Immunodeficiencies

Question 1

HIV

Answer 1

1. retroviral infection of CD4 helper T lymphocytes
2. first noted in 1981
3. now identified as early as 1959

Question 2

HIV is transmitted ___

Answer 2

Intimate contact

1. mainly risky sexual practices
   * *primarily heterosexual
   * *primarily MSM (developed countries)

Question 3

How is HIV not transmitted?

Answer 3

1. air
2. water
3. insects
4. social contact
5. closed-mouth (social) kissing

Question 4

Clinical Features - HIV

Answer 4

1. initial acute viremia
2. seroconversion within months
3. asymptomatic stage (median=10 years)
   * *continuously infetious
   * *gradual destruction

Question 5

Oral Manifestations of AIDS

Answer 5

1. candidiasis
2. deep fungal infection (valley fever, mucal mycosis, etc)
3. chronic HHV-1 infection
4. Herpes Zoster virus
5. DMV
6. hairy leukoplakia
   * *AIDS defining disease
   * *caused by EBV
   * *located on lateral boarder of tongue
   * *has vertical corregations
7. Kaposi sarcoma
   * *seen intraorally and extraorally
8. non-hodgkin lymphoma

Question 6

Diagnosing HIV

Answer 6

1. clinical presentation

2. serology

Question 7

Tx of HIV

Answer 7

1. HAART therapy
   * *work well at suppressing the virus
2. tx with co-morbidities

Question 8

Dental Aspects - HIV

Answer 8

1. stable patients can be treated relatively risk-free
   * *get a consult when in doubt
2. increased complications
   * *low CD4 count
   * *high viral load
   * *low lymphocyte count
   * *neutropenia
   * *throbocytopenia
   * *concomitant infection

Question 9

Candidiasis, hairy leukoplakia, HIV gingivitis, NUG (soft tissue ONLY), HIV periodontitis (hard tissue), Kaposi saroma, and Non-Hodgkin lymphoma are associated with __

Answer 9

HIV/AIDS

Question 10

HIV gingivitis

Answer 10

1. looks like marginal gingivitis
2. patients don’t get better
3. may get candidal infection in sulcus

Question 11

Agranulocytosis (Leukopenia and Neutropenia)

Answer 11

Increased susceptibility to infection

1. Leukopenia
2. Neutropenia

Question 12

Fever, weakness, sore throat, oral/pharyngeal ulceration, lymphadenoapthy, cutaneous rash, thromboctopenia, hemmorrhagic mouth lesions is indicative of __

Answer 12

agranulocytes

Question 13

Diagnosis of Agranulocytosis

Answer 13

1. hematology

2. bone marrow biopsy

Question 14

How to manage agranulocytosis

Answer 14

1. discontinue offending drug
2. control location infection
3. aggressively treat septicemia

Question 15

Dental Aspects - Agranulocytosis

Answer 15

1. delay non-emergent dental care
2. consider colony stimulating factor
3. antibiotic/antifungal prophylaxis

Question 16

Congenital Immunodeficiency Diseases

Answer 16

1. multiple inheritance patterns
2. B cell deficiencies
   * *bacterial infections
   * *IgA deficiency (most common)
3. T cell deficiency
   * *viral and bacterial infections
   * *chronic mucocutaneous candidiasis

Question 17

__ deficiency is the most common antibody deficiency

Answer 17

IgA

Question 18

viral and bacterial infections

Answer 18

T cell deficiency

Question 19

chronic mucocutaneous candidiasis

Answer 19

T cell deficiency

Question 20

caused by EBV

Answer 20

hairy leukoplakia

Question 21

Hairy leukoplakia is located on __ (location)

Answer 21

lateral border of tongue

Question 22

vertical corregations

Answer 22

hairy leukoplakia

Question 23

oral/pharyngeal ulceration

Answer 23

agranulocytes

Question 24

lymphandenopathy

Answer 24

agranulocytes

Question 25

cutaneous rash

Answer 25

agranulocytes

Question 26

thrombocytopenia

Answer 26

agranulocytes

Question 27

hemorrhagic mouth lesions

Answer 27

agranulocytes