Oral lesions in borderline and reactional tuberculoid leprosy

Area of Science:

• Dermatology
• Infectious Diseases
• Oral Medicine

Background:

• Leprosy, a chronic infectious disease, primarily affects the skin and peripheral nerves.
• Oral manifestations in leprosy are not well-documented, particularly concerning their role in disease transmission.
• Understanding specific lesions in the buccal mucosa is crucial for assessing potential sources of Mycobacterium leprae elimination.

Purpose of the Study:

• To investigate the presence and characteristics of specific lesions in the buccal mucosa of patients with borderline and reactional tuberculoid leprosy.
• To evaluate the association between histopathologic findings and the presence of bacilli in oral lesions.
• To determine if the buccal mucosa serves as a significant site for bacillary elimination in these leprosy forms.

Main Methods:

• Clinical examination and histopathologic analysis of buccal mucosa biopsies were performed.
• Thirty patients were included: 15 with borderline leprosy and 15 with reactional tuberculoid leprosy.
• Lesions were characterized based on inflammation, presence of granulomas, and detection of bacilli.

Main Results:

• Specific lesions were identified in 5 reactional tuberculoid and 8 borderline patients.
• Lesions included chronic granulomatous inflammation (with or without bacilli) and nonspecific chronic inflammatory lesions (with bacilli).
• Oral lesions showed limited extension, low bacterial load, and rare ulceration, suggesting minimal bacillary shedding.

Conclusions:

• The buccal mucosa in patients with borderline and reactional tuberculoid leprosy exhibits specific lesions but is generally not a major source of bacillary elimination.
• The limited bacterial presence and low incidence of ulceration indicate a minor role in Mycobacterium leprae transmission.
• Further research may explore other mucosal sites for potential bacillary shedding in leprosy.