Oral Lesions, Blood Disorders, and Related Conditions

Oral Diseases Associated with HIV

Group 3: Lesions Associated with HIV

• Bacterial infections (e.g., Actinomyces israelii, Escherichia coli pneumonia)
• Cat-scratch disease
• Drug reactions (ulcerative, toxic epidermal necrolysis)
• Fungal infections (e.g., Cryptococcus neoformans, Geotrichum candidum)
• Neurological disturbances (e.g., facial palsy, trigeminal neuralgia)
• Viral infections (e.g., cytomegalovirus)

Kaposi's Sarcoma

Multifocal, vascular neoplasm.

• Decreased immunocompetence activates the latent virus.
• Palate and gingiva are the most common sites.
• Painless red macules progress to nodular lesions.

Differential Diagnosis

• Hemangioma
• Varicosity
• Bacillary angiomatosis
• Pyogenic granuloma

Treatment

• Intralesional injections of vinblastine 0.1 mg/cm² or 0.2 mg/mL saline.

Red Blood Cells (RBC)

Increased RBC Count

• Polycythemia
  • Primary (Polycythemia Vera)
  • Secondary

Decreased RBC Count (Anemia)

• Hemolytic Anemia
  • Sickle cell anemia
  • Thalassemia
  • G6PD deficiency
• Reduced Erythropoiesis
  • Iron deficiency anemia
  • Pernicious anemia
  • Aplastic anemia

Polycythemia Vera

Clonal neoplastic proliferation of myeloid stem cells.

• More common in males (M > F), typically in the sixth decade.
• Results in increased blood viscosity.
• May be associated with hypersensitivity.

Lab Tests to Identify AIDS/HIV

• Antibody tests
• Antigen tests
• Virus isolation
• Demonstration of viral nucleic acid (NA)
• HIV viral load
• CD4 counts
• Antiviral susceptibility assays

Definitive Tests

• Enzyme-Linked Immunosorbent Assay (ELISA)
• Western blot
• Polymerase Chain Reaction (PCR)
• Indirect Fluorescent Antibody (IFA)

Chairside Tests

• OraQuick Advance Rapid HIV-1/2 Antibody Test
• Tri-dot test

Necrotizing Ulcerative Periodontitis (NUP)

An acute periodontal disease characterized by:

• Erythema of the gingiva and alveolar mucosa.
• Ulcerated interdental papillae.
• Interdental craters of the soft tissue and bone.
• Loss of periodontal attachment.

Necrotizing Ulcerative Gingivitis (NUG)

A painful infection of the mouth and throat characterized by:

• Ulcerations of the mucous membranes.
• Bleeding.
• Foul breath.

It is often associated with bacteria like Fusobacterium nucleatum.

White Blood Cells (WBC)

Non-Neoplastic WBC Disorders

• Quantitative disorders
• Qualitative disorders

Neoplastic WBC Disorders

• Leukemia
• Lymphoma
• Multiple myeloma

Antibody Deficiency

• Primary
• Secondary

Chediak-Higashi Syndrome

A rare autosomal recessive disorder.

Clinical Features

• Partial oculocutaneous albinism
• Photophobia
• Frequent pyogenic infections
• Lymphadenopathy
• Hair color is metallic silver
• Skin color ranges from white to grey
• Defective melanosomes
• Peripheral or cranial neuropathies
• Severe gingivitis and ulcerations of the tongue
• Early onset periodontitis
• Accelerated phase phenomena

Cellular Level Findings

• Affects platelets, PMNs, melanosomes, and lysosomes.
• Hallmark is the presence of large azurophilic inclusions in the cytoplasm of neutrophils.

Treatment

• Bone marrow transplant.