The recurrence of leprosy reactional episodes could be associated with oral chronic infections and expression of serum IL-1, TNF-α, IL-6, IFN-γ and IL-10

Abstract

The aim of this study was to determine whether the presence of leprosy reactional episodes could be associated with chronic oral infection. Thirty-eight leprosy patients were selected and divided into 2 groups: group I - 19 leprosy patients with oral infections, and group II - 19 leprosy patients without oral infections. Ten patients without leprosy, but presenting oral infections, were assigned to the control group. Leprosy patients were classified according to Ridley and Jopling classification and reactional episodes of the erythema nodosum type or reversal reaction were identified by clinical and histopathological features associated with serum IL-1, TNF-alpha, IL-6, IFN-gamma and IL-10 levels. These analyses were performed immediately before and 7 days after the oral infection elimination. Patients from group I presenting oral infections reported clinical improvement of the symptoms of reactional episodes after dental treatment. Serum IL-1, TNF-alpha, IL-6, IFN-gamma and IL-10 levels did not differ significantly before and after dental treatment as determined by the Wilcoxon test (p>0.05). Comparison of the 2 groups showed statistically significant differences in IL-1 and IL-6 at baseline and in IL-1, IL-6 and IL-10 on the occasion of both collections 7 days after therapy. Serum IL-6 and IL-10 levels in group I differed significantly at baseline compared to control (Mann-Whitney test; p<0.05). These results suggest that oral infection could be involved as a maintenance factor in the pathogenesis of leprosy reactional episodes.

Effect of Cytokine Interplay on Macrophage Polarization during Chronic Pulmonary Infection with Cryptococcus neoformans

“…The mechanism of an "early/transient" Th2 response leading to chronic inflammation is likely involved not only in ABPM but also in other persistent infections. The chronic presence of microbe and absence of clearance are frequently associated with a perturbed immune response characterized by a mixed cytokine profile rather than with a "pure" Th2 immunity (3,8,19,29,38). Our data from the IL-4…”

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

“…It has been observed that PBMCs present different levels of proliferation index of cytokines when they are stimulated in vitro with Mycobacterium leprae extracts [21][22][23] . On the other hand, we observed that the leprosy reactional episodes are frequent in patients presenting oral infections 14,15 and other coinfections 24 . Therefore, this study attempted to clarify whether chronic oral infections could influence the intracellular production of cytokines in leprosy patients, and to verify the relationship with the development of reactional episodes.…”

“…The coexistence of oral chronic infections with leprosy can modulate the inflammatory reaction by elevation of the intracellular inflammatory markers expression, probably stimulating a spill-over of these inflammatory products into the peripheral circulation where they can act as inducers of an inflammatory reaction, exacerbating the insidious chronic evolution of leprosy and, consequently, acting like an inducer, stimulatory or maintaining factor in leprosy reactions 14,15,24 . In addition, the presence of these chronic infections can influence the production of intracellular cytokines, and can reflect the fact that most of the leprosy patients with coinfection (Group I) presented reactional episodes, corroborating the hypothesis of a synergistic action of the two kinds of inflammatory reaction on the course of leprosy.…”

“…In a previous study evaluating the expression of proinflammatory serum biomarkers we observed that leprosy patients with oral infections presented more leprosy reactions associated with higher C-reactive protein (CRP), chemokine IP-10, interleukin-1 (IL-1) and interleukin-6 (IL-6) levels than leprosy patients without oral infections, suggesting that oral infections can act as a maintenance factor of the proinflammatory state 14,15 . However, these results do not show the real participation of peripheral blood cells and the amount of cytokines produced by each cell population, compromising the understanding of the inflammatory response.…”

Leprosy, a neglected disease that causes a wide variety of clinical conditions in tropical countries

“…Additionally, we evaluated the expression of proinflammatory serum biomarkers in LPs presenting oral infections (periodontal diseases, irreversible pulpitis, pulpal necrosis, or inflammatory periapical lesions) and we observed higher CRP, IL-10, IL-1 and IL-6 levels in the presence of oral infections, suggesting that oral infections can act as a maintenance factor of the proinflammatory state (Motta et al 2010. Thus, the coexistence of chronic oral infections with leprosy can stimulate the inflammatory reaction by elevating the expression of intracellular inflammatory markers.…”