Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

B Cells Drive Autoimmunity in Mice with CD28-Deficient Regulatory T Cells.

Follicular regulatory T (TFR) cells are a newly defined regulatory T cell (Treg) subset that suppresses follicular helper T cell-mediated B cell responses in the germinal center reaction. The precise costimulatory signal requirements for proper TFR cell differentiation and function are still not known. Using conditional knockout strategies of CD28, we previously demonstrated that loss of CD28 signaling in Tregs caused autoimmunity in mice (termed CD28-ΔTreg mice), characterized by lymphadenopathy, accumulation of activated T cells, and cell-mediated inflammation of the skin and lung. In this study, we show that CD28 signaling is required for TFR cell differentiation. Treg-specific deletion of CD28 caused a reduction in TFR cell numbers and function, which resulted in increased germinal center B cells and Ab production. Moreover, residual CD28-deficient TFR cells showed a diminished suppressive capacity as assessed by their ability to inhibit Ab responses in vitro. Surprisingly, genetic deletion of B cells in CD28-ΔTreg mice prevented the development of lymphadenopathy and CD4+ T cell activation, and autoimmunity that mainly targeted skin and lung tissues. Thus, autoimmunity occurring in mice with CD28-deficient Tregs appears to be driven primarily by loss of TFR cell differentiation and function with resulting B cell-driven inflammation.