Histopathologic Characteristics

Chronic hyperplastic or pseudomembra-nous candidiasis is a form of infection with distinct clinical and histopathological characteristics. The histologic features of this infection include a hyperplastic and parak-eratotic response of the surface epithelium, which is invaded by hyphal organisms. The inflammatory infiltrate consists primarily of PMN, which form microabscesses within the epithelium, whereas very few PMN are found within the lamina propria in association with blood vessels (Eversole et al.,

1997). A chronic inflammatory infiltrate is also present in the superficial lamina propria close to the epithelial border, with a characteristic high presence of IgA-expressing lymphocytes (Williams et al., 1997).

In HIV+ patients, neutrophils appear to be a rare finding in oral candidiasis lesions and are only encountered in a limited number of erythematous forms. The inflammatory cell infiltrate is primarily mononuclear in both pseudomembranous and erythema-tous cases of HIV-associated infection (Romagnoli et al., 1997). Few Candida hyphae are associated with the atrophic epithelium in erythematous candidiasis, whereas numerous organisms are found invading into the prickle cell layer of oral epithelium in pseudomembranous candidia-sis. In HIV+ patients the inflammatory infiltrate is heavier in erythematous candidiasis and consists of CD8+ lymphocytes and CD1a+ Langerhans cells (Romagnoli et al., 1997). In fact, in this study CD1a+ dendritic cells were the only cell type to be significantly increased in HIV+ oral candidiasis as compared to HIV+ or HIV- controls. These cells were almost exclusively restricted to the basal layer of the oral epithelium. Overall a change in localization of inflammatory cells such as macrophages and dendritic cells from the lamina propria into the basal epithelial cell layer was observed, as opposed to an increase in cell number (Romagnoli et al., 1997). A more recent immunohistochemical analysis of the T cell populations in HIV-associated oral can-didiasis showed an intriguing accumulation of high numbers of CD8+ T cells at the lamina propria-epithelium interface of the infected sites as compared to unin-fected controls, and a positive correlation between the numbers of CD8+ T cells and oral fungal burden in HIV+OPC- individuals (Myers et al., 2003). Interestingly, CD4+ cells were also found in these lesions. These cells did not colocalize with CD3+ cells and were highly irregular in shape, suggesting that the majority were not T cells but macrophages or dendritic cells (Myers et al., 2003).

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