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ENT Manifestations In

HIV Patients

Muhammad Asyraf Mohammad Naim

071303086

Group F2Batch 22

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y70% of HIV infected patients willpresent with ENT manifestations.

Did You Know?

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EAR

y Otitis externa

y Otitis media

y SN Hearing Loss

y Facial paralysis

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Otitis Externa

y Pseudomonas aeruginosa

y Osteomyelitis of temporal bone and skull base

y Conductive hearing loss

y Severe painy Edematous

y Erythematous

y Purulent discharge

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Otitis Media

y Serous type

y Eustachian tube dysfunction due to:

-Recurrent upper respiratory tract infection

-Adenoid hypertrophy-Nasopharyngeal tumour

y S. pneumoniae, H. influenzae, Moraxella

catarrhalis

y Pneumocystis jiroveci- unique toAIDS patients

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Sensorineural Hearing Loss

y Causes:

-Cytomegalovirus infection of middle ear/CN VIII

-Direct effect of HIV on CNS

-CNS infections: Cryptococcal meningitis, neurosyphilisy Unilateral or bilateral

y Steadily worsens with increasing frequencies

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Facial Paralysis

y 7.2% of HIV patients affected

y Unilateral or bilateral

y Causes:

-Idiopathic facial(VII) nerve paralysis(Bells Palsy)

-Infection of the facial nerve by HSV

-CNS toxoplasmosis

-HIV encephalitis

-CNS lymphoma

y Loss of taste sensations from the anterior 2/3rd of tongue.

y Impaired hearing

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Facial Paralysis

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NOSE

y Sinusitis

yAllergic rhinitis

y Lymphoid hypertrophy

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Sinusitis

y 20 68% of HIV patients

y Bacterial:

-If CD4 count is above 200cells/mm:

Pneumococci & H.influenza-If below 200cells/mm:

P. aeruginosa &Staph. Aureus

y Fungal:

-Aspergillus

-Mucormycosis

y Fungal sinusitis is rapidly invasive and extendsintracranially

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Allergic Rhinitis

y Cellular immunity is depressed, but increased polyclonal B-cell activation

y Increased circulating immune complexes & increased IgElevels; predispose to hypersensitivity

y Profuse, thick rhinorrhea

y Nasal congestion

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Lymphoid Hypertrophy

y Involves entire Waldeyer's ring (adenoids, tubal, palatine &lingual tonsils)

y Peripheral lymph nodes - persistent generalizedlymphadenopathy

y Asymptomatic

y Nasal obstruction

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ORAL CAVITY

y Candidiasis

yAngular cheilitis

y Recurrent aphthous ulcers

y Hairy leukoplakia

y Kaposis sarcoma

y Non-Hodgkins Lymphoma

y HSV

y Gingivitis & Periodontal Disease

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Oral Candidiasis

y Thrush

y Candida albicans

y Most frequent opportunistic infection in HIV patients (90%

affected)y Tender, white, pseudomembranous or plaque-like lesions

y angular cheilitis

y Can interfere with the administration of medications and

nutritional intakey May spread to the esophagus

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Oral Candidiasis

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Recurrent Aphthous Ulcers

y Ulcers with well circumscribed erythematous margins

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Hairy Leukoplakia

y Almost pathognomic of HIV

y Indicates progression to AIDS

y Causative agent: EBV

y

One of the first opportunistic infections seen in HIV-positive patients

y White plaque on lateral border of

the tongue

y Grows bilaterally

y Asymptomatic

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Kaposis Sarcoma

y Multifocal neoplasm of vascular endothelial spindle cellsy Most common oral malignancy in HIVy Agent: HHV-8y May be first symptom of late stage

HIV diseasey Commonly seen in hard palate & soft

palate(95%), gingiva, buccal mucosa,oropharynx, tongue

y Purplish

y At first, flat and asymptomatic

y Later, exophytic and ulcerated

y Secondary infection: severe, increasing

pain, difficult mastication and swallowing

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Non-Hodgkins Lymphoma

y Diffuse undifferentiated type

y B-cell origin

y Agent: EBV

y Occur in 10-30% of AIDS patients

y Agressivey Occurs in late stage of disease when

CD4 count < 200/mm

y Poor prognostic indication

y Firm painless swelling with/without ulcery Exophytic, large ulcerative lesion in the

mouth or pharynx

y Gingiva & palate, extend to Waldeyers ring

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HSV

y HSV-1

y Extraorally/intraorally

y Herpes labialis is most common

y Palate, gingiva, or other oral mucosal surfaces.y May extend onto adjacent skin - giant herpetic lesions

y Present as vesicles

Flat, reddish; non-blanching

It can enlarge, ulcerate or infected Pain and bleeding common

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Gingivitis & Periodontal Disease

y Common in HIV patient

y Can progress rapidly from mild gingivitis to a necrotizingprocess

y

Severe pain, soft tissue loss and gingival recessiony Bone exposure and sequestration.

y Acute necrotising ulcerative gingivitis (ANUG)

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OTHERS

y Parotid

y Oesophagus

y Neck

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Parotid

y Parotid cysts

y Parotitis

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Oesophagus

y Candida infection

-causes dysphagia

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Neck

y Cervical lymphadenopathy

y Causes:

-Secondary infection

-Lymphoma

-Tuberculosis

-Kaposis Sarcoma

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REFERENCES

y Disease of Ear, Nose, Throat. Dhingra PL. 5th ed.

y Lee KC. Otolaryngologic manifestations of HIV (1998).http://hivinsite.ucsf.edu/InSite?page=kb-04-01-13

y http://emedicine.medscape.com/article/1167229-overview