Piluso S, Ficarra G, Lucatorto F M, Orsi A, Dionisio D, Stendardi L, Eversole L R
Institute of Stomatology, University of Florence.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Aug;82(2):166-72. doi: 10.1016/s1079-2104(96)80220-4.
To study the cause and clinical aspects of oral ulcers in HIV-infected patients.
Forty-one consecutive HIV-positive patients with long-standing oral ulcers were examined; 19 were evaluated by biopsy. From these 19 cases, viral, bacterial, and fungal cultures and biopsies were taken in each patient. When indicated, special microbial stains were undertaken to identify bacteria or fungi. Ten cases without granulomatous bacterial fungal or lymphomatous features were available for in situ hybridization to detect viral DNA of herpes simplex virus 1 and 2, cytomegalovirus, varicella-zoster virus, and Epstein-Barr virus.
Most of the oral ulcers occurred in patients with severe immunodepression. Median CD4 T-lymphocyte count was 60 cell/mm3 (range, 3 to 335). It was ascertained that nine (47%) patients had nonspecific aphthous-like ulcers, and ulcers caused by herpes group viruses were identified in six (31.5%) patients. One (5%) person was diagnosed with non-Hodgkin's lymphoma; and in one (5%) patient, multiple ulcers were an expression of lues maligna. Two ulcers (10.5%) in the palate harbored mycotic granulomatous foci (cryptococcosis, histoplasmosis). In this population, almost all of these ulcers were found to be large, persistent, and painful.
Nontumefactive oral ulcers in HIV-positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long-standing ulcers because either infection or a neoplastic process may be extant. In the absence of infection or neoplasm, such lesions are then designated as ulcers not otherwise specified.
研究HIV感染患者口腔溃疡的病因及临床特征。
对41例连续的长期患有口腔溃疡的HIV阳性患者进行检查；其中19例接受了活检。在这19例患者中，对每例患者进行病毒、细菌和真菌培养及活检。必要时，采用特殊微生物染色来鉴定细菌或真菌。10例无肉芽肿性细菌、真菌或淋巴瘤特征的病例用于原位杂交，以检测单纯疱疹病毒1型和2型、巨细胞病毒、水痘带状疱疹病毒及EB病毒的病毒DNA。
大多数口腔溃疡发生在免疫严重抑制的患者中。CD4 T淋巴细胞计数中位数为60个细胞/mm³（范围为3至335）。经确定，9例（47%）患者患有非特异性口疮样溃疡，6例（31.5%）患者的溃疡由疱疹病毒组引起。1例（5%）被诊断为非霍奇金淋巴瘤；1例（5%）患者的多发性溃疡是恶性梅毒的表现。腭部的2个溃疡（10.5%）含有真菌性肉芽肿病灶（隐球菌病、组织胞浆菌病）。在这组人群中，几乎所有这些溃疡都较大、持续存在且疼痛。
HIV阳性患者的非肿瘤性口腔溃疡可能因潜在病理实体的多样性和病因的多重性而造成诊断困难。对于长期存在的溃疡应始终进行活检，因为可能存在感染或肿瘤性病变。在没有感染或肿瘤的情况下，此类病变则被归类为未另作说明的溃疡。
