Candida infection in oral lesions of kaposi sarcoma
Date
2011-11-11
Authors
Sibda, Arshaad
Journal Title
Journal ISSN
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Abstract
Background
Oral candidiasis is the most common infection of the oral mucosa of HIV-seropositive
patients, although its frequency is rapidly decreasing with the advent of highly active
antiretroviral therapy (HAART). Many questions regarding its complex pathogenesis remain
unanswered. The diagnosis is usually established with non-invasive techniques such as
mucosal smears. Oral lesions of HIV-associated Kaposi sarcoma (HIV-KS) are routinely
biopsied and frequently show secondary infection with Candida albicans or other Candida
species.
Aims and objectives
The aim of this investigation was to determine the frequency and histomorphology of
secondary Candidal infection of the surface epithelium of oral HIV-associated KS lesions
(HIV-KS), which are routinely biopsied in HIV infected patients.
Materials and methods
Haematoxylin and eosin (HE), and Periodic Acid-Schiff (PAS) stains of 133 cases of oral
Kaposi sarcoma diagnosed between the period 2003 and 2007 within the Division of Oral
Pathology were examined histologically for intensity and morphology of Candidal
colonisation, depth of invasion, number of organisms, epithelial reactions and associated
inflammatory response. The depth of Candidal invasion and severity of infection were
correlated with the available CD4 T cell counts of HIV seropositive patients at the time of
biopsy. Results
Almost forty one percent (40.62%) of all oral HIV-KS cases were secondarily infected with
Candida species. The intensity varied from an isolated single pseudohyphus to matted
colonies of vegetative yeasts and psuedohyphae. Whilst in most cases the organisms did not
invade beyond the parakeratin layer, pseudohyphae were noted extending into the stratum
spinosum in 2 cases, and a single case showed a pseudohyphus within the lamina propria. A
further 2 cases showed pseudohyphae growing in the pyogenic membrane. Neutrophilic
permeation of the epithelium and Munro micro-abscess formation, features commonly
associated with Candidal infection, were frequently present even in the absence of Candidal
infection. Candidal organisms were often present in the absence of inflammation.
Conclusion
Oral lesions of HIV-KS are commonly secondarily infected with large numbers of Candidal
organisms. The morphological characteristics of secondary Candidal infection within the
surface epithelium of HIV-KS lesions suggest an altered pathogenetic pathway. Further
studies are necessary in this regard.