title: Multifocal epithelial hyperplasia in a community in the Mayan area of Mexico.
abstract: BACKGROUND
  Multifocal epithelial hyperplasia is a pathology of the oral mucosa which has been reported in diverse ethnic groups. Human papillomavirus (HPV) types 13 and 32 DNA has been detected in these lesions. The aims of this paper are to describe the epidemiological and clinical characteristics of an outbreak in a rural community in the Mayan area of Mexico and to identify a possible route of transmission through saliva.
  
  
  METHODS
  A cross-sectional study was conducted in Chemax (Yucatan, Mexico). Clinical and epidemiological data were obtained through direct interviews. Samples of oral cells and saliva were taken. HPV 13 and 32 were identified by polymerase chain reaction using specific primers.
  
  
  RESULTS
  A total of 57 patients were studied, of whom 79.1% were aged <15 years, 38.6% were male, and 61.3% were female. The duration of lesions ranged from one month to 50 years. Lesions were located on the lips, jugal mucosa, and more frequently, the tongue. HPV 13 was found in all the patients and HPV 32 in none. A total of 42 saliva samples were positive for HPV 13.
  
  
  CONCLUSIONS
  Human papillomavirus type 13 is involved in multifocal epithelial hyperplasia among the Mexican Mayan population. The presence of HPV 13 in cells from saliva, combined with poor hygiene behaviors, may explain the familial distribution of the pathology.
authors.affiliation: Laboratorio de Virología, Centro de Investigaciones Regionales, Universidad Autónoma de Yucatán (Virology Laboratory, Regional Research Center, Autonomous University of Yucatan), Mérida, Yucatan, Mexico. glosa@uady.mx
authors.forename: Maria R
authors.initials: MR
authors.lastname: González-Losa
authors.forename: Rosa E
authors.initials: RE
authors.lastname: Suarez-Allén
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Canul-Canche
authors.forename: Laura
authors.initials: L
authors.lastname: Conde-Ferráez
authors.forename: Nixma
authors.initials: N
authors.lastname: Eljure-Lopez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D017573:Focal Epithelial Hyperplasia / Q000208:ethnology / Q000473:pathology / Q000821:virology; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000208:ethnology / Q000473:pathology / Q000635:transmission; D012424:Rural Population / Q000706:statistics & numerical data; D012463:Saliva / Q000821:virology; D055815:Young Adult