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Lin Y, Li S, Mo C, Liu H, Bi J, Xu S, Jia B, Liu C, Liu Z. Oral microbial changes and oral disease management before and after the treatment of hematological malignancies: a narrative review. Clin Oral Investig 2023; 27:4083-4106. [PMID: 37071220 DOI: 10.1007/s00784-023-05021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Patients with hematological malignancies have dynamic changes in oral microbial communities before and after treatment. This narrative review describes the changes in oral microbial composition and diversity, and discusses an oral microbe-oriented strategy for oral disease management. MATERIALS AND METHODS A literature search was performed in PubMed/Medline, Web of Science, and Embase for articles published between 1980 and 2022. Any articles on the changes in oral microbial communities in patients with hematological malignancies and their effects on disease progression and prognosis were included. RESULTS Oral sample detection and oral microbial sequencing analysis of patients with hematological malignancies showed a correlation between changes in oral microbial composition and diversity and disease progression and prognosis. The possible pathogenic mechanism of oral microbial disorders is the impairment of mucosal barrier function and microbial translocation. Probiotic strategies, antibiotic strategies, and professional oral care strategies targeting the oral microbiota can effectively reduce the risk of oral complications and the grade of severity in patients with hematological malignancies. CLINICAL RELEVANCE This review provides dentists and hematologists with a comprehensive understanding of the host-microbe associated with hematologic malignancies and oral disease management advice.
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Affiliation(s)
- Yunhe Lin
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Siwei Li
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chuzi Mo
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Hongyu Liu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jiaming Bi
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Bo Jia
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chengxia Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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2
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Mendes FR, Bruniera FR, Schmidt J, Cury AP, Rizeck C, Higashino H, Oliveira FN, Rossi F, Rocha V, Costa SF. Capnocytophaga sputigena bloodstream infection in hematopoietic stem cell transplantations: two cases report and review of the literature. Rev Inst Med Trop Sao Paulo 2020; 62:e48. [PMID: 32667390 PMCID: PMC7359719 DOI: 10.1590/s1678-9946202062048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/24/2020] [Indexed: 12/03/2022] Open
Abstract
Capnocytophaga is a group of facultative anaerobic gram-negative bacteria present in the oral cavity of humans, dogs and cats, as part of their normal oral flora. Here, we described two cases of bloodstream infections (BSI) caused by Capnocytophaga in neutropenic autologous hematopoietic stem cell transplantation (auto-HSCT) patients with mucositis (Grade I and Grade III) identified by Maldi-Tof. They were successfully treated with β-lactam (meropenem and piperacillin-tazobactam). The species C. sputigena was confirmed by 16S rRNA gene sequencing in one patient. The review of literature showed that C. ochraceae was the most frequent species causing BSI in auto-HSCT patients and that the patients usually presented mucositis and were neutropenic at the onset of the infection.
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Affiliation(s)
- Fernanda Rodrigues Mendes
- Unidade de Transplante de Medula Óssea, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Felipe Ribeiro Bruniera
- Unidade de Transplante de Medula Óssea, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Jayir Schmidt
- Unidade de Transplante de Medula Óssea, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Paula Cury
- Laboratório de Microbiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Camila Rizeck
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Hermes Higashino
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Fernando Nivaldo Oliveira
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Flavia Rossi
- Laboratório de Microbiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Unidade de Transplante de Medula Óssea, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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3
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Zecha JAEM, Raber-Durlacher JE, Laheij AMGA, Westermann AM, Epstein JB, de Lange J, Smeele LE. The impact of the oral cavity in febrile neutropenia and infectious complications in patients treated with myelosuppressive chemotherapy. Support Care Cancer 2019; 27:3667-3679. [PMID: 31222393 PMCID: PMC6726710 DOI: 10.1007/s00520-019-04925-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022]
Abstract
Febrile neutropenia (FN) is an inflammatory response causing fever that may develop during cancer therapy-induced neutropenia. FN may herald life-threatening infectious complications and should therefore be considered a medical emergency. Patients presenting with FN are routinely subjected to careful history taking and physical examination including X-rays and microbiological evaluations. Nevertheless, an infection is documented clinically in only 20-30% of cases, whereas a causative microbial pathogen is not identified in over 70% of FN cases. The oral cavity is generally only visually inspected. Although it is recognized that ulcerative oral mucositis may be involved in the development of FN, the contribution of infections of the periodontium, the dentition, and salivary glands may be underestimated. These infections can be easily overlooked, as symptoms and signs of inflammation may be limited or absent during neutropenia. This narrative review is aimed to inform the clinician on the potential role of the oral cavity as a potential source in the development of FN. Areas for future research directed to advancing optimal management strategies are discussed.
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Affiliation(s)
- Judith A E M Zecha
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Judith E Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Alexa M G A Laheij
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Anneke M Westermann
- Department of Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joel B Epstein
- Cedars-Sinai Health System, Los Angeles and City of Hope Cancer Center, Duarte, CA, USA
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| | - Ludi E Smeele
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Centre for Dentistry, (ACTA), University of Amsterdam, Amsterdam, The Netherlands.,Department of Head & Neck Oncology & Surgery, Netherlands Cancer Institute- Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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4
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Levin BR, Baquero F, Ankomah PP, McCall IC. Phagocytes, Antibiotics, and Self-Limiting Bacterial Infections. Trends Microbiol 2017; 25:878-892. [PMID: 28843668 DOI: 10.1016/j.tim.2017.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022]
Abstract
Most antibiotic use in humans is to reduce the magnitude and term of morbidity of acute, community-acquired infections in immune competent patients, rather than to save lives. Thanks to phagocytic leucocytes and other host defenses, the vast majority of these infections are self-limiting. Nevertheless, there has been a negligible amount of consideration of the contribution of phagocytosis and other host defenses in the research for, and the design of, antibiotic treatment regimens, which hyper-emphasizes antibiotics as if they were the sole mechanism responsible for the clearance of infections. Here, we critically review this approach and its limitations. With the aid of a heuristic mathematical model, we postulate that if the rate of phagocytosis is great enough, for acute, normally self-limiting infections, then (i) antibiotics with different pharmacodynamic properties would be similarly effective, (ii) low doses of antibiotics can be as effective as high doses, and (iii) neither phenotypic nor inherited antibiotic resistance generated during therapy are likely to lead to treatment failure.
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Affiliation(s)
- Bruce R Levin
- Department of Biology, Emory University, Atlanta, GA, USA; Co-first authors.
| | - Fernando Baquero
- Ramón y Cajal Institute for Health Research (IRYCIS), Ramón y Cajal University Hospital, CIBERESP, Madrid, Spain; Co-first authors
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5
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Sampson MM, Nanjappa S, Greene JN. Mucositis and oral infections secondary to gram negative rods in patients with prolonged neutropenia. IDCases 2017; 9:101-103. [PMID: 28736716 PMCID: PMC5512178 DOI: 10.1016/j.idcr.2017.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/30/2022] Open
Abstract
Patients with prolonged neutropenia are at risk for a variety of complications and infections including the development of mucositis and oral ulcers. The changes in oral flora during chemotherapy and its effects on the development of infections of the oral cavity have been studied with inconsistent results. However, there is evidence that supports the colonization of gram negative rods in patients undergoing chemotherapy. In this report, we present two leukemic patients who developed oral ulcers secondary to multi-drug resistant Pseudomonas aeruginosa. It is important to suspect multi-drug resistant gram negative rods in patients with prolonged neutropenia who develop gum infections despite appropriate antibiotic coverage.
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Affiliation(s)
- Mindy M Sampson
- Department of Internal Medicine, University of South Florida, 17 Davis Blvd., Suite 308, 33606 Tampa, FL, United States
| | - Sowmya Nanjappa
- Department of Internal Medicine and Department of Oncologic Sciences, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, United States
| | - John N Greene
- Infectious Diseases and Hospital Epidemiologist, H. Lee Moffitt Cancer Center and Research Institute,12902, Magnolia Drive, FOB-3, United States
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6
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Ehrmann E, Jolivet-Gougeon A, Bonnaure-Mallet M, Fosse T. Multidrug-resistant oral Capnocytophaga gingivalis responsible for an acute exacerbation of chronic obstructive pulmonary disease: Case report and literature review. Anaerobe 2016; 42:50-54. [PMID: 27531625 DOI: 10.1016/j.anaerobe.2016.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Capnocytophaga genus was recently known to highly contribute to the beta-lactam (BL) and macrolide-lincosamide-streptogramin (MLS) resistance gene reservoir in the oral microbiota (BL: blaCSP-1 and blaCfxA; MLS: erm(F) and erm(C)). But fluoroquinolone (FQ) resistance remains uncommon in literature, without available data on resistance mechanisms. CASE REPORT For the first time, a case of acute exacerbation of chronic obstructive pulmonary disease (COPD) was described in a 78-year-old immunocompetent patient due to a multidrug-resistant Capnocytophaga gingivalis isolate with significant microbiological finding. C.gingivalis acquired resistance to third generation cephalosporins (blaCfxA3 gene), MLS (erm(F) gene), and fluoroquinolones. Genetics of the resistance, unknown as regards fluoroquinolone, was investigated and a substitution in QRDR of GyrA was described (Gly80Asn substitution) for the first time in the Capnocytophaga genus. LITERATURE REVIEW A comprehensive literature review of Capnocytophaga spp. extra-oral infection was conducted. Including the present report, on 43 cases, 7 isolates were BL-resistant (17%), 4 isolates were MLS-resistant (9.5%) and 4 isolates were FQ-resistant (9.5%). The studied clinical isolate of C.gingivalis was the only one to combine resistance to the three groups of antibiotics BL, MLS and FQ. Four cases of Capnocytophaga lung infection were reported, including three infections involving C. gingivalis (two FQ resistant) and one involving C. sputigena. CONCLUSION This multidrug-resistant C. gingivalis isolate illustrated the role of oral flora as a reservoir of antibiotic resistance and its contribution to the limitation of effective antibiotics in severe respiratory infections.
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Affiliation(s)
- Elodie Ehrmann
- Pôle odontologie, CHU de Nice, Nice, France; Faculté d'odontologie, Université de Nice-Sophia-Antipolis, Nice, France
| | - Anne Jolivet-Gougeon
- Equipe de Microbiologie EA 1254, Université de Rennes 1, France; CHU de Rennes, Rennes, France.
| | - Martine Bonnaure-Mallet
- Equipe de Microbiologie EA 1254, Université de Rennes 1, France; CHU de Rennes, Rennes, France
| | - Thierry Fosse
- Service d'hygiène et vaccinations, Centre Hospitalier Universitaire de Nice, 06003 Nice, France; Faculté de Médecine, Université de Nice Sophia-Antipolis, Nice, France
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7
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Oral complications in hematopoietic stem cell recipients: the role of inflammation. Mediators Inflamm 2014; 2014:378281. [PMID: 24817792 PMCID: PMC4003795 DOI: 10.1155/2014/378281] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.
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8
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Ye Y, Carlsson G, Agholme MB, Wilson JAL, Roos A, Henriques-Normark B, Engstrand L, Modéer T, Pütsep K. Oral bacterial community dynamics in paediatric patients with malignancies in relation to chemotherapy-related oral mucositis: a prospective study. Clin Microbiol Infect 2013; 19:E559-67. [PMID: 23829394 PMCID: PMC4413823 DOI: 10.1111/1469-0691.12287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/12/2013] [Accepted: 05/28/2013] [Indexed: 12/31/2022]
Abstract
The role of oral bacteria in the development of chemotherapy-related oral mucositis has not been fully elucidated. This study aimed to investigate oral bacterial community diversity and dynamics in paediatric patients with malignancies in relation to the occurrence of oral mucositis. Patients with malignancies (n = 37) and reference individuals without known systemic disorders (n = 38) were recruited. For patients, oral bacterial samples were taken from mucosal surfaces both at the time of malignancy diagnosis and during chemotherapy. If oral mucositis occurred, samples were taken from the surface of the mucositis lesions. Oral mucosal bacterial samples were also taken from reference individuals. All samples were assessed using a 16S ribosomal RNA gene 454 pyrosequencing method. A lower microbial diversity (p < 0.01) and a higher intersubject variability (p < 0.001) were found in patients as compared with reference individuals. At the time of malignancy diagnosis (i.e. before chemotherapy) patients that later developed mucositis showed a higher microbial diversity (p < 0.05) and a higher intersubject variability (p < 0.001) compared with those without mucositis. The change of bacterial composition during chemotherapy was more pronounced in patients who later developed mucositis than those without mucositis (p < 0.01). In conclusion, we found a higher microbial diversity at the time of malignancy diagnosis in patients who later develop oral mucositis and that these patients had a more significant modification of the bacterial community by chemotherapy before the occurrence of mucositis. These findings may possibly be of clinical importance in developing better strategies for personalized preventive management.
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Affiliation(s)
- Y Ye
- Division of Paediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; School and Hospital of Stomatology, Peking University, Beijing, China
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9
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Piau C, Arvieux C, Bonnaure-Mallet M, Jolivet-Gougeon A. Capnocytophaga spp. involvement in bone infections: a review. Int J Antimicrob Agents 2013; 41:509-15. [PMID: 23642766 DOI: 10.1016/j.ijantimicag.2013.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 03/06/2013] [Indexed: 10/26/2022]
Abstract
Capnocytophaga are commensal gliding bacteria that are isolated from human and animal oral flora and are responsible for infections both in immunocompromised and immunocompetent hosts. Accumulation of microbial plaque, loss of collagen attachment, and alveolar bone resorption around the tooth can lead to local Capnocytophaga spp. bone infections. These capnophilic bacteria, from oral sources or following domestic animal bites, are also causative agents of bacteraemia and systemic infections as well as osteomyelitis, septic arthritis, and infections on implants and devices. The present literature review describes the main aetiologies of bone infections due to Capnocytophaga spp., the cellular mechanisms involved, methods used for diagnosis, antimicrobial susceptibility, and effective treatments.
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Affiliation(s)
- Caroline Piau
- Laboratoire de Bactériologie, Rennes University Hospital, rue Henri Le Guilloux, 35043 Rennes, France
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10
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Periodontal status and bacteremia with oral viridans streptococci and coagulase negative staphylococci in allogeneic hematopoietic stem cell transplantation recipients: a prospective observational study. Support Care Cancer 2013; 21:1621-7. [PMID: 23288398 DOI: 10.1007/s00520-012-1706-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
AIM This study was aimed to investigate whether any association could be found between the presence of an inflamed and infected periodontium (e.g., gingivitis and periodontitis) and the development of bacteremia during neutropenia following allogeneic hematopoietic stem cell transplantation (HSCT). METHODS Eighteen patients underwent a periodontal examination before HSCT. Patients were classified as periodontally healthy [all periodontal pocket depths (PPD) ≤ 4 mm and bleeding on probing (BOP) ≤ 10%) or as having gingivitis/periodontitis (PPD ≥ 4 mm and BOP > 10%]. Oral mucositis (OM) was scored using the daily mucositis score. Blood cultures were taken at least twice weekly. RESULTS Five patients were periodontally healthy, while 13 patients had gingivitis or periodontitis. Twelve patients (67%) developed bacteremia during neutropenia, of which 11 patients (61%) had one or more episodes of bacteremia due to coagulase-negative staphylococci (CONS, most often Staphylococcus epidermidis) or to oral viridans streptococci (OVS), or both. Patients with gingivitis/periodontitis more often had bacteremia than those with a healthy periodontium (p = 0.047), and BOP was associated with bacteremia (p = 0.049). All patients developed ulcerative OM, but its severity and duration were not associated with bacteremia. OM duration and the length of stay in the hospital were strongly correlated (R = 0.835, p ≤ 0.001). CONCLUSION This study indicates that periodontal infections may contribute to the risk of developing OVS and CONS bacteremia during neutropenia following HSCT. While our results point to the importance of periodontal evaluation and management before HSCT, further studies on periodontal contribution to systemic infectious complications are warranted.
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Kumagai J, Takiguchi Y, Shono K, Suruga Y, Akiba Y, Yamamoto K, Terano T. Acute myelogenous leukemia with Leptotrichia trevisanii bacteremia. Intern Med 2013; 52:2573-6. [PMID: 24240799 DOI: 10.2169/internalmedicine.52.9580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old woman visited an otolaryngology clinic with pharyngeal pain, and was diagnosed with a peritonsillar abscess. She received antibiotics and underwent incisional drainage, but displayed high white blood cell and blast cell counts, and was referred to our hospital. Gram-negative rods (Leptotrichia trevisanii) were detected in blood cultures performed on admission. She was diagnosed with bacteremia and acute myelogenous leukemia (FAB classification: M1). After antibiotic therapy, she temporarily recovered from the bacteremia, but subsequently died on day 34. Although Leptotrichia trevisanii bacteremia is extremely rare, clinicians should consider it in cases involving immunocompromised patients with oral lesions.
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Affiliation(s)
- Jin Kumagai
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Japan
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12
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Ulstrup AK, Hartzen SH. Leptotrichia buccalis: A rare cause of bacteraemia in non-neutropenic patients. ACTA ACUST UNITED AC 2009; 38:712-6. [PMID: 16857623 DOI: 10.1080/00365540500452465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The anaerobic bacterium, Leptotrichia buccalis (Lb), belongs to the normal oral flora of humans and is seldom found in clinically significant specimens. However, on rare occasions, Lb has been isolated from blood cultures from patients with lesions of the oral mucosa, in particular from patients with neutropenia. Over a period of 6 months, Lb was isolated from blood cultures in our laboratory from 2 immunocompetent patients. The identification characteristics of Lb are described including the typical morphology at microscopy. Furthermore, we review the bacteraemic cases reported so far together with present knowledge of the pathogenicity and epidemiology of Lb.
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Epstein JB, Raber-Durlacher JE, Raber-Drulacher JE, Wilkins A, Chavarria MG, Myint H. Advances in hematologic stem cell transplant: an update for oral health care providers. ACTA ACUST UNITED AC 2009; 107:301-12. [PMID: 19217013 DOI: 10.1016/j.tripleo.2008.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/30/2008] [Accepted: 12/02/2008] [Indexed: 12/20/2022]
Abstract
Oral supportive care is critical in the management of patients receiving hematopoietic cell transplantation (HCT). Advances in HCT, such as the use of stem cells isolated from peripheral blood instead of bone marrow, have resulted in more rapid engraftment and thus a shorter duration of pancytopenia. Reduced-intensity conditioning regimens, associated with less toxicity, make HCT available to older patients and patients with comorbidities. These new developments have led to increased transplant rates and an altered spectrum of therapy-related complications, such as mucositis, and to shifts in the prevalence and pattern of occurrence of infections and graft-versus-host disease. The purpose of this paper is to review the main principles of HCT and to update dental providers on new technologies being applied to transplantation that may influence oral complications and oral care.
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Affiliation(s)
- Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, University of Illinois, and Illinois Masonic Hospital, Chicago, Illinois 60612, USA.
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14
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Eribe ERK, Olsen I. Leptotrichia species in human infections. Anaerobe 2008; 14:131-7. [PMID: 18539056 DOI: 10.1016/j.anaerobe.2008.04.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 04/29/2008] [Indexed: 11/28/2022]
Abstract
Leptotrichia species typically colonize the oral cavity and genitourinary tract. These anaerobic bacteria belong to the normal flora of humans and are seldom found in clinically significant specimens. However, on rare occasions, Leptotrichia has been isolated from blood cultures of patients with lesions in the oral mucosa, in particular from patients with neutropenia. These organisms should be considered potential pathogens in neutropenic patients, especially when breaks in the mucosal barriers are present through which they frequently spread to the bloodstream. Leptotrichia has also been recovered from immunocompetent persons, e.g. patients with endocarditis. Although their role in infections remains elusive and not much is known, they have been suggested as emerging pathogens. The present review deals with taxonomy, diagnosis, clinical importance, pathogenesis, host defence, infection control, and spectrum of Leptotrichia infections, and ends with a few typical case reports. Currently, six species have been validly published, but a number of yet uncultivable species exist. Molecular methods recovering uncultivable species should be used to get a real idea of their role as pathogens.
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16
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Jolivet-Gougeon A, Sixou JL, Tamanai-Shacoori Z, Bonnaure-Mallet M. Antimicrobial treatment of Capnocytophaga infections. Int J Antimicrob Agents 2007; 29:367-73. [PMID: 17250994 DOI: 10.1016/j.ijantimicag.2006.10.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 10/06/2006] [Indexed: 11/30/2022]
Abstract
Capnocytophaga spp. are normal inhabitants of the oropharyngeal flora. They are also involved in periodontal diseases or animal bites, complicated by septicaemia with dissemination to a great variety of sites, both in immunocompetent and immunocompromised hosts. This review will focus on their pathogenesis, spectrum of clinical infections and susceptibility to disinfectants and antibiotics. The spread of beta-lactamase-producing strains limits the use of beta-lactams as first-line treatments, underlying the necessity to test the in vitro susceptibility of clinical strains. Many antimicrobial treatments have been used, despite an absence of randomised studies and guidelines regarding the duration of treatment according to infected sites. Imipenem/cilastatin, clindamycin or beta-lactamase inhibitor combinations are always effective and their use can be recommended in all infections.
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Affiliation(s)
- Anne Jolivet-Gougeon
- Equipe Microbiologie, UPRES-EA 1254, CHU Pontchaillou Rennes et Université de Rennes I, 2 avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.
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Handal T, Giraud-Morin C, Caugant DA, Madinier I, Olsen I, Fosse T. Chromosome- and plasmid-encoded beta-lactamases in Capnocytophaga spp. Antimicrob Agents Chemother 2005; 49:3940-3. [PMID: 16127077 PMCID: PMC1195385 DOI: 10.1128/aac.49.9.3940-3943.2005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chromosome- and plasmid-encoded CfxA2 and CfxA3 beta-lactamases were detected in Capnocytophaga spp. from oral sources in France, Norway, and the United States. Unidentified chromosome-encoded beta-lactamases were present in Capnocytophaga sputigena. Nucleotide sequence analysis of the CfxA3-encoding plasmid from C. ochracea revealed an unreported insertion sequence (ISCoc1) upstream of the cfxA gene.
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Affiliation(s)
- Trude Handal
- Department of Oral Biology, Dental Faculty, University of Oslo, P.O. Box 1052 Blindern, 0316 Oslo, Norway.
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Eribe ERK, Paster BJ, Caugant DA, Dewhirst FE, Stromberg VK, Lacy GH, Olsen I. Genetic diversity of Leptotrichia and description of Leptotrichia goodfellowii sp. nov., Leptotrichia hofstadii sp. nov., Leptotrichia shahii sp. nov. and Leptotrichia wadei sp. nov. Int J Syst Evol Microbiol 2004; 54:583-592. [PMID: 15023979 DOI: 10.1099/ijs.0.02819-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sixty strains of Gram-negative, anaerobic, rod-shaped bacteria from human sources initially assigned to Leptotrichia buccalis (n=58) and 'Leptotrichia pseudobuccalis' (n=2) have been subjected to polyphasic taxonomy. Full-length 16S rDNA sequencing, DNA-DNA hybridization, RAPD, SDS-PAGE of whole-cell proteins, cellular fatty acid analysis and enzymic/biochemical tests supported the establishment of four novel Leptotrichia species from this collection, Leptotrichia goodfellowii sp. nov. (type strain LB 57(T)=CCUG 32286(T)=CIP 107915(T)), Leptotrichia hofstadii sp. nov. (type strain LB 23(T)=CCUG 47504(T)=CIP 107917(T)), Leptotrichia shahii sp. nov. (type strain LB 37(T)=CCUG 47503(T)=CIP 107916(T)) and Leptotrichia wadei sp. nov. (type strain LB 16(T)=CCUG 47505(T)=CIP 107918(T)). Light and electron microscopy showed that the four novel species were Gram-negative, non-spore-forming and non-motile rods. L. goodfellowii produced arginine dihydrolase, beta-galactosidase, N-acetyl-beta-glucosaminidase, arginine arylamidase, leucine arylamidase and histidine arylamidase. L. shahii produced alpha-arabinosidase. L. buccalis and L. goodfellowii fermented mannose and were beta-galactosidase-6-phosphate positive. L. goodfellowii, L. hofstadii and L. wadei were beta-haemolytic. L. buccalis fermented raffinose. With L. buccalis, L. goodfellowii showed 3.8-5.5 % DNA-DNA relatedness, L. shahii showed 24.5-34.1 % relatedness, L. hofstadii showed 27.3-36.3 % relatedness and L. wadei showed 24.1-35.9 % relatedness. 16S rDNA sequencing demonstrated that L. hofstadii, L. shahii, L. wadei and L. goodfellowii each formed individual clusters with 97, 96, 94 and 92 % similarity, respectively, to L. buccalis.
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Affiliation(s)
- Emenike R K Eribe
- Institute of Oral Biology, Dental Faculty, University of Oslo, POB 1052, Blindern, N-0316 Oslo, Norway
| | - Bruce J Paster
- Department of Oral and Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
- Department of Molecular Genetics, The Forsyth Institute, 140 The Fenway, Boston, MA 02115, USA
| | - Dominique A Caugant
- Division for Infectious Disease Control, Norwegian Institute of Public Health, POB 4404, Nydalen, N-0403 Oslo, Norway
- Institute of Oral Biology, Dental Faculty, University of Oslo, POB 1052, Blindern, N-0316 Oslo, Norway
| | - Floyd E Dewhirst
- Department of Oral and Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA
- Department of Molecular Genetics, The Forsyth Institute, 140 The Fenway, Boston, MA 02115, USA
| | - Verlyn K Stromberg
- Department of Plant Pathology, Physiology and Weed Science, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0330, USA
| | - George H Lacy
- Department of Plant Pathology, Physiology and Weed Science, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0330, USA
| | - Ingar Olsen
- Institute of Oral Biology, Dental Faculty, University of Oslo, POB 1052, Blindern, N-0316 Oslo, Norway
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Raber-Durlacher JE, Barasch A, Peterson DE, Lalla RV, Schubert MM, Fibbe WE. Oral Complications and Management Considerations in Patients Treated with High-Dose Chemotherapy. ACTA ACUST UNITED AC 2004; 1:219-29. [DOI: 10.3816/sct.2004.n.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Fanourgiakis P, Vekemans M, Georgala A, Daneau D, Vandermies A, Grenier P, Aoun M. Febrile neutropenia and Fusobacterium bacteremia: clinical experience with 13 cases. Support Care Cancer 2003; 11:332-5. [PMID: 12720077 DOI: 10.1007/s00520-003-0452-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2002] [Accepted: 01/30/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the disease spectrum of Fusobacterium bacteremia in our neutropenic patients and review the literature. METHODS This was a 6.5-year retrospective study in which all the records of neutropenic patients with Fusobacterium bacteremia were analyzed. RESULTS Fusobacterium bacteremia was found in 13 neutropenic patients, 10 with hematological malignancies and 3 with solid tumors. The standard clinical presentation was that of primary bacteremia with benign evolution under antibiotics with anaerobic coverage. Most patients presented with oral mucositis as the probable portal of entry. Coinfection with other germs was documented in four patients. No patient had a localized infection documented. Most patients were receiving ciprofloxacin chemoprophylaxis. None of the patients had catheter-related infection. All tested strains were susceptible to all standard anaerobic agents. Fusobacterium spp. were responsible for 5% of bacteremias in neutropenic patients in our hospital during the last 6.5 years. CONCLUSION Fusobacterium bacteremia is a possible cause of febrile neutropenia, especially in the setting of quinolone prophylaxis and oral mucositis after intense chemotherapeutic regimens. We think that its benign outcome if there is no localized infection detected does not justify the use of antianaerobic prophylaxis. Combination of beta-lactams and beta-lactamase inhibitors is a safe and reasonable treatment.
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Affiliation(s)
- P Fanourgiakis
- Département des Maladies Infectieuses et Laboratoire de Microbiologie, Institut Jules Bordet, rue Héger-Bordet 1, 1000 Brussels, Belgium
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21
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Bonatti H, Rossboth DW, Nachbaur D, Fille M, Aspöck C, Hend I, Hourmont K, White L, Malnick H, Allerberger FJ. A series of infections due to Capnocytophaga spp in immunosuppressed and immunocompetent patients. Clin Microbiol Infect 2003; 9:380-7. [PMID: 12848750 DOI: 10.1046/j.1469-0691.2003.00538.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the epidemiology, microbiology and outcome of infections caused by Capnocytophaga spp. at a single center. METHODS We report on ten documented infectious episodes caused by Capnocytophaga observed between 1994 and 1999 at the Innsbruck University Hospital. RESULTS In seven of ten patients, Capnocytophaga septicemia was diagnosed during periods of neutropenia. In contrast, the remaining three patients had normal white blood cell counts when acquiring Capnocytophaga septicemia (one) and pleural empyema (two). Blood cultures containing long, slender, Gram-negative rods, which grew slowly under anaerobic conditions and lacked susceptibility to metronidazole, were subcultivated in a CO2-enriched atmosphere (5%). Subcultivation yielded Capnocytophaga in all ten cases within 2-12 days. The patients were then placed on appropriate antibiotic therapy, with or without additional surgical intervention, and the organism was eradicated. CONCLUSION Identification of Capnocytophaga facilitates appropriate, and in most cases effective, antimicrobial therapy.
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Affiliation(s)
- H Bonatti
- Department for General and transplant Surgery, Institute for Hygiene, University of Innsbruck, Innsbruck, Austria.
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Le Moal G, Landron C, Grollier G, Robert R, Burucoa C. Meningitis due to Capnocytophaga canimorsus after receipt of a dog bite: case report and review of the literature. Clin Infect Dis 2003; 36:e42-6. [PMID: 12539089 DOI: 10.1086/345477] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2002] [Accepted: 09/30/2002] [Indexed: 11/03/2022] Open
Abstract
We describe a case of meningitis due to Capnocytophaga canimorsus and review 18 cases with attention to risk factors, clinical features, diagnosis, treatment, and outcome. In most of the reported cases, contact with dogs and predisposing factors were found. Clinical manifestations and the findings of examinations of cerebrospinal fluid specimens were similar to those of classic bacterial meningitis; however, the mortality rate for C. canimorsus meningitis very low when compared with the rate for C. canimorsus septicemia (5% vs. 30%).
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Affiliation(s)
- Gwenaël Le Moal
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire La Milétrie, 86021 Poitiers, France.
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23
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Akintoye SO, Brennan MT, Graber CJ, McKinney BE, Rams TE, Barrett AJ, Atkinson JC. A retrospective investigation of advanced periodontal disease as a risk factor for septicemia in hematopoietic stem cell and bone marrow transplant recipients. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:581-8. [PMID: 12424452 DOI: 10.1067/moe.2002.128960] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Septicemia is a cause of death in hematopoietic stem cell transplant (HSCT) recipients. Extraction of teeth with advanced periodontitis has been advocated before HSCT to prevent septicemia in myeloablated hosts. The primary aim of the present study was to determine impact of chronic periodontitis, as measured by radiographic alveolar bone loss, on septicemia and transplant mortality. STUDY DESIGN A retrospective design was used to study 77 subjects who received pretransplant dental evaluation, panoramic radiography, and full myeloablative allogeneic HSCT to treat hematologic malignancies. Radiographic crestal alveolar bone loss was measured with a Schei ruler on all teeth. Microorganisms isolated from positive blood cultures within the first 100 days after transplant were categorized as of likely origin from periodontal, oral, or any body sites. Spearman correlation and logistic regression analysis assessed associations between positive blood cultures, mean subject whole-mouth percent radiographic crestal alveolar bone loss, and 100-day survival. RESULTS Radiographic crestal alveolar bone loss per study subject averaged 13% +/- 7%, with 18.2% exhibiting bone loss of 20% or greater. During the initial 100 days after transplant, 63.6% subjects yielded septicemia-associated positive blood cultures, with Staphylococcus epidermidis, Streptococcus mitis, Enterococcus faecalis, Streptococcus sanguis, Staphylococcus aureus, and Escherichia coli as the most common isolates recovered. No statistically significant associations were found between mean subject radiographic alveolar bone loss and septicemia of likely periodontal or oral origin. CONCLUSION In this preliminary study, no relationship was found between radiographic periodontal status and septicemia or mortality within the initial 100 days after transplant. A larger-sized, prospective study is warranted to further delineate the risk of septicemia from periodontal and other oral diseases in immunocompromised patients.
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Affiliation(s)
- Sunday O Akintoye
- Clinical Research Core and Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Health (NIH), Bethesda, MD, 20892-4320 USA.
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Cobo Martínez F, Sanbonmatsu Gámez S, Manchado Mañas P, Cuesta Casas MA, Carabantes Ocón FJ. [Capnocytophaga spp. bacteremia in neutropenic patients]. Rev Clin Esp 2002; 202:413-4. [PMID: 12139833 DOI: 10.1016/s0014-2565(02)71097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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25
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Geisler WM, Malhotra U, Stamm WE. Pneumonia and sepsis due to fluoroquinolone-resistant Capnocytophaga gingivalis after autologous stem cell transplantation. Bone Marrow Transplant 2001; 28:1171-3. [PMID: 11803363 DOI: 10.1038/sj.bmt.1703288] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2001] [Accepted: 09/02/2001] [Indexed: 11/08/2022]
Abstract
Human oral Capnocytophaga species have been only rarely described as a cause of sepsis in patients following stem cell or marrow transplantation, and pneumonia has not been reported in this setting. In addition, fluoroquinolone resistance is rarely seen in these species, and has never been reported in C. gingivalis. We report a case of pneumonia (confirmed by culture of bronchoalveolar lavage fluid) and sepsis due to fluoroquinolone- resistant Capnocytophaga gingivalis in a patient following autologous stem cell transplantation, who responded to treatment with linezolid and metronidazole. Capnocytophaga infections should be considered in patients with fever following stem cell or marrow transplantation, especially those with neutropenia and mucositis. Susceptibility testing is needed given the existence of multidrug-resistant isolates.
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Affiliation(s)
- W M Geisler
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
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26
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Bunetel L, Tricot-Doleux S, Agnani G, Bonnaure-Mallet M. In vitro evaluation of the retention of three species of pathogenic microorganisms by three different types of toothbrush. ORAL MICROBIOLOGY AND IMMUNOLOGY 2000; 15:313-6. [PMID: 11154423 DOI: 10.1034/j.1399-302x.2000.150508.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The retention and survival of microorganisms on toothbrushes pose a threat of recontamination for certain patients at risk. In order to measure the influence of brush design and optimize the choice of toothbrush model for complementary studies, the in vitro retention of three microbial species (Porphyromonas gingivalis ATCC 33277, Streptococcus mutans ATCC 25175 and Candida albicans ATCC 26555) was evaluated for three types of toothbrush. Two series of standardized experiments were carried out for each brush and microorganism. The first series tested the retention of the microorganisms on the head portion of the brush, while the second measured retention on the head of the brush and the part of the handle inserted in the mouth during brushing. For each series, the microorganisms were counted at T0 and T24 (after storage of the brushes at room temperature for 24 h). Depending on the microorganism studied, from 0.2% to 2% of the initial inoculum was retained on the brush. The number detected increased with the size of the exposed area. After 24 h, P. gingivalis and S. mutans were found on only one type of brush. C. albicans survived on all three. These results confirm that microorganisms can quickly colonize toothbrushes.
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Affiliation(s)
- L Bunetel
- Equipe de Biologie Buccale, Université de Rennes 1, France
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Vidal AM, Sarria JC, Kimbrough RC, Keung YK. Anaerobic bacteremia in a neutropenic patient with oral mucositis. Am J Med Sci 2000; 319:189-90. [PMID: 10746831 DOI: 10.1097/00000441-200003000-00010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An increasing number of anaerobic bloodstream infections in neutropenic cancer patients have been reported in the last decade. The type of anaerobes isolated from most of these patients suggests an oral source of infection. We describe a case of anaerobic bacteremia in a neutropenic patient with oral mucositis that highlights the importance of considering these organisms when selecting empiric prophylactic or therapeutic antimicrobial regimens, especially in the setting of periodontal disease or oral mucositis.
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Affiliation(s)
- A M Vidal
- Section of Infectious Diseases, Texas Tech University Health Sciences Center, Lubbock 79430, USA
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Patel JB, Clarridge J, Schuster MS, Waddington M, Osborne J, Nachamkin I. Bacteremia caused by a novel isolate resembling leptotrichia species in a neutropenic patient. J Clin Microbiol 1999; 37:2064-7. [PMID: 10325382 PMCID: PMC85034 DOI: 10.1128/jcm.37.6.2064-2067.1999] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of Leptotrichia species bacteremia in a patient undergoing treatment for acute myelogenous leukemia. Like previously reported Leptotrichia species, this is a gram-variable, pleomorphic rod that is catalase negative and utilizes glucose and sucrose. However, it is more fastidious than previously reported isolates of Leptotrichia and may represent a novel species.
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Affiliation(s)
- J B Patel
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
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Sixou JL, De Medeiros-Batista O, Gandemer V, Bonnaure-Mallet M. The effect of chemotherapy on the supragingival plaque of pediatric cancer patients. Oral Oncol 1998; 34:476-83. [PMID: 9930358 DOI: 10.1016/s1368-8375(98)00062-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The anaerobic cultivable flora of the dental plaque was investigated in 16 cancer children at days 0, 7, 14 and 21 of a first cure of chemotherapy. Results were compared with those obtained in 16 healthy children. Diseased children showed more quantitative variations of the flora than the controls, especially during the first week of chemotherapy. Whatever the day of sampling, the flora of the diseased children was significantly less complex than that of the controls. Viridans streptococci, Capnocytophaga, and to a lesser extent staphylococci, appeared to be the most strongly affected in diseased children. This could be explained by different mechanisms, uncontrolled recolonization of the dental plaque, selection of multidrug-resistant strains or nosocomial acquisition. These results indicate that variations in quantity, complexity and quality of the oral flora occur during chemotherapy, leading to a major imbalance of the ecosystem.
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Affiliation(s)
- J L Sixou
- Department of Pedodontics and Equipe de Biologie Buccale (UPRES-EA 1256), Rennes, France.
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Hall G, Heimdahl A, Nord CE. Comparison of E Test and Agar Dilution Methods for Determining Antibiotic Susceptibilities of Anaerobic Bacteria and Viridans Streptococci Isolated from Blood. Anaerobe 1998; 4:29-33. [PMID: 16887621 DOI: 10.1006/anae.1997.0138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/1997] [Accepted: 12/18/1997] [Indexed: 11/22/2022]
Abstract
The antimicrobial susceptibilities of 311 strains of anaerobic bacteria and 140 strains of aerobic bacteria, isolated from blood after dental extraction, were determined by the E test and compared with the results obtained by the agar dilution method on PDM-ASM 2 agar. E test MICs agreed within +/-1 dilution step to the agar dilution MICs in 93%, 52%, 90%, 94% of the tested anaerobes for penicillin V, cefaclor, clindamycin and erythromycin, respectively. For aerobic bacteria the agreement was > or = 90% for the antibiotics tested. The in vitro activities of penicillin V, clindamycin and erythromycin were higher than the activity of cefaclor against the majority of bacteria tested.
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Affiliation(s)
- G Hall
- Department of Oral and Maxillofacial Surgery, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden
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Bianchini H, Canigia LF, Predari SC, Rollet R, Litterio M, Berestein P, Castello L, De Martino A, Greco G, Hardie N. Broth disk elution method for anaerobic bacteria: a collaborative study to assess its reliability for clinical purposes. Anaerobe 1997; 3:225-31. [PMID: 16887595 DOI: 10.1006/anae.1997.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/1996] [Accepted: 06/09/1997] [Indexed: 11/22/2022]
Abstract
A collaborative study involving seven laboratories was undertaken to evaluate the reproducibility and the reliability of the broth disk elution test against anaerobic bacteria by comparing with the reference agar dilution method. A two breakpoint broth test was also evaluated. Assays were performed using the same testing conditions (i.e. medium, temperature, atmosphere and incubation time). One hundred Gram-negative and Gram-positive clinical isolates were initially studied. Overall agreement of 98.5% and 97.5%, were found for disk elution and the two breakpoint tests, respectively. In order to assess the reliability of the disk elution test, two different lots (LOT1 and LOT2) of disks of piperacillin and clindamycin were selected, to obtain two final concentrations after dilution (10 and 60 mg/mL; 1 and 4 mg/mL, respectively). Two hundred and eighty assays were performed against one strain of both Bacteroides fragilis(piperacillin MIC, 8.0 mg/mL; clindamycin MIC, <0.5 mg/mL) and Bacteroides thetaiotaomicron(piperacillin MIC, 16.0 mg/mL; clindamycin MIC, <0.5 mg/mL). With LOT 1, considering both species and both antibiotics, the agreement among six laboratories ranged from 85% to 100% (P > 0.05) with the higher concentration. Overall agreement among all laboratories was 91%. No optimal agreement (>90%) for clindamycin-Bacteroides thetaiotaomicron using the LOT1 (77%) was found. Since this finding was not observed with LOT2 (100% agreement), discrepancies were attributed to variation between lots. Overall agreement with LOT2 was 100% for all centres. The present study indicates that the broth disk elution method proved to be a reliable and suitable alternative for routine susceptibility testing for anaerobic bacteria, as a resistance screening method for clinical purposes.
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Affiliation(s)
- H Bianchini
- Department of Clinical Analyses, Laboratory of Microbiology, Centre of Medical Education and Clinical Research (CEMIC), Billingshurst 2447, (1425), Buenos Aires, Argentina
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Messiaen T, Lefebvre C, Geubel A. Hepatic abscess likely related to Leptotrichia buccalis in an immunocompetent patient. LIVER 1996; 16:342-3. [PMID: 8938638 DOI: 10.1111/j.1600-0676.1996.tb00758.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present the case of a 64-year-old previously healthy man admitted for long evoluating fever. Buccal examination showed severe parodontitis. Blood cultures were positive for Leptotrichia buccalis and computed abdominal tomography discovered a hepatic abscess. So far, only exceptional cases of systemic diseases associated with Leptotrichia buccalis infections have been described in immunocompetent patients. Thus, in cases of severe parodontitis and long evoluating fever, attention must be paid to secondary anaerobic infections even in immunocompetent subjects.
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Affiliation(s)
- T Messiaen
- Service de Médecine Interne Générale, Cliniques Universitaires St-Luc, Brussels, Belgium
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34
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Sixou JL, de Medeiros-Batista O, Bonnaure-Mallet M. Modifications of the microflora of the oral cavity arising during immunosuppressive chemotherapy. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1996; 32B:306-10. [PMID: 8944833 DOI: 10.1016/0964-1955(96)00006-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Infections are a major cause of mortality among immunosuppressed cancer patients. The oral cavity is a possible reservoir for those microorganisms, both commensal and acquired, whose virulence is exacerbated in the immunosuppressed patient. The mouth consists of multiple habitats offering ecological niches to a variety of organisms. The object of this article is to review the literature devoted to quantitative and qualitative variations in the flora of the oral cavity during immunosuppressive treatment of cancer patients. Examination of these different studies reveals modifications of the commensal flora, as well as an increase in Gram negative rods, in staphylococci and in yeasts. These data confirm the necessity for constant surveillance of the oral cavity during chemotherapy.
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Affiliation(s)
- J L Sixou
- Equipe de Biologie Buccale (EA 1256), Université de Rennes, France
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35
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Gomez-Garces JL, Alos JI, Sanchez J, Cogollos R. Bacteremia by multidrug-resistant Capnocytophaga sputigena. J Clin Microbiol 1994; 32:1067-9. [PMID: 8027314 PMCID: PMC267185 DOI: 10.1128/jcm.32.4.1067-1069.1994] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A case of bacteremia caused by a multiresistant strain of Capnocytophaga sputigena in a patient with hematological malignancy is described. The strain presented with a pattern of marked resistance to beta-lactams, with MICs of > 256 mg/liter for ampicillin, ticarcillin, piperacillin, cefazolin, and cefuroxime, 64 mg/liter for cefotaxime, and 32 mg/liter for ceftazidime. In addition, the MIC of ciprofloxacin was 16 mg/liter. Both of these groups of antimicrobial agents are frequently used in the empiric treatment of infections in immunocompromised patients. The appearance of resistant strains suggests the need for antimicrobial susceptibility studies in all patients with severe infections caused by Capnocytophaga spp. or other capnophilic organisms present in the oral microflora of these patients.
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36
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Barrett AP, Schifter M. Antibiotic strategy in orofacial/head and neck infections in severe neutropenia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1994; 77:350-5. [PMID: 8015798 DOI: 10.1016/0030-4220(94)90196-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A strategy for empiric antibiotic therapy for orofacial/head and neck bacterial infections that appear as clinical swellings in patients with severe neutropenia is assessed. Daily examinations were made in the hospital. Only those with peripheral blood neutrophil counts < 100/mm3 that persisted for at least 5 days after the commencement of resolution of the swelling were included in this article. The strategy consisted of sequential additions of a beta-lactam/aminoglycoside combination, metronidazole to intensify anaerobe cover and a beta-lactamase stable agent (such as vancomycin and floxacillin) as dictated by clinical signs. Progressive and complete resolution of infection occurred in 26 of 27 patients treated.
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Affiliation(s)
- A P Barrett
- Dental Clinical School Westmead Hospital, New South Wales, Australia
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Roscoe DL, Zemcov SJ, Thornber D, Wise R, Clarke AM. Antimicrobial susceptibilities and beta-lactamase characterization of Capnocytophaga species. Antimicrob Agents Chemother 1992; 36:2197-200. [PMID: 1444299 PMCID: PMC245475 DOI: 10.1128/aac.36.10.2197] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Capnocytophaga species have been associated with a wide variety of infections in both immunocompetent and immunocompromised patients. On the basis of data from antimicrobial susceptibility studies, beta-lactam antibiotics have been considered efficacious therapy. Six of 19 isolates from primarily clinical sources across Canada demonstrated beta-lactamase production, and agar dilution susceptibility testing showed broad resistance to beta-lactam antibiotics. For the beta-lactamase producing isolates, clavulanate reduced the MIC of amoxicillin for 90% of the strains tested by 64-fold. Isolates were highly susceptible to clindamycin, imipenem, and ciprofloxacin. Characterization of the beta-lactamases produced by two of these isolates (Van1 and Van2) was performed. Isoelectric focusing revealed an identical isoelectric point of 5.6 for both enzymes, but they had markedly different relative hydrolysis efficiencies, and different conditions were required to extract the enzymes. This study demonstrates the production of different types of beta-lactamases by Capnocytophaga spp. and suggests the need to screen all clinical isolates of Capnocytophaga spp. for the presence of beta-lactamases.
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Affiliation(s)
- D L Roscoe
- Division of Medical Microbiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
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