Oral manifestations in chikungunya patients: A systematic review

Abstract

Background Chikungunya fever is considered an abrupt onset arbovirus transmitted by mosquitoes, mainly Aedes aegypti and Aedes albopictus. The disease has a significant impact on the quality of life of affected persons, and many of its numerous symptoms have not yet been properly clarified, such as the manifestations that can occur in the oral cavity. The aim of this study was to identify the main oral manifestations related to chikungunya fever, as well as describe the demographic characteristics of patients, by conducting a systematic review of the literature. Methods and findings Searches were performed in MEDLINE (PubMed), Embase (Elsevier), LILACS (VHL), Cochrane Library, Scopus, and CAPES electronic databases for theses and dissertations published up to January 16, 2021 without language and date restrictions. Additional manual searches of gray literature, reference list, and Google Scholar were carried out. We included 27 studies highlighting mainly oral manifestations that cause masticatory discomfort such as ulcers and oral thrush, gingival bleeding, pain and burning of the oral mucous membranes, temporomandibular joint (TMJ) arthralgia, opportunistic infections, and changes in taste. Conclusions There seems to be a predominance of oral manifestations that cause discomfort when chewing, such as ulcerations in the acute phase of the disease, with complete remission within 3 to 10 days after the onset, apparently mostly affecting women and older persons. These oral manifestations can be compatible with basic viral infections related to inflammatory response and transitory immunosuppression. Author summary Since its resurgence in 2004, control of the transmission of chikungunya fever has become a challenge to public health worldwide. As it is capable of diminishing the quality of life of infected persons, it has aroused interest in the scientific community in developing more in-depth studies. Many of its numerous symptoms have not yet been properly clarified, such as the manifestations that can occur in the oral cavity. A study conducted in India in 2010, with the aim of verifying the prevalence of oral manifestations in chikungunya patients, found a positive outcome in 96.37% of the 110 suspected cases and 100% of the 37 confirmed cases. Given the above findings, our aim in this study was to carry out a systematic review on the subject of oral manifestations in patients with chikungunya. Based on the 27 studies selected, we were able to point out the main oral manifestations that cause masticatory discomfort such as ulcers and oral thrush, gingival bleeding, pain and burning of the oral mucous membranes, temporomandibular joint (TMJ) arthralgia, opportunistic infections, and changes in taste. Studies have reported that both frequency and worsening of oral mucosal lesions occur with increasing age and higher predominance in females. However, many studies have pointed out that most oral manifestations such as ulcerations were more frequently observed in the acute phase of the disease, with complete remission occurring 3 to 10 days after the onset of the symptoms.