Oral Manifestations of Immunodeficiency

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Immunodeficie ncies and their oral manifestation s Done by : Mohammad salah qrea 5 th year And presented to Dr. fahed habash

Transcript of Oral Manifestations of Immunodeficiency

Page 1: Oral Manifestations of Immunodeficiency

Immunodeficiencies and their

oral manifestations

Done by :Mohammad salah qrea

5th yearAnd presented toDr. fahed habash

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Immunity • A complex interaction of certain types of

cells.

• Innate immunity with born vs. adaptive immunity along time.

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Innate immunity

Phagocytes

Skin Complement system

Interferons

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IMD disorders

• Part of the body's immune system is missing or defective.

• impairing the body's ability to fight infections.

• As a result, the person with an IMD will have frequent infections that are generally more severe and last longer than usual.

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Types of IMDs

• Primary or congenital ID.

• Acquired ID.

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Primary IMD

• Congenital disorder of one or more of immune system.

• T and B cell defects.

• Phagocytes defects.

• IgA deficiency.

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Acquired IMD• Infections (HIV, chicken pox, German

measles, measles, tuberculosis, chronic hepatitis, lupus, bacterial and fungal infections).

• Malnutrition (vitamins, iron, and zinc).

• Some cancers.

• Some drugs.

• Some metabolic diseases.

• Alcoholism.

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Prevention of AIMDs

• Good nutrition.

• Avoiding responsible infections.

• And safe sex “ for AIDS prevention,

IF YOU DON’T KNOW YOUR PARTNER USE CONDOM”

• Illegal intravenous drugs.

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Oral manifestations of IMD disorders

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JANE C. ATKINSON, D.D.S., ANNE O’CONNELL, B.DENT.SC., M.SC. and DORON AFRAMIAN, D.M.D., M.SC.

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General rule

T-cell deficiencyCandidal infections + herpetic infections

B-cell deficiency Bacterial infections

Phagocyte deficiency

Periodontitis + candidal

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Severe pseudomembranous candidiasis in a young man with Job’s syndrome.

T- CELL DEFICENCY

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phagocyte function

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leukocyte adhesion deficiency

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leukocyte adhesion deficiency

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Treatment modalities

• Bone marrow transplantation.

• Prophylactic antibiotic regimens.

• Aggressive preventive dental care.

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Secondary immunodeficiency oral manifestations

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Acquired immunodeficiency syndrome

Causative agent: HIV

Target cells: CD4+ T cells, monocytes, macrophages, dendritic cells, etc.

Importance of gp120

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• Diagnosis: detection of viral Ag, anti-viral Ab

• Prognosis: CD4/CD8 ratio, skin tests (DTH), Lymphocyte transformation test

• Treatment: • 1. Treatment of microbial

infections• 2. Anti-viral drugs • 3. Immunorestoration: BM

transplantation, Ig injections, cytokines

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Oral manifestations of

AIDS

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• Fungal Candidiasis     Pseudomembranous  Erythematous     Angular cheilitis Histoplasmosis Cryptococcosis.

• Viral Herpes simplex Herpes zoster Human papillomavirus lesions Cytomegalovirus ulcers Hairy leukoplakia

• Bacterial Linear gingival erythema Necrotizing ulcerative Periodontitis Mycobacterium avium complex Bacillary angiomatosis

• Neoplastic Kaposi's sarcoma Non-Hodgkin's lymphoma

• Other Recurrent aphthous ulcers Immune thrombocytopenic purpura HIV salivary gland disease.

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CANDIDIASIS• Exfoliative cytology, biopsy for

diagnosis.

• TREATED BY:• Topical antifungal (e.g., nystatin [Mycostatin].• Suspension, clotrimazole [Mycelex] troches,

fluconazole [Diflucan] suspension.

• Or systemic antifungal (e.g., fluconazole, ketoconazole [Nizoral], itraconazole [Sporanox])

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Pseudomembranous candidiasis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Median rhomboid glossitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Angular cheilitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Histoplasmosis

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Oral thrush

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Recurrent aphthous stomatitis• Yellowish white pseudomembrane

surrounded by erythematous zone.

• Treated by:• Fluocinonide gel (Lidex) or triamcinolone

acetonide (Kenalog in Orabase), amlexanox paste (Aphthasol), chlorhexidine gluconate (Peridex) mouthwash.

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Recurrent aphthous stomatitis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Multiple canker sores

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Erythema migrans

• Migrating, central erythema surrounded by white- to-yellow elevated borders; typically on tongue.

• TREATED BY:

• Symptomatic cases may be treated with topical corticosteroids, zinc supplements, or topical anesthetic rinses.

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Erythema migrans

waxes and wanes

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Hairy tongue

• Elongated filiform papillae.

• Predisposing factors, smoking, poor oral hygiene, antibiotics and psychotropics.

• TREATED BY:

• Regular tongue brushing or scraping; avoidance of predisposing factors

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Hairy tongue

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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VIRUSES

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Recurrent herpes labialis

• Prodrome, 12 to 36 hours, rupture vesicles.

• Reactivation triggers: ultraviolet light, trauma, fatigue, stress, menstruation.

• TRAETED BY:• Topical agents include 1% penciclovir cream

(Denavir)• Systemic agents (e.g., acyclovir [Zovirax],

valacyclovir [Valtrex], famciclovir [Famvir]) are most effective if initiated during prodrome.

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Recurrent herpes labialis

WANDA C. GONSALVES, MEDICAL UNIVERSITY OF SOUTH CAROLINA, CHARLESTON, SOUTH CAROLINA

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Herpes zoster

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Human papilloma virus

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Cytomegalovirus

• Ulcers confused with aphthous ulcers.

• necrotizing ulcerative periodontitis and lymphoma.

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Kaposi's Sarcoma

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Lymphoma

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Idiopathic Thrombocytopenic Purpura

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And thanks