DOCSLIB.ORG

Management of the Oral Infection: Part 2 a Peer-Reviewed Publication Written by Ian Shuman, DDS, MAGD, AFAAID © Stiggdriver | Dreamstime.Com © Stiggdriver

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of the Oral Infection: Part 2 a Peer-Reviewed Publication Written by Ian Shuman, DDS, MAGD, AFAAID © Stiggdriver | Dreamstime.Com © Stiggdriver Earn 3 CE credits This course was written for dentists, dental hygienists, and assistants. Management of the Oral Infection: Part 2 A Peer-Reviewed Publication Written by Ian Shuman, DDS, MAGD, AFAAID © Stiggdriver | Dreamstime.com © Stiggdriver Abstract Educational Objectives Author Profile This is the second of a two-part course on oral At the conclusion of this educational Ian Shuman DDS, MAGD, AFAAID maintains a full-time general, infection. It includes the clinical and diagnostic activity participants will be able to: reconstructive, and aesthetic dental practice in Pasadena, Maryland. features of infections that clinicians are most likely to 1. Identify clinical features associated with Since 1995 Dr. Shuman has lectured and published on advanced, encounter: fungal, viral and bacterial. Published clinical different viral, fungal and bacterial minimally invasive techniques. He has taught these procedures to recommendations and current scientific literature are infections thousands of dentists and developed many of the methods. Dr. Shuman reviewed and management strategies are discussed. In 2. Describe the various strategies for has published numerous articles on topics including adhesive resin den- tistry, minimally invasive restorative, cosmetic and implant dentistry. addition, scientifically supported alternative therapies treating acute fungal and viral infection He is a Master of the Academy of General Dentistry, an Associate Fellow are mentioned where applicable. The reader should 3. Implement appropriate medication of the American Academy of Implant Dentistry, a Fellow of the Pierre refer to current pharmacology and dosing information management of fungal, viral and Fauchard Academy. Dr. Shuman was named one of the Top Clinicians in prior to prescribing any antifungal therapy.1 bacterial infections. Continuing Education since 2005, by Dentistry Today. Author Disclosure Dr. Shuman has no commercial ties with the sponsors or the providers of the unrestricted educational grant for this course. INSTANT EXAM CODE 15154 Go Green, Go Online to take your course Publication date: Mar. 2017 Supplement to PennWell Publications Expiration date: Feb. 2020 This educational activity was developed by PennWell’s Dental Group with no commercial support. This course was written for dentists, dental hygienists and assistants, from novice to skilled. Educational Methods: This course is a self-instructional journal and web activity. Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or third party has had any input into the development of course content. Requirements for Successful Completion: To obtain 3 CE credits for this educational activity you must pay the required fee, review the material, complete the course evaluation and obtain a score of at least 70%. CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with products PennWell designates this activity for 3 continuing educational credits. or services discussed in this educational activity. Heather can be reached at [email protected] Educational Disclaimer: Completing a single continuing education course does not provide enough information to result Dental Board of California: Provider 4527, course registration number CA# 03-4527-15154 in the participant being an expert in the field related to the course topic. It is a combination of many educational courses “This course meets the Dental Board of California’s requirements for 3 units of continuing education.” and clinical experience that allows the participant to develop skills and expertise. Image Authenticity Statement: The images in this educational activity have not been altered. The PennWell Corporation is designated as an Approved PACE Program Provider by the Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and represents Academy of General Dentistry. The formal continuing dental education programs of this the most current information available from evidence based dentistry. program provider are accepted by the AGD for Fellowship, Mastership and membership Known Benefits and Limitations of the Data: The information presented in this educational activity is derived from the data and information contained in reference section. The research data is extensive and provides direct benefit to the patient maintenance credit. Approval does not imply acceptance by a state or provincial board of and improvements in oral health. dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to Registration: The cost of this CE course is $59.00 for 3 CE credits. (10/31/2019) Provider ID# 320452. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing. Educational Objectives Figure 2. At the conclusion of this educational activity participants will be able to: 1. Identify clinical features associated with different viral, fungal and bacterial infections 2. Describe the various strategies for treating acute fungal and viral infection 3. Implement appropriate medication management of fungal, viral and bacterial infections. Abstract This is the second of a two-part course on oral infection. It in- cludes the clinical and diagnostic features of infections that cli- Figure 3. nicians are most likely to encounter: fungal, viral and bacterial. Published clinical recommendations and current scientific lit- erature are reviewed and management strategies are discussed. In addition, scientifically supported alternative therapies are mentioned where applicable. The reader should refer to current pharmacology and dosing information prior to prescribing any antifungal therapy.1 Oral Fungal Infection Figure 4. Fungi are commonly found in the oral cavity (oral mycoses) and in healthy individuals do not pose a threat of infection. How- ever, in a conducive environment, infection can occur for a mul- titude of reasons. These include but are not limited to aging,2 xerostomia,3 organ transplants,4 HIV and AIDS,5 and systemic diseases such as diabetes mellitus.6 There over 15 distinct Can- dida species that can cause human disease with Candida albicans the most common oral fungal organism7 associated with infec- tion.8 (Figure 1) Superficial mucosal infection caused by this organism is classified as acute pseudomembranous candidiasis, (Figure 2) acute erythematous candidiasis or chronic atrophic (erythematous) candidosis (or chronic hyperplastic candidosis). Infection caused by C. albicans also includes angular cheilitis (Figure 3) (formed at the commissure of the lips), rhomboid Other, species in the genus Candida that can cause oral in- glossitis (on the dorsum of the tongue) (Figure 4) and ‘pros- fection includes C. glabrata, C. tropicalis, C. parapsilosis, and thetic’ stomatitis (commonly found on the palate). C. krusei.9,10 Candida Glabrata a common cause of oral thrush is now estimated to be involved in about 15 to 30 percent of yeast Figure 1. infections.11 It is very common in AIDS patients, and involves white, cheese-like lesions on the inside of the cheeks, the gums and the tongue. C. glabrata infections have a higher mortality rate than most other yeast species. Another species present in otherwise healthy people, Candida dubliniensis, has been re- covered primarily from the oral cavities of human immunode- ficiency virus (HIV)-infected individuals and AIDS patients.12 The duration of fungal infection is dependent on variables such as immune suppression, and long-term antibiotic or cor- ticosteroid use, among others.13,14 Symptoms associated with candidiasis can include taste disturbance, dry mouth, oral burning,15 oral ulcers16 and difficulty swallowing.17 The diag- nosis of candidiasis is primarily clinical, based on observable lesions that vary in their presentation:18 2 www.DentalAcademyOfCE.com • Pseudomembranous candidosis presents with white identifying tests does not imply infection. It is the invasion of the plaques on the mucosa and tongue resembling milk mucosa by the fungal organism that is definitive with respect to curds.19 Wiping them exposes an underlying erythematous the diagnosis. Microbiological identification techniques incor- epithelium that may bleeds. porating biopsy and DNA testing may be necessary in question- • Erythematous candidosis is generally found as red areas able clinical diagnosis, resistance to treatment with antifungal on the palate, depapillated areas on the dorsum of the medication, or determination of the responsible organism.24 tongue, and on the buccal mucosa.20 It should be noted that there are several noncandidal oral • Chronic hyperplastic candidosis (candidal leukoplakia) mycoses and include histoplasmosis, blastomycosis, aspergil- usually occur on the buccal mucosa and less commonly on losis, paracoccidioidomycosis, cryptococcosis, and zygomycosis the tongue. They present as raised lesions that may vary from (mucormycosis).25 This group is far less common than oral can- small, palpable, translucent, or whitish, to large, dense, opaque didiasis, producing subclinical infection, especially pulmonary plaque-like lesions that are hard and rough to the touch.21 infections. Immunocompromised persons (including those with • Denture-related stomatitis is a typically asymptomatic, leukemia, leukopenia, solid tumors,
Load more

Recommended publications
  • Glossary for Narrative Writing
    Periodontal Assessment and Treatment Planning Gingival description Color: o pink o erythematous o cyanotic o racial pigmentation o metallic pigmentation o uniformity Contour: o recession o clefts o enlarged papillae o cratered papillae o blunted papillae o highly rolled o bulbous o knife-edged o scalloped o stippled Consistency: o firm o edematous o hyperplastic o fibrotic Band of gingiva: o amount o quality o location o treatability Bleeding tendency: o sulcus base, lining o gingival margins Suppuration Sinus tract formation Pocket depths Pseudopockets Frena Pain Other pathology Dental Description Defective restorations: o overhangs o open contacts o poor contours Fractured cusps 1 ww.links2success.biz [email protected] 914-303-6464 Caries Deposits: o Type . plaque . calculus . stain . matera alba o Location . supragingival . subgingival o Severity . mild . moderate . severe Wear facets Percussion sensitivity Tooth vitality Attrition, erosion, abrasion Occlusal plane level Occlusion findings Furcations Mobility Fremitus Radiographic findings Film dates Crown:root ratio Amount of bone loss o horizontal; vertical o localized; generalized Root length and shape Overhangs Bulbous crowns Fenestrations Dehiscences Tooth resorption Retained root tips Impacted teeth Root proximities Tilted teeth Radiolucencies/opacities Etiologic factors Local: o plaque o calculus o overhangs 2 ww.links2success.biz [email protected] 914-303-6464 o orthodontic apparatus o open margins o open contacts o improper
    [Show full text]
  • NIH Medlineplus Magazine Winter 2010
    Trusted Health Information from the National Institutes of Health ® NIHMedlineWINTER 2010 Plusthe magazine Plus, in this issue! • Treating “ Keep diverticulitis the beat” Healthy blood Pressure • Protecting Helps Prevent Heart disease Yourself from Shingles • Progress against Prostate cancer • Preventing Suicide in Young Adults • relieving the Model Heidi Klum joins The Heart Truth Pain of tMJ Campaign for women’s heart health. • The Real Benefits of Personalized Prevent Heart Medicine Disease Now! You can lower your risk. A publication of the NatioNal Institutes of HealtH and the frieNds of the NatioNal library of MediciNe FRIENDS OF THE NATIONAL LIBRARY OF MEDICINE Saying “Yes!” to Careers in Health Care ecently, the Friends of NLM was delighted to co-sponsor the fourth annual “Yes, I Can Be a Healthcare Professional” conference at Frederick Douglass Academy in Harlem. More than 2,300 students and parents from socioeconomically disadvantaged communities throughout the entire New York City metropolitan area convened for Rthe daylong session. It featured practical skills workshops, discussion groups, and exhibits from local educational institutions, health professional societies, community health services, and health information providers, including the National Library of Medicine (NLM). If you’ll pardon the expression, the enthusiasm among the attendees—current and future Photo: NLM Photo: healthcare professionals—was infectious! donald West King, M.d. fNlM chairman It was especially exciting to mix with some of the students from six public and charter high schools in Harlem and the South Bronx enrolled in the Science and Health Career Exploration Program. The program was created by Mentoring in Medicine, Inc., funded by the NLM and Let Us Hear co-sponsored by the Friends.
    [Show full text]
  • Cutaneous Manifestations of HIV Infection Carrie L
    Chapter Title Cutaneous Manifestations of HIV Infection Carrie L. Kovarik, MD Addy Kekitiinwa, MB, ChB Heidi Schwarzwald, MD, MPH Objectives Table 1. Cutaneous manifestations of HIV 1. Review the most common cutaneous Cause Manifestations manifestations of human immunodeficiency Neoplasia Kaposi sarcoma virus (HIV) infection. Lymphoma 2. Describe the methods of diagnosis and treatment Squamous cell carcinoma for each cutaneous disease. Infectious Herpes zoster Herpes simplex virus infections Superficial fungal infections Key Points Angular cheilitis 1. Cutaneous lesions are often the first Chancroid manifestation of HIV noted by patients and Cryptococcus Histoplasmosis health professionals. Human papillomavirus (verruca vulgaris, 2. Cutaneous lesions occur frequently in both adults verruca plana, condyloma) and children infected with HIV. Impetigo 3. Diagnosis of several mucocutaneous diseases Lymphogranuloma venereum in the setting of HIV will allow appropriate Molluscum contagiosum treatment and prevention of complications. Syphilis Furunculosis 4. Prompt diagnosis and treatment of cutaneous Folliculitis manifestations can prevent complications and Pyomyositis improve quality of life for HIV-infected persons. Other Pruritic papular eruption Seborrheic dermatitis Overview Drug eruption Vasculitis Many people with human immunodeficiency virus Psoriasis (HIV) infection develop cutaneous lesions. The risk of Hyperpigmentation developing cutaneous manifestations increases with Photodermatitis disease progression. As immunosuppression increases, Atopic Dermatitis patients may develop multiple skin diseases at once, Hair changes atypical-appearing skin lesions, or diseases that are refractory to standard treatment. Skin conditions that have been associated with HIV infection are listed in Clinical staging is useful in the initial assessment of a Table 1. patient, at the time the patient enters into long-term HIV care, and for monitoring a patient’s disease progression.
    [Show full text]
  • Metronidazole Induced Aphthous Ulcer with Angular Cheilitis
    Pharmacy & Pharmacology International Journal Case Report Open Access Metronidazole induced aphthous ulcer with angular cheilitis Abstract Volume 4 Issue 3 - 2016 Metronidazole is an antiprotozoal drug, which has broad spectrum cidal activity Aruna Bhushan,1 Ved Bhushan ST2 against anaerobic protozoa and microaerophillic bacteria. Aphthous ulcer is a very 1Associate Professor, Department of Pharmacology, India rare side effect with metronidazole. Here we report a case of 55 year old male suffered 2Professor of Surgery, KLE- Centrinary Charitable Hospital, from metronidazole induced aphthous ulcer with angular cheilitis. India metronidazole, adrs, cheilites Keywords: Correspondence: Aruna Bhushan, Associate Professor, Department of Pharmacology, BIMS, Karnataka, India, Tel 9480538661, Email [email protected] Received: April 04, 2016 | Published: April 19, 2016 Introduction complex and Anti histaminic CPM (chlorpheniramine maleate 10mg tablets) twice daily was started. Patient was also prescribed topical Metronidazole, chemically a nitroimidazole is an antiprotozoal anesthetics Zytee (choline salicylate and benzalkonium chloride drug, which has broad spectrum cidal activity against anaerobic solution 10ml gel) small quantity to be applied on affected area twice protozoa, anaerobic and microaerophillic bacteria. It was introduced daily. in 1959 for trichomoniasis, and later found to be highly active amoebicide. Metronidazole after entering the cell by diffusion, its The patient gradually and progressively improved within 5-7days nitro group is reduced by certain redox proteins to a highly reactive lesions resolved within 7-10days and completely recovered in 2weeks. nitro radical, which acts as an electron sink competes with the biological electron acceptors generated by cell mitochondria and Discussion hence interferes with energy metabolism. The drug is completely Metronidazole is a frequently prescribed drug for amoebiasis, absorbed orally, metabolized in liver followed by renal excretion.
    [Show full text]
  • Cracked Tooth Syndrome, an Update
    International Journal of Applied Dental Sciences 2021; 7(2): 314-317 ISSN Print: 2394-7489 ISSN Online: 2394-7497 IJADS 2021; 7(2): 314-317 Cracked tooth syndrome, an update © 2021 IJADS www.oraljournal.com Received: 19-02-2021 Dariela Isabel Gonzalez-Guajardo, Guadalupe Magdalena Ramirez- Accepted: 21-03-2021 Herrera, Alejandro Mas-Enriquez, Guadalupe Rosalia Capetillo- Dariela Isabel Gonzalez-Guajardo Hernandez, Leticia Tiburcio-Morteo, Claudio Cabral-Romero, Rene Master in Sciences Student, Hernandez-Delgadillo and Juan Manuel Solis-Soto Universidad Autonoma de Nuevo Leon, Facultad de Odontologia, Monterrey, Nuevo Leon, CP 64460, DOI: https://doi.org/10.22271/oral.2021.v7.i2e.1226 Mexico Guadalupe Magdalena Ramirez- Abstract Herrera Introduction: Cracked tooth syndrome is defined as an incomplete fracture initiated from the crown and Professor, Universidad Autonoma de extending cervically, and sometimes gingivally, and is usually directed mesiodistally. Objective: To Nuevo Leon, Facultad de analyze the literature about cracked tooth syndrome, its etiology, prevalence, pulp involvement and Odontologia, Monterrey, Nuevo Leon, CP 64460, Mexico treatment. Methodology: Using the keywords “cracked tooth syndrome”, “etiology”, “prevalence”, “pulp Alejandro Mas-Enriquez involvement” and “treatment”, the MEDLINE/PubMed and ScienceDirect databases were searched, with Associate Professor, Universidad emphasis on the last 5 years. It was evaluated with the PRISMA and AMSTAR-2 guidelines. Autonoma de Nuevo Leon, Facultad de Odontologia, Monterrey, Nuevo Results: There are many causes for cracks, the main one being malocclusion. Another is due to Leon, CP 64460, Mexico restorations, pieces to which amalgam was placed due to the extension of the cavity for the retentions. The second lower molar presents more frequently fissures due to premature contact.
    [Show full text]
  • Alcohol Use and Oral Health Fact Sheet for PROVIDERS OCTOBER 2017
    Alcohol Use and Oral Health Fact Sheet FOR PROVIDERS OCTOBER 2017 The Challenge… Glossitis – tongue inflammation Patients who drink alcohol regularly may experience specific problems related to their oral health and hygiene. Angular cheilitis – corners of the mouth chronically inflamed and cracked What you need to know… Candida – yeast infection • Patients who drink high amounts of alcohol daily may brush Oral Ulceration – painful round or oval less effectively than those who don’t drink alcohol, despite sores reporting similar brushing frequency. Also, impaired motor Acute Necrotizing activity can affect their ability to perform basic dental hygiene adequately.1 Ulcerative Gingivitis – infection of the gums that causes ulcers, swelling, and • Alcohol is also the most common cause of sialadenosis dead tissue in the mouth of the parotid gland. This condition causes swelling of the parotid gland and decreased secretion of saliva.2 Ways You Can Help… • Poor nutrient intake and absorption combined with decreased salivary excretion frequently can lead to glossitis, Recommend: angular cheilitis, candida infection, oral ulceration, and acute • Brushing thoroughly two times daily with a necrotizing ulcerative gingivitis (ANUG).2 fluoridated toothpaste. • A decreased immune response combined with a nutritionally • Rinse mouth with non-alcoholic mouth rinse. poor diet, poor oral hygiene, decreased salivary flow, and a • Have an oral examination and cleaning by a high incidence of smoking among these patients, provides dental professional at least two times per year. an environment conducive to rapid progression of periodontal • Regular oral exams that include a periodontal disease, dental caries and increased risk of oral thoracic evaluation and oral cancer screenings to detect cancers.2 any signs of suspicious lesions.3 • High consumption of alcohol may damage the liver and bone marrow resulting in excessive bleeding during dental treatment.
    [Show full text]
  • Tobacco Induced Oral Keratosis. Oral Sub-Mucous Fibrosis. Nicotine Stomatitis
    Tobacco induced oral keratosis. Oral sub-mucous fibrosis. Nicotine stomatitis. Actinic keratosis. Actinic cheilitis Assoc. prof. Zornitsa Mihaylova, DDS, PhD Dept. of Dental, oral and maxillofacial surgery, Faculty of Dental medicine, Medical Universtity- Sofia Precancerous lesions are morphologically altered tissues that possess greater than normal tissues risk of malignant transformation. The term “potentially malignant disorders” (PMD) is broadly accepted in order to avoid terminological confusion. In significant number of cases the oral cancer is preceded by a premalignancy. On the other hand PMD may not undergo malignant transformation (especially when the bad habits are ceased and proper treatment with long-term follow up have been conducted). The following risk factors may play a significant role in the development of PMD and cancer: tobacco smoking, smokeless tobacco, betel quid, alcohol consumption (the combination of smoking and alcohol significantly increases the risk of malignant transformation), oral HPV infection, radiation, vitamin deficiency, bacterial infections, immunosuppression and immunodeficiency, drugs, poor oral hygiene, chronic trauma. It is well established that the effects of the etiologic factors may vary depending on the geographic region, the lifestyle and the habits of the population. Tobacco induced oral keratosis There are three types of smokeless tobacco: dry snuff, moist snuff and chewing tobacco. Smokeless tobacco is mainly used by young males. The long-term/chronic smokeless tobacco use causes local alterations of the oral structures due to the significant nicotine absorption. Some of the most common oral changes related to smokeless tobacco are oral mucosa lesions, periodontal disease and dental caries. Clinically asymptomatic white lesions of the oral mucosa are identified.
    [Show full text]
  • Orofacial Pain
    QUINTESSENCE INTERNATIONAL OROFACIAL PAIN Noboru Noma Cracked tooth syndrome mimicking trigeminal autonomic cephalalgia: A report of four cases Noboru Noma DDS, PhD1/Kohei Shimizu DDS, PhD2/Kosuke Watanabe DDS3/Andrew Young DDS, MSD4/ Yoshiki Imamura DDS, PhD5/Junad Khan BDS, MSD, MPH, PhD6 Background: This report describes four cases of cracked All cases mimicked trigeminal autonomic cephalalgias, a group tooth syndrome secondary to traumatic occlusion that mim- of primary headache disorders characterized by unilateral icked trigeminal autonomic cephalalgias. All patients were facial pain and ipsilateral cranial autonomic symptoms. referred by general practitioners to the Orofacial Pain Clinic at Trigeminal autonomic cephalalgias include cluster headache, Nihon University Dental School for assessment of atypical facial paroxysmal hemicrania, hemicrania continua, and short-lasting pain. Clinical Presentation: Case 1: A 51-year-old woman unilateral neuralgiform headache attacks with conjunctival presented with severe pain in the maxillary and mandibular injection and tearing/short-lasting neuralgiform headache left molars. Case 2: A 47-year-old woman presented with sharp, attacks with cranial autonomic features. Pulpal necrosis, when shooting pain in the maxillary left molars, which radiated to caused by cracked tooth syndrome, can manifest with pain the temple and periorbital region. Case 3: A 49-year-old man frequencies and durations that are unusual for pulpitis, as was presented with sharp, shooting, and stabbing pain in the max- seen in these cases. Conclusion: Although challenging, dif- illary left molars. Case 4: A 38-year-old man presented with ferentiation of cracked tooth syndrome from trigeminal intense facial pain in the left supraorbital and infraorbital areas, autonomic cephalalgias is a necessary skill for dentists.
    [Show full text]
  • Cardiovascular Drugs-Induced Oral Toxicities: a Murky Area to Be Revisited and Illuminated
    Pharmacological Research 102 (2015) 81–89 Contents lists available at ScienceDirect Pharmacological Research j ournal homepage: www.elsevier.com/locate/yphrs Review Cardiovascular drugs-induced oral toxicities: A murky area to be revisited and illuminated a, b b Pitchai Balakumar ∗, Muthu Kavitha , Suresh Nanditha a Pharmacology Unit, Faculty of Pharmacy, AIMST University, Semeling, 08100 Bedong, Malaysia b Faculty of Dentistry, AIMST University, 08100 Bedong, Malaysia a r t i c l e i n f o a b s t r a c t Article history: Oral health is an imperative part of overall human health. Oral disorders are often unreported, but are Received 20 July 2015 highly troublesome to human health in a long-standing situation. A strong association exists between Received in revised form 22 August 2015 cardiovascular drugs and oral adverse effects. Indeed, several cardiovascular drugs employed clinically Accepted 8 September 2015 have been reported to cause oral adverse effects such as xerostomia, oral lichen planus, angioedema, Available online 25 September 2015 aphthae, dysgeusia, gingival enlargement, scalded mouth syndrome, cheilitis, glossitis and so forth. Oral complications might in turn worsen the cardiovascular disease condition as some reports suggest an Keywords: adverse correlation between periodontal oral disease pathogenesis and cardiovascular disease. These are Cardiovascular drugs certainly important to be understood for a better use of cardiovascular medicines and control of associated Oral adverse effects oral adverse effects. This review sheds lights on the oral adverse effects pertaining to the clinical use of Dry mouth Angioedema cardiovascular drugs. Above and beyond, an adverse correlation between oral disease and cardiovascular Dysgeusia disease has been discussed.
    [Show full text]
  • Pemphigus. S2 Guideline for Diagnosis and Treatment
    DOI: 10.1111/jdv.12772 JEADV GUIDELINES Pemphigus. S2 Guideline for diagnosis and treatment – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV) M. Hertl,1,* H. Jedlickova,2 S. Karpati,3 B. Marinovic,4 S. Uzun,5 S. Yayli,6 D. Mimouni,7 L. Borradori,8 C. Feliciani,9 D. Ioannides,10 P. Joly,11 C. Kowalewski,12 G. Zambruno,13 D. Zillikens,14 M.F. Jonkman15 1Department of Dermatology, Philipps-University Marburg, Marburg, Germany 2Department of Dermatology, Masaryk University, Brno, Czech Republic 3Department of Dermatology, Semmelweis University Budapest, Budapest, Hungary 4Department of Dermatology, School of Medicine University of Zagreb, Zagreb, Croatia 5Department of Dermatology, Akdeniz University, Antalya, Turkey 6Department of Dermatology, Karadeniz Technical University, Trabzon, Turkey 7Department of Dermatology, Tel-Aviv University, Tel-Aviv, Israel 8Department of Dermatology, University of Bern, Inselspital, Switzerland 9Department of Dermatology, University of Parma, Parma, Italy 10Department of Dermatology, Aristotle University of Thessaloniki, Thessaloniki, Greece 11Department of Dermatology, Rouen University Hospital, Rouen, France 12Department of Dermatology, Medical University of Warsaw, Warsaw, Poland 13Department of Dermatology, L’Istituto Dermopatico dell’Immacolata, Rome, Italy 14Department of Dermatology, University of Lubeck,€ Lubeck,€ Germany 15Department of Dermatology, University of Groningen, Groningen, The Netherlands *Correspondence: M. Hertl. E-mail: [email protected] Abstract Background Pemphigus encompasses a group of life-threatening autoimmune bullous diseases characterized by blis- ters and erosions of the mucous membranes and skin. Before the era of immunosuppressive treatment, the prognosis of pemphigus was almost fatal. Due to its rarity, only few prospective controlled therapeutic trials are available.
    [Show full text]
  • HIV Infection and AIDS
    G Maartens 12 HIV infection and AIDS Clinical examination in HIV disease 306 Prevention of opportunistic infections 323 Epidemiology 308 Preventing exposure 323 Global and regional epidemics 308 Chemoprophylaxis 323 Modes of transmission 308 Immunisation 324 Virology and immunology 309 Antiretroviral therapy 324 ART complications 325 Diagnosis and investigations 310 ART in special situations 326 Diagnosing HIV infection 310 Prevention of HIV 327 Viral load and CD4 counts 311 Clinical manifestations of HIV 311 Presenting problems in HIV infection 312 Lymphadenopathy 313 Weight loss 313 Fever 313 Mucocutaneous disease 314 Gastrointestinal disease 316 Hepatobiliary disease 317 Respiratory disease 318 Nervous system and eye disease 319 Rheumatological disease 321 Haematological abnormalities 322 Renal disease 322 Cardiac disease 322 HIV-related cancers 322 306 • HIV INFECTION AND AIDS Clinical examination in HIV disease 2 Oropharynx 34Neck Eyes Mucous membranes Lymph node enlargement Retina Tuberculosis Toxoplasmosis Lymphoma HIV retinopathy Kaposi’s sarcoma Progressive outer retinal Persistent generalised necrosis lymphadenopathy Parotidomegaly Oropharyngeal candidiasis Cytomegalovirus retinitis Cervical lymphadenopathy 3 Oral hairy leucoplakia 5 Central nervous system Herpes simplex Higher mental function Aphthous ulcers 4 HIV dementia Kaposi’s sarcoma Progressive multifocal leucoencephalopathy Teeth Focal signs 5 Toxoplasmosis Primary CNS lymphoma Neck stiffness Cryptococcal meningitis 2 Tuberculous meningitis Pneumococcal meningitis 6
    [Show full text]
  • Reaction of Antigens Isolated from Herpes Simplex Virus Transformed Cells with Sera of Squamous Cell Carcinoma Patients1
    [CANCERRESEARCH36,4394-4401,December1976] Reaction of Antigens Isolated from Herpes Simplex Virus transformed Cells with Sera of Squamous Cell Carcinoma Patients1 Mary F. D. Notter and John J. Docherty2 Department of Microbiology and Cell Biology, The Pennsylvania State University, University Park, Pennsylvania 16802 SUMMARY we examined the reactive patterns of cancer patient sera with antigens isolated from cells transformed by these vi Antigens isolated from herpes simplex virus type 1, muses. Our studies reveal a positive correlation between herpes simplex virus type 2, on cytomegalovinus-trans sera of patients with diagnosed squamous cell carcinoma formed hamster cells were tested against 66 semafrom non and antigens isolated from both HSV-1- and HSV-2-trans cancer individuals or patients with different types of cancer. farmed cells. By use of the microcomplement fixation procedure to quan tify all antigen-antibody interactions, it was observed that MATERIALS AND METHODS 94% (p < 0.001) of all semafrom patients with squamous cell carcinoma reacted with antigens from herpes simplex virus Cells. Hamster cells transformed by HSV-1 [14-012-8-1; type 1-transformed cells, while 84% (p < 0.001) of the same (9)], HSV-2 [333-8-9 (8)], on cytomegalovirus [CX-90-3B, T2 sena reacted with antigen preparations from herpes simplex (2)] were acquired from F. Rapp, M. S. Hershey Medical virus type 2-transformed cells. When semafrom patients with Center, Hershey, Pa., while cell cultures of normal non adenocancinoma, sarcoma, liposarcoma, and melanoma transformed hamster cells were prepared from 13-day-old were tested against these antigens, there was no significant embryos (Lakeview Hamster Colony, Newfield, N.
    [Show full text]