Biomedical subjects
Publications and source records attributed to D Wray.
Oral hairy leukoplakia is an Epstein-Barr virus-associated lesion that is considered to be a marker of immunosuppression. We report a case of oral hairy leukoplakia in a healthy nonimmunosuppressed elderly patient with no evidence of HIV infection on repeated investigation. This report has important implications on our understanding of the significance of this lesion.
One hundred forty-nine patients attending Edinburgh Dental Hospital had oral keratosis diagnosed clinically and histologically. The keratoses were grouped into erosive and nonerosive lichen planus, other keratoses infiltrated with inflammatory cells, and noninfiltrated keratoses. Drug histories were obtained from each patient on presentation, and the groups were analyzed to assess the association between the ingestion of commonly prescribed drugs and oral keratoses. Patients with infiltrated keratoses took nonsteroidal anti-inflammatory drugs twice as often as patients in the other groups, whereas those with lichen planus more frequently ingested antihypertensive drugs. Patients with erosive lichen planus were 10 times more likely to ingest nonsteroidal anti-inflammatory drugs than those with nonerosive lichen planus (p = 0.01).
Oral lesions have been reported frequently in patients seropositive for human immunodeficiency virus. A case is reported of HIV-associated periodontitis complicated by necrotising stomatitis and the development of an oro-antral fistula; the role of extractions in the management of this condition is highlighted.
Hairy leukoplakia is a recently described oral mucosal condition seen in immunosuppressed individuals, usually in association with HIV infection, when it is thought to be a sign of decreasing immunocompetence. It probably results from reactivation of infection by Epstein-Barr virus (EBV) and usually presents as bilateral white patches on the lateral borders of the tongue. From a histological study of 20 cases we have found that the typical appearance of hairy leukoplakia is of acanthotic, hyperparakeratinized epithelium with Candida hyphae sometimes present in the parakeratin. A band of EBV infected, koilocyte-like cells is present in the upper part of the prickle cell layers, these cells being swollen and pale staining, with prominent cell borders and perinuclear vacuoles. There is a paucity of inflammation in both the epithelium and lamina propria. An atypical appearance shows the koilocyte-like cells lying isolated or in small groups, irregularly arranged in the prickle cell layer and without a hyperparakeratinized surface. Diagnosis of hairy leukoplakia should normally be confirmed by demonstrating EBV in the koilocyte-like cells by immunocytochemistry or DNA in situ hybridization.
Pemphigus vulgaris is characterized by bound and circulating IgG antibodies to an epithelial antigen, antibody binding resulting in acantholysis. This study examines the role of pemphigus serum in the initiation and perpetuation of acantholysis. Oral epithelial cells derived from a patient with pemphigus vulgaris were cultured in vitro in the presence of normal serum. Also, normal oral epithelial cells were cultured in pemphigus serum for between 0.5 and 72 h or exposed to pemphigus serum for 72 h and then cultured in normal serum for 2 wk. Oral epithelial cells from the pemphigus patient continued to display acantholysis for the 3-wk duration of the culture. Normal oral epithelial cells showed acantholysis within 30 min exposure to pemphigus serum and the acantholysis persisted in the cultures, pulse exposed to pemphigus serum, for the duration of the explant culture. These results support the notion that pemphigus serum is directly responsible for acantholysis which may then be persistent.
A rapid method for the detection of EBV-DNA in paraffin sections of lesions of oral hairy leukoplakia (OHL) is described. The method makes use of advances in molecular technology, including the use of synthetic oligonucleotides with digoxigenin labelling in an in situ hybridisation (ISH) reaction, which can be completed in 24 h. Using this method, sections from 15 of 17 patients clinically diagnosed as having OHL contained readily detectable EBV-DNA in small foci along the upper layers of the stratum spinosum. The sections examined from the two remaining patients appeared to be EBV-DNA negative but both patients were on AZT therapy and one was in addition receiving acyclovir.
Polymorphonuclear neutrophils (PMN) are the predominant cell type in the established lesion of recurrent aphthous stomatitis (RAS). The function of these cells was studied in 15 patients with RAS and 15 age and sex matched controls. Production of oxygen radicals was assessed using cytochrome-c and nitroblue tetrazolium dye (NBT) reduction assays. Oxidative metabolism was found to be similar for experimental and control groups in both stimulated and non-stimulated assays. Adherence to glass surfaces by PMN was also measured. Adherence of PMN, both from patients and controls, was significantly reduced by serum, but to a lesser extent by serum from patients compared to controls. This effect of serum on adherence was reversed by phorbol myristate acetate (PMA) stimulation. These studies suggest that increased adherence of stimulated PMN, due to humoral factors, may be involved in perpetuating ulcerative lesions in RAS.
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Hairy leukoplakia (HL) is an Epstein-Barr (EB) virus related lesion of oral mucosa that is principally associated with human immunodeficiency virus-induced immunosuppression. To understand the nature of EB virus involvement in these lesions, this study compares the distribution of EB virus DNA and EB viral gene products with the pattern of keratinocyte differentiation in 12 lateral tongue biopsies of HL. Evidence of replicating EB viral infection and abundant virus production was demonstrated in the superficial epithelium of most (92%) samples by means of in situ hybridization and immunocytochemical techniques. Epstein-Barr virus latent membrane protein also was identified in 45% of samples, suggesting that this viral gene product, which is usually associated with EB virus latent infection, may be transiently expressed during viral replication in HL epithelium. The absence of detectable EB virus involvement in basal keratinocytes, however, fails to support the theory that latent infection occurs in basal epithelium. From this study, EB viral gene expression in HL appears to be linked with epithelial maturation. Conversely, the normal patterns of keratinocyte differentiation in these lesions do not appear to be appreciably altered by association with EB virus.
The clinical features, treatment and outcome of 29 patients with oral Crohn's disease seen over a 6-year period have been reviewed. Findings on clinical examination included labial swelling (19 patients), buccal mucosal cobblestoning (11), linear ulceration (11), lumps (five), and mucosal tags (two). Eleven patients had multiple features. Eight patients developed symptoms within the first decade of life and nine patients had symptoms for more than 4 years before diagnosis; the mean age at diagnosis was 30 (range 6-78) years. Fourteen of these patients (48 per cent) have Crohn's disease elsewhere in the alimentary tract, and in nine patients the oral disease predated the development or detection of Crohn's disease at other sites. Eight patients (25 per cent) have required no specific therapy for their oral disease and 12 have been treated with systemic corticosteroids of whom three are steroid-dependent. No other pharmacological approach to treatment has been successful and elimination diets, tried by five patients, had no effect. Oral Crohn's disease has a characteristic naked-eye appearance, may be the first or only manifestation of Crohn's disease and usually improves with oral corticosteroid treatment.
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The objectives of this preliminary study were to determine the prevalence of oral candidal carriage and infection in a group of HIV-positive individuals and compare the humoral immune responses in serum and saliva in this group with a control group of HIV-negative subjects. Patients were examined clinically with particular reference to the presence of candidal lesions and oral swabs taken to identify carriers. Venous blood and whole saliva were obtained for estimation of total and anti-Candida antibody levels. Pseudomembranous candidiasis was the commonest clinical variant in HIV-positive individuals. Candida albicans was the commonest species isolated in both groups. Increased levels of anti-Candida IgG were found in both serum and saliva of HIV-negative individuals who were either carriers of Candida species or had clinical candidiasis. This was associated with a reciprocal fall in anti-Candida IgA. Similar trends were seen in HIV-positive individuals in association with candidal carriage and infection, although the changes were more marked.
A study was carried out of 121 elderly edentulous individuals living in institutionalised homes in the Lothian Region, Scotland to determine the prevalence of yeasts and associated oral disease. Clinical examinations found that 65(54%) of the individuals suffered from denture stomatitis, and yeasts were recovered from 51(78%) of these individuals. The main yeasts isolated were Torulopsis glabrata and Candida albicans. Culture of saliva samples produced a slightly higher recovery rate of yeasts compared with swabbing of the floor of mouth and palate. The number of cigarettes smoked per day had a significant positive effect on the presence of denture stomatitis. No difference in disease state was shown between secretors and non-secretors of blood group antigens in saliva. This study demonstrates a significant level of oral mucosal infection in an institutionalised elderly population.
Four groups of mice, each of a different genotype, were orally inoculated with Actinomyces viscosus. The resulting periodontal bone loss was monitored and the isotype specific anti-A. viscosus serum humoral immune responses measured by ELISA. Maximum periodontal bone loss occurred in all genotypes with inoculation of 1.6 x 107 colony forming units of A. viscosus. IgG and IgM isotype levels increased with inoculation of 1.6 x 107 colony forming units of A. viscosus in three of the four groups, indicating that IgA may be important in producing periodontal bone loss.
One of the innate defences against superficial infections by Candida species appears to be the ability of an individual to secrete the water-soluble form of his ABO blood group antigens into body fluids. There was a significantly higher number of non-secretors (48.9%) among 174 patients with either oral or vaginal candida infections compared with the proportion of non-secretors in the local population (26.6%). The protective effect afforded by the secretor gene might be due to the ability of glycocompounds in the body fluids of secretors to inhibit adhesins on the surface of the yeast. In attachment studies, preincubation of blastospores with boiled secretor saliva significantly reduced their ability to bind to epithelial cells. Non-secretor saliva did not reduce the binding and often enhanced the numbers of attached yeasts. Possible host-parasite interactions underlying the susceptibility of non-secretors to candida and other infections are discussed.
The inability to secrete the water-soluble glycoprotein form of the ABO blood group antigens is a genetic characteristic associated with susceptibility to superficial fungal infections and also insulin-dependent diabetes mellitus (IDDM). As oral carriage of Candida albicans in healthy adults is associated with non-secretion, we examined oral carriage of yeasts among 275 patients attending diabetic outpatient clinics, 137 with IDDM and 138 with non-insulin dependent diabetes mellitus (NIDDM) with reference to ABO blood group, secretor status and yeast species. Of the 166 yeast isolates, 109 (66.7%) were C. albicans, a lower proportion compared with 94% reported for healthy individuals. There was no association between ABO blood group and carriage. There was no increase in the proportion of non-secretor carriers of C. albicans among patients with IDDM; but among those with NIDDM, 44% of non-secretors were carriers compared with 21% who were non-carriers (p less than 0.01). The results are discussed in the context of host-parasite interactions influencing colonization.
Desquamative gingivitis is an unsightly condition characterized by erythema and desquamation of the attached gingivae. The use of acrylic labial veneers as a vehicle for delivering medication and as a way to improve the esthetics is described.
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