HIV/TB co-infection: literature review and report of multiple tuberculosis oral ulcers

Department of Periodontology and Oral Medicine, Medunsa Oral Health Centre Faculty of Dentistry, University of Limpopo, South Africa.
SADJ: journal of the South African Dental Association = tydskrif van die Suid-Afrikaanse Tandheelkundige Vereniging 10/2005; 60(8):330-2, 343.
Source: PubMed


Human immunodeficiency virus/tuberculosis (HIV/TB) co-infected subjects demonstrate enhanced HIV replication and plasma viremia; CD4+ T-cell depletion; morbidity and mortality; and susceptibility to secondary bacterial and fungal infections compared to subjects solely infected with HIV. As the incidence of HIV/TB infection has been increasing, one would have expected to encounter oral lesions of tuberculosis more frequently. However, such oral lesions are uncommon. The lesions usually occur as ulcerations of the tongue. We report an additional case in an HIV/TB co-infected 39 year-old black male, who presented with chronic, painless, multiple oral ulcers, occurring simultaneously on the tongue, bilaterally on the palate and mucosa of the alveolar ridge. Microscopic examination confirmed the presence of chronic necrotizing granulomatous inflammation, with the identification of acid fast bacilli in the affected oral mucosal tissue. Anti-retroviral and anti-tuberculous treatment resulted in the resolution of the oral lesions. Confirmatory histopathological diagnosis following a biopsy is essential to determine the exact nature of chronic oral ulceration in an HIV individual and especially to distinguish between oral squamous cell carcimoma, lymphoma, infection (bacterial or fungal) and non-specific or aphthous type ulceration.

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    • "Subsequently both macrophages and CD4+ T cells secrete a variety of cytokines that in turn recruit and activate lymphocytes and mononuclear phagocytes, which fuse into multi-nucleated giant cells and generate the typical T cell mediated immunoinflammatory granuloma (tubercle) that contains the M.tb microorganisms [1] [13]. Reactive nitric oxide metabolites produced by activated macrophages play an important role in the intracellular neutralization of the bacteria [1] [3]. CD8+ cytotoxic T effector cells recognize M.tb antigens on infected macrophages in the context of MHC class 1 molecules and induce either killing of the intracellular pathogens or lysis of the infected cells by means of granzymes, granulysin or perforin. "
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    ABSTRACT: We present a case of primary oral tuberculosis that led to the diagnosis of HIV infection. Our patient had clinically nonspecific ulcers on the labial mucosa and on the ventral surface of the tongue which were diagnosed as being tuberculous only on histological examination. This raised the suspicion of HIV infection that was subsequently confirmed by blood tests. The oral lesions resolved after 4 weeks of antituberculosis treatment. Some aspects of the pathogenesis of HIV-tuberculosis coinfection are discussed.
    Full-text · Article · Dec 2010 · Pathology Research International
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    • "Mycobacterium tuberculosis species complex (MTC), M. tuberculosis, M. bovis, M. africanum, M. canetti and M. microti, are the etiologic agents of tuberculosis, a major worldwide health problem [1] [2] . The success of these pathogens relies on their ability to inhibit host immune defences and persist in a potentially hostile environment, namely the macrophage phagosome by mechanisms not completely understood [3] . "
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    ABSTRACT: This chapter describes the techniques used to prepare a uniform and consistent mycobacterial culture and for the infection of macrophages in vitro. Here, protocols are described for the achievement of a certain number of single cell bacilli per macrophage. Confocal microscopy in combination with the software ImageJ are highlighted, and these techniques will be correlated with quantification by FACS and confirmed by colony forming units (CFU) the classical method to validate the intracellular survival of Mycobacterium tuberculosis. Conventional CFU for quantification of intracellular slow growing mycobacteria is labour-intensive, with incubation requirements that can take up to several weeks. New alternatives and fast methods are required for a rapid assessment of the immune response as well to test new antibacterial drugs in high-throughput screens.
    Full-text · Chapter · Dec 2010
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    ABSTRACT: SUMMARY LIP TUBERCULOSIS SECONDARY TO PULMONARY TUBERCULOSIS Extrapulmonary tuberculosis occurs in 10-15% of tuberculosis (TB) cases. Oral cavity involvement is usually develops se- condary to pulmonary TB and constitutes approximately 0.2-1.5% of this percentage. In the oral cavity region, tongue is the most frequently affected organ. Lips, cheeks, soft palate, uvula, and gingiva may also be affected by TB. In this study, a case of upper lip TB, secondary to pulmonary TB is presented. A 60 year old-female patient was admitted to our clinic with a history of 6 to 7 months of coughing, sputum production, weight loss, fever, swallen lip and a painful ulce- ration in the upper lip mucosa. There was no previous TB history in patient and her family background. The biopsy re- port of the upper lip lesion showed presence of a granulotamous inflammation. In sputum ARB smear, TB bacilli were identified rarely and the sputum culture was positive. The TB treatment regimen applied to the patient included isoni- azid, rifampicin, ethambutol and pyrazinamide. In the follow up period of 3 months, ulcerated lesion in the upper lip improved with scar formation and regression was seen in the lung parenchyma.
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