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J Zhejiang Univ (Med Sci)  2021, Vol. 50 Issue (2): 141-147    DOI: 10.3724/zdxbyxb-2021-0105
    
Diagnostic strategies for oral manifestations of infectious diseases
CHEN Qianming1(),LI Zaiye2,ZENG Xin2,*()
1. Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine & Clinical Research Center for Oral Diseases of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou 310006, China;
2. Department of Oral Medicine, West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chengdu 610041, China
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Abstract  

Infectious diseases are caused by infection of organism with pathogenic agents, which may lead to epidemics. Many infectious diseases such as syphilis, diphtheria, measles, and acquired immunodeficiency syndrome have specific and non-specific manifestations in the oral cavity. However, the same disease may have different oral manifestations in different patients clinically. We can apply the strategy of “three unusuals and one change” in clinical reasoning for diagnosis of infectious diseases with oral manifestations. The so-called “three unusuals” refer to unusual age, unusual location and unusual effect, and “one change” means the change from rare to common. In this article, we will give a comprehensive introduction about the oral manifestations of common communicable diseases and their diagnostic strategies.



Key wordsInfectious diseases      Oral diseases      Oral manifestations      Diagnosis      Differential diagnosis     
Received: 25 January 2021      Published: 18 June 2021
CLC:  R781.5  
Corresponding Authors: ZENG Xin     E-mail: qmchen@zju.edu.cn;zengxin22@163.com
Cite this article:

CHEN Qianming,LI Zaiye,ZENG Xin. Diagnostic strategies for oral manifestations of infectious diseases. J Zhejiang Univ (Med Sci), 2021, 50(2): 141-147.

URL:

http://www.zjujournals.com/med/10.3724/zdxbyxb-2021-0105     OR     http://www.zjujournals.com/med/Y2021/V50/I2/141


常见传染病口腔表征及其辨析策略

传染病是指病原微生物感染人体后产生的有传染性并在一定条件下可造成流行的疾病,许多法定传染病如梅毒、白喉、麻疹、获得性免疫缺陷综合征等在口腔内都有特异性和非特异性表征。但在临床实践过程中,同样的疾病在不同患者口腔内表现也有所不同,可运用“三错一变”的策略大致剖析病情。所谓“三错”指临床表现错龄、错位、错效,“一变”指临床表现罕见变常见。本文将对目前常见传染病的口腔表征及其辨析策略进行介绍。


关键词: 传染病,  口腔疾病,  口腔表征,  诊断,  鉴别诊断 

疾病名称

病原体

好发人群

口腔好发部位

特异性体征或症状

非特异性体征

猩红热

A 组乙型溶血性链球菌

儿童

草莓舌

黏膜充血

结核

结核分枝杆菌

任何年龄

所有部位

结核性溃疡

非特异性溃疡

白喉

白喉棒状杆菌

婴幼儿

喉部

白色厚实假膜

梅毒

苍白密螺旋体

性活跃人群

所有部位

硬下疳、黏膜斑、树胶样肿

黏膜炎、溃疡

麻疹

麻疹病毒

儿童

上颌第 1、2 磨牙对应颊黏膜

科氏斑

AIDS

HIV

性活跃人群

所有部位

卡波西肉瘤、毛状白斑

牙龈炎、牙周炎、溃疡

COVID-19

SARS-CoV-2

任何年龄

舌、腭、唇、口咽

味觉消失

坏死性溃疡,散在疱样溃疡、面神经麻痹

手足口病

肠道病毒

婴幼儿

舌、颊、唇、牙龈

红斑、水疱、溃疡

Table 1 Oral manifestations of common infectious diseases
Figure 1 Oral thrush in a patient with AIDS
Figure 2 The labial chancre in a patient with primary syphilis
Figure 3 Oral tuberculous ulcer in a patient with tuberculosis
Figure 4 HIV related Kaposi’s sarcoma in a patient with AIDS
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