Treatment of Oral Diseases. George Laskaris

aspergillosis. Rarely, the oral lesions are the initial manifestation of the disease.

      Oral Manifestations

      The oral lesions present as irregular ulcers with a typical yellowish-black surface due to necrosis of the tissues. The lesions are usually localized to the palate, tongue, and lips

      Invasive Pulmonary Aspergillosis

      Fever, cough, dyspnea, retrosternal and pleuritic pain, and tachycardia are the most common symptoms and signs. However, many patients with invasive pulmonary aspergillosis are asymptomatic

      

Diagnosis

      Oral lesions should be biopsied and histopatho-logically examined. A computed tomography (CT) scan of the chest for suspected pulmonary infection is recommended. Bronchoscopy, biopsy, and respiratory cultures can also be useful.

      

Differential Diagnosis

      •Histoplasmosis

      •Mucormycosis

      •Cryptococcosis

      •Other systemic mycoses

      •Agranulocytosis

      •Squamous cell carcinoma

      •Non-Hodgkin lymphoma

      •Malignant granuloma

      •Wegener granulomatosis

      

Treatment

      Basic Guidelines

      •The treatment of oral lesions of aspergillosis must be undertaken in collaboration with the specialist.

      •Invasive pulmonary aspergillosis is one of the most difficult diseases to treat and mortality is high.

      •Early diagnosis and early initiation of antifungal treatment are important for a successful outcome.

      •Remission and control of the underlying disease are important for a favorable prognosis.

      •Relapse may occur.

      •The treatment of aspergillosis is always systemic.

      Suggested Therapies

      •Intravenous amphotericin B is the first-line drug for invasive aspergillosis. The drug must be given only by specialists in a hospital unit.

      •Oral itraconazole is an important agent in the treatment of all types of aspergillosis. A dose of 200-400 mg/day is given for weeks to months depending on the type and the severity of the disease. In addition, itraconazole oral solution 5 mg/kg per day is effective.

      

      •Corticosteroids are used only for allergic as-pergillosis.

      Future Therapies

      Voriconazole and caspofungin seem to be effective in invasive aspergillosis. However, more clinical trials are needed.

      References

      Andriole VT. Aspergillus infections: Problems in diagnosis and treatment. Infect Agent Dis 1996;5:47.

      Johnson LB, Kauffman CA. Voriconazole: A new triazole antifungal agent. Clin Infect Dis 2003;36:630–637.

      Kontoyiannis DP, Bodey GP. Invasive aspergillosis in 2002; An update. Eur J Clin Microbiol Infect Dis 2002;21:161–172.

      Koss T, Bagheri B, Zeama C, et al. Amphotericin B-resistant. Aspergillus flavus infection successfully treated with caspofungin, a novel antifungal agent J Am Acad Dermatol 2002;46:945–947.

      Letscher-Bru V. Herbecht R. Caspofungin: The first representation of a new antifungal class. J Antimicrob Chemother 2003;51:513–521.

      Myoken Y. Sugata T, Kyo T, et al. Itraconazole prophylaxis for invasive gingival aspergillosis in neutropenic patients with acute leukemia. J Periodontal 2002;73:33–88.

      Rubin AI, Bagheri B, Scher RK. Six novel antimycotics. Am J Clin Dermatol 2002;3:71–81.

      Bacillary Angiomatosis

      

Definition

      Bacillary angiomatosis is a recently described uncommon tumor-like bacterial infection.

      

Etiology

      The causative organisms are Bartonella henselae and quintana. The disease usually affects patients in advanced stages of HIV infection (CD₄+ lymphocytes <50 cells/mm³) and rarely other immunocompromised patients or patients with malignancies.

      

Main Clinical Features

      Visceral, skin, and oral lesions may occur.

      Oral Lesions

      •Asymptomatic, dark red. slightly elevated nodule or tumor

      •Soft on palpation

      •Gingiva, palate, and tongue are most commonly affected

      Skin Lesions

      •Dark red and violaceous papules and nodules

      •Usually painless

      •Subcutaneous nodules which may erode the skin surface

      Constitutional Symptoms

      •Fever, malaise, night sweats

      •Lymphadenopathy

      •Abdominal pain

      •Hepatosplenomegaly

      •Anemia

      

Diagnosis

      The diagnosis should be confirmed by biopsy and histologic examination.

      

Differential Diagnosis

      •Kaposi sarcoma

      •Pyogenic granuloma

      •Pregnancy granuloma

      •Peripheral giant cell granuloma

      •Hemangioma

      •Leiomyoma

      •Brown giant cell tumor

      •Other vascular tumors

      

Treatment

      Basic Guidelines

      •Oral bacillary angiomatosis should be regarded as an important marker for predicting the progression of HIV infection.

      •Treatment is always systemic.

      •Surgical excision of solitary lesions is usually not necessary.

      Suggested Therapies

      •Erythromycin 500 mg four times daily, or azithromycin 250 mg daily, or clarithromycin 500 mg twice daily is the drug of choice for bacillary angiomatosis. The treatment should continue for 6-8 months.

      •Oral doxycycline 100 mg twice daily or oral ciprofloxacin 500-750 mg twice daily can also be used with excellent results.

      References

      Click M, Cleveland DB. Oral mucosal bacillary (epithelial) angiomatosis in a patient with AIDS associated with rapid