Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review

Abstract

Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, “leprosy reactions” and “inflammatory mediators”; Stage II, “dental infections” and “inflammatory mediators”; and Stage III, “leprosy reactions,” “dental infections,” and “inflammatory mediators”). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1β, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1β were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1β were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum.

The involvement of endothelial mediators in leprosy

“…Leprosy reactions are acute inflammatory episodes superimposed to the chronic course of the disease and responsible for irreversible nerve damage ( Scollard et al 2015) . Leprosy reactions are classified as type 1 (T1R) and type 2 (T2R) reactions, and show distinct immunological characteristics that may occur before and during the treatment or up to five years after the conclusion of multidrug therapy (MDT) ( Pandhi & Chhabra 2013 , Cortela et al 2015) .…”

“…T2R develops in lepromatous leprosy (LL) and borderline lepromatous (BL), in which is observed high bacterial load and ill-defined antigen specific T cells functions (de Souza et al 2016) . T2R is described as abruptly induced recurrent episodes of immune complex-mediated reactions, where local signs are accompanied by systemic involvement ( Stefani et al 2009 , Cortela et al 2015) . The identification of specific markers of leprosy reactions could allow more efficient management of patients at higher risk.…”

Higienização bucal em pacientes com deformidades nas mãos: uso de adaptador para escova dental

“…Mais que isso, a doença periodontal pode ser um fator desencadeador dessas reações 19 . De fato, os mediadores proinflamatórios envolvidos nos processos imunopatológicos para a infecção gengival e para as reações hansênicas são idênticos 20 . Assim, o monitoramento efetivo do tratamento dessas infecções poderia diminuir a incidência do dano neural e das incapacidades nos casos de hanseníase, assim como a perda dental de modo geral.…”

The oral cavity in leprosy: what clinicians need to know

“…There are two main types of reactional episodes: the reverse reaction (RR) or type 1, and the erythema nodosum leprosum (ENL) or type 2 (Foss et al , ; Moraes et al , ; Putinatti et al , ; Reibel et al , ). Their pathophysiological mechanisms are uncertain and are possibly associated with the inflammatory reaction related to conditions such as immunization, stress, pregnancy, puberty, childbirth, surgery, use of drugs such as antibiotics, potassium iodide, progesterone, and vitamin A, and infectious diseases, including viral or bacterial recurrent infections (Sarno et al , ; Foss et al , ; Lastoria and Abreu, ; Cortela et al , ).…”