oral manifestations of immunodeficiency

Immunodeficiencies and their

oral manifestations

Done by :Mohammad salah qrea

5th yearAnd presented toDr. fahed habash

Immunity • A complex interaction of certain types of

cells.

• Innate immunity with born vs. adaptive immunity along time.

Innate immunity

Phagocytes

Skin Complement system

Interferons

IMD disorders

• Part of the body's immune system is missing or defective.

• impairing the body's ability to fight infections.

• As a result, the person with an IMD will have frequent infections that are generally more severe and last longer than usual.

Types of IMDs

• Primary or congenital ID.

• Acquired ID.

Primary IMD

• Congenital disorder of one or more of immune system.

• T and B cell defects.

• Phagocytes defects.

• IgA deficiency.

Acquired IMD• Infections (HIV, chicken pox, German

measles, measles, tuberculosis, chronic hepatitis, lupus, bacterial and fungal infections).

• Malnutrition (vitamins, iron, and zinc).

• Some cancers.

• Some drugs.

• Some metabolic diseases.

• Alcoholism.

Prevention of AIMDs

• Good nutrition.

• Avoiding responsible infections.

• And safe sex “ for AIDS prevention,

IF YOU DON’T KNOW YOUR PARTNER USE CONDOM”

• Illegal intravenous drugs.

Oral manifestations of IMD disorders

JANE C. ATKINSON, D.D.S., ANNE O’CONNELL, B.DENT.SC., M.SC. and DORON AFRAMIAN, D.M.D., M.SC.

General rule

T-cell deficiencyCandidal infections + herpetic infections

B-cell deficiency Bacterial infections

Phagocyte deficiency

Periodontitis + candidal

Severe pseudomembranous candidiasis in a young man with Job’s syndrome.

T- CELL DEFICENCY

phagocyte function

leukocyte adhesion deficiency

leukocyte adhesion deficiency

Treatment modalities

• Bone marrow transplantation.

• Prophylactic antibiotic regimens.

• Aggressive preventive dental care.

Secondary immunodeficiency oral manifestations

Acquired immunodeficiency syndrome

Causative agent: HIV

Target cells: CD4+ T cells, monocytes, macrophages, dendritic cells, etc.

Importance of gp120

• Diagnosis: detection of viral Ag, anti-viral Ab

• Prognosis: CD4/CD8 ratio, skin tests (DTH), Lymphocyte transformation test

• Treatment: • 1. Treatment of microbial

infections• 2. Anti-viral drugs • 3. Immunorestoration: BM

transplantation, Ig injections, cytokines

Oral manifestations of

AIDS

• Fungal Candidiasis     Pseudomembranous  Erythematous     Angular cheilitis Histoplasmosis Cryptococcosis.

• Viral Herpes simplex Herpes zoster Human papillomavirus lesions Cytomegalovirus ulcers Hairy leukoplakia

• Bacterial Linear gingival erythema Necrotizing ulcerative Periodontitis Mycobacterium avium complex Bacillary angiomatosis

• Neoplastic Kaposi's sarcoma Non-Hodgkin's lymphoma

• Other Recurrent aphthous ulcers Immune thrombocytopenic purpura HIV salivary gland disease.

CANDIDIASIS• Exfoliative cytology, biopsy for

diagnosis.

• TREATED BY:• Topical antifungal (e.g., nystatin [Mycostatin].• Suspension, clotrimazole [Mycelex] troches,

fluconazole [Diflucan] suspension.

• Or systemic antifungal (e.g., fluconazole, ketoconazole [Nizoral], itraconazole [Sporanox])

Pseudomembranous candidiasis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Median rhomboid glossitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Angular cheilitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Histoplasmosis

Oral thrush

Recurrent aphthous stomatitis• Yellowish white pseudomembrane

surrounded by erythematous zone.

• Treated by:• Fluocinonide gel (Lidex) or triamcinolone

acetonide (Kenalog in Orabase), amlexanox paste (Aphthasol), chlorhexidine gluconate (Peridex) mouthwash.

Recurrent aphthous stomatitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Multiple canker sores

Erythema migrans

• Migrating, central erythema surrounded by white- to-yellow elevated borders; typically on tongue.

• TREATED BY:

• Symptomatic cases may be treated with topical corticosteroids, zinc supplements, or topical anesthetic rinses.

Erythema migrans

waxes and wanes

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Hairy tongue

• Elongated filiform papillae.

• Predisposing factors, smoking, poor oral hygiene, antibiotics and psychotropics.

• TREATED BY:

• Regular tongue brushing or scraping; avoidance of predisposing factors

Hairy tongue

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

VIRUSES

Recurrent herpes labialis

• Prodrome, 12 to 36 hours, rupture vesicles.

• Reactivation triggers: ultraviolet light, trauma, fatigue, stress, menstruation.

• TRAETED BY:• Topical agents include 1% penciclovir cream

(Denavir)• Systemic agents (e.g., acyclovir [Zovirax],

valacyclovir [Valtrex], famciclovir [Famvir]) are most effective if initiated during prodrome.

Recurrent herpes labialis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

Herpes zoster

Human papilloma virus

Cytomegalovirus

• Ulcers confused with aphthous ulcers.

• necrotizing ulcerative periodontitis and lymphoma.

Hairy leukoplakia EBV

Kaposi's Sarcoma

Lymphoma

Idiopathic Thrombocytopenic Purpura

Immunosuppresive drugs

• glucocorticoids

• cytostatics

• antibodies

• drugs acting on immunophilins

• other drugs.

And thanks