FIGURE 2 Necrotizing ulcerative periodontitis Source Courtesy of the International AIDS SocietyUSA From Refs 3 4

with severe malnutrition and coexisting chronic infections in developing countries. Anaerobic indigenous flora seems to play a role in maintaining the destructive character of the lesion, but the pathogenesis is unclear.

Treatment is best left to an HIV dental specialist and includes debridement of necrotic tissue, aggressive local care with antiseptics and chlorhexidine mouthwashes, and systemic antibiotics with some degree of anaerobic coverage, such as doxycycline, amoxicillin/clavulanate, metronidazole, or clindamycin.

Other Bacterial Causes of Stomatitis. Cases of Klebsiella, Enterobacter cloacae, and Mycobacterium avium complex stomatitis with oral nodules, masses, or oral ulcers have been reported in HIV-infected persons. These responded to etiologic treatment with systemic antibiotics.

Bacillary Angiomatosis—Bartonellosis. Caused by the species Bartonella quintana and Bartonella henselae, bacillary angiomatosis has been reported to present with oral papules that resemble Kaposi's sarcoma (KS), and biopsy, special stains (Warthin-Starry stain), and culture may be required for definite diagnosis. Serology for specific antibodies is available. The infection responds well to macrolides and doxycycline.

Syphilis. Infection with Treponema pallidum can present with head and neck symptoms. Primary syphilitic chancre can occur in the oral or nasal mucosa or the perioral skin at the site of inoculation. This usually has the appearance of an indurated, relatively painless ulcer. Mucous patches of secondary syphilis and the rash associated with it can be found in the head and neck area. Syphilis is discussed in detail in Chapter 15.

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