DIAGNOSTIC AND TREATMENT CHARACTERISTICS OF LEPTOTHRICHOSIS OF THE ORAL MUCOSA
Authors: Skrypnіkova T.P. , Skrypnikov P.M. 
Published: October 2019

Leptotrichia species play an important role in the microflora composition of the oral cavity, a genus of asporogenous gram-negative anaerobic bacteria, in the form of sticks that belong to the family of Fusobakterium. According to the morphological data, the structure of the cell wall, antigenic structure, they are part of the opportunistic flora of the oral cavity. Their peculiarities are the sensitivity to the toxic effects of oxygen, the absence of spores, the complexity of food processes. It also allows to refer them to the family of lactic acid bacteria that promote lactic acid fermentation.

Violation of homeostasis in the oral cavity and the presence of somatic diseases lead to the transformation of leptotrichia from the category of opportunistic microflora into pathogenic one. Different opinions about approaches to treatment in the presence of leptotrichia in the oral cavity are expressed. Some authors say that abundantly vegetative leptotrichia do not indicate pathology. Others, on the contrary, have the opposite view, believing that leptotrichosis is a disease close to opportunistic mycosis. But there is the third opinion: some authors attribute leptotrichosis to HIV - associated diseases. Clinical similarities with other fungal infections make it difficult to manage these patients.

There are some important traits for differential diagnosis such as identified symptoms, in some cases the lack of effectiveness of previous or current treatment, postponed and concomitant diseases, sociodemographic status, use of medicines. Subjective, objective and additional examination methods were used for diagnosis.

Objective examination of patients was carried out according to the recommendations of experts of the World Health Organization (WHO).

As additional method of examination it has been used microscopic research, which was the most effective, clinical analysis of blood, urine, blood for sugar. If necessary, patients were referred for consultation to other specialists. Candidiasis of the oral mucosa has a code ICD - B.370.

Patients have such complaints as burning of the mucous membrane of the lips, cheeks, hard and soft palate, dry mouth. There is a coarse keratinized epithelium of filamentous papillae, which gives them the appearance of spiky, pointed, very dense growths of gray or yellowish-gray color. The plaque may cover some areas of the oral mucosa. It adheres tightly to the tissues, is difficult to remove, exposing a loose bleeding surface. Inflammation is not identified. The mucous membrane appearance is worried patients, they examine it several times a day, which causes a phobia.

In some cases, the filamentous papillae of the tongue may be atrophied, it becomes smooth, but the color of the mucosa is not changed. Patients suffer from eating spicy food.

Among all diagnostic methods (subjective and objective) only the microscopic one is effective. Leptotrichosis accounts for 5 cases (4.09%) of the examined 122 patients with fungal origin stomatitis. This disease is quite rare, only a few clinical cases are described in the literature.

The pathogenesis of the disease (incomplete cellular immunity, shift of the phagocytic activity of neutrophils, monocytes, eosinophils, the host sensitization of leptotrichia’s byproducts, high saccharolytic activity, and others) is considered in leptotrichosis management. Leptotrichosis of the oral cavity mucosa is characterized by a chronic course (for several months). The treatment plan is made with an internist. A dentist has to know different alternative kind of treatment. Patients should be examined dynamically.