Oral lesions after infection by SARS CoV 2: two case reports / Lesiones bucales posteriores a infección por SARS CoV 2 presentación de dos casos

Introduction: The SARS CoV 2 infection has resulted in several health, economic, and social crises in all areas. The disease shows a substantial biological diversity in humans causing a series of sequels in the trans- or post-infection period in the entire organism. Case Report: The manifestations that occur in the oral cavity and pharynx have not been evaluated. In this study, two clinical cases are reported. The first patient, a 67-year-old male, presents erosive lesions on the dorsal surface of his tongue after SARS CoV 2 infection. Results: Therapy consisting of reinforcing oral cleaning, use of antifungal solutions, mouthwashes containing superoxidation solution and B complex was given to the patient. The reported lesions improved satisfactorily. The second case, a 47-year-old male patient, presented vesiculobullous lesions on the lingual and labial mucosa accompanied by severe painful symptoms after SARS CoV 2 infection. An incisional biopsy was performed. The histopathological result was compatible with pemphigus vulgaris, and the treatment protocol was started with 0.1% topical mometasone and 2g miconazole gel, observing adequate involution of the lesions after 20 days. Conclusions: The aim of this study is to report on the lesions affecting the oral cavity and pharynx in post-COVID patients with the aim of carrying out a thorough intraoral examination, establishing a clinical or histopathological diagnosis to implement a specific treatment plan in each case to improve the health and quality of life of the patients. Keywords: SARS-CoV-2; Oral manifestations; Oral ulcer; Pemphigus; Mouth; Mucous membrane.

Introducción: La infección por virus de SARS CoV 2 ha dejado a su paso una estela de crisis en materia de salud, económica, social y en todos los ámbitos a la fecha seguimos realizando la observación del comportamiento de la enfermedad en los seres humanos con una diversidad biológica importante y que ha traído como consecuencia una serie de secuelas que se presentan en el periodo trans o posterior a la infección en toda la economía corporal. Reporte de Caso: Se ha evaluado poco las manifestaciones que se presentan en la cavidad bucal y faringe; se presentan dos casos clínicos el primero paciente masculino de 67 años de edad posterior a la infección por SARS CoV 2 presenta diluciones de continuidad en bordes laterales de la lengua se indica terapia y refuerza limpieza bucal, antimicótico, colutorios con solución de superoxidación y complejo B, las úlceras involucionan de manera satisfactoria. Resultados: El segundo caso masculino de 47 años posterior a la infección por SARS CoV 2 debuta con lesiones vesículo-ampollosas en mucosa lingual, labial con sintomatología dolorosa severa, se realiza biopsia incisional donde el resultado histopatológico es compatible con pénfigo vulgar, se inicia protocolo de tratamiento con mometasona tópica al 0.1% y miconazol gel 2g observándose una adecuada involución de las lesiones a los 20 días. Conclusiones: El objetivo de este trabajo es poner en contexto de la comunidad médica y científica las lesiones concernientes a la cavidad bucal y faringe que están presentando los pacientes postcovid con el objetivo de realizar una exhaustiva exploración intraoral, establecer un diagnóstico clínico o histopatológico y con base en esto instaurar un plan de tratamiento específico en cada caso en particular con el fin fundamental de mejorar la salud y calidad de vida del paciente.

Distribution and Drug Resistance of Pathogens in Oral Mucositis Associated with Chemotherapy in Patients with Malignant Hematopathy / 中国实验血液学杂志

OBJECTIVE@#To analyze the distribution and drug resistance of pathogens in oral mucositis associated with chemotherapy in hospitalized patients with malignant hematopathy, so as to provide scientific evidences for rational selection of antibiotics and infection prevention and control.@*METHODS@#From July 2020 to June 2022, 167 patients with malignant hematopathy were treated with chemical drugs in the Department of Hematology, Hainan Hospital, and secretions from oral mucosal infected wounds were collected. VITEK2 COMPECT automatic microbial identification system (BioMerieux, France) and bacterial susceptibility card (BioMerieux) were used for bacterial identification and drug susceptibility tests.@*RESULTS@#A total of 352 strains of pathogens were isolated from 167 patients, among which 220 strains of Gram-positive bacteria, 118 strains of Gram-negative bacteria and 14 strains of fungi, accounted for 62.50%, 33.52% and 3.98%, respectively. The Gram-positive bacteria was mainly Staphylococcus and Streptococcus, while Gram-negative bacteria was mainly Klebsiella and Proteus. The resistance of main Gram-positive bacteria to vancomycin, ciprofloxacin and gentamicin was low, and the resistance to penicillin, cefuroxime, ampicillin, cefotaxime, erythromycin and levofloxacin was high. The main Gram-negative bacteria had low resistance to gentamicin, imipenem and penicillin, but high resistance to levofloxacin, cefotaxime, cefuroxime, ampicillin and vancomycin. The clinical data of oral mucositis patients with oral ulcer (severe) and without oral ulcer (mild) were compared, and it was found that there were statistically significant differences in poor oral hygiene, diabetes, sleep duration less than 8 hours per night between two groups (P<0.05).@*CONCLUSION@#Gram-positive bacteria is the main pathogen of oral mucositis in patients with malignant hematopathy after chemotherapy. It is sensitive to glycopeptide antibiotics and aminoglycosides antibiotics. Poor oral hygiene, diabetes and sleep duration less than 8 hours per night are risk factors for oral mucositis with oral ulcer (severe).

Utilidad del Oleozón® tópico en las úlceras orales del paciente con ventilación artificial mecánica, Guantánamo 2018 / Utilidade do Oleozón® tópico nas úlceras orais do paciente com ventilação artificial mecânica, Guantanamo 2018 / Usefulness of topical Oleozón® in the oral ulcers of the patient with mechanical artificial ventilation, Guantanamo 2018

Introducción: Las úlceras de la mucosa oral son comunes en los pacientes con ventilación artificial mecánica. Objetivo: Determinar la utilidad del Oleozón® tópico en el tratamiento de las úlceras de la mu cosa oral en pacientes tratados con ventilación artificial mecánica en la Unidad de Cuidados Intensivos (UCI) del Hospital General Docente Dr Agostinho Neto. Método: Se realizó un estudio tipo caso-control durante enero-julio de 2018. El universo lo conformaron 70 pacientes, de los que se seleccionó una muestra aleatoria y se agruparon en un grupo control (n=20) que se les realizó limpieza de la cavidad bucal con solución salina fisiológica 0,9 por ciento y un grupo estudio (n=20) que se les realizó cura de la úlcera con Oleozón® tópico. Se analizó la localización, área, forma de presentación y magnitud de la úlcera y la evolución clínica de acuerdo al tratamiento que se aplicó. Resultados: La evolución satisfactoria de este tipo de úlcera se precisó en el 40,0 por ciento de los pacientes que conformaron el grupo control y el 90,0 por ciento de los que integraron el grupo estudio (p < 0,01). En este último grupo la ventana entre el inicio del tratamiento y control de la úlcera oral fue de 4,5 ± 1,1 días y para el primero fue 8,1 ± 2,7 días (p < 0,01). Conclusión: Se revela la conveniencia de la aplicación de Oleozón® tópico al tratamiento de las úlceras de la mucosa oral que se presentan en los pacientes tratados con ventilación artificial mecánica(AU)

Introduction: Ulcers of the oral mucosa are common in patients with mechanical artificial ventilation. Objective: To determine the usefulness of topical Oleozón® in the treatment of oral mucosal ulcers in patients treated with mechanical artificial ventilation in the Intensive Care Unit (ICU) of the General Teaching Hospital "Dr. Agostinho Neto". Method: A case-control study was carried out during January-July 2018. The universe was made up of 70 patients, from which a random sample was selected and grouped in a control group (n=20) who were cleaned the oral cavity with 0.9per cent physiological saline solution and a study group (n=20) who were cured of the ulcer with topical Oleozón®. The location, area, form of presentation and magnitude of the ulcer and the clinical evolution were analyzed according to the treatment that was applied. Results: The satisfactory evolution of this type of ulcer was required in 40.0por cento of the patients that formed the control group and 90.0per cent of those who made up the study group (p<0.01). In this last group, the window between the start of treatment and control of the oral ulcer was 4.5 ± 1.1 days and for the first one it was 8.1 ± 2.7 days (p<0.01). Conclusion: The convenience of the application of topical Oleozón® to the treatment of oral mucosal ulcers that occur in patients treated with mechanical artificial ventilation is revealed(AU)

Introdução: Úlceras da mucosa oral são comuns em pacientes com ventilação artificial mecânica. Objetivo: Determinar a utilidade do Oleozón® tópico no tratamento de úlceras na mucosa oral em pacientes tratados com ventilação artificial mecânica na Unidade de Terapia Intensiva (UTI) do Hospital Geral de Ensino "Dr. Agostinho Neto". Método: Foi realizado um estudo de caso-controle no período de janeiro a julho de 2018. O universo foi constituído por 70 pacientes, dos quais uma amostra aleatória foi selecionada e agrupada em um grupo controle (n=20) que foi limpo de cavidade oral com solução salina fisiológica a 0,9por cento e um grupo de estudo (n=20) curado da úlcera com Oleozón® tópico. A localização, área, forma de apresentação e magnitude da úlcera e a evolução clínica foram analisadas de acordo com o tratamento aplicado. Resultados: A evolução satisfatória desse tipo de úlcera foi necessária em 40,0por cento dos pacientes que formaram o grupo controle e em 90,0por cento daqueles que fizeram parte do grupo de estudo (p<0,01). Neste último grupo, a janela entre o início do tratamento e o controle da úlcera oral foi de 4,5 ± 1,1 dias e no primeiro foi de 8,1 ± 2,7 dias (p<0,01). Conclusão: É revelada a conveniência da aplicação tópica de Oleozón® no tratamento de úlceras na mucosa bucal que ocorrem em pacientes tratados com ventilação artificial mecânica(AU)

Therapeutic effect of Aloe vera and silver nanoparticles on acid-induced oral ulcer in gamma-irradiated mice

Abstract Radiation combined injury, a life-threatening condition, has higher mortality than simple radiation injury. The aim of the present study was to analyze the efficiency of Aloe vera and silver nanoparticles in improving the healing of ulcerated oral mucosa after irradiation. Thirty male Albino mice were divided into five groups: control, radiation, Aloe vera (AV), silver nanoparticles (NS), and AV+NS. The mice were exposed to whole body 6Gy gamma-radiation. After one hour, 20% acetic acid was injected into the submucosal layer of the lower lip for ulcer induction. The animals received topical treatment with the assigned substances for 5 days. Lip specimens were subjected to hematoxylin and eosin and anti alpha-smooth muscle actin immunohistochemical staining. Results demonstrated occurance of ulcer three days post irradiation in all groups except in the AV+NS group where only epithelial detachment was developed. After seven days, data revealed persistent ulcer in radiation group, and almost normal epithelium in the AV+NS group. A significant reduction of epithelial thickness was detected in all groups at the third day as compared to control. At the seventh day, only the AV+NS group restored the epithelial thickness. Area percent of alpha-smooth muscle actin expression was significantly decreased in radiation group at the third day followed by significant increase at the seventh day. However, all treatment groups showed significant increase in alpha-smooth muscle actin at the third day, which decreased to normal level at the seventh day. Our study demonstrated the efficiency of Aloe vera and silver nanoparticles in enhancing ulcer healing after irradiation.

Oral manifestation of histoplasmosis on the palate

Abstract This case report describes an uncommon manifestation of histoplasmosis on the soft palate. The importance of appropriate treatment and follow-up in complex cases is emphasized, especially in patients with chronic diseases. Oral lesions may occur as multiple, granular and painful ulcers, as well as verrucous growths. Lesions may also be deep, with infiltrative edges and erythematous or with white areas, accompanied by local lymphadenopathy, resembling a carcinoma on clinical examination. In this sense, a fast and accurate diagnosis is essential to the success of treatment of oral histoplasmosis.

TNF-alpha expression, evaluation of collagen, and TUNEL of Matricaria recutita L. extract and triamcinolone on oral ulcer in diabetic rats

ABSTRACT Diabetes mellitus (DM) is a disease associated with delayed wound healing of oral ulcers by increased expression of proinflammatory cytokines and cellular apoptosis. Objective to evaluate the influence of Tumor Necrosis Factor alpha (TNF-α) and apoptosis in rats with DM treated with chamomile extract or triamcinolone. Material and Methods Wistar male rats (210.0±4.2 g) were divided into five groups: negative control group (NCG) without diabetes; positive control group (PCG) with DM (alloxan, 45 mg/kg); and groups treated with chamomile extract (normoglycemic= NCG group and diabetic= DCG group) and with triamcinolone (TG). Traumatic ulcers were performed on all animals that received topical triamcinolone, chamomile extract or saline 12/12 hours for ten days. Results On days five and ten the animals were euthanized and the ulcers were analyzed by light microscopy, TUNEL assay, and immunohistochemically (TNF-α). The NCG (p=0.0062), PCG (p=0.0285), NCG (p=0.0041), and DCG (p<0.0001) groups were completely healed on the 10th day, however, there was no healing on the TG (p=0.5127) group. The TNF-α expression showed a significant reduction from the 5th to the 10th day in NCG (p=0.0266) and DCG (p=0.0062). In connective tissue, the TUNEL assay showed a significant reduction in the number of positive cells in NCG (p=0.0273) and CNG (p=0.0469) and in the epithelium only in CDG (p=0.0320). Conclusions Chamomile extract can optimize the healing of traumatic oral ulcers in diabetic rats through the reduction of apoptosis in the epithelium and TNF-α expression.

Mucocutaneous Lesions of Behcet's Disease

Behcet's disease is particularly prevalent in "Silk Route" populations, but it has a global distribution. The diagnosis of the disease is based on clinical criteria as there is as yet no pathognomonic test, and mucocutaneous lesions, which figure prominently in the presentation and diagnosis, may be considered the diagnostic hallmarks. Among the internationally accepted criteria, painful oral and genital ulcers, cutaneous vasculitic lesions and reactivity of the skin to needle prick or injection (the pathergy reaction) are considered hallmarks of Behcet's disease, and often precede other manifestations. Their recognition may permit earlier diagnosis and treatment, with salutary results. This paper describes the various lesions that constitute the syndrome and focuses on those that may be considered characteristic.

Ulcera eosinofílica de la lengua: reporte de un caso clínico / Eosinophilic ulcer of the tongue: report of a clinical case

El propósito de este trabajo es describir un caso clínico de úlcera eosinofílica de la lengua en una mujer de 71 años y hacer énfasis en sus características clínicas e histológicas, así como en el diagnóstico diferencial con carcinoma epidermoide, cuyo tratamiento y pronóstico es diferente. Otras entidades con las que puede confundirse incluyen: tuberculosis, histoplasmosis, chancro, infiltración leucémica, linfoma, etc. Se destaca la importancia de la biopsia y el establecimiento del diagnóstico correcto

Hematologic abnormalities in recurrent oral ulceration.

The aim of this study was to analyse the hematologic status in patients with recurrent oral ulceration (ROU). Twenty-three patients with ROU and 19 control subjects were examined consecutively for hematological abnormalities including serum folate, red cell folate and vitamin B12 levels. Their complete blood counts, hemoglobin typing, serum and red cell folate and serum vitamin B12 levels were studied. Low red cell folate levels were found in 11 out of 23 patients (47.83%) with ROU. They were defined as having folate deficiency (n=5), folate deficient erythropoiesis (n=1), and folate depletion (n=5). The serum and red cell folate levels in the control group were within normal range. There was a statistically significant low red cell folate in the ROU compared to the control group (p=0.000). The serum vitamin B12 levels were within normal range in both ROU and control groups. Hemoglobin, hematocrit and mean corpuscular hemoglobin concentrations were in the normal range in both groups and none had anemia or macrocytosis.

Enfermedades eosinofílicas cutáneas / Skin eosinophilis diseases

Los eosinófilos son importantes en un grupo de enfermedades cutáneas y frecuentemente constituyen un elemento clásico en la histología de estas entidades. Además, aunque los eosinófilos no sean identificados en los tejidos, participan en la patogenia de otras enfermedades, a través del depósito de sus gránulos. En este trabajo realizamos una revisión de las entidades que comprenden el primer grupo: hiperplasia angiolinfoide con eosinofilia, enfermedad de Kimura, foliculitis pustulosa eosinofílica, síndrome de Wells, granuloma facial y úlcera eosinofílica de la mucosa oral

Ulceras orales: claves diagnósticas / Oral ulcers: diagnostic guidelines

Las úlceras orales(UO) son motivo de consulta relativamente frecuente. Pueden ser la primera manifestación de una enfermedad de mayor gravedad o con compromiso multisistémico. Se revisa de manera esquemática las causas de estas lesiones y las claves para ayudar al diagnóstico de estos pacientes. Se revisan medicamentos involucrados en la patogenia de estas lesiones y las medidas terapéuticas generales

Lesiones orales en niños VIH+/SIDA bajo dos diferentes tipos de terapias antirretrovirales / HIV/AIDS-associated oral lesions in children treatment with two anti-retroviral schemes

Introducción. Pacientes adultos VIH+/SIDA bajo terapia antirretroviral altamente activa (TAAA) que incluya inhibidores de proteasa VIH-1, muestran disminución de infecciones oportunistas, desconociéndose si las lesiones orales de niños VIH+/SIDA bajo TAAA muestran esta asociación. Objetivo: determinar si los niños VIH+/SIDA bajo TAAA muestran disminución de lesiones orales.Material y métodos. Veintiocho niños VIH+/SIDA (Clínica de Inmunodeficiencia, Hospital Infantil de México Federico Gómez) fueron incluidos en este estudio; 16 pacientes estuvieron bajo tratamiento con AZT+3TC+ritonavir, y 12 pacientes con tratamiento DDI+D4T. Todos los pacientes fueron oralmente examinados al inicio, 6 y 12 meses de tratamiento, determinándose la prevalencia de lesiones orales. Análisis estadístico: X2, exacta de Fisher, X2 de Mantel-Haenszel para tendencias.Resultados. Grupo AZT+3TC+ritonavir: prevalencia de lesiones orales: inicial=25 por ciento; 6 meses=12.5 por ciento, 12 meses=31.2 por ciento. Grupo DDI+D4T: prevalencia inicial de lesiones orales=41.6 por ciento; 6 meses=50 por ciento: 12 meses=33.3 por ciento. X2 de Mantel-Haenszel=4.3 (P=0.037).Conclusiones. Los niños VIH+/SIDA bajo TAAA aparentemente muestran disminución de lesiones orales.