oral-manifestion-of-HIV..ppt

Oral Manifestations of HIVOral Manifestations of HIVHIVHIV口腔表征口腔表征 Yang Sai&Zhang Jiao Yang Sai&Zhang JiaoAesthetic Medicine&Skin DepartmentAesthetic Medicine&Skin DepartmentGuangdong Provincial Dermatology HospitalGuangdong Provincial Dermatology Hospital Oral Manifestations of HIV HIVOral Manifestations of HIV HIV口腔表征口腔表征 Significance Significance HIV HIV口腔表征的意义口腔表征的意义 HIV HIV口腔表征的分类口腔表征的分类 Classification Classification Management HIVManagement HIV口腔表征的治疗口腔表征的治疗 Early clinical features of HIV infectionEarly clinical features of HIV infectionGreenspan JS,et al.Oral Surg Oral Med Oral Pathol Greenspan JS,et al.Oral Surg Oral Med Oral Pathol 1992;73:142-4.1992;73:142-4.Agbelusi GAAgbelusi GA，et.al.Oral Dis;11:370-373et.al.Oral Dis;11:370-373感染感染HIVHIV病毒的早期临床表现病毒的早期临床表现 90%of HIV patients 90%of HIV patients 1 oral manifestation 1 oral manifestation Strong indication of the presence of HIV infectionStrong indication of the presence of HIV infectionMarkers for immune deterioration,disease progression,Markers for immune deterioration,disease progression,prognosisprognosis 90%90%以上以上HIVHIV患者患者一个口腔表征一个口腔表征口腔表征强烈提示感染了口腔表征强烈提示感染了HIVHIV免疫受损和疾病进展、预后差的标志免疫受损和疾病进展、预后差的标志 Significance of oral lesions of HIVSignificance of oral lesions of HIVClassification of oral lesions of HIVClassification of oral lesions of HIVAdapted with permission from Greenspan D,Greenspan JS.Adapted with permission from Greenspan D,Greenspan JS.Oral manifestations of HIV infection.AIDS Clin Care Oral manifestations of HIV infection.AIDS Clin Care 1997;9:29-33.1997;9:29-33.真菌感染真菌感染 ：念珠菌病念珠菌病 伪膜伪膜性念珠菌病性念珠菌病 红斑红斑性念珠菌病性念珠菌病 口角口角炎炎 组织胞浆菌病组织胞浆菌病 隐球菌病隐球菌病 病毒感染：病毒感染：单纯疱疹单纯疱疹 带状疱带状疱疹疹 人类乳人类乳头瘤病毒感染头瘤病毒感染 巨细胞巨细胞病毒性溃疡病毒性溃疡 毛状白毛状白斑斑细菌感染：线性牙龈红斑细菌感染：线性牙龈红斑 坏死溃坏死溃疡性牙周炎疡性牙周炎 胞内鸟胞内鸟分支杆菌感染分支杆菌感染 杆菌性杆菌性上皮样血管瘤病上皮样血管瘤病肿瘤性：卡波西肉瘤肿瘤性：卡波西肉瘤 非霍奇金非霍奇金淋巴瘤淋巴瘤HPVHPVCMVCMV其他：其他：复发性阿弗他溃疡复发性阿弗他溃疡 免疫性血小板减少免疫性血小板减少性紫癜性紫癜 艾滋病唾液腺疾病艾滋病唾液腺疾病classificationclassification clinical features clinical featuresDiagnosisDiagnosisTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersCandidiasisCandidiasis（念珠菌病）（念珠菌病）Most common intra-oral lesion Most common intra-oral lesion 最常见的口腔内皮损最常见的口腔内皮损 Pathogen Pathogen：Candida albicans Candida albicans 白色念珠菌白色念珠菌 Non-albicans species Non-albicans species 非白色念珠菌非白色念珠菌Four typesFour types：Pseudomembraneous candidiasisPseudomembraneous candidiasis ：5570%5570%伪膜性念珠菌病伪膜性念珠菌病Erythematous candidiasis Erythematous candidiasis：2650%2650%红斑性念珠菌病红斑性念珠菌病Angular cheilitis Angular cheilitis：01.7%01.7%口角炎口角炎Hyperplastic candidiasis 01%Hyperplastic candidiasis 01%增殖性念珠菌病增殖性念珠菌病CandidiasisCandidiasis（念珠菌病）（念珠菌病）clinical featuresclinical features classification classificationTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersSymptomsSymptoms（临床表现）：（临床表现）：Creamy,white plaques Creamy,white plaques Mucosa may appear red when plaque Mucosa may appear red when plaque is removed is removedPseudomembraneous candidiasis Pseudomembraneous candidiasis 伪膜性念珠菌病伪膜性念珠菌病Predilection sitePredilection site（好发部位）：（好发部位）：buccal mucosa,palate&tongue buccal mucosa,palate&tongue 颊粘膜，颚，舌颊粘膜，颚，舌 DiagnosisDiagnosisPseudomembranous candidiasis Pseudomembranous candidiasis 伪膜性念珠菌病伪膜性念珠菌病PalatePalate 颚颚ucreamy creamy uwhitewhiteuremovableremovableu奶油状奶油状 u白色白色u可去除可去除 PalatePalateTongueTongue舌舌 Pharynx Pharynx（咽部）（咽部）Pseudomembranous candidiasis Pseudomembranous candidiasis 伪膜性念珠菌病伪膜性念珠菌病clinical featuresclinical features classification classificationTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersSymptomsSymptoms：flat,red patches flat,red patches burning mouth and change of taste burning mouth and change of taste（味觉改变）（味觉改变）Erythematous candidiasisErythematous candidiasis 红斑性念珠菌病红斑性念珠菌病Predilection sitePredilection site：palate,dorsal of the tongue,buccal mucosa palate,dorsal of the tongue,buccal mucosa 上颚、舌背、颊粘膜上颚、舌背、颊粘膜DiagnosisDiagnosis Erythematous candidiasis Erythematous candidiasis 红斑性念珠菌病红斑性念珠菌病uFlatFlatuRedReduVaring Varing sizesizeu扁平扁平u红色红色u大小不等大小不等 Erythematous candidiasis Erythematous candidiasis硬腭红斑性念珠菌病硬腭红斑性念珠菌病Pseudomembranous and erythematous candidiasisPseudomembranous and erythematous candidiasis 伪膜性和红斑性念珠菌病伪膜性和红斑性念珠菌病Erythematous Erythematous candidiasiscandidiasisPseudomembranous Pseudomembranous candidiasiscandidiasisPseudomembranous and erythematous candidiasis Pseudomembranous and erythematous candidiasis 伪膜性和红斑性念珠菌病伪膜性和红斑性念珠菌病clinical featuresclinical features classification classificationTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersSymptomsSymptoms：redness,ulceration(redness,ulceration(溃疡溃疡),fissuring(),fissuring(裂隙裂隙)painful painful Angular cheilitis Angular cheilitis 口角炎口角炎 Predilection sitePredilection site：at the corners of the mouth(at the corners of the mouth(口角口角)DiagnosisDiagnosisCornerCornerofofthethem mouthouth（口角）（口角）Angular cheilitisAngular cheilitis口角炎口角炎Angular cheilitisAngular cheilitis口角炎口角炎Pseudomembranous candidiasis&Angular cheilitisPseudomembranous candidiasis&Angular cheilitis 伪膜性念珠菌病和口角炎伪膜性念珠菌病和口角炎clinical featuresclinical features classification classificationTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersSymptomsSymptoms：White White（hyperkeratosishyperkeratosis）and and hyperplastichyperplastic cannot be removed by scraping cannot be removed by scraping（难剥脱）（难剥脱）Hyperplastic CandidiasisHyperplastic Candidiasis（增殖性念珠菌病）（增殖性念珠菌病）DiagnosisDiagnosisHyperplastic candidiasisHyperplastic candidiasis增生性皮损增生性皮损DiagnosisDiagnosis classification classification clinical featuresclinical featuresTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersTypical clinical appearanceTypical clinical appearance（典型临床表现）（典型临床表现）GramGrams stains stainsmear smear（涂片示：（涂片示：G+G+）Fungal culturesFungal cultures（真菌培养）（真菌培养）Biopsy Biopsy （活检）（活检）CandidiasisCandidiasis（念珠菌病）（念珠菌病）TreatmentTreatment classification classification clinical featuresclinical featuresDiagnosisDiagnosis FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersTopical:Topical:LozengesLozenges（含片）（含片）:Nystatin :Nystatin 制霉菌素制霉菌素 Amphotericin Amphotericin 两性霉素两性霉素MouthwashMouthwash：Chlorhexidine Chlorhexidine 复方氯己定含漱液复方氯己定含漱液CandidiasisCandidiasis（念珠菌病）（念珠菌病）TreatmentTreatment classification classification clinical featuresclinical featuresDiagnosisDiagnosis FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersSystemicSystemic：FluconazoleFluconazole（氟康唑）（氟康唑）:150mg daily(Diflucan):150mg daily(Diflucan)MiconazoleMiconazole（咪康唑）（咪康唑）:250mg daily:250mg dailyKetoconazoleKetoconazole（酮康唑）（酮康唑）:200mg daily:200mg daily ItraconazoleItraconazole（伊曲康唑）（伊曲康唑）:200mg daily:200mg daily Duration 2 weeks or more Duration 2 weeks or moreCandidiasisCandidiasis（念珠菌病）（念珠菌病）DiagnosisDiagnosisTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersHerpes SimplexHerpes Simplex（单纯疱疹）（单纯疱疹）PathogenPathogen（病原体）（病原体）:HSV1&2:HSV1&2SymptomsSymptoms：clusters of painful small vesicles clusters of painful small vesiclesPredilection sitePredilection site：hard palate,gingiva,lips hard palate,gingiva,lips 硬腭、牙龈、唇红缘硬腭、牙龈、唇红缘 classification classificationclinical featuresclinical features Oral Manifestations of HIVOral Manifestations of HIVDiagnosisDiagnosis classification classification clinical featuresclinical featuresTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersClinical appearance Clinical appearance Rising antibody titersRising antibody titersCultureCulturePCRPCR Oral Manifestations of HIVOral Manifestations of HIVTreatmentTreatment classification classification clinical featuresclinical featuresDiagnosisDiagnosis AciclovirAciclovir（阿昔洛韦）（阿昔洛韦）ValaciclovirValaciclovirFamciclovirFamciclovirFUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS Othersclinical featuresclinical features classification classificationDiagnosisDiagnosisTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS Others PathogenPathogen：Varicella zoster virus Varicella zoster virusSymptomsSymptoms：unilateral multiple vesicles unilateral multiple vesicles 单侧多发水疱单侧多发水疱Predilection sitePredilection site：Maxillary and/or mandibular branches Maxillary and/or mandibular branches of the trigeminal nerve(V)of the trigeminal nerve(V)三叉神经上颌和三叉神经上颌和/或下颌支或下颌支Herpes Zoster Herpes Zoster（带状疱疹）（带状疱疹）TreatmentTreatment classification classification clinical featuresclinical featuresDiagnosisDiagnosis AciclovirAciclovir（阿昔洛韦）（阿昔洛韦）：Valaciclovir or famciclovirValaciclovir or famciclovir（伐昔洛韦或泛昔（伐昔洛韦或泛昔洛韦）洛韦）AntibioticsAntibiotics（抗生素）（抗生素）AnalgesicsAnalgesics（止痛药）（止痛药）FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersHerpes Zoster Herpes Zoster（带状疱疹）（带状疱疹）clinical featuresclinical features classification classificationDiagnosisDiagnosisTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersHuman Papillomavirus(HPV)Lesions Human Papillomavirus(HPV)Lesions 人乳头瘤病毒感染人乳头瘤病毒感染Oral WartOral Wart唇粘膜病毒疣唇粘膜病毒疣labial mucosalabial mucosa 唇粘膜唇粘膜clinical featuresclinical features classification classificationDiagnosisDiagnosisTreatmentTreatment FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS Others PathogenPathogen：Epstein Barr virus(EBV)Epstein Barr virus(EBV)（EBEB病毒）病毒）SymptomsSymptoms：Asymptomatic,nonmovable,white,Asymptomatic,nonmovable,white,vertical,corrugated lesionvertical,corrugated lesion 无症状，或难去除的白色、垂直、褶皱样皮损无症状，或难去除的白色、垂直、褶皱样皮损Predilection sitePredilection site：on the lateral margins of on the lateral margins of the tongue the tongue 舌侧缘舌侧缘 Oral Hairy LeukoplakiaOral Hairy Leukoplakia（毛状白斑）（毛状白斑）Hairy leukoplakiaHairy leukoplakia 褶皱样毛状白斑褶皱样毛状白斑Extensive hairy leukoplakiaExtensive hairy leukoplakia 广泛的毛状白斑广泛的毛状白斑TreatmentTreatment classification classification clinical featuresclinical featuresDiagnosisDiagnosis FUNGAL LESIONS VIRAL LESIONSBACTERIAL LESIONSNEOPLASTIC LESIONS OthersDoes not usually require treatment Does not usually require treatment Scully C,et all.(1992):Management of oral Scully C,et all.(1992):Management of oral health in persons with HIV infection73:215-25.health in persons with HIV infection73:215-25.Hairy LeukoplakiaHairy Leukoplakia（毛状白斑）（毛状白斑）后面内容直接删除就行后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用主要经营：网络软件设计、图文设计制作、主要经营：网络软件设计、图文设计制作、发布广告等发布广告等公司秉着以优质的服务对待每一位客户，做公司秉着以优质的服务对待每一位客户，做到让客户满意！到让客户满意！致力于数据挖掘，合同简历、论文写作、致力于数据挖掘，合同简历、论文写作、PPTPPT设计、计划书、策划案、学习课件、各设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求类模板等方方面面，打造全网一站式需求The user can demonstrate on a projector The user can demonstrate on a projector or computer,or print the presentation or computer,or print the presentation and make it into a film to be used in a and make it into a film to be used in a wider fieldwider field