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Benlamkadam S, Errahmany A, Raymond K, Chraa M, Kissani N. Hansen's Disease: A Practical Update on a Neglected Globally Significant Infection. Cureus 2024; 16:e57374. [PMID: 38694670 PMCID: PMC11061821 DOI: 10.7759/cureus.57374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
Leprosy is a great mimicker. It is caused by Mycobacterium leprae and Mycobacterium lepromatosis, together termed the M. leprae complex. Leprosy can result in systemic manifestations; however, the neurocutaneous syndrome is the most classic. There is a gap in recognizing the condition leading to misdiagnosis and delays in treatment. Leprosy remains an important cause of aesthetic and functional impairment. In this paper, we provide a practical review of leprosy touching on pathophysiology, clinical manifestation, classification, diagnostic approach and management of the condition in a way that can translate into clinical practice and help physicians better identify and manage potential cases of leprosy.
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Affiliation(s)
| | - Amina Errahmany
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Klevor Raymond
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Mohamed Chraa
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
| | - Najib Kissani
- Neurology, Mohammed VI University Medical Center, Marrakesh, Marrakesh, MAR
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Panigrahi R, Priyadarshini SR, Sahoo PK, Alam T, Saeed S, Hasan S. Lepromatous Leprosy Manifesting As Chronic Macrocheilia: Report of a Rare Case. Cureus 2023; 15:e47859. [PMID: 38021977 PMCID: PMC10680308 DOI: 10.7759/cureus.47859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis. These bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body. Lately, there has been a notable reduction in mucosal symptoms, largely attributed to the timely diagnosis and treatment of leprosy. Nonetheless, oral lesions continue to hold significant epidemiological importance due to their crucial role in disease transmission. Oral manifestations, although rare, are frequently encountered in individuals afflicted with multi-bacillary leprosy. Chronic macrocheilia is an exceedingly rare manifestation of the disease, with only a few documented case reports and case studies. This article aims to document an exceptionally uncommon case of lepromatous leprosy with chronic macrocheilia as the sole presenting feature.
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Affiliation(s)
- Rajat Panigrahi
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Smita R Priyadarshini
- Department of Oral Medicine and Radiology, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Pradyumna K Sahoo
- Department of Prosthodontics, Institute of Dental Sciences, Siksha O Anusandhan University, Bhubaneswar, IND
| | - Tanveer Alam
- Department of Dental Surgery, College of Dentistry King Khalid University, Abha, SAU
| | - Shazina Saeed
- Department of Epidemiology and Public Health, Amity Institute of Public Health & Hospital Administration, Amity University, Noida, IND
| | - Shamimul Hasan
- Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
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3
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Characteristics of Oral Lesions in Patients With Hansen Disease. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moronta Castellano G, Villarroel-Dorrego M, Crespo Lessmann L. Caracterización de lesiones bucales de pacientes con enfermedad de Hansen. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:671-677. [DOI: 10.1016/j.ad.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
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Maymone MBC, Laughter M, Venkatesh S, Dacso MM, Rao PN, Stryjewska BM, Hugh J, Dellavalle RP, Dunnick CA. Leprosy: Clinical aspects and diagnostic techniques. J Am Acad Dermatol 2020; 83:1-14. [PMID: 32229279 DOI: 10.1016/j.jaad.2019.12.080] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 01/27/2023]
Abstract
Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Hyderabad, India
| | | | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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Oro-facial manifestations in lepromatous leprosy patients in Central India: clinical findings from a cross-sectional study. Clin Oral Investig 2019; 24:1981-1986. [PMID: 31435822 DOI: 10.1007/s00784-019-03061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To clinically evaluate the oro-facial manifestations in lepromatous leprosy patients undergoing multidrug therapy in Central India. MATERIALS AND METHODS Two hundred patients from 2 leprosy treatment centers in Central India who satisfied the diagnostic criteria set by the WHO (2006-2010) committee on leprosy were included in the study. To avoid bias, only patients who started the multi-drug treatment regimen less than 1 year ago were included. All the patients were examined for the presence of oral and facial manifestations. To confirm that the oro-facial manifestations were not due to HIV co-infection, serological diagnostic tests including ELISA, Immunocomb, and Tri-dot were performed. RESULTS Majority of the patients (n = 189) exhibited oral (n = 145) and/or facial (n = 147) manifestations. The most common oral lesions were found to be fissuring and depapillation of the tongue followed by fibrosis and loss of uvula. Among the facial manifestations, facial skin lesions and loss of eyebrows were most prevalent followed by sagging of facial skin and facies leonine. CONCLUSION The facial manifestations of leprosy are quite common, readily recognizable, and relatively specific to the disease. Thus, the presence of facial manifestations, especially with co-existing oral lesions must prompt the clinician to mandate further investigations to confirm the diagnosis. CLINICAL RELEVANCE As evidenced by the present study, facial manifestations and oral lesions are an integral part of leprosy. In addition to being a diagnostic parameter, facial manifestations and oral lesions could potentially be used to monitor the disease progression and treatment outcome.
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Mortazavi H, Safi Y, Baharvand M, Jafari S, Anbari F, Rahmani S. Oral White Lesions: An Updated Clinical Diagnostic Decision Tree. Dent J (Basel) 2019; 7:dj7010015. [PMID: 30736423 PMCID: PMC6473409 DOI: 10.3390/dj7010015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 02/06/2023] Open
Abstract
Diagnosis of oral white lesions might be quite challenging. This review article aimed to introduce a decision tree for oral white lesions according to their clinical features. General search engines and specialized databases including PubMed, PubMed Central, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “mouth disease”, “oral keratosis”, “oral leukokeratosis”, and “oral leukoplakia”. Related English-language articles published since 2000 to 2017, including reviews, meta-analyses, and original papers (randomized or nonrandomized clinical trials; prospective or retrospective cohort studies), case reports, and case series about oral diseases were appraised. Upon compilation of data, oral white lesions were categorized into two major groups according to their nature of development: Congenital or acquired lesions and four subgroups: Lesions which can be scraped off or not and lesions with the special pattern or not. In total, more than 20 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by a stepwise progression method.
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Affiliation(s)
- Hamed Mortazavi
- Oral Medicine Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
| | - Yaser Safi
- Oral and Maxillofacial Radiology Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
| | - Maryam Baharvand
- Oral Medicine Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
| | - Soudeh Jafari
- Oral Medicine Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
| | - Fahimeh Anbari
- Oral Medicine Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
| | - Somayeh Rahmani
- Oral Medicine Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, 1983969411 Tehran, Iran.
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Tiwari L, Alsarraf A, Yeoh SC, Balasubramaniam R. Systemic considerations for orofacial neuropathy. AUST ENDOD J 2018. [DOI: 10.1111/aej.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lalima Tiwari
- Oral Medicine; Dental School; University of Western Australia; Perth Western Australia Australia
| | - Abdulhameed Alsarraf
- Oral Medicine; Dental School; University of Western Australia; Perth Western Australia Australia
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Matos FZ, Aranha AMF, Borges ÁH, Pedro FLM, Raslan SA, Hamida F, Veiga K, Porto AN. Can different stages of leprosy treatment influence the profile of oral health? Oral status in leprosy. Med Oral Patol Oral Cir Bucal 2018; 23:e376-e383. [PMID: 29924752 PMCID: PMC6051674 DOI: 10.4317/medoral.22220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/11/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects. MATERIAL AND METHODS A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA). RESULTS The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment). CONCLUSIONS It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals.
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Affiliation(s)
- F-Z Matos
- University of Cuiaba-UNIC-Mato Grosso,
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Kasai N, Kondo O, Suzuki K, Aoki Y, Ishii N, Goto M. Quantitative evaluation of maxillary bone deformation by computed tomography in patients with leprosy. PLoS Negl Trop Dis 2018. [PMID: 29522533 PMCID: PMC5862504 DOI: 10.1371/journal.pntd.0006341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Facial deformation as a sequela of leprosy is caused not only by a saddle nose but also by regression of the maxilla, as well documented in paleopathological observations of excavated skeletal remains of patients with leprosy. However, maxillary changes in living patients have been evaluated only by the subjective visual grading. Here, we attempted to evaluate maxillary bone deformation in patients with leprosy using three-dimensional computed tomography (3D-CT). Methods Three-dimensional images centered on the maxilla were reconstructed using multiplanar reconstruction methods in former patients with leprosy (n = 10) and control subjects (n = 5); the anterior-posterior length of the maxilla (MA-P) was then measured. The difference between the MA-P of the patients and those of controls was evaluated after compensating for individual skull size. These findings were also compared with those from previous paleopathological studies. Findings Three former patients with lepromatous leprosy showed marked atrophy of the maxilla at the prosthion (-8.6, -11.1 and -17.9 mm) which corresponded with the visual appearance of the maxillary deformity, and these results were consistent with paleopathological findings of excavated skeletal remains. Additionally, the precise bone defects of the maxilla could be individually calculated for accurate reconstructive surgery. Interpretation We have successfully illustrated maxillary bone deformities in living patients with leprosy. This study also confirmed the maxillary regression described in paleopathological studies. The sequelae of leprosy are diverse and include facial deformity. A characteristic facial deformity is saddle nose, and the common clinical approach to this facial deformity has been rhinoplasty. Paleopathological studies from excavated skeletal remains have revealed that leprosy also causes deformation of the maxillary bone, which supports the external nose; however, these changes have not been evaluated in living patients with leprosy. In this study, we reconstructed three-dimensional and stereoscopic images of the cranium from CT scan data and evaluated maxillary deformities both qualitatively and quantitatively. Out of the ten former patients with leprosy, three had severe deformity of the maxilla including: atrophy of the anterior nasal spine, resorption of the medial part of the alveolar process, loss of sharpness of the piriform aperture margins, and atrophy of the nasal turbinate and the septum. These changes were consistent with previous findings from paleopathological studies. We also developed a novel method for measuring the anterior-posterior length of the maxilla using 3D-CT images, with compensation for individual differences in cranial size. The calculated values are indicative of the severity of the maxillary defects as well as the thickness of bone that needs to be reconstructed to correct the deformed maxilla.
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Affiliation(s)
- Norio Kasai
- Department of Otolaryngology, National Sanatorium Oku-Komyoen, Setouchi City, Okayama, Japan
- Department of Otolaryngology, National Sanatorium Nagashima-Aiseien, Setouchi City, Okayama, Japan
| | - Osamu Kondo
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Itabashi-ku, Tokyo, Japan
- Leprosy Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Yoshinori Aoki
- Department of Otolaryngology, National Sanatorium Oku-Komyoen, Setouchi City, Okayama, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Masamichi Goto
- National Sanatorium Hoshizuka-Keiaien, Kanoya, Kagoshima, Japan
- * E-mail:
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Irani S. Orofacial Bacterial Infectious Diseases: An Update. J Int Soc Prev Community Dent 2017; 7:S61-S67. [PMID: 29184830 PMCID: PMC5682706 DOI: 10.4103/jispcd.jispcd_290_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Most of the oral infections with odontogenic origin are very common and can be treated by tooth extraction, endodontic therapy, or surgical treatment. Other infectious lesions are the manifestations of systemic diseases such as tuberculosis and syphilis. Skin and underlying subcutaneous tissue, fascia, or muscle is also involved with infectious diseases which range from superficial epidermal infections to very serious necrotizing fasciitis. MATERIALS AND METHODS An extensive literature in PubMed, Google Scholar, and Scopus search was performed from 1980 to 2017. All related articles were analyzed. RESULTS Most oral infections have odontogenic origin. Skin and the underlying subcutaneous tissue, fascia, or muscles are also involved with infectious diseases which range from superficial epidermal infections to very serious necrotizing fasciitis. CONCLUSIONS These facts prove that the interaction between the oral cavity, face skin, and the other organs can risk the people's life. The establishment of a correct diagnosis and recognition of clinical findings are the crucial steps to support and improve professional orofacial health status.
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Affiliation(s)
- Soussan Irani
- Department of Oral Pathology, Dental Research Center, Research Centre for Molecular Medicine, Dental Faculty, Hamadan University of Medical Sciences, Hamadan, Iran
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Rodrigues GA, Qualio NP, de Macedo LD, Innocentini L, Ribeiro-Silva A, Foss NT, Frade M, Motta A. The oral cavity in leprosy: what clinicians need to know. Oral Dis 2016; 23:749-756. [PMID: 27606832 DOI: 10.1111/odi.12582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/29/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a bacillus that has a tropism for skin and peripheral nerves. Leprosy treatment is based on a multidrug therapy established by the World Health Organization in 1982 and, despite its widespread use, Brazil ranks second worldwide in numbers of cases. Oral involvement in leprosy has been poorly described in the literature, and few studies have shown that although the bacillus is found in mucosa, specific leprosy lesions are rare and affect patients with advanced stages of the disease. This review aimed to assess the literature on oral manifestations in leprosy and the aspects involving oral cavity in leprosy pathogenesis.
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Affiliation(s)
- G A Rodrigues
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Oral Diagnosis Division, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - N P Qualio
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Oral Diagnosis Division, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - L D de Macedo
- Dentistry and Stomatology Division, Ribeirão Preto Clinical Hospital, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lmar Innocentini
- Dentistry and Stomatology Division, Ribeirão Preto Clinical Hospital, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A Ribeiro-Silva
- Department of Pathology and Forensic Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - N T Foss
- Department of Internal Medicine, Dermatology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Mac Frade
- Department of Internal Medicine, Dermatology Division, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Acf Motta
- Department of Stomatology, Public Oral Health and Forensic Dentistry, Oral Diagnosis Division, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree. Int J Dent 2016; 2016:7278925. [PMID: 27781066 PMCID: PMC5066016 DOI: 10.1155/2016/7278925] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] Open
Abstract
Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression.
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Nagappa M, Chickabasaviah YT, Mahadevan A, Parthiban R, Taly AB. Pitfalls in the diagnosis of leprous neuropathy: Lessons learnt from a University hospital in an endemic zone. J Neurol Sci 2015; 357:252-6. [DOI: 10.1016/j.jns.2015.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 01/30/2023]
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Abstract
PURPOSE OF REVIEW Infectious neuropathies are heterogeneous neuropathies with multiple causes. They still represent an important world health burden and some of them have no current available therapy. RECENT FINDINGS Leprosy incidence has decreased by 50% during the last years, but leprosy-related neuropathies still cause severe disability. The pure neuritic leprosy is a diagnostic challenge that may require nerve biopsy or nerve aspiration cytology. The treatment itself may lead to a 'reversal reaction', which further causes injuries to the nerve. HCV-related neuropathies may be related or not to the presence of cryoglobulins. The absence of vasculitis, the most frequent form is a peripheral sensory neuropathy involving small nerve fibers, and more accurately diagnosed by pain-related evoked potentials. HIV-related neuropathy has become the major neurological complication of HIV infection. Both HIV-induced neuropathy and antiretroviral toxic neuropathy are clinically indistinguishable. The existence of an isolated chronic polyneuropathy due to Borrelia burgdorferi remains highly controversial. Lastly, an active infectious ganglioneuritis caused by varicella zoster virus, producing shingles, is the most frequent infectious neuropathy in the world and may cause various neurological complications. Zoster sine herpete remains frequently undiagnosed. SUMMARY Recent data have improved our knowledge and diagnostic tools of infectious neuropathies. Treatment of the injured nerves is not yet available, and prevention and rapid diagnosis remain the main priorities for the clinician.
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da Rosa FB, de Souza VC, de Almeida TAP, do Nascimento VA, Vásquez FG, Cunha MDGS, Naveca FG. Detection of Mycobacterium leprae in saliva and the evaluation of oral sensitivity in patients with leprosy. Mem Inst Oswaldo Cruz 2013. [PMID: 23903971 PMCID: PMC3970609 DOI: 10.1590/0074-0276108052013006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate sensitivity disorders in the
oral cavity related to the presence of Mycobacterium leprae in
the saliva of treatment-naïve patients with leprosy in the state of Amazonas,
Brazil. A cross-sectional study was conducted involving 45 subjects with
leprosy. The subjects were interviewed to evaluate the sensitivity of the oral
cavity. For the detection of M. leprae, saliva and slit-skin
smear samples were collected. The samples were analysed using a bacteriological
index (BI) protocol and the real-time quantitative polymerase chain reaction
(qPCR). The results indicated that 15 of the 45 (33.3%) subjects with leprosy
showed decreased oral sensitivity, which confirmed the importance of the oral
cavity sensitivity evaluation. There was not a direct relationship between the
presence of M. leprae in saliva and changes in oral
sensitivity. Positive saliva qPCR results from six (31.6%) of 19 paucibacillary
(PB) patients suggested the possibility of a new site for sample collection.
Positive results using these diagnostic techniques (BI, slit-skin smear and
saliva qPCR) increased to 55.5%, thus opening the possibility of combining these
different techniques to increase the rate of positive diagnoses, especially in
PB patients.
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Affiliation(s)
- Fernanda Borowsky da Rosa
- Universidade Federal do Amazonas, Manaus, AM, Brasil , Universidade Nilton Lins, Manaus, AM, Brasil , Corresponding author:
| | | | | | | | | | | | - Felipe Gomes Naveca
- Universidade Federal do Amazonas, Manaus, AM, Brasil , Instituto Leônidas e Maria Deane-Fiocruz, Manaus, AM, Brasil
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