ENT Manifestations In HIV Patients

Muhammad Asyraf Mohammad Naim 071303086 Group F2 Batch 22

Did You Know?

y70% of HIV infected patients will

present with ENT manifestations.

EAR
y Otitis externa y Otitis media y SN Hearing Loss y Facial paralysis

Otitis Externa
y Pseudomonas aeruginosa y Osteomyelitis of temporal bone and skull base y Conductive hearing loss y Severe pain y Edematous y Erythematous y Purulent discharge

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 to AIDS patients

Sensorineural Hearing Loss

y Causes:

-Cytomegalovirus infection of middle ear/CN VIII -Direct effect of HIV on CNS -CNS infections: Cryptococcal meningitis, neurosyphilis y Unilateral or bilateral y Steadily worsens with increasing frequencies

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

Facial Paralysis

NOSE
y Sinusitis y Allergic rhinitis y Lymphoid hypertrophy

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 extends intracranially

Allergic Rhinitis
y Cellular immunity is depressed, but increased polyclonal B-

cell activation y Increased circulating immune complexes & increased IgE levels; predispose to hypersensitivity y Profuse, thick rhinorrhea y Nasal congestion

Lymphoid Hypertrophy
y Involves entire Waldeyer's ring (adenoids, tubal, palatine &

lingual tonsils) y Peripheral lymph nodes - persistent generalized lymphadenopathy y Asymptomatic y Nasal obstruction

ORAL CAVITY
y Candidiasis y Angular cheilitis y Recurrent aphthous ulcers y Hairy leukoplakia y Kaposis sarcoma y Non-Hodgkins Lymphoma y HSV y Gingivitis & Periodontal Disease

Oral Candidiasis
y Thrush y Candida albicans y Most frequent opportunistic infection in HIV patients (90% y y y y

affected) Tender, white, pseudomembranous or plaque-like lesions angular cheilitis Can interfere with the administration of medications and nutritional intake May spread to the esophagus

Oral Candidiasis

Recurrent Aphthous Ulcers

y Ulcers with well circumscribed erythematous margins

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

Kaposis Sarcoma
y y y y y

y y y y

Multifocal neoplasm of vascular endothelial spindle cells Most common oral malignancy in HIV Agent: HHV-8 May be first symptom of late stage HIV disease Commonly seen in hard palate & soft palate(95%), gingiva, buccal mucosa, oropharynx, tongue Purplish At first, flat and asymptomatic Later, exophytic and ulcerated Secondary infection: severe, increasing pain, difficult mastication and swallowing

Non-Hodgkins Lymphoma
y Diffuse undifferentiated type y B-cell origin y Agent: EBV y Occur in 10-30% of AIDS patients y Agressive y Occurs in late stage of disease when y y y

CD4 count < 200/mm Poor prognostic indication Firm painless swelling with/without ulcer Exophytic, large ulcerative lesion in the mouth or pharynx Gingiva & palate, extend to Waldeyers ring

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

Gingivitis & Periodontal Disease

y Common in HIV patient y Can progress rapidly from mild gingivitis to a necrotizing

process y Severe pain, soft tissue loss and gingival recession y Bone exposure and sequestration. y Acute necrotising ulcerative gingivitis (ANUG)

OTHERS
y Parotid y Oesophagus y Neck

Parotid
y Parotid cysts y Parotitis

Oesophagus
y Candida infection

-causes dysphagia

Neck
y Cervical lymphadenopathy y Causes:

-Secondary infection -Lymphoma -Tuberculosis -Kaposis Sarcoma

Most Commonly Seen

y Oral Candidiasis (oral thrush & esophagus) y Kaposis Sarcoma y Pneumocystis jiroveci y Tuberculosis y Hairy Leukoplakia y Parotid cyst y Cryptococcosis

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