Hand-foot-and-mouth disease: report of a case in Texas

Coxsackie virus infections are highly contagious and can occur at epidemic levels within low socioeconomic populations. Since these diseases spread by contact, summer and fall occurrences increase significantly. A low grade fever and malaise are often related to non-specific viral infections. Hand-foot-and mouth disease (HFMD) is specifically caused by coxsackie virus.     

Increased odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis

The ACE2 receptor, the binding sites for the COVID‐19, is expressed abundantly in the oral cavity, raising the question of whether the mouth is a target for the virus in addition to organs such as kidneys and lungs. Recently, a flurry of individual case reports on oral manifestation of COVID‐19 including ulceration, blistering lesions, and stomatitis were published. However, it is not clear whether the oral presentations that are not unique to the virus are indeed related to the virus and appear at a higher prevalence than in the general population. We used the i2b2 platform of hospital patient's registry to determine the odds ratio for COVID‐19 in patients that were diagnosed with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall odds ratio for COVID‐19 in patients with recurrent aphthous stomatitis before adjustments was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively. The odds ratio remained increased after adjustments of the comorbidities such as respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated with COVID‐19. African American race and age‐group 18‐34 were additional significant risk factors. The present study has demonstrated a significant association between COVID‐19 and RAS; however, additional longitudinal and laboratory studies are necessary to establish a cause and effect relationship between these 2 conditions.     

Necrotizing ulcerative stomatitis in human immunodeficiency virus-seropositive individuals: a review of the histopathologic, immunohistochemical, and virologic characteristics of 18 cases

OBJECTIVE: The purpose of this retrospective study was to delineate the histopathologic, immunohistochemical, and virologic characteristics of 18 cases of necrotizing ulcerative stomatitis. STUDY DESIGN: Eighteen examples or oral ulcerations in human immunodeficiency virus-seropositive individuals were identified that displayed unique histopathologic features. Immunohistochemic staining for CD1a, CD3, CD23, CD68, HLA-DR, p24, cytomegalovirus, HSV-1, and HSV-2 was performed, along with in situ hybridization for Epstein-Barr virus RNA and special staining for bacteria and fungi. RESULTS: The lesions demonstrated ulceration, extensive necrosis, leukocytoclasia, histiocytic vasculitis with luminal fibrin clots, and a prominent infiltrate of large atypical cells with amphophilic cytoplasm, vesicular nuclei, and prominent nucleoli, interspersed with crescentic histiocytes, a histologic picture resembling extranodal Kikuchi's disease. Immunohistochemical findings suggested that the large atypical cells were histiocytes. Fifty-six percent (10/18) of the cases were immunoreactive for human immunodeficiency virus p24 within focal histiocytes, whereas Epstein-Barr virus RNA was identified in 1 (6%) of 17 cases. CONCLUSIONS: Necrotizing ulcerative stomatitis is an inflammatory disease characterized by specific, reproducible microscopic features. We postulate that the histopathologic resemblance of necrotizing ulcerative stomatitis to extranodal Kikuchi's disease reflects a similar immune response to differing pathogens.     

Ulcerative diseases of animals with an infectious etiology.

The oral lesions of five viral diseases of cattle are compared. Two of the diseases, foot-and-mouth disease and vesicular stomatitis, cause vesicles, and rinderpest, bovine virus diarrhea and malignant catarrhal fever produce sharply demarcated erosive lesions. Gross lesions of different diseases appear similar: however, histologically, there are subtle differences in the development of the lesions.     

Ulcerative diseases of animals with an infectious etiology

Abstract The oral lesions of five viral diseases of cattle are compared. Two of the diseases, foot-and-mouth disease and vesicular stomatitis, cause vesicles, and rinderpest, bovine virus diarrhea and malignant catarrhal fever produce sharply demarcated erosive lesions. Gross lesions of different diseases appear similar: however, histologically, there are subtle differences in the development of the lesions.     

芦荟治疗口腔黏膜病的系统评价

目的 系统性评价芦荟治疗口腔黏膜病的有效性及安全性。方法 使用计算机文献检索确定所有以这为主题的已发表的文章。使用特定的关键字用PubMed、Cochrane、Database、Embase、Cbm、Cnki、万方和维普数据库,检索建库至2017年5月收录的关于芦荟治疗口腔黏膜病的随机对照实验(randomized controlled trials ,RCT)。由两名研究人员使用Cochrane Reviewer Hand booker 5.1系统分别独立进行文献筛选和质量评价。结果 25项研究符合纳入标准。临床诊断为口腔黏膜病变的研究样本患者人群从20例到120例。25项研究中包括5项口腔扁平苔藓（oral lichen planus ,OLP）、6项口腔粘膜下纤维化（oral submucous fibrosis,OSMF）、8项口腔溃疡（oral ulcer）、3项放射性口腔黏膜炎（radioaction oral mucositis）,其他研究为灼口综合征（burning mouth syndrome,BMS）、义齿性口炎（denture stomatitis）和口干（xerostomic）。大多数研究表明,芦荟治疗口腔疾病的有效性具有显著的统计学意义,且未发现有任何副作用。结论 芦荟治疗口腔黏膜病虽然有一定的效果,但仍需扩大临床对照试验来证明芦荟在口腔黏膜疾病治疗中的有效性及安全性。     

Cell-protective effect of human saliva specific for herpes simplex virus

Saliva from normal human adults pre-incubated with human amnion cell cultures protected these cells against destruction by herpes simplex virus. In two-thirds of subjects tested, protection amounted to plaque reduction of 55–94 per cent. Protection seemed to be achieved by direct action on cells rather than inactivation of virus. Evidence indicates that the active material was not antibody, although it was more active against herpes simplex virus than vaccinia or vesicular stomatitis virus. This cell-protective activity correlated with recurrent herpes labialis and may be significant in the varying resistance of individuals to symptomatic recurrences and may explain the tendency of recurrent lesions to involve the lips and circumoral skin although sparing the oral mucous membrane.     

Oral staphylococcal mucositis: A new clinical entity in orofacial granulomatosis and Crohn's disease

OBJECTIVE: Orofacial granulomatosis and the oral manifestations of Crohn's disease comprise many clinical features, of which stomatitis is one. The purpose of this study was to establish a role for Staphylococcus aureus in mucositis affecting some patients with orofacial granulomatosis or oral Crohn's disease. STUDY DESIGN: Four patients (2 with orofacial granulomatosis and 2 with oral Crohn's disease), from a total of 450 patients examined over 10 years, had stomatitis involving the entire oral mucosa, from which S aureus was cultured by the oral rinse technique. These patients were treated with flucloxacillin or erythromycin. RESULTS: A heavy growth of S aureus was isolated from the mouth of each patient. All 4 patients responded to treatment with flucloxacillin or erythromycin. CONCLUSIONS: S aureus is a potential cause of panstomatitis in patients with orofacial granulomatosis or Crohn's disease. This infection responds rapidly to antimicrobial treatment.     

Hand, foot and mouth disease

A bstract — The clinical course of hand, foot, and mouth disease in a girl 3–5 years old is described and its characteristics compared with other short-term illnesses having similar oral lesions. The possibility of increased prevalence associated with groater numbers of private swimming pools is suggested.     

Oral manifestations of viral infections in immunocompromised patients.

Viral infections are a significant cause of morbidity and mortality in immunosuppressed patients. It is clear that diseases or medical treatments that have cytostatic or cytotoxic effects on lymphocytes and disrupt cytokine production or activity increase the risk of viral infections. While the rate of viral infection varies with the nature and degree of immunosuppression, it is clear that reactivation of latent virus is the most important determinant of the types of viral infections most frequently noted in immunosuppressed patients result from the reactivation of latent virus. Herpesviruses account for the majority of oral viral infections. Herpes simplex virus, varicella-zoster virus, and Epstein-Barr virus infections nearly always result from reactivation of latent virus, while cytomegalovirus infections, besides presenting as reactivated disease, are almost as likely to present as a primary infection in susceptible hosts. Other viral pathogens potentially of concern in immunocompromised patients are enteric viruses (adenoviruses and coxsackieviruses), human papillomaviruses, and possibly the recently identified human herpesvirus type 6. Ninety-eight percent of herpes simplex virus lesions are caused by reactivated disease and tend to be characterized by large, very painful ulcerative lesions throughout the mouth. Varicella-zoster virus is also rarely seen as primary infection, and the herpes zoster lesions involving cranial nerves can cause significant morbidity, including postherpetic neuralgia, corneal scarring, cranial nerve palsies, and deafness. Distinct oral ulcerative lesions caused by Epstein-Barr virus and cytomegalovirus have only recently been described in detail and are usually associated with disseminated disease. Oral human papillomavirus lesions are noted as warts and condylomas. The contribution of enteric viruses and human herpesvirus type 6 to oral disease in immunosuppressed patients is yet to be determined.     

HIV-associated periodontitis complicated by necrotizing stomatitis

This report describes a case of HIV-associated periodontitis complicated by necrotizing stomatitis in a homosexual male patient with AIDS. Necrotizing stomatitis is a rapidly progressive ulcerative and necrotic infection that causes massive destruction of the oral tissues and underlying bone. Like HIV periodontitis, it appears to be related to the immune suppression caused by human immunodeficiency virus (HIV) infection; importantly, it may be life threatening. In this case, initial resolution resulted from local debridement in association with metronidazole therapy. Long-term clinical management consisted of monthly professional prophylaxis, good oral hygiene, and daily rinses with chlorhexidine. This case suggests that progressive oral necrotizing infection should be recognized as one element in the spectrum of oral manifestations of HIV infection.     

Is chronic ulcerative stomatitis a variant of lichen planus,or a distinct disease?

Chronic ulcerative stomatitis is an immune‐mediated mucocutaneous disorder characterized clinically by erosions or ulcers. Most cases are limited to the mouth. The histopathological features are non‐specific or mimic those of oral lichen planus, and studies by immunofluorescent microscopy are essential for definitive diagnosis. The defining immunopathogenic mechanism is the binding of IgG to the nuclear protein deltaNp63alpha of keratinocytes in the basal and parabasal cell layers of the oral stratified epithelium. DeltaNp63alpha functions as a regulator of epithelial stem cell activity and as an antiapoptotic agent and regulates the expression of cell‐to‐cell and cell‐to‐basement membrane adhesion molecules. The autoimmune IgG‐deltaNp63alpha interaction is thought to result in damage to the structural attachment of keratinocytes to one another and to the epithelial basement membrane zone and in dysregulation of the cell cycle and apoptosis of basal keratinocytes with the development of erosions or ulcers. The aims of treatment are to suppress the pathogenic immunoinflammatory responses, to prevent local infection and to promote healing. The purpose of this article is to provide a succinct review of the diagnostic, clinical and etiopathogenic features of, and treatment guidelines for chronic ulcerative stomatitis, and to argue that this disease should be regarded as a variant of oral lichen planus, rather than as a distinct entity.     

吸毒人群口腔黏膜疾病的调查

目的 了解吸毒人群口腔卫生习惯、个人嗜好，以及口腔黏膜病的患病情况，以期对此类人群进行早期口腔黏膜病的防治。方法 1999～2000年对厦门戒毒所200名吸毒人员进行口腔健康调查，通过询问及口腔检查了解此类人群口腔黏膜患病情况及与不良嗜好的关系。结果 200人中有125人患有9种口腔黏膜病，患病率最高为尼古丁口炎(27．5％)，其次为口干症(26．6％)，白色水肿(22．5％)。有口腔梅毒病史4例。200人均有吸烟嗜好，饮酒者190人，嗜酒者32人，占16％。结论 吸毒人群是不良嗜好的高发人群，是口腔黏膜病的高发人群，是性病高发人群。     

Recurrent aphthous stomatitis revisited; clinical features,associations, and new association with infant feeding practices?

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common oral mucosal disease, characterized by painful oral ulcerations whose causes is poorly understood. The aim of the present study was to assess the characteristics of patients suffering from RAS. METHODS: Five hundred and twenty-eight consecutive patients attending an Oral Medicine Specialist Clinic in the UK were examined and 143 specific attributes recorded. RESULTS: Patients with a clinical diagnosis of RAS were significantly more often males (P = 0.001) younger (P < 0.001). Significant correlations were observed between a diagnosis of RAS and trauma (P = 0.044), stress (P = 0.006), non-smoking (P < 0.001), a family history (P < 0.001), breast feeding (P = 0.017) and the site in the mouth (buccal, labial, floor of mouth) (P < 0.007). CONCLUSION: This retrospective analysis of patients attending a tertiary referral center provides evidence to support some long held beliefs about RAS, such as young age of onset, sites affected, and associations with trauma, stress, familial history and hormonal changes, while raising a new and interesting decreased incidence with breast feeding.     

Recurrent aphthous stomatitis: current concepts of etiology, pathogenesis and management

Recurrent aphthous stomatitis (RAS) is a common oral disorder, however, despite detailed clinical, immunologic, hematologic and microbiologic investigation, the etiology of RAS remains unknown. At present, topical steroids and antimicrobial mouth rinses are the mainstays of treatment, but there is still no means of preventing recurrence of the oral ulceration.     

Denture stomatitis in the elderly

A study was carried out of 121 elderly edentulous individuals living in institutionalised homes in the Lothian Region, Scotland to determine the prevalence of yeasts and associated oral disease. Clinical examinations found that 65(54%) of the individuals suffered from denture stomatitis, and yeasts were recovered from 51(78%) of these individuals. The main yeasts isolated were Torulopsis glabrata and Candida albicans. Culture of saliva samples produced a slightly higher recovery rate of yeasts compared with swabbing of the floor of mouth and palate. The number of cigarettes smoked per day had a significant positive effect on the presence of denture stomatitis. No difference in disease state was shown between secretors and non-secretors of blood group antigens in saliva. This study demonstrates a significant level of oral mucosal infection in an institutionalised elderly population.     

Effectiveness of health care worker training on the oral health of elderly residents of nursing homes

OBJECTIVES: The aim of this study was to evaluate the effect of a staff training programme on mouth care on the oral health of elderly residents of long-term care institutions. METHODS: Seventy-eight residents of five long-stay institutions were enrolled and underwent a baseline oral health assessment. Staff caring for residents in three of the sites received intensive training in mouth care. This comprised lecture and video material complemented by clinical demonstrations. The oral health of residents at all five sites was reassessed at periods of 3 and 9 months. Staff caring for residents in the remaining two institutions were then provided with mouth care training and all patients were reassessed at 18 months. Statistical analyses were undertaken to examine for significant changes in selected oral health parameters after training, within each group. RESULTS: Oral mucosal disease and oral dryness were common at baseline. The staff training was well received. Following staff training, there was a significant reduction in the number of residents left to undertake their own oral care. There were significant improvements in denture hygiene and a reduction in the number of residents wearing dentures overnight. The prevalence of oral mucosal disease dropped, with significant reductions in angular cheilitis and denture stomatitis. CONCLUSION: This education programme was effective in changing oral health care procedures within long-stay institutions for the elderly, with measurable improvements in oral health of the residents.     

Interferon activity and its characterization in the sera of patients with premalignant lesions arising in oral mucosa

The interferon (IFN) assay of the sera from the 26 patients with premalignant lesions such as lichen planus and leukoplakia arising in oral mucosa was performed by the plaque-reduction assay with vesicular stomatitis virus in FL cells derived from human amniotic membrane. When the serum IFN activity was characterized by acid treatment, significant increase of acid-stable IFN in the patients was found as compared with those in the normal controls. The titers of gamma-like IFN defined by anti-HuIFN-alpha and anti-HuIFN-beta in the sera of patients of 50-79 years age group (n = 17, P less than 0.002) showed a highly significant increase as compared with the relevant normal controls (n = 20). All of the 26 patients were treated with topical administration of HuIFN-beta. When the correlation between prognosis of the disease and titers of serum IFN was investigated by measuring gamma-like IFN and acid-stable IFN in the sera of patients, all of 13 patients with good prognosis after the HuIFN-beta therapy showed significantly decreased levels of gamma-like IFN (P less than 0.01), whereas the serum level of acid-stable IFN after HuIFN-beta therapy showed a significant increase compared to that before the therapy (P less than 0.05). These findings indicate that the endogenous IFN system may be associated with the pathophysiology in patients with the oral mucosal lesions.