4 (m) Flashcards
1
Q
A condition characterized by profound impairment of the immune system caused by HIV.
A
Acquired Immunodeficiency Syndrome (AIDS)
2
Q
Transmission of Acquired Immunodeficiency Syndrome (AIDS) is mainly through
A
-unprotected sex (4x risk, male to male mostly but
may also be male to female)
-sharing of abused injected drugs.
-Exposure to blood and blood products can cause transmission (blood transfusion, mother to child delivery or breastfeeding).
3
Q
HIV gets attracted to immune cells of our immune system specially the ____, affecting the helper T lymphocytes (T4 cells).
A
CD4 cell
4
Q
Many subgroups have been identified (which increases the resistance to antiviral drugs)
A
● M= major, has 10 subtypes
● N= new or non-M
● O=outlier
5
Q
impairment of the immune system via interference with ____ and other immune cell functions.
A
T4 (CD4) Lymphocytes
6
Q
_______is found on the surface of the CD4 cells and serves as entry for HIV into the cell
A
Chemokine receptor type 5 (CCR5)
7
Q
_____ of the mucosa become infected and may allow the virus
to enter the bloodstream
A
Epithelial cells
8
Q
T/f
Transmission occurs almost exclusively by sexual contact, illicit use of injection drugs, or exposure to blood or blood produce
A
T
9
Q
EPIDEMIOLOGY of aids and at what age?
A
SUB-SAHARAN AFRICA
● Is the Global Epicenter
● Youngest age group: 13 -24
10
Q
Stage?
Asymptomatic infection or persistent generalized
lymphadenopathy
A
1
11
Q
Stage?
Mild symptoms such as mild unexplained weight loss,
angular cheilitis
A
2
12
Q
Stage?
herpes zoster, recurrent oral ulcerations
A
2
13
Q
Stage?
papular pruritic eruptions
A
2
14
Q
Stage?
seborrheic dermatitis
A
2
15
Q
Stage?
fungal infections, and
recurrent respiratory infections
A
2
16
Q
Stage?
Advanced symptoms such as severe weight loss,
chronic diarrhea, persistent intermittent or constant fever
A
3
17
Q
Stage?
pulmonary tuberculosis
A
3
18
Q
Stage?
chronic thrombocytopenia persistent oral candidiasis
A
3
19
Q
Stage?
severe bacterial infections, unexplained anemia,
neutropenia,
A
3
20
Q
Stage?
oral hairy leukoplakia, acute necrotizing stomatitis, gingivitis, and periodontitis
A
3
21
Q
stage ?
Severe symptoms such as HIV wasting syndrome
A
Clinical stage 4
22
Q
stage ?
Pneumocystis pneumonia
A
4
23
Q
stage ?
chronic herpes simplex infection of more than 1 month’s duration, esophageal candidiasis,
A
Clinical stage 4
24
Q
stage ?
invasive cervical carcinoma, among others
A
Clinical stage 4
25
T/f
AIDS may be present with either clinical stage 3 or stage 4 disease.
A CD4 count of less than ___/mm³ is considered diagnostic for AIDS in adults, and in children who are 5 years old or older.
T
350
26
TESTING FOR HIV INFECTION the GOLD STANDARD:
1. Enzyme-Linked Immunosorbent Assay (ELISA)
2. Western Blot Test (WB)
27
Both were the original methods for determining the presence of HIV-1 and HIV-2 antibodies in serum or plasma
1. Enzyme-Linked Immunosorbent Assay (ELISA)
2. Western Blot Test (WB)
28
T/f
➔ ELISA TEST is performed first, and it is repeated if the first test is positive If it is positive a second time, WB is performed, and a positive finding
is considered diagnostic for the infection.
T
29
T/f
ANTIRETROVIRAL THERAPY
● 36 drugs have been approved by DFA
T
30
ANTIRETROVIRAL THERAPY
Reservoir for infection has been located in GIT, ____, breast, lungs, in ____, oral cavity (saliva). ______ enlargement is
a common manifestation.
reproductive tracts, brain
Parotid gland
31
ORAL LESIONS CORRELATED WITH HIV INFECTION: (5)
1. Oral Candidiasis
2. Oral Hairy Leukoplakia
3. Atypical Periodontal Disease
4. Oral Kaposi Sarcoma
5. Oral Non-Hodgkin Lymphoma
32
Caused by Epstein-Barr Virus (EBV)
ORAL HAIRY LEUKOPLAKIA
33
Oral hairy leukoplakia: appearing as ______ on the lateral
margin of the tongue
corrugations
34
Lesion is characterized by an asymptomatic, poorly demarcated,
keratotic area that ranges in size from a few millimeters to several
centimeters
ORAL HAIRY LEUKOPLAKIA
35
Vertical striation, surface is shaggy and appear hairy when dried
ORAL HAIRY LEUKOPLAKIA
36
T/f
ORAL HAIRY LEUKOPLAKIA LESION DOES NOT RUB OFF
T
37
Resemble other keratotic oral lesions of ORAL HAIRY LEUKOPLAKIA
o Melanotic Hyperpigmentation,
o Mycobacterial Infections, Necrotizing
o Ulcerative Stomatitis, Miscellaneous Oral
o Ulcerations, Viral Infections
38
White, slightly elevated lesions on the tongue and lips are typical of ___
ORAL CANDIDIASIS
39
Most common oral lesion with HIV disease
● Found approx. 90%of patients with AIDS
ORAL CANDIDIASIS
40
"THRUSH" , painless, yellow-white curd like lesions which can be readily scraped, in the palate, buccal and labial mucosa.
ORAL CANDIDIASIS
41
ORAL CANDIDIASIS
It usually has one of four clinical presentations:
Pseudomembranous candidiasis,
erythematous,
or hyperplastic
candidiasis or
angular cheilitis
42
◆ Painless or slightly sensitive, yellow-white, curd-like lesions
that can be readily scraped and separated from the surface
of the oral mucosa
◆ Most common on the hard and soft palate and the buccal
or labial mucosa, but it can occur anywhere in the oral
cavity
Pseudomembranous candidiasis (thrush)
43
Appearing as red patches on the buccal or palatal mucosa,
or associated with depapillation of the tongue
Erythematous Candidiasis
44
If the gingiva is affected, it may be misdiagnosed as
desquamative gingivitis
Erythematous Candidiasis
45
◆ Least common
◆ Resistance to removal than other types
Hyperplastic candidiasis
46
Hyperplastic candidiasis Seen in ____ mucosa and ___
Buccal, tongue
47
Commissures of the lips appear erythematous, with surface
crusting and fissuring
Candida-related angular cheilitis
48
The diagnosis of candidiasis is made by clinical evaluation, culture analysis, or microscopic examination of the tissue sample or smear of material scraped from the lesion, which shows ____ and yeast
forms of the organisms
hyphae
49
diagnostic sign of AIDS in CANDIDIASIS
Esophageal candidiasis
50
T/f
DIAGNOSIS for candidiasis
Microscopic examination by scraping the lesion ( ____) which shows hyphae and yeast
oral cytology
51
TREATMENT FOR CANDIDIASIS:
_______ drugs
Anti-fungal
52
T/f
CANDIDIASIS, It is often recurrent and refractory
T
53
Oral CANDIDIASIS
Relapse is _____ to _____after treatment due to anti-fungal resistant strains
4 weeks to 3 months
54
______ oral suspension is more effective against C. albicans.
Amphotericin B
55
TREATMENT FOR CANDIDIASIS:
_____ oral suspension is more effective than liquid nystatin
Fluconazole
56
TREATMENT FOR CANDIDIASIS:
Chlorhexidine and ______ rinses have prophylactic
use
cetylpyridinium chloride
57
TREATMENT FOR CANDIDIASIS
Systemic anti-fungal drugs, drug of choice?
Fluconazole
58
TREATMENT FOR CANDIDIASIS:
Systemic anti-fungal drugs: (4)
Fluconazole,
ketoconazole,
itraconazole,
amphotericin B
59
Treatment of ORAL HAIRY LEUKOPLAKIA (OHL)
HIV drug therapy,
antiviral agents (Acyclovir, Ganciclovir, Foscarnet,
Valacyclovir)
60
Treatment
● Lesions can be removed by laser or surgery, topical application of
podophyllin, retinoids, oral acyclovir, or interferon.
● Recurrence happens when therapy is discontinued.
ORAL HAIRY LEUKOPLAKIA (OHL)
61
Most common malignancy associated with ATDS
KAPOSI SARCOMA
62
Found in older men, in patients after organ transplants
KAPOSI SARCOMA
63
Causative agent: Human Herpesvirus (HHV-8)
KAPOSI SARCOMA
64
The oral cavity may often be the 1" and only site of the lesion.
KAPOSI SARCOMA
65
Painless, reddish purple macules on mucosa
KAPOSI SARCOMA
66
● As it progresses, it becomes nodular
● Brown, blue or purple
Kaposi Sarcoma
67
May be exacerbated by existing periodontal lesions, or necrotizing diseases may superimpose it
KAPOSI SARCOMA
68
T/f
The expanded KS may resorb bone, increase tooth mobility and tooth loss
T
69
A malignancy characterized by proliferation of lymphoid cells, and it is a strong predictor of AIDS related lymphoma
NON-HODGKIN LYMPHOMA
70
Oral lesions:
Erythematous, painless, ulcerated due to trauma, bone
may be involved
NON-HODGKIN LYMPHOMA
71
NON-HODGKIN LYMPHOMA Diagnosis is done by?
Physical exam, differential CBC, imaging studies, biopsy
72
HIV Patients have higher incidence of recurrent herpetic lesions and aphthous stomatitis
Atypical Ulcers
73
The CDC HIV classification system indicates that mucocutaneous herpes that lasts more than 1 month is diagnostic of AIDS in HIV- infected individuals
Atypical Ulcers
74
Herpes labialis may be given topical Acyclovir, Penciclovir, Docosanol, or systemic antiviral drugs like Acyclovir, Valacyclovir, Famciclovir
Atypical Ulcers
75
is treated by topical corticosteroids,
chlorhexidine rinse, oral tetracycline rinses, topical amlexanox
Recurrent Aphthous Stomatitis
76
Large aphthae: prednisone 40-60mg daily
Atypical Ulcers
77
Salivary Gland Disorders
_______ and ____ may be most common among HIV-infected individuals
Salivary gland hypofunction, xerostomia
78
Why is the oral cavity rarely a site of HIV transmission?
○ Because the saliva acts as an important part of the oral
mucosa immune system, it contains many HIV inhibitors. It
also contains an anti-HIV factor known as _______
Secretory leukocyte protease inhibitor
79
(Salivary Gland Disorders )
The enlargement of the major salivary glands, especially ____, is more common in HIV-positive individuals.
Parotid
80
(Salivary Gland Disorders)
DENTAL TREATMENT COMPLICATIONS (3)
1. HEMORRHAGE
2. INFECTION
3. DELAYED WOUND HEALING
81
When possible, avoid antibiotics in severely immunocompromised
individuals to minimize risk of opportunistic infections such as
candidiasis, superinfection, and microorganism drug resistance.
Salivary Gland Disorders
82
T/f
(Salivary Gland Disorders)
Periodontal diseases are common in HIV-infected users of injection drugs, but
more due to poor oral hygiene, rather than decreased CD4 cell counts
T
83
A persistent, linear, easily bleeding erythematous gingivitis in HIV patients
LINEAR GINGIVAL ERYTHEMA
84
Due to candida infection, human herpes virus as triggers or cofactors
- Diagnosis is difficult
LINEAR GINGIVAL ERYTHEMA
85
LINEAR GINGIVAL ERYTHEMA Treatment
meticulous oral hygiene to be evaluated after 2-3 weeks. If
it persists, candida infection should be suspected.
86
T/f
Recall 2-3months because this is refractory to treatment in terms of LINEAR GINGIVAL ERYTHEMA
T
87
T/f
There is increased incidence of NUG in HIV infected persons
T
88
Characteristics of NUP
a. soft tissue necrosis
b. rapid periodontal destruction
c. interproximal bone loss
89
Bone is often exposed resulting to necrosis & sequestration, Severe painful onset. It undergoes spontaneous resolution of necrotizing
lesions leaving painless deep interproximal craters.
Necrotizing ulcerative periodontitis
90
Do not use hydrogen peroxide. See the patient daily or every other day for debridement.
TREATMENT FOR NUP
91
TREATMENT FOR NUP
Local debridement, SRP
chlorhexidine gluconate
or povidone-iodine (Betadine)
Antibiotics (Metronidazole)- must be used with caution to prevent
candidiasis or cadidal septicemia
Prescribe Chlorhexidine 0.12% rinse.
Recall after 1 month.
92
Severely destructive, acutely painful affecting soft tissues and bone. It may occur separate from NUP or as an extension
due to severe suppression of CD4 immune cells and increased viral load
NUS (Necrotizing Ulcerative Stomatitis)
93
It is identical to cancrum oris (NOMA), a rare necrotizing destructive process described as stomatitis gangrenosa, seen in malnutrition, in Africa.
NUS (Necrotizing Ulcerative Stomatitis)
94
NUS (Necrotizing Ulcerative Stomatitis) treatment
Metronidazole, chlorhexidine gluconate, removal of affected bone to promote healing.
95
GOALS OF THERAPY
(Chronic Periodontitis)
1. Restoration and maintenance of oral health, comfort, and function
2. Conservative non-surgical periodontal therapy should be the treatment option for all HIV positive patients
96
Chronic Periodontitis MAINTENANCE
meticulous oral hygiene, recall 2-3 months
97
T/f
HIV infection of neuronal cells may affect brain function and lead to dementia
T
