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 Slide 33 – Oral
manifestations associated with HIV infection
Mouth is frequently involved by major (+)
and minor (+++) opportunistic diseases in the course of HIV infection.
They are mainly in relation to opportunistic
pathogens and to malignancies.
The most frequently observed manifestations
are:
 Oral candidiasis
Angular cheilitis
Oesophageal candidiasis
Herpetic stomatitis
Hairy leucoplakia
Necrotizing gingivitis
Slide 34 – Oropharyngeal
candidiasis
Superficial infection of the oral cavity
with Candida (thrush) generally presents as a white, cheesy exudate on the tongue and posterior oropharynx.
Early lesions may be detected along the
gingival–labial margins. The exudation is easy to scrape and branching pseudohyphae are easily detected on wet-mount KOH
preparations.
In women with HIV infection, vaginal yeast
infections are an early sign of immunodeficiency. Slide 35 –
Angular cheilosis due to candidiasis
Angular cheilosis
due to Candida in a patient with HIV.
Candidiasis is the most common
fungal infection in HIV-infected patients. Almost all patients experience
some form of candida infection during their
illness. Candida infections often occur early in the course of HIV
disease and may mark the onset of clinically apparent immunodeficiency.
Usually, only the mucosal surfaces are involved. Invasive disease is
extremely rare and occurs predominantly as a consequence of iatrogenic
measures such as use of in-dwelling catheters or broad-spectrum antibiotics
or drug induced neutropenia. Slide 36 – Oesophageal candidiasis
This slide shows a thick pseudomembrane
covering the esophageal mucosa.
Esophageal candidiasis
is a common cause of dysphagia and sometimes odynophagia (pain on swallowing). Slide 37 –
Herpes simplex virus (HSV) infection of the tongue
Multiple shallow ulcers on the tongue due to
herpes simplex virus infection in a patient with HIV infection. Slide 38 – Oral
hairy leucoplakia
This condition presents as white, frond-like
lesions on the lateral aspect of the tongue and sometimes on the adjacent
oral mucosa.
This manifestation is observed in about 25
per cent of HIV-infected patients.
These lesions are sometimes confused with candidiasis. However, they are quite distinct and, in
contrast to Candida lesions, cannot be removed by scraping. Epstein-Barr
virus is thought to play a causative role. These lesions have a high
spontaneous remission rate (25–50 per cent). Slide 39 –
Necrotizing ulcerative periodontitis
Necrosis of the gingival soft tissue extends
into tooth-supporting tissues, causing bleeding, pain, loss
of alveolar bone, with loosening of teeth and, in the end, their loss.
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