Herpes simplex type-1 virus infection.

Oral infection caused by the herpes simplex virus represents one of the more common conditions the dental practitioner will be called upon to manage. Unique in its ability to establish latency and undergo subsequent recurrence, it is an ubiquitous infectious agent for which a cure does not exist. For the immunocompetent patient, herpes virus simplex infection typically represents nothing more than a nuisance. However, for the immunocompromised patient, this infection is associated with increased morbidity and mortality. Recently introduced antiviral drug regimens may reduce the morbidity and potential mortality of the herpes simplex virus, especially in immunocompromised patients. The value of antiviral therapy in the management of recurrent herpes simplex virus infection in the immunocompetent patient remains an area of contentious debate.     

Intraoral infection with Mycobacterium chelonae. A case report

An 8-year-old girl had a visibly enlarged submandibular lymph node and a reddish, spongy swelling of the gingiva in the upper right canine region. Culturing of the gingival tissue resulted in the isolation of Mycobacterium chelonae, and the patient showed a specific skin hypersensitivity reaction to M. chelonae sensitin. The gingival swelling disappeared spontaneously without scarring within 5 weeks after the biopsy. There was no recurrence intraorally during the 2 1/2-year follow-up, the generalized lymphadenopathy subsided within 2 years, and at the last visit, the submandibular lymph node could barely be felt. The patient received no medication during the course of the disease. A tortoise held as a pet by the girl could possibly have been the source of infection since iatrogenic sources of infection could be excluded.     

Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome.

A case of descending mediastinitis resulting from dental infection and complicated by adult respiratory distress syndrome (ARDS) is reported. The patient had a long history of heavy drinking. His condition was so serious that he died despite some successful therapies. The cause of ARDS appeared to be aspiration pneumonia. It is extremely rare for oral and maxillofacial surgeons to encounter a patient with ARDS.     

HIV and dentistry. Part 9. HIV infection and dental care

Dental treatment of HIV-infected or AIDS patients can be safely performed in the dental office. In general, no special precautions are necessary. Only in case of severe illness a dental emergency may have to be referred to a dedicated clinic. Ideally, the dentist should have the possibility to treat his own patient in such a clinic.     

Abnormal immune response to infection of the dental pulp. Report of a case.

The following case illustrates an unusual response by the dental pulp to caries in an immunodeficient patient. The patient, a 14-year-old boy, suffered from thymic dysplasia and IgA deficiency. Deep dentinal caries produced relatively little destruction of the pulp and only a mild inflammatory response, in spite of the presence of a large number of bacteria in the pulp chamber. The patient's immunologic disorder was diagnosed as hereditary combined immunodeficiency of unknown type. However, it may have been a variant of Nezelof's syndrome.     

Brain abcess following dental infection.

A 48-year-old woman underwent root canal treatment of the upper left lateral incisor and lower right second premolar. Close to the conclusion of the endodontic treatment she complained about headaches. Later on, because of aggravation of her condition, with headaches, fever, malaise, weakness, and numbness of the right limbs, she was admitted to the hospital. The disease progressed to an epileptic state, with appearance of a right hemiparesis. A brain scan and carotid arteriogram revealed the presence of a mass occupying the left parietal space. Craniotomy disclosed an abscess containing yellow pus from which Streptococcus viridans was cultured. After thorough surgical cleansing of the area, removal of the bone for decompression, and treatment with ampicillin the patient improved gradually and slowly regained the mobility of her right side.     

Aspergillus infection in a patient receiving immunosuppressive drugs.

A rare case of an indolent Aspergillus infection in a deep neck space in an immunologically compromised patient is reported. Aggressive measures were taken to identify the cause of the infection. Despite concerted antifungal therapy, the patient died.     

Occipital neuralgia secondary to respiratory tract infection

Occipital neuralgia is an extracranial pain that may be confused with other headaches. It can be attributed to multiple causes. The authors report the case of a 55-year-old woman suffering from right occipital neuralgia secondary to respiratory tract infection that began 6 days before the pain started. The patient suffered from a sharp and burning pain with paroxysms in the right occipital region and at the top of the right ear. Sensation was decreased in the affected area, and hypersensitivity to touch and cold water was also noted. Tinel's sign was present, and local anesthetic block produced pain relief. The combination of gabapentin and amitriptyline did not provide significant pain relief but led to marked adverse effects. Carbamazepine (300 mg/d) was required for pain control. A month later the patient appeared totally pain-free. The treatment was continued for 3 months, and the patient remained pain-free over a subsequent follow-up period of more than 6 months. Thus, in the case of occipital pain, a careful assessment of symptoms and a thorough history are necessary to obtain the correct diagnosis and to choose the appropriate treatment plan.     

Methicillin-resistant Staphylococcus aureus. A continuing infection control challenge

The ability of MRSA and other staphylococci to colonize, persist, and adapt to multiple environmental and tissue conditions has allowed for these bacteria to be virtually ubiquitous in their distribution. The effectiveness of commonly used antibiotics, such as penicillin, has continued to decline against infections caused by MRSA and increasingly resistant strains. The challenge for both dental and medical health professionals is to routinely apply proven, evidence-based infection control precautions. As mentioned earlier in this discussion, when compliance with effective aseptic technique practices improves, the patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded. Clean and disinfect clinical contact surfaces that are not barrier-protected by using an environmental protection agency-registered hospital disinfectant with a low- (ie, HIV and HBV label claims) to intermediate-level (ie, tuberculocidal claim) activity after each patient. When the surface is visibly contaminated with blood, an intermediate-incidence of detectable infections can be reduced. Microorganisms will continue to evolve and adapt in order to survive and thrive, sometimes at the expense of susceptible human hosts. The struggle is to constantly remain aware of impending infectious threats which may challenge current precautions, and maintain and improve the quality of infection control to minimize the potential for disease.     

Oral Histoplasma capsulatum infection in association with HIV infection: a case report

The fungus Histoplasma capsulatum causes histoplasmosis, the most common endemic respiratory mycosis in the United States. Disseminated histoplasmosis in adults is often associated with immunosuppression, such as occurs in HIV infection. We report a case of oral histoplasmosis in an HIV-seropositive patient who presented with an ulceration on the left tip of the tongue, extending to the floor of the mouth, but was otherwise free of any active systemic disease. Histoplasma capsulatum was shown, by both histopathology and staining with a fluorescent antibody reagent specific for the organism, to be present in the lesion and was deduced to be the causative organism.     

Concurrent oral cytomegalovirus and herpes simplex virus infection in association with HIV infection: A case report

Recurrent oral herpes simplex virus lesions are common in both immunocompetent and immunocompromised persons. In contrast, cytomegalovirus-associated intraoral lesions are rarely seen, even in the immunocompromised host. We report a case of concurrent oral herpes simplex virus and cytomegalovirus infection, appearing as an ulcerative lesion of the labial mucosa in a patient with acquired immunodeficiency syndrome. Herpes simplex virus type 1 was shown to be present in the lesion by culture tests, histopathologic examination, immunohistochemistry findings and a direct immunofluorescence assay, and cytomegalovirus by histopathologic examination and immunohistochemistry findings. We deduce that the lesion was due to concurrent herpes simplex virus-1 and cytomegalovirus infection. The patient responded well to 2 weeks of treatment with a high dose of acyclovir.     

Mediastinitis from odontogenic infection. Report of three cases and review of the literature

Descending necrotizing mediastinitis secondary to dental infection occurs infrequently. The diagnosis of this condition is difficult and often a surgical approach is delayed due to initial clinical improvement after antimicrobial therapy. An incorrect evaluation of this apparent improvement may result in fatal mediastinitis and septic shock. We report 3 cases of mediastinitis of odontogenic origin. In one patient, a nonproductive cough was the first sign of thoracic involvement. A total of 25 similar cases of mediastinitis from odontogenic infection have been collected from the literature in the last 15 years. Some features have to be emphasized, such as the polymicrobial flora, the higher prevalence in males, and the high mortality rate of approximately 44%.     

Oral soft-tissue manifestations as presenting symptom/sign of HIV infection.

This prospective study reports oral manifestations noted in 17 patients as the first indications of HIV infection, and serves to remind health workers of the need to examine the oral soft tissues thoroughly. This study also demonstrated that other HIV-associated oral lesions are often seen in addition to the presenting symptom or sign, which was highly variable and not lesion-specific. Appropriate management of the patient after recognition of the significance of these signpost oral lesions could affect quality of life, influence the course of the disease and reduce the risk of transmission. Dentists need to be alert to and knowledgeable about these lesions which will become more prevalent as the numbers of HIV-positive persons increase in South Africa.     

Gingival Kaposi's Sarcoma: the first indication of HIV infection.

This article presents a case of gingival Kaposi's sarcoma that initially mimicked an acute periodontal infection, but was the first clinical sign of HIV infection in a 38-year-old male homosexual patient. The clinical features and treatment of oral Kaposi's sarcoma are discussed and the variable histopathology of the lesion is demonstrated.     

Governmental regulations concerning infection control in dentistry.

This review discusses how governmental regulations concerning infection control affect dental practice procedures. Recently, changes have been made in state and federal legislation regarding these matters. These changes have forced dentists to evaluate seriously the risks involved in providing patient care.     

C4Staphylococcus aureus infection associated with orofacial granulomatosis

Presenting problem:  A 6-year-old girl attended the Department of Paediatric Dentistry at Edinburgh Dental Institute complaining of swelling and blistering of her upper lips and adjacent gingivae, which had been present for approximately 1 month. The patient had an unremarkable medical history.
Clinical management:  Examination revealed submandibular lymphadenopathy with vesiculation and erythema in the upper incisor region. There was swelling and crusting of the upper lip with slight swelling of the lower lip. Foetor oris was evident. An initial diagnosis of primary herpetic gingivostomatitis was made. Despite treatment the lesions did not resolve. At review, the patient's mother stated that the patient was now suffering abdominal pain and diarrhoea. Haematological investigations revealed no abnormalities. Punch biopsies of the lips carried out under general anaesthesia showed lymphoedema but no granulomata. It was felt by the pathologist that the appearance was of a secondarily infected lesion with an underlying allergic component, most likely to be orofacial granulomatosis (OFG). Swabs sent for bacterial and fungal culture identified no fungal species but Staphlycoccous aureus was present in large numbers. The patient was prescribed Nystaform^® cream and oral flucloxacillin which has improved the appearance of the upper lips. The patient has been referred for patch testing, and also to gastroenterology for investigation.
Discussion:  Staphylococcal mucositis has been reported previously in a series of patients with OFG. This case demonstrates an unusual presentation of Staphylococcus aureus infection, previously unreported, in a child with OFG.     

Pulmonary nocardiosis associated with primary nocardial infection of the oral cavity.

A case of pulmonary nocardiosis associated with primary nocardial infection of the oral cavity in a compromised host is presented. Nocardia asteroides, an aerobic, gram-positive, branching, filamentous fungus, was demonstrated in the sputum and in pathologic specimens from gingival sulci stained by Gram's method and the acid-fast method Kinyoun. The organism was identified in cultures made on Sabouraud's glucose agar. Marked clinical improvement was noted when the patient received high dosage of sulfisoxazole diolamine (8 to 12 Gm. per day) for a prolonged period of time (9 to 12 months). Because of an apparent relative increase in the incidence of nocardiosis and a paucity of information on the subject in the dental literature, this article is timely.     

Recurrent intra-oral herpes simplex 1 infection

Human herpes simplex 1 virus (HSV-1) is a DNA virus that has the ability to lie latent and be subsequently re-activated at any point during a patient's life. In the immunocompetent patient, resolution of clinical signs and symptoms usually occurs spontaneously after 14 days. In the immunocompromised patient, healing is often delayed and the effects are much more debilitating. Indications for therapeutic regimes of systemic antiviral treatment are discussed. Clinical Relevance: Recurrent oral ulceration caused by HSV-1 may be seen by the general dental practitioner and can cause significant morbidity.     

Actinomyces parotid infection after mandibular third molar extraction

Actinomycosis is currently an uncommonly diagnosed human disease. The disease is a chronic suppurative infection caused by micro-organism from the Actinomyces group, most often Israelii. A patient with cervicofacial actinomycosis generally reports a history of recent dental treatment which, usually, involves extraction of a mandibular molar. The common initial signs and symptoms of infection (such as sudden onset of cervicofacial pain, swelling, erythema, edema and suppuration) can be absent. In this case report a 29-year-old man presented a mass in his left parotid area, 1 week after mandibular molar extraction. Echography and CT scans revealed a parotid abscess area. The needle-biopsy of swelling revealed infection due to Actinomyces. Therapy was started with intravenous cefazolin (fl 1g X 2 in 100 s.s. i.v.) and methylprednisolone (25 mg tablet, 1/die) for 9 days; 14 days after treatment suspension the lesion reappeared with a fistula and a new therapy was given (ceftriaxone 1 g/die and gentamicin 80 mg/i.m. for 3 weeks). To prevent a relapse, the patient received cefalexin 1 gx2/die per os for 4 weeks. After a follow-up of 1 year, the patient was still asymptomatic.     

The incidence of clinical infection after periodontal surgery. A retrospective study

A large-scale retrospective study was undertaken to determine the incidence of clinical infection after periodontal surgery and the effectiveness of prophylactic antibiotic therapy in preventing postoperative infection. All second-year postgraduate students reviewed their patient records and completed a questionnaire. Eight infections were found in 884 operations performed without antibiotics, while one infection was found in 43 operations performed with antibiotics. Of 268 operations involving osseous surgery, six infections were noted while two infections were observed following 336 operations involving flap surgery without osteoplasty or ostectomy. The data indicated that the incidence of infection after periodontal surgery is very low in patients treated with or without antibiotics. It was concluded that unless there is a medical indication, there is no justification for using prophylactic antibiotic therapy to prevent infection following periodontal surgery.