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Previous issue date: 2016-12-22 / Sj?gren's syndrome (SS) is a systemic autoimmune disease that affects mostly middle age women in a 9:1 ratio when compared to men. Although SS's inflammatory process can affect any organ, the most frequent symptoms are ocular and oral dryness due to lymphocytic infiltration of exocrine glands. The pathogenesis of this illness is not fully comprehended yet. SS can be classified as primary (pSS), when the patient does not present any concomitant autoimmune disease or secondary (sSS), when it is associated with other pathology of this nature. SS patients are more susceptible to oral complications due to hyposalivation. This study evaluated patients with pSS, sSS and healthy individuals considering the following aspects: non-stimulated salivary flow, colonization pattern of yeast in the oral cavity, salivary glands ultrasonographic findings and impact of oral health on quality of life. The information obtained was compared between the experimental groups. SS patients presented a decreased salivary flow rate when compared to the controls. Inverse relationships between age and salivary flow rate in all groups and between time since SS diagnosis and salivary flow rate among pSS and pSS groups were observed. A chromogenic medium was used for yeast culturing and presumptively identification of the species. Molecular identification performed by polymerase chain reaction (PCR), DNA sequencing and phylogenetic analysis recognized 11 species from six different genera. C. albicans was the most prevalent species in all groups followed by C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. Total CFU/mL and C. albicans counts were higher in the pSS and sSS patients when comparing them to the control group. An inverse relationship between age and salivary flow rate and between salivary flow rate and the occurrence of C. albicans, C. tropicalis and C. glabrata occured in all groups. Although healthy individuals presented a greater variety of species in the oral cavity, SS patients had a higher CFU's count, as well as a higher incidence of clinical manifestations of candidiasis. No statistically significant difference was detected among the three groups when the scores of the questionnaire OHIP-14 were compared. The most frequent alteration detected during ultrasonography examination was inhomogeneous echogenicity of at least one of the parotid and/or submandibular glands followed by decreased gland size and the presence of multiple small oval hypoechoic areas. / A s?ndrome de Sj?gren (SS) ? uma doen?a autoimune sist?mica que afeta principalmente mulheres de meia idade, em uma propor??o de 9:1 quando comparado aos homens. Embora o processo inflamat?rio decorrente da SS possa afetar qualquer ?rg?o, os sintomas mais frequentes s?o o ressecamento ocular e oral devido ? infiltra??o linfoc?tica nas gl?ndulas ex?crinas. A patog?nese desta enfermidade ainda n?o ? totalmente compreendida. A SS pode ser classificada como prim?ria (SSp), quando o paciente n?o apresenta qualquer doen?a autoimune concomitante ou secund?ria (SSs), quando associada ? outra patologia desta natureza. Os indiv?duos afetados tornam-se mais suscet?veis a complica??es orais devido ? hipossaliva??o. Este estudo avaliou pacientes com SSp, SSs e indiv?duos saud?veis considerando os seguintes aspectos: fluxo salivar n?o estimulado, padr?o de coloniza??o de leveduras na cavidade oral, achados ultrassonogr?ficos nas gl?ndulas salivares e impacto da sa?de bucal na qualidade de vida. As informa??es obtidas foram comparadas entre os grupos experimentais. As pacientes com SS apresentaram diminui??o do fluxo salivar quando comparadas aos controles. Foram observadas rela??es inversas entre a idade e a taxa de fluxo salivar em todos os grupos e entre o tempo decorrido desde o diagn?stico e a taxa de fluxo salivar entre os grupos SSp e SSs. Utilizou-se um meio cromog?nico para cultura de leveduras e identifica??o presuntiva das esp?cies. A identifica??o molecular foi realizada atrav?s de rea??o em cadeia da polimerase (PCR), sequenciamento de DNA e an?lise filogen?tica, possibilitando a identifica??o de 11 esp?cies pertencentes a seis g?neros diferentes. A esp?cie mais prevalente em todos os grupos foi a Candida albicans, seguida por Candida tropicalis, Candida glabrata, Candida parapsilosis e Candida krusei. A contagem total de unidades formadoras de col?nias (UFC/mL), independentemente da esp?cie, e de Candida albicans foi maior nos pacientes dos grupos SSp e SSs quando comparados ao controle. Observou-se uma rela??o inversa entre idade e fluxo salivar e entre fluxo salivar e a presen?a de Candida albicans, Candida tropicalis e Candida glabrata em todos os grupos. Embora os indiv?duos saud?veis tenham apresentado uma maior variedade de esp?cies na cavidade oral, os pacientes com SS demonstraram uma maior contagem de UFC/mL, bem como maior incid?ncia de manifesta??es cl?nicas de candid?ase. N?o foi detectada diferen?a estat?stica significativa entre os tr?s grupos quando os escores do question?rio OHIP-14 foram comparados. A altera??o mais freq?ente detectada durante o exame de ultrassom foi a ecogenicidade n?o-homog?nea de pelo menos uma das gl?ndulas par?tidas e/ou submandibulares, seguida pela diminui??o do tamanho dessas estruturas e pelo aparecimento de m?ltiplas pequenas ?reas ovais hipoec?icas.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7220 |
| Date | 22 December 2016 |
| Creators | Medeiros, Clarissa Castro Galv?o |
| Contributors | Figueiredo, Maria Antonia Zancanaro de |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Odontologia, PUCRS, Brasil, Faculdade de Odontologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -8096554818733665164, 600, 600, 600, 4673435736271820140, -2070498469879244349 |
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