Nutrition and Oral Medicine (Nutrition and Health)

232 Part IV / Select Diseases and Conditionscell counts below 100 cells per mm 3 . Patients with hyperplastic candidiasis have a highpredilection for having, or developing, esophageal candidiasis, which is an AIDS-definingillness (2).Hyperplastic candidiasis presents as white or discolored plaques that may be solitaryor confluent but, in contrast to pseudomembranous candidiasis, cannot be wiped orrubbed off the mucosa. Patients tend to complain of an oral burning sensation and afeeling of having a “large ball of cotton in mouth.” The lesions may be found on anyintraoral surface but have a high prevalence on the hard or soft palate.Chronic candidiasis is often misdiagnosed as leukoplakia or, when it presents on thetongue, as OHL. Even though the clinical manifestation of the lesion is pathognomonic,the presence of hyphae and blastospores on a smear confirms a diagnosis. Treatment forthis type of candidiasis involves systemic antifungal agents, which may include intravenousformulations.3.2.1.4. Angular ChelitisAngular chelitis presents as radiating red fissures, occasionally with a pseudomembranouscover, from the corner of the mouth. This condition is frequently observed in olderindividuals with ill-fitting complete dentures and is not pathognomonic for HIV disease.It is commonly found together with xerostomia and may worsen during the cold wintermonths.Successful treatment of angular chelitis is accomplished by application of a topicalantifungal agent such as clotrimazole, miconazole, ketoconazole cream, or nystatin ointmentin combination with a topical antibacterial agent.3.2.2. HISTOPLASMOSISInfections with histoplasmosis can be found in individuals who work near dust-producingactivities in high endemic areas, such as the Ohio and Mississippi valleys. Histoplasmosisis caused by inhaling the spores of Histoplasma capsulatum, which is foundin the soil throughout the world. Disturbances of contaminated soil can cause the sporesto become airborne. Although rare in areas that are nonendemic, endemic areas haveexhibited prevalence rates of approx 70% of the adult population having a positivehistoplasmin test (41). In the immunocompetent host, most infections by H. capsulatumare subclinical and self-limiting. However, in the immunocompromised patient, H. capsulatumcan cause a serious opportunistic infection. Although not correlated with CD4cell count, histoplasmosis was included in the AIDS-defining illnesses category in 1985(3). Many cases of histoplasmosis are disseminated by the time of oral manifestations(42). The clinical presentations vary along a spectrum of ulcerations to granulomas. Adefinitive diagnosis is based on multiple factors, including clinical examination, serology,light microscopy, and culture (42). The treatment modality of choice is intravenousamphotericin B, however itraconazole and ketoconazole have also been used successfullyto treat disseminated histoplasmosis in immunocompromised patients (42,43).3.3. Bacterial Etiology3.3.1. PERIODONTAL DISEASEPeriodontal disease is a common condition found in both HIV-positive and HIVnegativeindividuals. HIV-infected individuals may show signs of a more rapidly pro-