Management of tooth extraction in a patient with ELANE gene mutation-induced cyclic neutropenia: A case report

Antibiotic Resistance to Pseudomonas Aeruginosa in the Saliva of Candidates of Bone Marrow Transplantation

Statement of the Problem

Opportunistic infections such as Pseudomonas aeruginosa, colonized from the oral cavity, are common in candidates of bone marrow transplantation. Therefore, it is important to prescribe appropriate antibiotics for this group of debilitated patients.

Purpose

In this study, we aimed to investigate the antibiotic resistance to Pseudomonas aeruginosa encountered in candidates of bone marrow transplantation referred to Imam Reza Clinic, Namazi Hospital, and Amir Hospital, Shiraz, Iran.

Materials and Method

This cross-sectional study was performed on 30 patients with leukemia and lymphoma. To identify Pseudomonas species, saliva samples were collected and cultured in a blood agar medium. Considering the present therapies, we examined the antibiotic sensitivity of Penicillin, Oxacillin, Gentamicin, Tetracycline, Cefepime, Ciprofloxacin, Imipenem, Ceftazidime, Cefotaxime, Erythromycin, Trimethoprim, Sulfamethoxazole, and Vancomycin. Statistical analysis was performed using chi-square test (χ2) and SPSS software. The p Value< 0.05 was considered significant.

Results

In 10 patients out of 30 for whom Pseudomonas aeruginosa was found positive (33.33%), all cultures were resistant to Penicillin and Oxacillin (100%), followed by Trimethoprim and Sulfamethoxazole (80%). The best performance was seen by Vancomycin (20%). No correlation was found in terms of age, gender, and type of disease (lymphoma or leukemia) for antibiotic resistance (p> 0.05).

Conclusion

It seems that Penicillin, Oxacillin, Tetracycline, Sulfamethoxazole have significant resistance to Pseudomonas aeruginosa. Further research on Gentamicin, Ceftazidime, Ciprofloxacin, and especially Vancomycin is recommended for effective antibiotic prescriptions against Pseudomonas aeruginosa.

Genetic risk variants implicate impaired maintenance and repair of periodontal tissues as causal for periodontitis-A synthesis of recent findings

Periodontitis is a complex inflammatory disease in which the host genome, in conjunction with extrinsic factors, determines susceptibility and progression. Genetic predisposition is the strongest risk factor in the first decades of life. As people age, chronic exposure to the periodontal microbiome puts a strain on the proper maintenance of barrier function. This review summarizes our current knowledge on genetic risk factors implicated in periodontitis, derived (i) from hypothesis-free systematic whole genome-profiling studies (genome-wide association studies [GWAS] and quantitative trait loci [QTL] mapping studies), and independently validated through further unbiased approaches; (ii) from monogenic and oligogenic forms of periodontitis; and (iii) from syndromic forms of periodontitis. The genes include, but are not limited to, SIGLEC5, PLG, ROBO2, ABCA1, PF4, and CTSC. Notably, CTSC and PLG gene mutations were also identified in non-syndromic and syndromic forms of prepubertal and early-onset periodontitis. The functions of the identified genes in this review suggest that the pathways affected by the periodontitis-associated gene variants converge in functions involved in the maintenance and repair of structural integrity of the periodontal tissues. Particularly, these genes play a role in the healing of inflamed and ulcerated periodontal tissues, including roles in fibrinolysis, extrusion of cellular debris, extracellular matrix remodeling and angiogenesis. Syndromes that include periodontitis in their phenotype indicate that neutrophils play an important role in the regulation of inflammation in the periodontium. The established genetic susceptibility genes therefore collectively provide new insights into the molecular mechanisms and plausible causal factors underlying periodontitis.

Acute Oral Lesions

A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.

Primary Immunodeficiencies With Defects in Innate Immunity: Focus on Orofacial Manifestations

The field of primary immunodeficiencies (PIDs) is rapidly evolving. Indeed, the number of described diseases is constantly increasing thanks to the rapid identification of novel genetic defects by next-generation sequencing. PIDs are now rather referred to as “inborn errors of immunity” due to the association between a wide range of immune dysregulation-related clinical features and the “prototypic” increased infection susceptibility. The phenotypic spectrum of PIDs is therefore very large and includes several orofacial features. However, the latter are often overshadowed by severe systemic manifestations and remain underdiagnosed. Patients with impaired innate immunity are predisposed to a variety of oral manifestations including oral infections (e.g., candidiasis, herpes gingivostomatitis), aphthous ulcers, and severe periodontal diseases. Although less frequently, they can also show orofacial developmental abnormalities. Oral lesions can even represent the main clinical manifestation of some PIDs or be inaugural, being therefore one of the first features indicating the existence of an underlying immune defect. The aim of this review is to describe the orofacial features associated with the different PIDs of innate immunity based on the new 2019 classification from the International Union of Immunological Societies (IUIS) expert committee. This review highlights the important role played by the dentist, in close collaboration with the multidisciplinary medical team, in the management and the diagnostic of these conditions.