Infecções odontogênicas, mediadores inflamatórios e episódios reacionais em indivíduos com hanseníase multibacilar

Abstract

The existing immune complex interaction between the host and Mycobacterium leprae can, under certain conditions, result in acute inflammatory episodes with clinical and immunological manifestations specific. Among the predisposing factors are likely to odontogenic borne infections. Objective: To analyze dental infections as the dental and gingival-periodontal conditions, as well as the inflammatory mediators involved as potential determinants of leprosy reactions. Method: Developed in 3 parts which include: observational case-control study unpaired residents leprosy patients in the state of Mato Grosso, with the first episode reaction (cases) compared to those without leprosy reaction (controls) according to variables related to dental conditions and gingival-periodontal parameters; review of primary literature on inflammatory mediators involved in immunopathological process of leprosy reactions and dental infections; and laboratory analysis of inflammatory mediators involved in the immune response of chronic periodontal disease (DPC) and leprosy reactions by RT-qPCR technique of skin biopsies and gum tissue and the ELISA serum mediators. Results: The study included 57 patients with multibacillary leprosy, of which 23 (40.4%) with the reactional episode of leprosy (cases) and 34 (59.6%) were non-reactive (controls). DPC was present in 22 (45.0%) patients and main odontogenic infection was associated with leprosy reactions (ORaj = 4.3; p = 0.033). The presence of periodontal pocket (ORaj = 3.6; p = 0.033), the need for dental extraction (ORaj = 24.6; p = 0.006) and the presence of alveolar bone loss (ORaj = 6.5; p = 0.030) also were associated leprosy reactions. The principal mediators involved in immunopathological process of DPC and lepra reactions were IL-6, IFN-γ, TNF-α, IL-1β and IL-4. Reactive patients had greater mean values for IL-6 (p = 0.036) in serum. Average serum levels of IL-4 (p <0.01) and IL-6 (p <0.05) in patients with the CPD and reaction were lower when compared to levels of CPD cases without and without leprosy reaction. Among patients with DPC and reactive serum levels of IFN-γ they proved to be higher when compared to that seen for no DPC and not reactive group (p = 0.044). Conclusion: Characterized as clinical potential determinants of leprosy reactions the presence of periodontal pockets, alveolar bone resorption, teeth requiring extraction and chronic periodontal disease. As immunological determinants involved in the immunopathogenesis of reactions include the IL-4, IL-6 and IFN-γ.