Salivary shedding of HHV‐8 in people infected or not by human immunodeficiency virus 1

J Oral Pathol Med (2011) 40 : 97–102 Background: Human herpesvirus 8 (HHV‐8), the main agent involved in the etiopathogenesis of Kaposi’s sarcoma (KS) is primarily transmitted through sexual contact. The potential of saliva as a source of HHV‐8 transmission remains unclear. The purpose of this work was to determine the frequency of HHV‐8 detection in saliva of HIV‐infected individuals and their family contacts. Methods: The study group comprised 210 individuals. Group 1: 35 HIV‐infected patients; group 2: 35 non‐HIV individuals; group 3: two siblings for each patient from group 1; group 4: two siblings for each individual from group 2. Each participant had non‐stimulated whole saliva collected and DNA was extracted. HHV‐8‐DNA amplification from ORF‐26 was performed using a nested PCR protocol. Results: HHV‐8 DNA was detected in saliva from 14/35 (40%) HIV‐infected individuals and 4/35 (11.4%) non‐HIV‐infected individuals (OR = 5.16, CI [1.49–17.88], P = 0.006). It was also possible to amplify HHV‐8 DNA in 11/70 (15.7%) relatives of HIV‐infected participants and 4/70 (5.71%) relatives of non‐HIV‐infected individuals(P = 0.041). Among the 14 group 1 patients with HHV‐8 DNA detected in saliva, eight (57.1%) had a household member in whom HHV‐8 DNA was also amplified (OR = 8, CI [1.58–40.29] P = 0.007). Conclusions: HHV‐8 DNA is frequently found in saliva. HIV‐infected individuals showed a higher frequency of detection of HHV‐8 than healthy controls. HHV‐8 DNA was significantly amplified in saliva of household members of HIV/HHV‐8 co‐infected individuals.     

Detection of human herpesvirus 6 in patients with oral chronic graft-vs-host disease following allogeneic progenitor cell transplantation

INTRODUCTION: Chronic graft-vs-host disease (cGVHD) is a major cause of morbidity in long-term survivors of allogeneic hematopoietic progenitor cell transplantation. Herpesviruses are involved in the occurrence and progression of various oral diseases. AIM: The aim of this study was to investigate the role of human herpesvirus 6 (HHV6) in patients with oral manifestations of cGVHD. MATERIALS AND METHODS: Peripheral blood and oral fluids (whole saliva, gingival crevicular fluid and parotid gland saliva) from 19 cGVHD patients, and 28 blood donors were examined for HHV6. Oral tissue samples were collected from 12 cGVHD patients and 12 healthy individuals. Nested polymerase chain reaction was employed to identify the HHV6. RESULTS AND CONCLUSION: The virus was detected in whole saliva in 13 cGVHD patients (68%) and in 19 blood donors (67%). HHV6 was not identified in any of the gingival crevicular fluid and parotid gland saliva samples in cGVHD patients. In the control group 14.3% of both, four gingival crevicular fluid and four parotid gland saliva samples were positive. Two oral tissue samples of cGVHD patients were positive for HHV6. These results indicate that patients with oral manifestations of cGVHD and healthy individuals present high and similar incidence of HHV6 in blood and oral fluids. These data do not support the importance of HHV6 in oral lesions of cGVHD.     

Detection of human herpesvirus-8 DNA in oral ulcer tissues of HIV-infected individuals

OBJECTIVE: To determine the frequency of detection of human herpesvirus-8 (HHV-8) in HIV-related oral ulcers. DESIGN: Analysis of archived biopsy material. METHODS: Nested polymerase chain reaction of DNA extracts. RESULTS: HHV-8 DNA was detected in six of 10 oral ulcers of HIV-positive patients without oral Kaposi's sarcoma (KS) lesions and five of 11 oral KS lesions. The positive non-KS samples were derived from various oral sites. CONCLUSIONS: In HIV-positive people, HHV-8 can infect oral tissues that are not affected by KS.     

Presence of human herpes virus-8 in saliva and non-lesional oral mucosa in HIV-infected and oncologic immunocompromised patients

BACKGROUND/AIM: Human Herpes Virus-8 (HHV-8) is a recently identified virus etiologically associated with Kaposi's sarcoma. Studies regarding its presence in the oral cavity have given variable results. This study attempted to determine the oral presence of HHV-8 in an area where classic Kaposi's sarcoma is primarily found such as Greece. METHODS: Three groups of patients were studied: 10 immunocompromised with hematologic malignancies, 10 immunocompromised with HIV infection and 20 immunocompetent as controls. Whole unstimulated saliva and scrapes from the lingual and the buccal mucosa were collected and polymerase chain reaction was applied to amplify HHV-8 DNA. RESULTS: None of the patients in any group had oral lesions. In the control group, all samples tested negative (0/60). HHV-8 DNA was detected in 5/30 (17%) of all samples from HIV-positive patients (the mean value of their CD4+ T-lymphocytes being 385/mm3) and in 13/30 (43%) of all samples from oncologic patients (mean CD4+ T-lymphocytes 51/mm3). HHV-8 DNA was found in 10% of saliva samples and 40% of lingual and buccal scrapes both of HIV-infected and of oncologic patients. CONCLUSION: HHV-8 is present in the saliva and the non-lesional oral mucosa (not simultaneously) of patients with impaired immunity, with or without HIV co-infection. The oral epithelium seems to represent an independent location of viral residency and may be of viral replication; the clinical implications need further clarification.     

Solitary plasmacytoma of the mandible in a renal transplant recipient

A solitary plasmacytoma occurring in the mandible of a 15-year-old Korean male 6 years after renal transplantation is reported. The tumour presented as a hyperplastic gingival overgrowth in the right madibular molar area. Histology and immunohistochemistry revealed plasmacytoma and monoclonality of the kappa chain and IgG. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) showed positive signals in the tumour cells. The tumour regressed after reducing the immunosuppressive agents with concurrent radiotherapy. The patient remains in a stable condition with normal renal functions after 7 years without recurrence. This case confirms that Epstein-Barr virus associated B-lymphoproliferative disorders are still a major complication of immunosuppression.     

Presence of human herpes virus‐8 in saliva and non‐lesional oral mucosa in HIV‐infected and oncologic immunocompromised patients

Background/Aim: Human Herpes Virus‐8 (HHV‐8) is a recently identified virus etiologically associated with Kaposi's sarcoma. Studies regarding its presence in the oral cavity have given variable results. This study attempted to determine the oral presence of HHV‐8 in an area where classic Kaposi's sarcoma is primarily found such as Greece. Methods: Three groups of patients were studied: 10 immunocompromised with hematologic malignancies, 10 immunocompromised with HIV infection and 20 immunocompetent as controls. Whole unstimulated saliva and scrapes from the lingual and the buccal mucosa were collected and polymerase chain reaction was applied to amplify HHV‐8 DNA. Results: None of the patients in any group had oral lesions. In the control group, all samples tested negative (0/60). HHV‐8 DNA was detected in 5/30 (17%) of all samples from HIV‐positive patients (the mean value of their CD4⁺ T‐lymphocytes being 385/mm³) and in 13/30 (43%) of all samples from oncologic patients (mean CD4⁺ T‐lymphocytes 51/mm³). HHV‐8 DNA was found in 10% of saliva samples and 40% of lingual and buccal scrapes both of HIV‐infected and of oncologic patients. Conclusion: HHV‐8 is present in the saliva and the non‐lesional oral mucosa (not simultaneously) of patients with impaired immunity, with or without HIV co‐infection. The oral epithelium seems to represent an independent location of viral residency and may be of viral replication; the clinical implications need further clarification.     

Concurrent oral shedding of feline calicivirus and feline herpesvirus 1 in cats with chronic gingivostomatitis

Oral mucosal salivary samples were collected from 25 cats with chronic gingivostomatitis and 24 cats with periodontal disease. Viral culture and isolation of feline calicivirus and feline herpesvirus 1 were performed. Eighty-eight per cent of cats with chronic gingivostomatitis were shedding both viruses, compared to 21% of cats without chronic oral inflammatory disease. Cats with chronic gingivostomatitis are significantly more likely to concurrently shed both feline calicivirus and feline herpesvirus 1 than are cats with classical periodontal disease.     

Asymptomatic shedding of HSV-1 in patients undergoing oral surgical procedures and attending for noninvasive treatment

Oral surgery and stress can trigger and/or increase asymptomatic shedding of herpes simplex virus type-1 (HSV-1) into human saliva. In this investigation we examined the frequency of HSV-1 shedding in 32 patients undergoing an oral surgery procedure compared with 40 control patients attending for noninvasive treatment. Control patients comprised 18 migraine patients and 22 patients with temporomandibular (TMD) joint problems. Nested-PCR was carried out on oral rinses collected from each patient prior to treatment and 7 days post-treatment. Fifty-two of sixty-one seropositive patients were positive for HSV-1 DNA in one or both oral rinses. The frequencies of HSV-1 shedding for the oral surgery and control patients were 84.6% and 85.7% respectively. Seropositive patients who started shedding after treatment were significantly higher in oral surgery patients (46.2%) compared to control patients (34.3%). Shedding of HSV-1 in the oral cavity is not only increased by direct surgical trauma, but also appears to be common in migraine and TMD patients attending for general dental treatment. Thus pain or pain-induced stress as well as anxiety associated with dental treatment may also be a risk factor for asymptomatic shedding in specific seropositive patients attending for dental treatment.     

Correlation of cytomegalovirus and human herpesvirus 7 with CD3+ and CD3+ CD4+ cells in chronic periodontitis patients

Thomasini RL, Bonon SH, Durante P, Costa SCB. Correlation of cytomegalovirus and human herpesvirus 7 with CD3 ⁺ and CD3 ⁺ CD4 ⁺ cells in chronic periodontitis patients. J Periodont Res 2012; 47: 114–120. © 2011 John Wiley & Sons A/S Background and Objective: Human chronic periodontitis is an inflammatory process characterized by dense accumulation of immune cells in the periodontal tissue. The periodontitis can lead to loss of teeth in the patient and the pathogenesis of this disease is not completely known. This study tested the hypothesis that chronic periodontitis‐affected sites can harbor betaherpesviruses and that viruses are linked to a profile of the inflammatory infiltrate. Material and Methods: Biopsies of periodontal tissue were taken from periodontitis‐affected patients and from healthy subjects. Immunohistochemistry was performed to count CD19⁺ B cells, CD3⁺ total T cells, T‐CD4⁺ and T‐CD8⁺ cell subsets, and PCR was performed to detect cytomegalovirus and human herpesvirus 6 and 7 in the samples. One slide of each sample was stained with Giemsa for histopathological examination and to evaluate the quality of the cellular infiltrate. Results: As expected, tissues collected from healthy subjects presented no significant level of inflammatory infiltration and were therefore excluded from immunostaining procedures. Results showed that CD19⁺ B cells were in higher number than CD3⁺ T cells in the periodontitis‐affected tissue, but this was not statistically significant. The T‐CD4⁺ lymphocyte subset was significantly higher than the T‐CD8⁺ lymphocyte subset (p = 0.004) in the samples. Cytomegalovirus and human herpesvirus 7 were found at periodontitis‐affected sites, but not in tissue collected from healthy subjects (p = 0.04 and p = 0.04, respectively). Human herpesvirus 6 was rarely detected. We found a correlation between cytomegalovirus and lower CD19⁺/CD3⁺ ratios (ratio < 0.9, p = 0.003) and between human herpesvirus 7 and lower CD19⁺/CD3⁺ ratios (ratio < 0.9, p = 0.003) and higher CD4⁺/CD8⁺ ratios (ratio > 1.1, p = 0.002). Conclusion: This study shows that cytomegalovirus and human herpesvirus 7 can be present at periodontitis‐affected sites but are uncommon at healthy periodontal sites. Moreover, our data suggest that cytomegalovirus can be related to an inflammatory infiltrate with predominance of CD3⁺ T cells, whereas human herpesvirus 7 can be associated with an infiltrate with predominance of T‐CD4⁺ cells. However, further studies are necessary to support this hypothesis. Herpesviruses could play a role in human chronic periodontitis by modulation of the T cell response.     

The importance of oral foci of infection in renal transplantation

During the treatment of patients with renal failure or renal transplants the most important consideration is to eliminate sources of infection before and after the treatment. Acute or chronic oral infections or bacteraemias resulting from dental procedures may cause serious complications in these patients who already have lowered host resistance caused by immunosuppressant therapy. In order to determine the latest concepts from some international transplantation centres relating to the importance of and the effect of infective sources in the oral cavity, a survey form was prepared which included several questions related to oral foci of infection and renal transplantations.
Results obtained from 22 centres from 12 countries indicated that the majority of the centres included a dental examination in their routine protocol and required completion of any necessary dental treatment before transplantation. However, full agreement among all these centres on the necessity for dental examination as part of the protocol has not yet been reached.     

Oral shedding of HSV-1 and EBV and oral manifestations in paediatric chronic kidney disease patients and renal transplant recipients

Objective: Previous research demonstrated that salivary shedding of HSV-1 and EBV occurs often in adult renal transplant recipients, but there is a lack of studies on the presence of them in the saliva of paediatric population. Therefore, the objective of this study is to describe oral characteristics and to compare the shedding profile of HSV-1 and EBV in the saliva of children with renal transplant to that of chronic kidney disease patients and controls.

Methods: This is a cross-sectional study involving 100 children, being 25 renal transplant recipients, 25 chronic kidney disease patients and 50 healthy children. Demographic and oral clinical characteristics were assessed. Saliva samples were collected and submitted to screening for EBV and HSV-1 by using nested polymerase chain reaction technique. Fisher’s exact, Pearson’s chi-square and Kruskal–Wallis tests were used for statistical analysis at a significance level of 5%.

Results: Oral shedding of HSV-1 (28%) and EBV (60%) were significantly higher in renal transplant recipients compared to the other groups. Single vesicles in the oral mucosa were statistically associated with the presence of HSV-1 (p?=?.035). In children with chronic kidney disease, there was a higher prevalence of pale oral mucosa (32%) and enamel hypoplasia (40%) compared to paediatric renal transplant recipients and controls. Dental calculus (36%), candidiasis (8%), drug-induced gingival overgrowth (16%), mouth blisters (8%), xerostomia (12%) and salivary gland enlargement (20%) were more common in paediatric renal transplant recipients.

Conclusions: Therefore, it can be concluded that salivary shedding of HSV-1 and EBV in paediatric patients was more often found in renal transplant recipients than in the renal failure and control children. Transplanted recipients showed more oral manifestations than renal failure and control children did.     

云南地区HIV感染者疱疹病毒相关口腔损害发病情况分析

目的 探讨HIV感染者中与人类疱疹病毒1、3、4、5、8型相关的口腔损害的发病情况及其与CD4的关系,以期初步明确HIV感染者中常见的口腔疱疹病毒损害的发病特征.方法 对2007年12月至2011年12月昆明市第三人民医院感染—科992例未接受高效抗反转录病毒治疗的HIV感染者进行口腔检查,并收集患者CD4计数等资料,采用SPSS11.3软件建立数据库并进行相关指标的统计学分析.结果 992例患者中发生与疱疹病毒相关的口腔损害209例(21.1％),单纯疱疹、带状疱疹、毛状白斑、复发性阿弗他溃疡和卡波西肉瘤分别占10.8％(107/992)、0.7％ (7/992)、9.1％(90/992)、9.3％(92/992)和0.5％(5/992).单纯疱疹和毛状白斑与CD4计数有关(P＜0.05),而复发性阿弗他溃疡、口腔带状疱疹和卡波西肉瘤与CD4计数无关.结论 云南地区HIV感染者中人类疱疹病毒感染相关口腔损害以单纯疱疹病毒感染、复发性阿弗他溃疡和毛状白斑多见.     

HAART对HIV感染者唾液人类疱疹病毒5-8型分布的影响

目的：探讨高效抗逆转录病毒治疗（HAART）对HIV感染者唾液中人类疱疹病毒5至8型即CMV、HHV-6、HHV-7和HHV-8的分布影响情况。方法：利用巢式PCR技术对受试人群唾液CMV、HHV-6、HHV-7和HHV-8DNA的存在进行检测,并采用SPSS18．0软件建立数据库并进行相关指标的统计分析。结果：HIV患者HAART组与非HAART组比较,4种HHV唾液检出率并无差异（P〉0．05）,HAART组、非HAART组与正常组比较有差异性,而且三组都存在CMV、HHV-6、HHV-7和HHV-8多重感染,HIV人群病毒共同检出率高于正常组,非HAART组高于其它两组。结论：HIV患者中口腔疱疹病毒5-8型感染较为普遍,其中以HHV-6和HHV-7最为突出,HHV-8晶低,唾液可能在疱疹病毒传播中起作用。     

Clinical, histological and immunohistochemical findings in oral Kaposi's sarcoma in a series of Mexican AIDS patients. Comparative study

Background:  The origin of spindle cells (SC) in oral Kaposi's sarcoma (OKS) is still an intriguing aspect. Thus the aim of the present study was to compare the clinical, histological and immunohistochemical characteristics of OKS and oral pyogenic granuloma (OPG), in order to contribute to the knowledge of the cells involved in Kaposi's sarcoma pathogenesis.
Methods:  In this retrospective, observational and comparative study, 39 OKS and 30 OPG cases were included. Immunohistochemical studies were performed for vimentin, αSMA, desmin, C-kit, CD34, D2-40 and LANA-1 [human herpesvirus-8(HHV-8)]. Statistical comparisons were done using the chi-square and Wilcoxon–Mann–Whitney rank sum tests.
Results:  Fourteen (35.9%) OKS cases also affected the skin, and 83.8% involved the palate. All OKS and OPG were positive for vimentin and CD34. OKS samples were positive for αSMA, and 25.6% expressed C-kit. All OKS cases were positive for HHV-8, and the number of positive cells increased significantly from early / intermediate to late histological stage. D2-40 was expressed in the cellular component and vascular walls of all OKS cases, but it was negative in OPG. HHV-8 expression was increased in late histological stages of OKS lesions.
Conclusions:  The expression of D2-40 marker in the vascular walls and SC supports the view of a lymphatic differentiation in neoplastic cells of OKS. Desmin, αSMA , D2-40, C-kit and HHV-8 were the main markers differently expressed in OKS and OPG.     

Effect on human teeth of renal transplantation: a postmortem study

Extracted teeth from five deceased patients treated by renal transplantation were examined radiographically and histologically, and compared with teeth from healthy persons of approximately the same age. In three of the patients with a renal transplant, the radiographs showed normal pulp chamber sizes, but histologic examination revealed a widened predentin zone, approximately four times greater than in the controls. In two of the patients the radiographs showed marked reduction of the pulp chamber size. The histologic changes of these teeth were mainly an extensive amount of secondary dentin along the pulp chamber walls and the root canals, with a markedly reduced pulp space. One explanation for the difference between the patients was that patients with extensive pulp calcifications were given a higher total amount of corticosteroids than patients with a widened predentin zone.