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AIDS
| Sunblind
- Tue Nov 30, 2004 12:43 am |
Hello, sorry this is so long...I just wanted to know if it sounds like HIV/AIDS could be behind these symptoms. Around late September I began experiencing tongue pain, and it appeared that some of my taste buds were inflamed (they were bigger than usual and white, with the surrounding area a little red). The inflammation has gone down considerably (as has the pain), but small white bumps are still present on the top of my tongue, and the top seems to have a whitish color to it, at least more so than the sides or underneath (and it does not scrape off), and is more red at the tip. In addition, there are larger red bumps on the back of my tongue, that seem to be somewhat in line. I've also noticed a few tonsil stones from time to time also. My tongue seems to get better (normal color with just a few small white bumps) to worse (a generally white color, more coating in the back and some discomfort - sort of a burning sensation) - it seems like it cycles. Besides this, I have sweat in my sleep a little bit (not enough to change my clothes or sheets, but enough to notice) about 4 or 5 times over these past couple months. No other symptoms of illness, such as fever, sore throat, swollen lymph nodes, weight loss, loose stools, etc. are present however. As a side note-a day or two before the tongue problems began, I experienced mouth trauma by accidentally gouging my gum with my fingernail pretty badly. The wound was infected and turned into a cancer sore, all around the same time as the inflammation of my tongue. I saw a doctor and he seemed to think it was connected to the mouth trauma. He only told me that it wasn't very impressive and that I should rinse my mouth with salt water (which I haven't done by the way), but that was before I began to entertain the idea of HIV, so I hadn't even thought to ask him. That was nearly three weeks ago, and yet these small pin size bumps are still here. I feel fine other than my tongue, and I'm not in a high-risk group for the virus, but I'm still at a loss as to why my tongue hasn't seemed to return to normal, and as to what this is. It resembles no description of any oral manifestations of HIV or any other disease that I can find. I would go to the doctor again and explain my fears, but I'm a recent college graduate and I still have no health insurance (and doctors visits are quite expensive), so any advice you could give me would help a lot. Thanks so much!
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| Dr. Anthony Solomon
- Sat Dec 04, 2004 3:08 am |
Your main complaints are an oral cavity disease and occasional night sweats. You wish to know if these symptoms by themselves are suggestive of HIV disease.
You claim you are not in a high risk group which implies that you have not had blood transfusions, multiple sexual partners, a history of STDs, and intravenous drug use. You also claim not to have any of the major signs of later stage HIV such as weight loss, chronic diarrhoea and prolonged fever.
The mainstay of a diagnosis for HIV disease is a positive blood test. Your mouth disease alone cannot be diagnostic of HIV infection unless the lesion in your mouth is a condition called Oral Hairy Leukoplakia which occurs almost exclusively in HIV-infected persons. In short, Oral Hairy Leukoplakia has not been seen outside of HIV disease.
However, oral cavity diseases are extremely common in HIV disease; especially in those persons with a CD4 cell count less than 300 cells per cmm. The list of oral diseases associated with HIV disease include:
Oral Candidiasis
Oral Hairy Leukoplakia
Kaposi’s Sarcoma
Gingivitis
Aphthous Ulceration
Intraoral Warts.
HIV-positive patients with these lesions have a high rate of progression to AIDS.
You describe the lesions on your tongue as coated and white. You further state that the whitish coating cannot be scraped off. I shall therefore confine my response to those diseases from the list that can be described as such. The only two from the list that produce a whitish coating are:
Oral Candidiasis (OC) and
Oral Hairy Leukoplakia (OHL)
As mentioned earlier, OHL has not been seen outside of HIV disease (very rare cases occur in cancer and organ transplant patients). It appears as vertical, parallel, corrugated, white lines on the sides of the tongue which may be flat or raised. The lesions cannot be removed by scraping with a tongue blade. It is not troubling to patients and sometimes regresses spontaneously. In your description, you admit that the sides of your tongue have some whitish coating but less so than the top. Your description is unclear, therefore I cannot comment or confirm. A physician's examination would be helpful.
Oral Candidiasis (OC) occurs very commonly in HIV-infected individuals. Although the presence of OC strongly suggests HIV infection, it can also occur in diabetes mellitus, cancer, pregnancy and in those on broad-spectrum antibiotics and corticosteroids. However, the presence of OC in an HIV-infected person predicts progression to AIDS independent of the CD4 cell count.
OC may appear in 4 different forms:
** tthick white plaques anywhere in the mouth: tongue, buccal mucosa, palate, gums and pharynx. Unlike OHL, the lesions can be readily scraped off with a tongue blade.
** patchy redness on the hard palate, or smooth areas on the tongue.
** cracking and redness at the corners of the mouth, known as angular cheilitis
** very rarely, non-removable white patches that can be differentiated from OHL by the absence of the typical parallel vertical white lines on the sides of the tongue.
I strongly recommend that you subject yourself to a physician’s examination as definitive diagnosis cannot be made online.
Thank you for contacting our website.
Dr Anthony Solomon
MB BS DTM&H DIP.VEN FRSM
Consultant Physician, Tropical & Genitourinary Medicine
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| Sunblind
- Sat Dec 04, 2004 5:29 pm |
Thanks so much for taking the time to address my concerns. Through my own research I had deducted that of all the oral manifestations of HIV infection, and that the only two that are similar to my own condition are OC and OHL. However, I should have been more clear because the "white coating" on my tongue is NOT present on the sides or underneath. It stops rather abruptly as it approaches the sides of my tongue, and doesn't resemble any pictures of OHL that I've seen, so I feel confident in ruling that out. My symptoms don't match any of the 4 types of OC that you've described either; the white area is not made up of plaques (it's more a coating, as you'd see from not brushing your teeth all day), no cracking or redness at the corners of my mouth, and no patchy redness on the hard palette, etc... In any case, my primary complaint is not the white coating of my tongue, it is the small white bumps on my tongue and the rough/burning sensation that has been with me throughout these past couple of months. The bumps are pinsized, not immediatly noticable, only present on the top of my tongue, and mostly towards the front. The rough/burning sensation is elusive and mild, but bothersome nonetheless. I cannot find any description of any disease that matches my symptom, and that's what is driving me crazy. I think my question is, what could be going on with me? Have you ever heard of anything that sounds like my problem, or a symptom of anything that resembles mine? In the later stages of HIV infection, when T-cell counts drop and opputunistic infections begin, wouldn't an individuals overall health decline? or could he/she have an isolated symptom like thrush and feel 100percent healthy besides? And lastly, if my symptom is not an oral cavity disease normally associated with AIDS/HIV, then could it just be a complication of the mouth trauma and infection that I suffered a couple prior to the onset of these symptoms? I'm sorry to ask so many questions, but none of the answers that I've found seem to explain what I'm going through, they only seem to make more questions. Thanks again for your help and your time, I really appreciate it more than you know.
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| Dr. Anthony Solomon
- Thu Dec 23, 2004 1:42 pm |
Hello again,
It appears that by your own inspection and self-examination, you are confident that you do not have Oral Hairy Leukoplakia. That should be reassuring to you, because as I stated earlier, the condition appears almost exclusively in HIV disease.
In your previous note, you stated that your doctor commented that the state of your gums and tongue was not impressive. What was his diagnosis? Is your dental hygiene satisfactory? Are you a chronic smoker? Are you on any long term medication?
The descriptions you give of “small, hardly noticeable, pin-sized white bumps on your tongue and a burning sensation" are insufficient for any doctor to arrive at a diagnosis. A good history and examination are mandatory, preferably by an oral surgeon, who may decide to conduct some tests. It is unethical to attempt a diagnosis without examination. As we state on this site, the information we provide is designed to support, not replace, the relationship existing between a site visitor and his/her physician. I note from your correspondences that you have done an extensive research on HIV disease and viewed several clinical photographs. I am of the opinion that you are very worried of the possibility that your complaints may be HIV-related. You are right to state that in later stage HIV disease when opportunistic infections develop, an individual’s health will decline to an extent that it is apparent. In your own case, you maintain that your general health is satisfactory. Since you claim you have no risk factors and are generally in good health, a negative HIV test will be reasuring.
It is not unlikely that you are suffering from a benign condition termed glossodynia. This condition is characterised by burning and pain of the tongue which may occur with or without an inflammation of the tongue. It is associated with diabetes, use of certain medications, tobacco, xerostomia, candidiasis and nutritional deficiencies. Once again, I advise you to consult a physician for diagnosis and reassurance.
Thank you for coming back to our website with your questions.
Dr Anthony Solomon
MB BS DTM&H DIP.VEN FRSM
Consultant Physician, Tropical & Genitourinary Medicine
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| ghristb
- Mon Jan 17, 2005 1:01 am |
Wow, I'm amazed that someone has the same exact description of their tongue as I do. What the doctor above said seems helpful, but none of those description measure up to what my mouth is like. My tongue gets progressively whiter toward the back. The front of it looks pretty normal, but towards the back of it looks white and frankly as if it is just decaying, because the surface is slightly uneven - that is kind of curdly, I think similar to the protrusions you described - hardly noticeable, except on close inspection. the main thing that stuck me is that you also said towards the back there are red regions that are kind of lined up. It's the same with me. At the very back in the whitest area there are breaches of the whiteness that are red. the difference between you and me is that I have not experienced any pain or soreness. Another very striking thing exists, however. Where my throat and mouth converge, on the sides, where I believe exist some glands (some tissure that bloats out a bit). From that tissue, from time to time comes some solid white stuff. This has been going on for several months continually. Anyways, I'm working on becoming a scientific researcher, partly so that I can do my own research if necessary to find out what in the world is wrong (I've been to doctors over several enigmatic symptoms including these. I know they add up to something, but have no idea what). I don't blame the doctors though, there's a lot of weird things that can go wrong with people. If either the original poster or a doctor comes up with any eurikas I'd be glad to hear about them.
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| Sunblind
- Wed Jan 26, 2005 12:25 am |
Maybe I didn't fully understand the symptoms that you described...I think that they sound somewhat different from mine. But anyway, check out this page http://www.tonsilstones.com/whitetongue.html -to me it sounds something like what you may be experiencing. Hope it helps, and best of luck.
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