Maxillofacial manifestations of acquired immunodeficiency syndrome

46 cases of acquired immunodeficiency syndrome permit the authors to detail the particular aspects of the oral and facial lesions in AIDS. In patients at risk, a lymphadenopathic syndrome is thought to represent a prodromic phase of the illness. The authors insist upon the differences between the classic Kaposi's sarcoma and that associated with the AIDS (mean age and initial sites of tumor). One third of these sarcomas is completed by a digestive candidiasis. The review of the literature reveals squamous cell carcinoma and Burkitt's lymphoma with the AIDS. We must be aware of early diagnosis and transmission factors in the individuals at risk with tumors and opportunistic infection.     

Sinus and nasal manifestations of the acquired immunodeficiency syndrome

The AIDS epidemic has made previously uncommon infectious diseases and tumors commonplace in HIV-infected individuals. In this article we discuss specific cases of various infections and tumors of the sinonasal tract. Several of these diseases may be the presenting signs of HIV-seropositivity and AIDS. As a result, the clinician first to see such patients must be aware of the diagnosis of these diseases and tumors so that proper testing and treatment may ensue.     

Pathologic manifestations of acquired immunodeficiency syndrome in the head and neck

Various diseases of the head and neck that appear in association with AIDS have been delineated. These diseases may be the initial manifestations of AIDS or may be part of systemic involvement following HIV infection. Both clinicians and pathologists must be aware of the protean manifestations of AIDS in order to establish an accurate and complete diagnosis. Once the diagnosis is established, therapy, which may potentially enhance the quality of life of the infected individual, can be initiated.     

Head and neck manifestations of the acquired immunodeficiency syndrome in children

The head-and-neck manifestations of HIV infection in children are very different from those in the adult population. Recurrent bacterial and viral infections are common manifestations, and persistent sinusitis or otitis media should make the otolaryngologist suspicious of HIV infection if the child has been exposed to the virus. Other common problems include mucocutaneous and esophageal candidiasis, recurrent herpes I and II and zoster infections, parotid swelling, and cervical lymphadeopathy.     

Otorhinolaryngologic manifestations in Chiari malformation

The Chiari malformation causes herniation of the cerebellar amygdalae through the foramen magnum, resulting in the descent of the brain stem and/or traction on the lower cranial pairs. It is important for otolaryngologists to recognize Chiari malformations as part of the differential diagnosis of balance disorders, because patients may initially exhibit symptoms related to the vestibular system, including ataxia, nystagmus, or vertigo. We report 2 cases.     

Otolaryngologic and head and neck manifestations of acquired immunodeficiency syndrome (AIDS)

Patients with acquired immune deficiency syndrome (AIDS) frequently present with signs and symptoms referable to the head and neck. Three hundred ninety-nine patients with AIDS presented at the University of California, San Francisco and its affiliated hospitals from 1980 to April 1984. One hundred sixty-five patients (41%) with AIDS presented with, or had on initial evaluation, head and neck manifestations. Of that group, 58 (35%) had cutaneous, oral, and pharyngeal lesions of Kaposi's sarcoma; 51 (31%) had oral, pharyngeal, esophageal, or laryngeal candidiasis; 36 (22%) had chronic cough and shortness of breath; 13 (8%) had rapidly enlarging neck masses; and 7 (4%) had herpes simplex lesions. With the increasing number of cases of AIDS it is important for the otolaryngologist to be aware of these presentations.     

Otorhinolaryngologic manifestations of masked mono- or oligosymptomatic depressions

Symptoms of masked depression are often localised in the otorhinolaryngeal field. Headache, facial pain, dysphagia, burning sensations in the tongue, tinnitus, vertigo and voice and respiratory disorders were frequent complaints of 48 patients at our out-patient clinic between 1980 and 1985. After careful exclusion of organic disease, they proved to be due to endogenous depressive disorder. An increase in the number of such cases has been noted. One patient is described as an example of the problems of diagnosis.     

Aspergillus otomastoiditis in acquired immunodeficiency syndrome

The diagnosis and therapy of fungal infection in the paranasal sinuses of the immunocompromised host, including those with acquired immunodeficiency syndrome (AIDS), has been discussed in recent literature. However, only limited reports have been presented on otologic infection in AIDS patients. A review of 26 such patients with otologic disease included no cases of fungal otopathology. Our recent experience with two patients with Aspergillus otomastoiditis is presented. The extent of fungal infection in these cases was early-stage in one patient and late-stage in the other. The case histories, management, and outcomes are presented to provide insight into this previously unreported complication of AIDS.     

Otologic disease in the acquired immunodeficiency syndrome

It appears that true otologic manifestations of AIDS are rare and that incidental otologic disease associated with AIDS is more common. A review of the literature revealed that otitis externa, acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media with cholesteatoma, and herpes zoster oticus may all represent incidental otologic disease occurring in patients with AIDS. Chronic otitis media without cholesteatoma (P carinii-infected aural polyps), sensorineural hearing loss, acceleration of otosyphilis from the latent stage, and development of Kaposi's sarcoma of the external auricle or nasopharynx may represent true otologic manifestations of AIDS.     

Aspergillus mastoiditis in acquired immunodeficiency syndrome.

OBJECTIVE: This study aimed to analyze the clinical presentation, diagnosis, management, and results of treatment in a series of three patients with acquired immunodeficiency syndrome (AIDS) in whom Aspergillus mastoiditis developed. This study also aimed to compare these aspects of Aspergillus mastoiditis in patients with AIDS with three additional cases present in the current literature. A classification system for fungal infections of the ear and temporal bone is proposed. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at multiple tertiary referral centers. PATIENTS: Three individuals with diagnosed AIDS and mastoiditis resulting from culture-proven Aspergillus were studied. INTERVENTION: Patients were treated with both medical and surgical methods including local and systemic antimicrobial/antifungal agents and mastoidectomy. MAIN OUTCOME MEASURES: These measures included return of facial nerve function, control/resolution of disease, and survival. RESULTS: All three patients in this series initially presented with otalgia and otorrhea and intact facial nerve function. Facial nerve paresis developed in all patients between 5 and 12 weeks after initial symptoms. Paresis uniformly improved or resolved after mastoidectomy. Two patients treated with systemic antifungal therapy and prompt surgical debridement after development of facial palsy had full resolution of infection. One patient had full recovery of facial paresis and the other had partial recovery. The third patient was lost to follow-up after initial treatment with antimicrobials and surgery and died 3 months later without a clear etiology. CONCLUSIONS: Aspergillus mastoiditis is an unusual infection in patients with AIDS. Because of its rarity, fungal mastoiditis in immunocompromised individuals can result in a significant delay in diagnosis and treatment. The decision between conservative antimicrobial therapy and aggressive surgical treatment also can present a therapeutic challenge in the management of these life-threatening infections, especially in patients with existing immunodeficiency and illness. Early surgical debridement followed by antimicrobial therapy may be life preserving in this patient population.     

Nasal histoplasmosis in the acquired immunodeficiency syndrome

Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in Brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegener's granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.     

Head and neck presentations of acquired immunodeficiency syndrome

Since December 1980, over 2,000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 72 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms and laboratory values. Symptoms tended to be non-specific and most often resembled an upper respiratory infection. Over 95% of the patients presented with either diffuse adenopathy, oral or facial lesions consistent with Kaposi's sarcoma, white oral lesions, or anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia and anemia. The in-hospital mortality rate was 26%. The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported in order to alert the otolaryngologic community to this entity.     

Otorhinolaryngologic aspects of Adamadiades-Beh?et syndrome

Beh?et's syndrome is a rare, progressive and systemic disease. It causes scrotal ulcers, bilateral conjunctivitis and recurrent oral aphthous ulcers. Genetic factors, mechanisms of autoimmunity as well as environmental factors interact in the etiology of the syndrome, according to the most recently developed hypotheses. The diagnostic and therapeutic traps which might appear during the contemporary O.R.L. practice are presented here, considering the oral ulcers of a frequently common appearance and especially the dysphagia which might be confused with many other clinicopathological entities.     

Patient care issues in the acquired immunodeficiency syndrome

The AIDS epidemic challenges practitioners to examine all aspects of the patient-physician relationship, including forms of interpersonal communication, the scope of physician responsibility, and the influence of the patient care experience on the physician's own psychological well-being. The burden of dealing with these challenges is exacerbated by the almost universally fatal outcome of this disease. Fortunately, there are many sources of information and assistance available to clinicians and their patients.     

Sinusitis in patients with the acquired immunodeficiency syndrome

AIDS patients suffer from multiple immunologic deficits involving humoral and cell-mediated immunity. The humoral deficits place the patient at a higher risk for recurrent bacterial infection than the general population. Sinusitis has been recognized to be a more common problem in AIDS patients than was previously appreciated. A high level of clinical suspicion is important, especially in patients with fever, headaches, or symptoms referrable to the upper respiratory tract. Should sinusitis be demonstrated, aggressive medical management is indicated. Surgical drainage is indicated in patients who worsen in spite of appropriate medical therapy, patients who have signs of systemic toxicity from the sinusitis that do not rapidly improve, and patients with recurrent sinusitis. Further studies are indicated to determine the true incidence of sinusitis in the AIDS population and to elucidate further the immunologic defects involved.     

Invasive fungal sinusitis in the acquired immunodeficiency syndrome

Invasive fungal sinusitis can present as either an indolent or fulminant process that primarily affects immunocompromised individuals. In this article, the clinical characteristics of four cases of invasive fungal sinusitis in patients with AIDS are analyzed and 22 additional previously reported cases in the literature are reviewed. In addition to HIV infection, other variables common to these cases include facial pain or headache out of proportion to clinical or radiographic findings, CD4 lymphocyte count less than 50 cells/mm(3), absolute neutrophil count less than 1,000 cells/mm(3), subtle radiographic evidence suggesting invasion and an indolent clinical course of the invasive infection. The most common pathogen detected was Aspergillus fumigatus. Maintaining a high index of suspicion, critically assessing these clinical findings, and prudently reviewing CT scans may facilitate early diagnosis and prompt intervention in these patients.     

艾滋病喉部表现一例

艾滋病(acquired immunodeficiency syndrome,ATDS)是由人免疫缺陷病毒(human immunodeficiency virus,HIV)感染引起的严重传染病.我国自1985年检出首例AIDS患者以来,HIV感染及AIDS发病率呈逐年上升趋势,尤其是近年来其流行在中国已进入快速增长期[1].我科发现国人艾滋病喉部表现1例,现报道如下.     

Lymphoma of the tympanic membrane in acquired immunodeficiency syndrome

Lymphoproliferative disease is more common in the immunocompromised host and can occur at unusual sites. Lymphomas of the temporal bone are rare. We present the first case of a large B-cell Lymphoma of the tympanic membrane in a patient with acquired immunodeficiency syndrome. The tympanic membrane is a site rich with antigen-presenting dendritic cells that may play an etiologic role in neoplastic transformation at this site. The staging, treatment and prognosis of an immunocompromised host afflicted with lymphoma is discussed. Future directions in improving survival include better therapy for the primary viral infection and less toxic therapy for the lymphoma.     

Toxicity of oral radiotherapy in patients with acquired immunodeficiency syndrome

Although radiotherapy is a standard form of management of head and neck tumors, treatment of the oral cavity in patients who have the acquired immunodeficiency syndrome has produced unacceptable toxicity. Five such patients are described as a warning of enhanced toxicity of oral radiotherapy in this patient population.