oralmanifestionofHIV

Oral Manifestations of HIVHIV口腔表征,Yang Sai & & Zhang Jiao,Aesthetic Medicine & Skin DepartmentGuangdong Provincial Dermatology Hospital,Oral Manifestations of HIV HIV口腔表征,Significance,HIV口腔表征的意义,HIV口腔表征的分类,Classification,Management HIV口腔表征的治疗,Early clinical features of HIV infection,Greenspan JS, et al. Oral Surg Oral Med Oral Pathol 1992;73:142-4.Agbelusi GA，et.al. Oral Dis; 11: 370-373,感染HIV病毒的早期临床表现,90% of HIV patients 1 oral manifestation,Strong indication of the presence of HIV infection,Markers for immune deterioration, disease progression, prognosis,90%以上HIV患者一个口腔表征,口腔表征强烈提示感染了HIV,免疫受损和疾病进展、预后差的标志,Significance of oral lesions of HIV,Classification of oral lesions of HIV,Adapted with permission from Greenspan D, Greenspan JS. Oral manifestations of HIV infection. AIDS Clin Care 1997;9:29-33.,真菌感染 ： 念珠菌病 伪膜性念珠菌病 红斑性念珠菌病 口角炎 组织胞浆菌病 隐球菌病,病毒感染： 单纯疱疹 带状疱疹 人类乳头瘤病毒感染 巨细胞病毒性溃疡 毛状白斑,细菌感染：线性牙龈红斑 坏死溃疡性牙周炎 胞内鸟分支杆菌感染 杆菌性上皮样血管瘤病,肿瘤性：卡波西肉瘤 非霍奇金淋巴瘤,其他： 复发性阿弗他溃疡 免疫性血小板减少性紫癜 艾滋病唾液腺疾病,classification,clinical features,Diagnosis,Treatment,Candidiasis（念珠菌病）,Most common intra-oral lesion 最常见的口腔内皮损 Pathogen： Candida albicans 白色念珠菌 Non-albicans species 非白色念珠菌,Four types：Pseudomembraneous candidiasis ：5570% 伪膜性念珠菌病Erythematous candidiasis ：2650% 红斑性念珠菌病Angular cheilitis ： 01.7% 口角炎Hyperplastic candidiasis 01% 增殖性念珠菌病,Candidiasis（念珠菌病）,clinical features,classification,Treatment,Symptoms（临床表现）： Creamy , white plaques Mucosa may appear red when plaque is removed,Pseudomembraneous candidiasis 伪膜性念珠菌病,Predilection site（好发部位）： buccal mucosa, palate & tongue 颊粘膜，颚，舌,Diagnosis,Pseudomembranous candidiasis 伪膜性念珠菌病,Palate 颚,creamy whiteremovable,奶油状 白色可去除,Palate,Tongue舌,Pharynx（咽部）,Pseudomembranous candidiasis 伪膜性念珠菌病,clinical features,classification,Treatment,Symptoms： flat, red patches burning mouth and change of taste（味觉改变）,Erythematous candidiasis 红斑性念珠菌病,Predilection site： palate, dorsal of the tongue, buccal mucosa 上颚、舌背、颊粘膜,Diagnosis,Erythematous candidiasis 红斑性念珠菌病,FlatRedVaring size,扁平红色大小不等,Erythematous candidiasis硬腭红斑性念珠菌病,Pseudomembranous and erythematous candidiasis 伪膜性和红斑性念珠菌病,Erythematous candidiasis,Pseudomembranous candidiasis,Pseudomembranous and erythematous candidiasis 伪膜性和红斑性念珠菌病,clinical features,classification,Treatment,Symptoms： redness, ulceration(溃疡), fissuring(裂隙) painful,Angular cheilitis 口角炎,Predilection site： at the corners of the mouth (口角),Diagnosis,Cornerofthemouth（口角）,Angular cheilitis口角炎,Angular cheilitis口角炎,Pseudomembranous candidiasis & Angular cheilitis 伪膜性念珠菌病和口角炎,clinical features,classification,Treatment,Symptoms： White（hyperkeratosis） and hyperplastic cannot be removed by scraping （难剥脱）,Hyperplastic Candidiasis（增殖性念珠菌病）,Diagnosis,Hyperplastic candidiasis增生性皮损,Diagnosis,classification,clinical features,Treatment,Typical clinical appearance（典型临床表现）Grams stainsmear （涂片示：G+）Fungal cultures（真菌培养）Biopsy （活检）,Candidiasis（念珠菌病）,Treatment,classification,clinical features,Diagnosis,Topical:Lozenges（含片）: Nystatin 制霉菌素 Amphotericin 两性霉素Mouthwash：Chlorhexidine 复方氯己定含漱液,Candidiasis（念珠菌病）,Treatment,classification,clinical features,Diagnosis,Systemic：Fluconazole（氟康唑）: 150mg daily (Diflucan)Miconazole（咪康唑） : 250mg dailyKetoconazole（酮康唑）: 200mg daily Itraconazole（伊曲康唑）: 200mg daily Duration 2 weeks or more,Candidiasis（念珠菌病）,Diagnosis,Treatment,Herpes Simplex（单纯疱疹）,Pathogen（病原体）: HSV1 & 2Symptoms： clusters of painful small vesiclesPredilection site： hard palate, gingiva, lips 硬腭、牙龈、唇红缘,classification,clinical features,Oral Manifestations of HIV,Diagnosis,classification,clinical features,Treatment,Clinical appearance Rising antibody titersCulturePCR,Oral Manifestations of HIV,Treatment,classification,clinical features,Diagnosis,Aciclovir（阿昔洛韦）ValaciclovirFamciclovir,clinical features,classification,Diagnosis,Treatment,Pathogen： Varicella zoster virusSymptoms： unilateral multiple vesicles 单侧多发水疱Predilection site： Maxillary and/or mandibular branches of the trigeminal nerve (V) 三叉神经上颌和/或下颌支,Herpes Zoster （带状疱疹）,Treatment,classification,clinical features,Diagnosis,Aciclovir（阿昔洛韦） ：Valaciclovir or famciclovir（伐昔洛韦或泛昔洛韦）Antibiotics（抗生素） Analgesics（止痛药）,Herpes Zoster （带状疱疹）,clinical features,classification,Diagnosis,Treatment,Human Papillomavirus (HPV) Lesions 人乳头瘤病毒感染,Oral Wart唇粘膜病毒疣,labial mucosa 唇粘膜,clinical features,classification,Diagnosis,Treatment,Pathogen：Epstein Barr virus (EBV) （EB病毒）Symptoms：Asymptomatic, nonmovable, white, vertical, corrugated lesion 无症状，或难去除的白色、垂直、褶皱样皮损Predilection site： on the lateral margins of the tongue 舌侧缘,Oral Hairy Leukoplakia（毛状白斑）,Hairy leukoplakia 褶皱样毛状白斑,