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European Journal of Medical Research Mar 2022Angular cheilitis, an infection mainly caused by Candida yeasts, is featured by the appearance of inflammatory lesions at the bilateral corners of the mouth,...
BACKGROUND
Angular cheilitis, an infection mainly caused by Candida yeasts, is featured by the appearance of inflammatory lesions at the bilateral corners of the mouth, particularly in patients with poor oral hygiene, ill-fitting dentures and old age. The first isolation of an atypical yeast, Cystobasidium calyptogenae, from oral samples of a patient presenting with angular cheilitis is discussed in this study.
CASE PRESENTATION
Angular cheilitis was diagnosed in a 60-year-old denture-wearing woman who presented with an irritation fibroma on her right lower buccal sulcus over the premolar region. Primary cultures of her oral swab and oral rinse samples grew a pure culture of an uncommon yeast strain resembling Rhodotorula sp. Sequence analysis of the yeast internal transcribed spacer (ITS) gene region and D1D2 domain showed highest similarity (99.6% and 100%, respectively) to C. calyptogenae CBS 9125 type strain. Following 2 weeks of treatment with miconazole/fusidic acid and mouthwash, the oral lesion showed improvement with less erythema. C. calyptogenae was not isolated from the patient's oral samples upon repeat sampling.
CONCLUSION
This is the first report on the isolation of C. calyptogenae from human oral samples. The ability of C. calyptogenae to grow at 37 °C and the fact that it was the only yeast species isolated from the patient's oral samples suggests its pathogenic potential and possible involvement in angular cheilitis. The ubiquitous nature of the Cystobasidium yeast is believed to increase the likelihood of opportunistic infections among immunocompromised individuals. As Cystobasidium is phenotypically indistinguishable from Rhodotorula, an emerging opportunistic pathogen, surveillance using molecular identification in clinical settings is essential in providing accurate diagnosis and treatment of uncommon yeast infections.
Topics: Basidiomycota; Candida; Cheilitis; Female; Humans; Middle Aged
PubMed: 35346364
DOI: 10.1186/s40001-022-00671-6 -
Special Care in Dentistry : Official... Sep 2022Autoimmune polyglandular syndrome type I (APS-I) is a rare condition of autosomal recessive and monogenic inheritance, which is characterized clinically by at least two...
AIMS
Autoimmune polyglandular syndrome type I (APS-I) is a rare condition of autosomal recessive and monogenic inheritance, which is characterized clinically by at least two signs of the classic triad: mucocutaneous candidosis, hypoparathyroidism, and Addison's disease. This study aims to report the oral manifestations of APS-I in a 42-year-old woman, who attended the Special Care Dentistry Center.
METHODS AND RESULTS
The patient presented with hypoparathyroidism, diabetes mellitus, and autoimmune hepatitis. Chronic hyperplastic candidosis (CHC) was the main oral manifestation and it was diagnosed based on clinical and cytologic characteristics. Microstomia, angular cheilitis, xerostomia, enamel hypoplasia, and microdontia were also present.
CONCLUSIONS
CHC was treated with topical nystatin and oral fluconazole, resulting in a significant improvement of the lesions.
Topics: Addison Disease; Adult; Candidiasis, Chronic Mucocutaneous; Dental Enamel Hypoplasia; Female; Humans; Hypoparathyroidism; Polyendocrinopathies, Autoimmune
PubMed: 35182449
DOI: 10.1111/scd.12703 -
Stomatologiia 2021The aim of the study is to clarify the stages of examination of patients with various clinical manifestations of nosological forms of candidiasis and to evaluate the...
OBJECTIVE
The aim of the study is to clarify the stages of examination of patients with various clinical manifestations of nosological forms of candidiasis and to evaluate the effectiveness of the ongoing antifungal therapy in the complex treatment of oral candidiasis, considering all factors and background diseases.
MATERIAL AND METHODS
56 patients were examined and treated, of which 41 were women and 15 were men with a clinical course of candidiasis (acute pseudomembranous candidiasis, chronic hyperplastic candidiasis, angular candidiasis cheilitis). The patients' age is from 33 to 78 years. All patients underwent a bacterioscopic examination of plaque. All patients diagnosed with oral candidiasis were prescribed complex treatment, which included both general and local therapy. The diagnosis and treatment of the patient's main diseases (diabetes mellitus, hypoparathyroidism, diseases of the gastrointestinal tract, blood diseases, etc.) were mandatory.
RESULTS
All patients taking antifungal therapy reported a significant improvement in the clinical condition of the oral mucosa. Burning sensation, pain, sensation of enlargement of the tongue, dryness in the oral cavity disappeared in the patients. After 2 weeks of drug therapy with fungicidal preparations, the patients were prescribed a second bacterioscopic examination. The results of laboratory studies showed the presence of single, non-budding Candida cells in the field of view and a minimal, diagnostically significant, degree of contamination, which corresponded to the candidacy.
CONCLUSIONS
The study showed that antifungal therapy for oral mucosa candidiasis should always be pathogenetically justified and should be carried out considering the patient's underlying disease.
Topics: Adult; Aged; Antifungal Agents; Candida; Candidiasis, Oral; Female; Humans; Male; Middle Aged; Stomatitis
PubMed: 35081700
DOI: 10.17116/stomat202110006243 -
Journal of Oral Science Jan 2022The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.
PURPOSE
The aim of this pilot study was to clarify the acceptability and clinical efficacy of an oxygen-enriched oil-based gel for treatment of angular cheilitis.
METHODS
A class IIb medical preparation, packaged in appropriate syringes, was tested. Patients were instructed how to use the gel for 10 days: finger rub application (3 times daily) on the dried lesion after meals, without eating, drinking, or speaking for at least 30 min thereafter. The Wilcoxon signed-rank test was used to assess whether there were any differences in the distributions of reported pain and lesion dimension. A microbiological examination was also performed with oral swabs; chi-squared test was used to compare the difference in the presence of microorganisms before and after treatment.
RESULTS
Thirty patients were treated. A significant improvement in reported outcome and a significant reduction in the initially measured largest dimension of the lesion were observed after use of the clinical protocol. Additionally, a significant reduction in the pathogen count was found.
CONCLUSION
Even if with limitations, data showed that this medical preparation facilitated prompt recovery from reported pain, without adverse reactions. Further work with a larger study population, and possibly a randomized control medication, will be needed.
Topics: Cheilitis; Humans; Oxygen; Pilot Projects; Prospective Studies; Treatment Outcome
PubMed: 34980827
DOI: 10.2334/josnusd.21-0428 -
The American Journal of Gastroenterology Dec 2021Spondyloarthritis (SpA) is a heterogeneous group of chronic autoinflammatory disorders that can present extra-articular gastrointestinal manifestations. Among them is...
BACKGROUND
Spondyloarthritis (SpA) is a heterogeneous group of chronic autoinflammatory disorders that can present extra-articular gastrointestinal manifestations. Among them is mainly inflammatory bowel disease (IBD). Although IBD mainly affects the intestinal tract, it can include early manifestations evident in the oral cavity. No comparative data on these oral manifestations in patients with SpA were found in the literature.
OBJECTIVE
To identify oral clinical manifestations due to changes in the oral mucosa associated with IBD in patients with SpA without a diagnosis of IBD and associate them with endoscopic and histological findings.
METHODS
80 patients with SpA and 52 healthy controls were evaluated. They were assessed intra- and extra-orally, following the modified World Health Organization guideline. In addition, by clinical parameters of rheumatological, gastrointestinal and laboratory activity. Ileocolonoscopy was performed with digital chromoendoscopy with magnification and histological analysis. Comparative analyzes were performed by Chi square tests, Fisher's exact tests, confirmed by univariate regression and discriminant analysis of multiple correspondences. Institutional ethics committee approval cod-2017-023.
RESULTS
The patients with SpA had 56% male gender, mean age of 42.8 years (SD ± 10.4) and a BMI in the range of 23.9 - 28.4. The healthy controls, 54% of the male gender with an average age of 41 years (SD ± 13.6) and a body mass index-BMI in the range of 22.9 - 27.6. The patients reported smoking only in 6.2%, however as a smoking history in 31% and passive smokers (15%), the majority employed (41%), married (56%) and professionals (49%). Of the healthy controls, they smoked (15%), with a history of smoking (31%), passive smokers (21%), the majority employed (77%), with their own home (67%), and professionals (54%). The patients with SpA reported a greater presence of some signs and symptoms of gastrointestinal origin 69%, while in the controls it was 7.7% (p = 0.001). Forty one of them were referred to colonoscopy with magnification being in 17.1 % changes in the mucosa of the rectum and in the same frequency changes in the mucosa of the sigmoid colon. Regarding the ileum, changes in the mucosa were evidenced in 41.5% of the cases. The presence of oral lesions was evident and predominated in them (63%) compared to controls p = 0.050. The main oral lesions associated with IBD were gingivitis (55%) (p = 0.001), followed by aphthous stomatitis (3.8%), angular cheilitis (2.6%) and perioral erythema with scaling (1.3%). 100% of the patients who presented alteration of the colonic mucosa presented oral lesions associated with IBD (p = 0039), which was also significantly associated with the presence of gingivitis/aphthous stomatitis (p = 0.029).
CONCLUSION
Patients with SpA without a diagnosis of IBD have more oral signs and symptoms compared to healthy controls. Gingivitis is important given its association with early endoscopic and histological findings. Manifestations in the oral cavity can precede intestinal manifestations, therefore the clinical assessment by the oral pathologist in conjunction with gastroenterology and rheumatology allows a timely referral to gastroenterology and an endoscopic and histological evaluation, impacting the quality of life of patients.
PubMed: 37461968
DOI: 10.14309/01.ajg.0000798800.50422.bc -
The American Journal of Gastroenterology Dec 2021Background: Metastatic Crohn's disease (MCD) is an unusual cutaneous manifestation in Crohn's disease (CD), and concomitant oral and vulvar involvement is even more...
CASE
Background: Metastatic Crohn's disease (MCD) is an unusual cutaneous manifestation in Crohn's disease (CD), and concomitant oral and vulvar involvement is even more unusual. It can debut with cavity lesions oral such as canker sores, ulcers, lip edema, granulomatosis, dry mouth, abscesses in the salivary ducts, erythema, gingivitis, glossitis, among others, however, simultaneous compromise with several oral lesions and so severe with loss of multiple pieces dental is very rare.
CASE PRESENTATION
Patient in the fourth decade of life with a family history of autoimmunity who debuts with severe oral manifestations with a requirement for extraction of 14 teeth, severe gingivitis, smooth tongue and glossitis, aphthous stomatitis, ulcers, lip edema and angular cheilitis, without clear cause, and in management by the oral pathology group. Associated with this, there was vulvo-perineal compromise with ulcerated, inflammatory, erythematous and infiltrated lesions. It was initially suspected of Behçet's disease, HLA B51 was performed, it was negative, also, negative pathergy test, and no other suggestive systemic findings. A vulvar biopsy was performed with marked edema of the dermis, dilated lymphatics with perivascular and interstitial lymphoplasmacytic infiltrate and noncaseating granulomas, negative for microorganisms. At this level, it was compatible with MCD, without presence of gastrointestinal symptoms and calprotectin levels in stool in normal range. High and low endoscopic studies and capsule endoscopy were performed in small intestine, without alterations, it was managed by dermatology with topical steroids and by dentistry with dental implants. It was considered patient with inflammatory bowel disease (IBD) type CD with severe extraintestinal manifestations (EIM), although it did not present compromise intestinal treatment, it was decided to start treatment with anti-TNF initially with adalimumab developing paradoxical psoriasis, later treatment with infliximab, again with presentation of severe paradoxical psoriasis, for which it was suspended. Cyclosporine was also used as an immunomodulator, presenting intolerable tachycardia. 18 months after these symptoms, she presented episcleritis of the left eye and begins with colicky abdominal pain and average diarrheal stools 5-a-day, it was performed high and low endoscopic studies without alterations and new capsule endoscopic of small intestine documenting Crohn's enteritis involving the duodenum, jejunum and ileum, considering a patient with IBD type CD, with EIM with vulvo-perineal compromise, severe oral involvement and episcleritis. Currently is under management with azathioprine and Ustekinumab, with clinical improvement significant.
CONCLUSIONS
MCD represents a diagnostic challenge, it can debut without gastrointestinal involvement, and its clinical and histopathological findings simulate other entities. A timely diagnosis is required to seek early benefit in the patient.
PubMed: 37461966
DOI: 10.14309/01.ajg.0000798792.71403.36 -
Scientific Reports Nov 2021Changes in the oral mucosa can appear in the course of inflammatory bowel disease in both children and adults. They often precede the appearance of gastrointestinal...
Changes in the oral mucosa can appear in the course of inflammatory bowel disease in both children and adults. They often precede the appearance of gastrointestinal symptoms. The aim of the study was to determine the nature of changes in the oral cavity at the time of diagnosis of inflammatory bowel disease in children compared to children without systemic diseases. 49 children diagnosed with inflammatory bowel disease and 60 children without systemic diseases were examined. The prevalence of the aphthae stomatitis and angular cheilitis was 24.5% in the examined group and 10% in the control group (p = 0.0772). Changes in the oral mucosa occurred more frequently in children with Crohn's disease 35.3% than with ulcerative colitis 18.7%. In children with Crohn's disease, the most frequently observed lesion was aphthous stomatitis 23.5%, and in ulcerative colitis, angular cheilitis 12.5%. Changes in the oral mucosa are a therapeutic problem requiring in general diseases patients both local and systemic treatment and interdisciplinary cooperation between dentists, paediatricians and gastroenterologists. The finding of repeated changes in the oral mucosa during a dental examination should be the reason for referring the patient to a paediatrician for the foreclosure or make a diagnosis of inflammatory bowel diseases.
Topics: Adolescent; Child; Female; Humans; Inflammatory Bowel Diseases; Male; Mouth; Mouth Mucosa; Pediatrics
PubMed: 34753969
DOI: 10.1038/s41598-021-01370-8 -
Clinical and Experimental Dental... Feb 2022Investigation of the prevalence of oral mucosal lesions in human immunodeficiency virus (HIV)-infected children undergoing highly active antiretroviral therapy (HAART).
OBJECTIVE
Investigation of the prevalence of oral mucosal lesions in human immunodeficiency virus (HIV)-infected children undergoing highly active antiretroviral therapy (HAART).
MATERIALS AND METHODS
Cross-sectional study of 66 HIV seropositive children, comprised of 28 (42.4%) females and 38 (57.6%) males (average age of 6 years). Study participants all required data regarding CD4+ T-helper cell counts and the viral load. All participants underwent an orofacial clinical examination by calibrated clinicians. Associations between the presence of oral mucosal lesions, CD4+ cell counts, and viral load were analyzed using Poisson regression.
RESULTS
The prevalence of oral manifestations was detected in 21 children (31.8%). Oral lesions were detected in 16 children with viral load copies <50 cells/mm and 22 children with CD4+ counts >500 cells/mm . Predominant lesions identified included angular cheilitis (36.7%), candidiasis (13.3%) and atypical oral ulcers (13.3%). The presence of one lesion was the most prevalent represented by 19 children. Oral lesions in relation to the CD4+ counts >500 resulted in; 14 children with one oral lesion, 5 with two lesions and 3 with three oral mucosal lesions. The other half of this CD4+ count patient group presented with no oral mucosal lesions. Oral lesions in relation Viral load copies <50 resulted in; 9 children with one oral lesion, 3 with two oral mucosal lesions and 4 with three oral mucosal lesions. The other half of this Viral load patient group presented with no oral mucosal lesions. No significant correlations were established between the presence of oral mucosal lesions and low CD4+ counts (p = 0.715) nor with high viral load counts (p = 0.638).
CONCLUSION
HIV-related oral mucosal lesions still presented in the participants despite management with HAART. Based on the results, CD4+ counts and viral load does not appear to be suitable markers of orofacial involvement in children.
Topics: Child; Cross-Sectional Studies; Female; HIV; HIV Infections; Humans; Male; Mouth Diseases; Prevalence; South Africa
PubMed: 34586712
DOI: 10.1002/cre2.484 -
Dental Research Journal 2021COVID-19 outbreak in 2019 took the entire world by a storm with the medical fraternity struggling to understand and comprehend its complex nature. A number of patients...
BACKGROUND
COVID-19 outbreak in 2019 took the entire world by a storm with the medical fraternity struggling to understand and comprehend its complex nature. A number of patients who are COVID positive have reported oral lesions. However, there is still a lingering question, whether these lesions are because of coronavirus infection or they are secondary to the patient's systemic condition. This article aims to report the oral findings of an observational study of 713 patients diagnosed with COVID-19.
MATERIALS AND METHODS
A singlssswe-institution, short-term observational study was conducted on patients admitted to Symbiosis University Hospital and Research Centre, Lavale, Pune who were positive to coronavirus, who presented varied oral findings such as herpes simplex, candidiasis, geographic tongue, and aphthous ulcer.
RESULTS
A total of 713 patients, 416 males and 297 females, who were positive to coronavirus, were screened from April 2020 to June 30, 2020, for oral ulcers. In this group, nine patients reported oral discomfort due to varied forms of oral lesions ranging from herpes simplex ulcers to angular cheilitis (1.26%).
CONCLUSION
This study supports the hypothesis that oral manifestations in patients diagnosed with COVID-19 could be secondary lesions resulting from local irritants or from the deterioration of systemic health or could be just coexisting conditions. No specific pattern or characteristic oral lesions were noted in a study of 713 COVID-positive patients in our study to qualify these lesions as oral manifestations of SARS-CoV-2 infection.
PubMed: 34584645
DOI: No ID Found -
Cureus Aug 2021Background and objective In developing countries, the dermatological manifestation of the human immunodeficiency virus (HIV) has a high prevalence. Apart from the...
Background and objective In developing countries, the dermatological manifestation of the human immunodeficiency virus (HIV) has a high prevalence. Apart from the systemic infection that ensues HIV, skin manifestations form a major part of the disease burden. They can present with atypical forms, and necessary tools for diagnosis may not be available in rural and remote parts of the country. Hence, they can stay misdiagnosed or undiagnosed, contributing to the morbidity of the patients. We attempted to enumerate the dermatologic opportunistic infections (OIs) in Rajkot city, Gujarat, India, in order to disseminate knowledge regarding the same. Material and methods It is a retrospective observational study. A total of 253 patients under treatment for HIV/acquired immunodeficiency syndrome (AIDS) at the ART Center (anti-retroviral therapy center) from 2011 to 2019 were included. The data recorded in the registry during the above-mentioned period were utilized in the study. The diagnoses of OIs were made clinically by multiple health care providers experienced in the field. Result Two hundred twenty-seven (227) of 253 (89.72%) of the patients had some form of dermatologic OI during the course of their treatment. Overall, fungal infections (33.03%) were most common, followed by bacterial infections (28.18%) and viral (14.55%) infections. Among the non-infectious causes, cheilitis/angular stomatitis topped the list. Among the STDs, herpes was the most common skin manifestation seen with a 10.57% prevalence. The CD4+ cell count for fungal infection ranged from 353-467 and was seen in stage 2 of the disease course. Bacterial infections were seen mainly during the early and middle stages of the disease while viral infections were most prevalent in stage 2 of the disease. Conclusion Skin manifestations can be useful clinical predictors of the disease stage, especially in resource-limited settings and in developing countries. They can present with unusual and atypical forms. Hence, knowledge about the prevalence of these OIs in a particular geographical area can be very useful for physicians in treating them and decreasing the disease burden.
PubMed: 34513432
DOI: 10.7759/cureus.16852