After 50 years of restriction to areas of Asia and Africa, Chikungunya outbreaks emerged in all continents in the past 20 years becoming part of the Centers for Disease Control and Prevention (CDC) list of traveller-related infections. As Chikungunya outbreaks increase in frequency, a wide variety of clinical manifestations related to this infection have been reported. This study aimed to characterize the oral lesions related to Chikungunya infection in a multicentre cohort in northeastern Brazil. The study was approved by the Research Ethics Committee of the Faculdade de Medicina da Bahia, Universidade Federal da Bahia (approval number: 1.657. 324). Written informed consent was obtained from all participants or legal guardians. In total, 105 individuals with acute (< 10 days of disease onset) mono-chikungunya virus (CHIKV). infection were evaluated by an otolaryngologist and dentist. Chikungunya infection was confirmed by polymerase chain reaction (PCR)(n= 61) and/or specific IgM (n= 63). Approximately 59 individuals tested positive for CHIKV by real-time PCR (RTPCR) in serum specimens, 14 in saliva and 12 in urine specimens.

Oral lesions were detected in 21 out of 105 cases (20%) with acute CHIKV infection. Five of these individuals tested positive for CHIKV in saliva samples. Oral lesions occurred 2–6 days after disease onset. Odynophagia and/or dysphagia were reported by 20 patients. Most cases (n= 15, 71.4%) presented isolated painful ulcers with well-circumscribed margins and erythematous halo (Figure 1). Gengival bleeding (n= 7, 33.3%) and vesicles (n= 3, 14.3%) were also observed, as well as edema (n= 1, 4.8%) in marginal vestibular gum in the absence of plaque and dental caries (Figure 1). Lesions mainly affected the following locations: gingiva (43%), lips (52.4%), tongue (43%) and jugal mucosa (28.6%).