RESUMO
Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. The disease may evolve for inflammatory reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL), the major cause of irreversible neuropathy in leprosy, which occur in 1 in 3 people with leprosy, even with effective treatment of M. leprae. Leprosy remains persistently endemic in our region where it predominantly affects lowest socioeconomic conditions people, as Toxoplasma gondii infection in the municipality studied. Previously, we have shown T. gondii coinfection as a risk marker for leprosy, mainly in its severe form. This present study assessed whether T. gondii infection is also a risk factor for leprosy reactions and the predictive value of immunoglobulin production prior to development of leprosy reactions. Patients with leprosy (n = 180), co-infected or not with T. gondii, had their serum investigated for levels of IgA, IgE, IgG1, IgG2, IgG3 and IgG4 anti-PGL-1 by ELISA prior to development of leprosy reactions. The serologic prevalence for T. gondii infection was 87.7% in leprosy reaction patients reaching 90.9% in those with ENL. The leprosy reaction risk increased in T. gondii seropositive individuals was two-fold ([OR] = 2.366; 95% confidence interval [CI 95%]: 1.024-5.469) higher than those seronegative, and considering the risk of ENL, this increase was even more evident (OR = 6.753; 95% CI: 1.050-72.85) in coinfected individuals. When evaluated the prediction of anti-PGL-1 immunoglobulin levels for development of leprosy reactions in patients coinfected or not with T. gondii, only the increase IgE levels were associated to occurrence of reactional episodes of leprosy, specifically ENL type, in patients coinfected with T. gondii, compared to those not coinfected or no reaction. Thus, the immunomodulation in co-parasitism T. gondii-M. leprae suggest increased levels of IgE as a biomarker for early detection of these acute inflammatory episodes and thereby help prevent permanent neuropathy and disability in leprosy patients.
Assuntos
Eritema Nodoso , Imunoglobulina E , Toxoplasma , Toxoplasmose , Humanos , Toxoplasmose/sangue , Toxoplasmose/complicações , Toxoplasmose/imunologia , Toxoplasmose/epidemiologia , Eritema Nodoso/imunologia , Eritema Nodoso/epidemiologia , Eritema Nodoso/sangue , Feminino , Masculino , Adulto , Imunoglobulina E/sangue , Pessoa de Meia-Idade , Toxoplasma/imunologia , Coinfecção/imunologia , Coinfecção/parasitologia , Mycobacterium leprae/imunologia , Adulto Jovem , Adolescente , Fatores de Risco , Idoso , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/sangue , Hanseníase Virchowiana/epidemiologiaRESUMO
BACKGROUND: Mycobacterium leprae and Toxoplasma gondii infections are both neglected tropical diseases highly prevalent in Brazil. Infection with certain parasite species can significantly alter susceptibility to other important pathogens, and/or influence the development of pathology. Here we investigated the possible influence of M. leprae/T. gondii co-parasitism on the manifestation of leprosy and its clinical forms. METHODS: Participants (n = 291) were recruited in Campos dos Goytacazes city, Rio de Janeiro state, southeast Brazil, from August 2015 to December 2019 and clinically diagnosed for leprosy. Participants were selected based on the presence (patients) or absence (healthy controls) of the leprosy disease. Contacts of patients were also recruited for this study. Serum samples from patients (n = 199) with leprosy, contacts (n = 40) and healthy controls (n = 52) were investigated for levels of IgM and IgG anti-phenolic glycolipid-1 (PGL-1) by ELISA. Additionally, IgG antibody against soluble Toxoplasma antigen (STAg) was measured in sera samples from leprosy patients, contacts and healthy controls for Toxoplasma gondii serology by ELISA. Anti-PGL-1 IgG and IgM levels were compared using one-way ANOVA Kruskal-Wallis or Mann-Whitney, while Spearman test was used to correlate levels of IgG anti-STAg and IgM/IgG anti-PGL-1 from seropositive and seronegative individuals for T. gondii infection. The risk of T. gondii infection for leprosy disease was assessed using Fisher's test. RESULTS: Levels of IgM anti-PGL-1 antibodies were significantly higher in multibacillary (MB) patients compared to paucibacillary (PB) patients (P = 0.0068). Higher IgM and IgG levels anti-PGL-1 were detected in patients with the lepromatous forms. The serologic prevalence for T. gondii infection was 74.9%. We detected increased anti-STAg antibody levels in leprosy patients (79.4%), reaching 88.8% within those with lepromatous form of this disease. The leprosy risk increase in T. gondii seropositive individuals was two-fold (odds ratio [OR] = 2.055; 95% confidence intervals [95% CI]: 1.18-3.51) higher than those seronegative, and considering the lepromatous leprosy risk this increase was even dramatic (OR = 4.33; 95% CI: 1.76-9.69) in T. gondii seropositive individuals. Moreover the leprosy risk in T. gondii seropositive individuals was weakly correlated to the levels of IgG anti-STAg and IgM/IgG anti-PGL-1. CONCLUSIONS: Altogether, our results suggest that T. gondii infection may exert immunomodulatory properties that influence to the susceptibility of leprosy, mainly on its more severe clinical form. A better understanding of parasite immunomodulation can ultimately contribute to the development of medical applications.
Assuntos
Anticorpos Antibacterianos/sangue , Hanseníase Virchowiana/epidemiologia , Mycobacterium leprae/imunologia , Toxoplasma/imunologia , Toxoplasmose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Comorbidade , Ensaio de Imunoadsorção Enzimática , Feminino , Glicolipídeos/imunologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Adulto JovemRESUMO
Background Mycobacterium leprae and Toxoplasma gondii infections are both neglected tropical diseases highly prevalent in Brazil. Infection with certain parasite species can significantly alter susceptibility to other important pathogens, and/or influence the development of pathology. Here we investigated the possible influence of M. leprae/T. gondii co-parasitism on the manifestation of leprosy and its clinical forms. Methods Participants (n=291) were recruited in Campos dos Goytacazes city, Rio de Janeiro state, southeast Brazil, from August 2015 to December 2019 and clinically diagnosed for leprosy. Participants were selected based on the presence (patients) or absence (healthy controls) of the leprosy disease. Contacts of patients were also recruited for this study. Serum samples from patients (n=199) with leprosy, contacts (n=40) and healthy controls (n=52) were investigated for levels of IgM and IgG anti-phenolic glycolipid-1 (PGL-1) by ELISA. Additionally, IgG antibody against soluble Toxoplasma antigen (STAg) was measured in sera samples from leprosy patients, contacts and healthy controls for Toxoplasma gondii serology by ELISA. Anti-PGL-1 IgG and IgM levels were compared using one-way ANOVA Kruskal-Wallis or Mann-Whitney, while Spearman test was used to correlate levels of IgG anti-STAg and IgM/IgG anti-PGL-1 from seropositive and seronegative individuals for T. gondii infection. The risk of T. gondii infection for leprosy disease was assessed using Fisher’s test. Results Levels of IgM anti-PGL-1 antibodies were significantly higher in multibacillary (MB) patients compared to paucibacillary (PB) patients (P=0.0068). Higher IgM and IgG levels anti-PGL-1 were detected in patients with the lepromatous forms. The serologic prevalence for T. gondii infection was 74.9%. We detected increased anti-STAg antibody levels in leprosy patients (79.4%), reaching 88.8% within those with lepromatous form of this disease. The leprosy risk increase in T. gondii seropositive individuals was two-fold (odds ratio [OR]=2.055; 95% confidence intervals [95% CI]: 1.18–3.51) higher than those seronegative, and considering the lepromatous leprosy risk this increase was even dramatic (OR=4.33; 95% CI: 1.76–9.69) in T. gondii seropositive individuals. Moreover the leprosy risk in T. gondii seropositive individuals was weakly correlated to the levels of IgG anti-STAg and IgM/IgG anti-PGL-1. Conclusions Altogether, our results suggest that T. gondii infection may exert immunomodulatory properties that influence to the susceptibility of leprosy, mainly on its more severe clinical form. A better understanding of parasite immunomodulation can ultimately contribute to the development of medical applications.
RESUMO
Objetivo Analizar la producción científica y la evidencia científica en periodoncia y terapéutica de implantes de las revistas a nivel de Iberoamérica. Materiales y métodos Perfil bibliométrico que analizó los artículos científicos publicados en las revistas odontológicas de los países que conforman la Federación Iberopanamericana de Periodoncia en el intervalo de los años 2012 hasta el 2014. La búsqueda de los artículos se realizó a través de un análisis manual vía el portal web de cada revista, así como a través de las bases de datos SciELO, RedALyC y LiLACS. Se analizaron la productividad científica por año, el tipo, el diseño y el nivel de evidencia de cada artículo, así como la temática de periodoncia y/o implantes dentales. Resultados Fueron analizados 505 artículos publicados en un periodo de 3 años, el 47,7% de estudios fueron publicados en Brasil, el 14,7% en México y el 8,1% en Chile. El 23,9% de los estudios fueron artículos de revisión y el 43,76% pertenecieron a un nivel de evidencia científica de nivel IV. Conclusión La mayor productividad de publicaciones se concentra en las revistas de los países de Brasil, México, Chile y España; la principal temática de las publicaciones científicas son las referidas a los implantes dentales. La calidad de las publicaciones a nivel de Iberoamérica es baja, con un predominio de los reportes de caso y artículos de revisión (nivel IV) y en menor medida las revisiones sistemáticas y los ensayos clínicos.
Aim To analyse the scientific production in therapeutic implants and periodontology in Latin American journals. Materials and methods A literature review that analysed scientific articles published in dental journals in the countries of the Ibero-Pan-American Federation of Periodontology during the years 2012-2014. The search for articles was made through a manual analysis via the web portal in each journal and through SciELO, RedALyC, and LiLACS data bases. The scientific productivity was determined by year, type, design, and level of evidence for each article, as well as the subject of Periodontology and/or dental implants. Results The analysis was performed on 505 articles over a period of 3 years, and most of them were published in three countries: 47.7% from Brazil, 14.7% in Mexico, and 8.1% in Chile. Of these, 23.9% were review articles and 43.76% had an evidence level of IV. Conclusion The highest productivity of publications is concentrated in journals from Brazil, Mexico, Chile, and Spain. The main theme of scientific publications referred to dental implants. The quality of publications at Latin American level is low, with a predominance of case reports and review articles (level IV), and less systematic reviews and clinical trials.
Assuntos
Humanos , Publicações Periódicas como Assunto , Doenças Periodontais , Bibliometria , Implantação Dentária , América LatinaRESUMO
A good amount and width of keratinized tissue around implants has been associated with better peri-implant health, less bone loss and improved esthetics. The purpose of this case was to evaluate a new porcine xenograft (collagen matrix) used as an interpositional graft to augment thickness of the peri-implant mucosa. There are few studies using a collagen matrix as a substitute for subepithelial connective graft around implants. This case involved a clinical implant in teeth 15 in which it was made the most of it during placement of healing abutment by taking the opportunity to increase peri-implant mucosa with a collagen matrix. Thickness increased 1.5mm while the amount of keratinized mucosa was kept at 4mm. It is concluded that the collagen matrix of porcine origin is a good alternative to increase thickness of the peri-implant mucosa and reduce morbidity. It is easy to handle and suture as well.
Una buena cantidad y grosor de tejido queratinizado alrededor de implantes ha sido asociado con una mejor salud periimplantaria, menos pérdida ósea y una mejora en la estética. El propósito de este caso clínico fue evaluar un nuevo xenoinjerto de origen porcino (matriz de colágeno) al ser utilizada como un injerto interposicional para au¬mentar el grosor de la mucosa periimplantaria. Son pocos los estudios que utilizan la matriz de colágeno como sustituto del injerto conectivo subepitelial alrededor de implantes. El caso clínico incluyó un implante a nivel de la pieza 15, en el cual durante la colocación del pilar de cicatrización se aprovechó para engrosar la mucosa periimplantaria utilizando una matriz de colágeno. Se obtuvo un aumento de grosor de 1,5mm manteniéndose la cantidad de mucosa queratinizada de 4mm. Se concluyó que la matriz de colágeno de origen porcino es una buena alternativa para aumentar el grosor de la mucosa periimplantaria, además de reducir la morbilidad, ser de fácil manejo y de fácil sutura.
Assuntos
Humanos , Pessoa de Meia-Idade , Colágeno/uso terapêutico , Estética Dentária , Implantação Dentária Endóssea/métodos , Mucosa Bucal/cirurgia , Queratinas , SuínosRESUMO
Achieving root coverage after exposure caused by gingival recession is one of the main goals of reconstructive periodontal surgery. Even though a large variety of techniques and mucogingival grafting procedures are available, their long-term results are not clear yet. Therefore, this study aimed to compare clinical effectiveness of the porcine collagen matrix with subepithelial connective graft for treating Miller class I and II gingival recessions. Materials and methods: The randomized clinical trial included twelve patients assigned to two groups. In the first group (experimental), six patients were treated using collagen matrix (mean age, 54.3 +/- 5.6 years; mean recession 2. 67 ± 1.03 mm). Another group (control) of six patients was treated using connective grafts (mean age, 57.1 +/- 2.7 years; mean recession 4.33 +/- 1.03 mm). All patients underwent periodontal evaluation and pre-surgical preparation including oral hygiene instruction and supragingival scaling. Gingival recessions were exposed through partial thickness flaps where the grafts and matrices were placed. Patients were assessed periodically until complete healing of tissue. Results: Root coverage parameters, amount of keratinized gingiva, gingival biotype and clinical attachment level were evaluated. The root coverage percentage for the group using connective graft was 24.7 +/- 13.5 percent and 16.6 +/- 26.8 percent for the one treated with the matrix. The amount of increased keratinized tissue was 4.33 +/- 2.06 mm and 4.5 +/- 0.83 mm for the control and experimental group respectively. Both groups increased gingival biotypes from thin to thick at 100 percent. The final clinical attachment level was 4.17 +/- 3.17 +/- 04mm for the control group and 0.98 mm for the experimental group. There were significant differences between the outcome of gingival recession and clinical attachment. Conclusion: Results indicate both techniques, besides being predictable...
Lograr la cobertura radicular que se expone por las recesiones gingivales es uno de los principales objetivos de las cirugías periodontales reconstructivas. Una gran variedad de técnicas e injertos mucogingivales se encuentran como opciones terapéuticas. Sin embargo, los resultados y efectividad a largo plazo aún no son claros. Este estudio tuvo como objetivo comparar la efectividad clínica de la matriz de colágeno de origen porcino versus el injerto conectivo subepitelial en el tratamiento de las recesiones gingivales Miller clase I y II. Materiales y métodos: Ensayo clínico aleatorizado donde participaron 12 pacientes asignados de manera aleatoria en 2 grupos; el primer grupo de 06 pacientes (grupo experimental) fueron tratados con la matriz de colágeno (promedio de edad de 54,3 +/- 5,6; promedio de las recesiones de 2,67 +/-1,03mm) y el segundo grupo de 06 pacientes (grupo control) fueron tratados con el injerto conectivo (promedio de edad de 57,1 +/- 2,7; promedio de las recesiones de 4,33 +/- 1,03mm). Todos los pacientes recibieron una evaluación periodontal y una preparación pre quirúrgica incluyendo las instrucciones de higiene oral y una raspaje supragingival. Las recesiones gingivales fueron expuestas a través de colgajos de espesor parcial en los cuales se colocaron los injertos y las matrices. Los pacientes fueron evaluados periódicamente hasta completar la cicatrización de los tejidos. Resultados: Se evaluaron los parámetros de cobertura radicular, cantidad de encía queratinizada, biotipo gingival y nivel de inserción clínica. El porcentaje de cobertura radicular para el grupo del injerto fue de 24,7 +/-13,5 por ciento y de 16,6+/- 26,8 por ciento para el grupo de la matriz. La cantidad de encía queratinizada aumentada fue de 4,33 +/- 2,06mm y de 4,5 +/- 0,83mm para el grupo del injerto y la matriz respectivamente. Ambos grupos aumentaron los biotipos gingivales de finos a gruesos...
Assuntos
Humanos , Masculino , Animais , Feminino , Pessoa de Meia-Idade , Tecido Conjuntivo , Colágeno/uso terapêutico , Retração Gengival/cirurgia , Doenças Periodontais/cirurgia , Seguimentos , Suínos , Resultado do TratamentoRESUMO
Las enfermedades que involucran a los tejidos que rodean a los dientes y a los implantes osteointegrados son el resultado de una interacción entre algún tipo de agente patológico (bacteriano, viral, etc.) y la respuesta inmunitaria del huésped. Estas interacciones se pueden dar tanto en los tejidos dentarios como en aquellos biomateriales que se introducen para tratar de corregir algún tipo de patología periodontal; los implantes al ser sustitutos biocompatibles de las piezas dentarias no están exentas de este tipo de interacciones que muchas veces cursan con patologías periodontales y periimplantarias. La periimplantitis es un tipo de patología que resulta de dicha interacción; los factores de riesgo e indicadores de riesgo de la periimplantitis son amplios y complejos. El presente artículo resume las múltiples fuentes de información de la literatura científica para abordar al detalle los aspectos de los principales factores de riesgo y la periimplantitis en la terapia implantológica.
Diseases involving tissue around the teeth and osseo integrated implants are the result of an interaction between some type of pathological agent (bacterial, viral, etc.) and host immune response. These interactions can occur both in the dental tissues as those biomaterials which are introduced to attempt to correct some type of periodontal disease, the implant being a biocompatible substitute of the teeth is not free from this type of interaction often enrolled periodontal and peri-implant pathology. The peri-implantitisis a type of disease that results from this interaction, the risk factors and risk indicators of peri-implantitis are broad and complex. This article summarizes the multiple sources of information in the scientific literature to address in detail the aspects of the main risk factors and the peri-implantitis in the peri implant therapy.