ent manifestations in hiv (batch 22)
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ENT Manifestations In
HIV Patients
Muhammad Asyraf Mohammad Naim
071303086
Group F2Batch 22
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y70% of HIV infected patients willpresent with ENT manifestations.
Did You Know?
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EAR
y Otitis externa
y Otitis media
y SN Hearing Loss
y Facial paralysis
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Otitis Externa
y Pseudomonas aeruginosa
y Osteomyelitis of temporal bone and skull base
y Conductive hearing loss
y Severe painy Edematous
y Erythematous
y Purulent discharge
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Otitis Media
y Serous type
y Eustachian tube dysfunction due to:
-Recurrent upper respiratory tract infection
-Adenoid hypertrophy-Nasopharyngeal tumour
y S. pneumoniae, H. influenzae, Moraxella
catarrhalis
y Pneumocystis jiroveci- unique toAIDS patients
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Sensorineural Hearing Loss
y Causes:
-Cytomegalovirus infection of middle ear/CN VIII
-Direct effect of HIV on CNS
-CNS infections: Cryptococcal meningitis, neurosyphilisy Unilateral or bilateral
y Steadily worsens with increasing frequencies
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Facial Paralysis
y 7.2% of HIV patients affected
y Unilateral or bilateral
y Causes:
-Idiopathic facial(VII) nerve paralysis(Bells Palsy)
-Infection of the facial nerve by HSV
-CNS toxoplasmosis
-HIV encephalitis
-CNS lymphoma
y Loss of taste sensations from the anterior 2/3rd of tongue.
y Impaired hearing
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Facial Paralysis
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NOSE
y Sinusitis
yAllergic rhinitis
y Lymphoid hypertrophy
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Sinusitis
y 20 68% of HIV patients
y Bacterial:
-If CD4 count is above 200cells/mm:
Pneumococci & H.influenza-If below 200cells/mm:
P. aeruginosa &Staph. Aureus
y Fungal:
-Aspergillus
-Mucormycosis
y Fungal sinusitis is rapidly invasive and extendsintracranially
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Allergic Rhinitis
y Cellular immunity is depressed, but increased polyclonal B-cell activation
y Increased circulating immune complexes & increased IgElevels; predispose to hypersensitivity
y Profuse, thick rhinorrhea
y Nasal congestion
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Lymphoid Hypertrophy
y Involves entire Waldeyer's ring (adenoids, tubal, palatine &lingual tonsils)
y Peripheral lymph nodes - persistent generalizedlymphadenopathy
y Asymptomatic
y Nasal obstruction
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ORAL CAVITY
y Candidiasis
yAngular cheilitis
y Recurrent aphthous ulcers
y Hairy leukoplakia
y Kaposis sarcoma
y Non-Hodgkins Lymphoma
y HSV
y Gingivitis & Periodontal Disease
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Oral Candidiasis
y Thrush
y Candida albicans
y Most frequent opportunistic infection in HIV patients (90%
affected)y Tender, white, pseudomembranous or plaque-like lesions
y angular cheilitis
y Can interfere with the administration of medications and
nutritional intakey May spread to the esophagus
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Oral Candidiasis
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Recurrent Aphthous Ulcers
y Ulcers with well circumscribed erythematous margins
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Hairy Leukoplakia
y Almost pathognomic of HIV
y Indicates progression to AIDS
y Causative agent: EBV
y
One of the first opportunistic infections seen in HIV-positive patients
y White plaque on lateral border of
the tongue
y Grows bilaterally
y Asymptomatic
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Kaposis Sarcoma
y Multifocal neoplasm of vascular endothelial spindle cellsy Most common oral malignancy in HIVy Agent: HHV-8y May be first symptom of late stage
HIV diseasey Commonly seen in hard palate & soft
palate(95%), gingiva, buccal mucosa,oropharynx, tongue
y Purplish
y At first, flat and asymptomatic
y Later, exophytic and ulcerated
y Secondary infection: severe, increasing
pain, difficult mastication and swallowing
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Non-Hodgkins Lymphoma
y Diffuse undifferentiated type
y B-cell origin
y Agent: EBV
y Occur in 10-30% of AIDS patients
y Agressivey Occurs in late stage of disease when
CD4 count < 200/mm
y Poor prognostic indication
y Firm painless swelling with/without ulcery Exophytic, large ulcerative lesion in the
mouth or pharynx
y Gingiva & palate, extend to Waldeyers ring
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HSV
y HSV-1
y Extraorally/intraorally
y Herpes labialis is most common
y Palate, gingiva, or other oral mucosal surfaces.y May extend onto adjacent skin - giant herpetic lesions
y Present as vesicles
Flat, reddish; non-blanching
It can enlarge, ulcerate or infected Pain and bleeding common
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Gingivitis & Periodontal Disease
y Common in HIV patient
y Can progress rapidly from mild gingivitis to a necrotizingprocess
y
Severe pain, soft tissue loss and gingival recessiony Bone exposure and sequestration.
y Acute necrotising ulcerative gingivitis (ANUG)
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OTHERS
y Parotid
y Oesophagus
y Neck
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Parotid
y Parotid cysts
y Parotitis
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Oesophagus
y Candida infection
-causes dysphagia
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Neck
y Cervical lymphadenopathy
y Causes:
-Secondary infection
-Lymphoma
-Tuberculosis
-Kaposis Sarcoma
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REFERENCES
y Disease of Ear, Nose, Throat. Dhingra PL. 5th ed.
y Lee KC. Otolaryngologic manifestations of HIV (1998).http://hivinsite.ucsf.edu/InSite?page=kb-04-01-13
y http://emedicine.medscape.com/article/1167229-overview