O r a l m a n i f e s t a t i o n s o f t ro p i c a l d i s e a s e s :
clinical and histopathological aspects
Flavia C B Lisboa, Sueli Carneiro, Arles M Brotas,
Eduardo H J Lago, Fátima P Fagundes, Marcia Ramos-e-Silva
Oral Dermatology Out-Patient Clinic, Sector of Dermatology and
Post-Graduation Course in Dermatology, HUCFF-UFRJ and School of Medicine
Universidade Federal do Rio de Janeiro, Brazil
INTRODUCTION
OBJECTIVE
MATERIAL AND METHODS
Tropical diseases are very common in Brazil and some, which show muco-cutaneous lesions, are included in this group. Diagnosis and early treatment are
very important to prevent disabilities and serious esthetic disturbances, moreover to break-down the contagious cycle. Oral lesions can disclose or be a clue
to the diagnosis of unspecific alterations in other areas or when associated with severe systemic disease.
To call attention of the oral lesions caused by tropical diseases.
Patients with oral mucosa lesions caused by tropical diseases were evaluated clinically and
histopathologically during the period from 1990 to 2000.
RESULTS
American muco-cutaneous leishmaniasis
Three endemic tropical dermatoses were more prevalent: leprosy, leishmaniasis and
paracoccidiodomycosis.
Leishmaniasis: patients showed erythema and infiltrative lesions, followed by ulceration
and atrophic-crusted lesions. Histopathological features depend on the species of
leishmania involved and the immunological response of the host. We observed a
nonspecific granulomatous chronic inflammatory infiltrate and, in a few cases, amastigota
forms.
Verrucous lesion of the lip
Lesion of the lip
simulating abscess
Ulcerated and fissured lesions
on the palate
Dense mononuclear
inflammatory infiltrate (HE 40X)
Inflammatory infiltrate and presence of
numerous amastigota (HE 400X)
Leprosy: nodules, plaques, papules, and ulcers especially in hard and soft palate, tongue,
lips and gingiva. Histology shows Virchow cells in the lepromatous form. Tuberculoid form
presents aspect of nodules with epithelioid cells with lymphocytes at the edges.
Paracoccidioidomycosis: ulcers with hemorrhagic and granular dots and sialorrheia are
frequent. Histology demonstrates mixed inflammatory infiltrate and round microorganisms
with multiple budding.
Lepromatous leprosy
CONCLUSION
Discrete whitish papules in an
erythematous area of the palate
Whitish plaques and
nodules on the palate
Ulceration and inflammatory infiltrate
predominantly composed of cells with
vacuolated cytoplasm (HE 100X)
Numerous bacilli isolated,
or forming globia, and macrophages
with foamy cytoplasm (Wade 400X)
Paracoccidioidomycosis
Vegetating lesion of the lip with the
typical aspect of hemorrhagic dots
Ulcerated lesion with hemorrhagic dots
in all extension of the hard and soft palate
Macrocheilitis
Ulcerated lesion with hemorrhagic
dots on the gengiva
Ulcerated lesion
on the buccal mucosa
REFERENCES
1. Bravo Puccio, Francisco G. El valor de la biopsia de piel en dermatología tropical. Folia dermatol 1997;8(3):28-31.
2. Convit J. Protozoa diseases of the skin. In: Elder D. ed. Lever´s histopathology of the skin. 8ed. Philadelphia: Lippincott-Haven; 1997:553-8.
3. Cuzzi-Maya T, Piñero-Maceira. Dermatopatologia: bases para o diagnóstico. São Paulo: Roca; 2001:224.
4. Hastings RC. Leprosy. New York: Churchill Livingstone; 1985:331.
5. Longley BJ. Fungal disease. In: Elder D. ed. Lever´s histopathology of the skin. 8ed. Philadelphia: Lippincott-Haven; 1997:517-52.
6. Lucas S. Bacterial diseases. In: Elder D. ed. Lever´s histopathology of the skin. 8ed. Philadelphia: Lippincott-Haven; 1997:457-502.
7. Machado-Pinto J. Doenças Infecciosas com manifestações dermatológicas. Rio de Janeiro: Medsi; 1994:600.
8. Piérard GE, Arrese JE, Piérard-Franchimont C. Esquisse des fondements de la dermatologie tropicale. Rev Med Liege 2000;55(6):516-26.
9. Ryan TJ. A fresh look at the management of skin diseases in the tropics. Int J Dermatol 1990;29(6):413-5.
10. Schmid-Grendelmeier P, Mahé A, Pünnighaus JM, Welsh O, Stingl P, Leppard B. Tropical dermatology. Part I. J Am Acad Dermatol 2002;46(4):571-83.
11. Talhari S, Neves RG. Dermatologia Tropical. Rio de Janeiro: Medsi; 1995:362.
12. Talhari S, Neves RG. Hanseníase. Manaus: Gráfica Tropical; 1997:167.
13. Welsh O, Schmid-Grendelmeier P, Stingl P, Hafner J, Leppard B, Mahé A. Tropical dermatology. Part II. J Am Acad Dermatol 2002;46(5):748-63.
14. Zaitz C, Ramos-e-Silva M. Tropical pathology of the oral mucosa. In: Lotti TM, Parish LC, Rogers RS, eds. Oral Diseases: texbook and atlas.
New York: Springer 1999:129-47.
[email protected]
Plaques and ulcerations on the
internal and external lip and the
buccal mucosa near the comissure
Presence of spherical organisms,
some with multiple budding
(silver impregnation 400X)
Presence of spherical organisms,
some with multiple budding
(silver impregnation 400X)
Round forms inside
a giant cell (HE 100X)
HUCFF-UFRJ
TECNOARTE (21) 2286-7657
Enantema of the anterior pillar
Histopathology is generally unspecific, but has a great value when special stains are
performed in early lesions. Clinical evaluation of the oral mucosa can be very suggestive,
especially in paracoccidiodo-mycosis, associated or not with severe respiratory
syndrome. In some cases, the clinical evaluation of oral mucosa was the key of the
diagnosis.