Oral infections due to Cytomegalovirus in immunocompromised patients

Abstract

Herpes group virus infections in the immunocompromised host are associated with significant morbidity and mortality. Herpes simplex virus (HSV) and to a lesser extent varicella zoster virus (VZV) have long been recognized as causes of oral and peri-oral lesions in subjects undergoing bone marrow transplantation and in individuals infected with the Human Immunodeficiency Virus (HIV). A role for Cytomegalovirus (CMV) in such lesions is less clear and not well documented. This report describes two bone marrow transplant recipients and one individual infected with HIV in whom CMV was implicated as the cause of oral lesions. Diagnostic and management issues as well as clinical implications are discussed.

Activation of Kaposi's Sarcoma-Associated Herpesvirus (Human Herpesvirus 8) Lytic Replication by Human Cytomegalovirus

“…HCMV and KSHV are both shed in saliva (6,9,30,59). Although HCMV replication is predominately found in salivary glands, and the data suggest that KSHV is not in the salivary gland but replicates in oral epithelial (12,59), in immunosuppressed patients HCMV replication can be found in the oral mucosa (48).…”

Cytomegalovirus Infection in Normal and Immunocompromised Humans

“…All cultures should be observed at least twice weekly to detect the focal cytopathic effect because the virus grows slowly in contrast with herpes simplex and herpes zoster viruses which grow rapidly in epithelial cell cultures [28]. Culture of CMV from oral lesions is considered to be not very specific because the virus can be excreted from other sites of the upper gastrointestinal tract [25]. …”

“…of the heel [19], crusted papules of the face [24]and ulcerations of the oral mucosa [25, 26]. An ulcerative vulvovaginitis attributed to CMV infection in a woman with AIDS has also been mentioned [27].…”

Adverse Drug Reactions in the Orofacial Region

“…Immunosuppressive agents may also cause ulceration. Ulcers in iatrogenically immunocompromised individuals may have a herpesvirus etiology, or occasionally other infective causes (Greenberg et al, 1987;Schubert et al, 1993). Opportunistic infection secondary to cytotoxic chemotherapy may cause oral ulceration.…”