An evaluation of oral ulcers in patients with AIDS and AIDS-related complex.
BACKGROUND
Patients with HIV infection can have recurrent and persistent oral ulcers, not attributable to known infectious agents.


OBJECTIVE
Our aim was to evaluate prospectively oral ulcers in patients with HIV infection to determine whether an etiologic agent could be identified.


METHODS
Sixteen patients with HIV infection who had oral ulcers not attributable to known causes had culture of the base and a biopsy specimen taken from the ulcer. Cultures were obtained for herpes simplex and varicella-zoster viruses, mycobacteria, and fungi. By polymerase chain reaction (PCR) analysis with primer/probe sets for herpes simplex viruses 1 and 2, varicella-zoster virus, cytomegalovirus, human papillomavirus, and Mycobacterium tuberculosis, each biopsy specimen was analyzed for the presence of DNA from these organisms. Specimens were also evaluated histologically.


RESULTS
Histoplasmosis was detected histologically in one biopsy specimen, candidiasis in a second, and herpetic changes in a third. Viral cultures were positive for herpes simplex virus 1 in four cases and herpes simplex virus 2 in one case. PCR analysis detected DNA for herpes simplex virus 1 in one case and herpes simplex virus 2 in another; DNA from other pathogens was not identified. In the remaining eight patients, hematoxylin-and-eosin staining revealed eosinophilic ulcers in five cases and nonspecific changes in three cases.


CONCLUSIONS
The etiologic agent of recurrent or persistent oral ulcers in patients with AIDS and AIDS-related complex was not identified in 50% of patients. PCR analysis was not useful. Herpes simplex virus or other pathogens were not detected in ulcers containing numerous eosinophils.
Liang
G S
GS
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Florida.
Daikos
G L
GL
Serfling
U
U
Zhu
W Y
WY
Pecoraro
M
M
Leonardi
C L
CL
Fischl
M A
MA
Penneys
N S
NS
D000386:AIDS-Related Complex / Q000150:complications*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D002908:Chronic Disease; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D018259:Herpesvirus 1, Human / Q000235:genetics; D018258:Herpesvirus 2, Human / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D009960:Oropharynx; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012008:Recurrence; D014456:Ulcer / Q000150:complications / Q000175:diagnosis / Q000382:microbiology
D004279:DNA, Viral