteria in human saliva

Abstract Objective. The aim of the current study was to investigate the presence of sulphate-reducing bacteria (SRB) in human saliva and correlate with oral and systemic conditions. Methods. Saliva samples were collected from 118 patients and inoculated in 2 ml of modified Postgates E medium culture. After 28 days of incubation at 30°C the presence of SRB was identified by the production of sulphide. Results. Of 118 saliva samples collected, 35 were positive for the presence of SRB. Three positive samples were randomly chosen to identify the species of SRB by PCR and sequenced. The three selected samples were identified as Desulfovibrio fairfieldensis, Desulfovibrio desulfuricans and Raoultella ornithinolytica. Gastritis (14.4%) was the most prevalent systemic disease, followed by diabetes (3.4%), while periodontitis (11%) and traumatic fibroma (4.2%) were the oral manifestations most frequently found. A bivariate analysis was performed to examine for the presence of SRB and the most prevalent systemic and oral manifestations. Only periodontitis showed a statistically significant association (p = 0.0003). Conclusions. The results showed SRB can be found in oral microbiota of healthy patients. Regarding the several conditions studied, there was a higher prevalence of SRB in patients with gastritis and patients with periodontal disease, with a possible correlation between the presence of SRB in the oral microbiota and periodontal disease.

Leucoplasia pilosa oral: aspectos histopatológicos da fase subclínica

Oral hairy leukoplakia (OHL) is one of the most common oral manifestations of AIDS, with diagnostic and prognostic value. OHL is associated to the Epstein-Barr virus and presents clinical and histological defined characteristics. There have already been reports about a subclinical stage of OHL, although they lacked histopathologic characterization. The present study had the aim to describe the histopathological characteristics of subclinical hairy leukoplakia, as well as to carry out a comparative analysis between clinical and subclinical OHL. For that, 11 cases were analyzed - 5 biopsies from patients who presented with the lesion and 6 samples from the borders of tongues obtained in necropsies. The histopathological findings in subclinical OHL were: absence of parakeratosis and papillomatosis, mild acanthosis, ballooning cells and nuclear alterations. In situ hybridization and immunostaining were positive for EBV in the nuclear alterations identified in the histophatological analysis. Based on the identification of EBV in the nuclear alterations, it was possible to conclude that subclinical OHL, similarly to the clinical lesion, presents histopathological features that are specific and sufficient to establish the definitive diagnosis, regardless of the identification of the virus.

Oral lichen planus: study of 21 cases

BACKGROUND: Lichen planus is considered to be the most common dermatological disease involving the oral mucosa. OBJECTIVE: To investigate the profile, clinical features, and the presence of dysplasia and candidiasis in patients with oral lichen planus. METHODS: A total of 21 patients were selected from 258 patients at risk for oral cancer development. RESULTS: Most of the patients were white (76,2%), female (66,6%), with mean age of 58.8 years. Eight were smokers and seven were alcohol consumers. The buccal mucosa was the most affected site, followed by the tongue and the gingiva. The reticular pattern was the most common appearance. Histopathology depicted dysplasia in nine cases and cytopathology was positive for Candida in eight cases in the first appointment. CONCLUSION: Our data are similar to the literature. Cytopathology was important for the diagnosis of candidiasis. Although the presence of dysplasia was verified, further studies are necessary to clarify the importance of this finding.

Actinic prurigo of the lip: Two case reports

Actinic prurigo is a photodermatosis that can affect the skin, conjunctiva and lips. It is caused by an abnormal reaction to sunlight and is more common in high-altitude living people, mainly in indigenous descendants. The diagnosis of actinic prurigo can be challenging, mainly when lip lesions are the only manifestation, which is not a common clinical presentation. The aim of this article is to report two cases of actinic prurigo showing only lip lesions. The patients were Afro-American and were unaware of possible Indian ancestry. Clinical exam, photographs, videoroscopy examination and biopsy were performed, and the diagnosis of actinic prurigo was established. Topical corticosteroid and lip balm with ultraviolet protection were prescribed with excellent results. The relevance of this report is to show that although some patients may not demonstrate the classical clinical presentation of actinic prurigo, the associated clinical and histological exams are determinants for the correct diagnosis and successful treatment of this disease.

The frequency of oral conditions detected in hematology inpatients

Background Oral manifestations may be the first signs of hematologic diseases, and may occur due to the disease itself or to treatment. Objective To evaluate the frequency and types of oral conditions presented by patients on a hematology ward. Methods Data were collected by oral examinations during weekly visits to a hematology ward. Six trained dentists performed the oral assessment based on the principles of oral semiology. All patients who accepted to be examined were included in the study. Patients who were unavailable or unable to have oral examinations were excluded. Data were recorded on protocol forms and in the electronic records of the institution. A descriptive analysis was performed. Results Seventy-nine patients were included in the analysis; 50.6% were female and the mean age was 41.49 years. The most common reasons for hospitalization were chemotherapy and complications (81%), relapse (13.9%) and pre-transplant preparation (5%). The most frequent underlying diseases were multiple myeloma (17.7%), acute myeloid leukemia (15.4%) and acute lymphocytic leukemia (11.5%). Oral conditions were found in 36 (45.6%) patients, some of whom presented more than one condition. The most common oral conditions were dry lips (12.6%), mucositis (10.1%), petechiae (8.9%) and candidiasis (7.6%). Of the detected oral conditions, 56.9% were related to the underlying disease or chemotherapy and 20.2% were not related to the disease. Conclusion This study shows the types and frequency of oral conditions observed in hematological inpatients. Awareness of these conditions is important for prevention and planning the care of patients with hematological diseases.

Bisphosphonate-related osteonecrosis of the jaws: Report of a case using conservative protocol

Bisphosphonates have been the first-line treatment option for osteometabolic diseases, such as osteoporosis, hypercalcaemia in malignant bone diseases, and in bone metastasis. It is possible to observe a growing number of cases of osteonecrosis of the jaws in patients using this medication, called bisphosphonate-related osteonecrosis of the jaws. The purpose of this study was to report a conservative treatment for bisphosphonate-related osteonecrosis of the jaws--Stage 2, using antibacterial solution and low-level laser therapy. At the end of the treatment, the patient presented improvement of the lesion with the healing of the mucosa. The literature still lacks successful definite protocols, thus the present case may contribute with another option for conservative management for bisphosphonate-related osteonecrosis of the jaws. More research is necessary in order to develop a good protocol management for bisphosphonate-related osteonecrosis of the jaws.

CLA and CD62E expression in oral lichen planus lesions

OBJECTIVE There are few reports on the migration of CLA+ T cells through E-selectin in cutaneous lichen planus, with only one study on oral lichen planus (OLP). This study aimed to analyze CLA expression and assess whether there is a correlation with E-selectin (CD62E) in OLP lesions. MATERIAL AND METHODS Biopsies were performed on 11 patients including two areas: one without clinical and histopathological features of OLP [perilesional group (PLG)] and the other with clinical and histopathological features of OLP [OLP group (OLPG)]. The specimens obtained were divided into two: One was fixed in formalin for routine analysis (H&E), and the other was frozen for CD3, CD4, CD8, CLA, and CD62E immunofluorescence markers. RESULTS More CD4+ (median 1409, range 860-2519), CD8+ (median 1568, range 654-3258), and CLA+ T cells (median 958, range 453-2198) and higher CD62E expression (median 37, range 27-85) were identified in OLPG (P = 0.003; P = 0.003; P = 0.004; P = 0.003, respectively) than those in PLG. The median prevalence analysis was also significantly higher for CLA+CD8+ T cells in OLPG (OLPG = 39.4%, range 18.4-64.2; PLG = 29.4%, range 12.1-47.1) (P = 0.026). None of the correlations between CD3+ or CLA+ T cells and CD62E in OLPG and in PLG were significant. CONCLUSION The significant presence of CLA+ T cells and E-selectin expressions in the OLPG suggests their involvement in the etiopathogenesis of OLP; however, only a weak correlation between CLA+ T cells and E-selectin was observed.

Comparative analysis of Gram’s method and PAS for the identification of Candida spp. samples from the oral mucosa

Introducao: Especies de Candida fazem parte da microbiota normal de individuos sadios, residindo como comensais. Entretanto, podem tornar-se patogenicas caso ocorram alteracoes nos mecanismos de defesa do hospedeiro ou comprometimento das barreiras anatomicas. A candidiase e a infeccao fungica mais frequente na mucosa oral, causada principalmente pela Candida albicans. O diagnostico baseia-se nos aspectos clinicos e nos sintomas, em conjunto com os metodos laboratoriais. Objetivos: Avaliar a sensibilidade e a especificidade do metodo de Gram na identificacao da Candida spp. em raspados de mucosa oral e avaliar o grau de concordância entre os metodos clinico e citopatologico no diagnostico de candidiase oral. Material e metodos: Teste cego de 171 esfregacos, provenientes dos pacientes atendidos no Hospital Universitario Antonio Pedro da Universidade Federal Fluminense (HUAP/UFF), corados pelas coloracoes de Gram (n = 57), acido periodico de Schiff (PAS) (n = 57) e Papanicolaou (n = 57). Resultados: A analise comparativa entre os metodos revelou que no PAS ha maior prevalencia de Candida spp. (12%) em relacao ao Gram; todavia, nao ha diferenca significativa entre os resultados. Dos casos com diagnostico clinico de candidiase, 93% foram confirmados pela citopatologia. Conclusao: A coloracao pelo Gram mostrou-se adequada, sendo necessario intensificar o treinamento do profissional para a identificacao das estruturas morfologicas do fungo. Apesar de o Papanicolaou representar o metodo mais utilizado na rotina citopatologica para diagnostico da candidiase, tambem se indica a utilizacao do PAS concomitantemente. Desse modo, sugere-se que o diagnostico de candidiase seja realizado por meio de avaliacao clinica associada a analise citopatologica, com base na presenca de hifas e/ou pseudo-hifas.