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Săndulescu M, Nicolescu MI, Funieru C, Şahin GÖ, Săndulescu O. Exposure to Biological Fluids in Dental Practice-Narrative Review on Appropriate Risk Assessment to Guide Post-Exposure Management. Pathogens 2023; 12:968. [PMID: 37513815 PMCID: PMC10383678 DOI: 10.3390/pathogens12070968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/03/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Accidental exposure to blood or other biological fluids is a common occurrence in dentistry, and its post-exposure management is a key component of infection prevention and control programs designed to prevent the transmission of blood-borne pathogens such as hepatitis B and C viruses (HBV, HCV) and human immunodeficiency virus (HIV). This narrative review aims to comprehensively review the risk assessment process for each of these pathogens at all steps of the epidemiological process, i.e., source-exposure route-receptive person, in order to provide a better understanding of the delicate differences that influence the transmission risk and that drive the individualized post-exposure management.
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Affiliation(s)
- Mihai Săndulescu
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihnea Ioan Nicolescu
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian Funieru
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gülşen Özkaya Şahin
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22362 Malmö, Sweden
- Laboratory Medicine, Department of Clinical Microbiology, Skåne University Hospital, 22242 Lund, Sweden
| | - Oana Săndulescu
- Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 021105 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
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Wang C, Hu Z, Zheng X, Ye M, Liao C, Shang M, Gong W, Guan Z, Lu H, Gu X, Shi M, Zhou P. A New Specimen for Syphilis Diagnosis: Evidence by High Loads of Treponema pallidum DNA in Saliva. Clin Infect Dis 2021; 73:e3250-e3258. [PMID: 33099614 PMCID: PMC8563222 DOI: 10.1093/cid/ciaa1613] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND DNA from many pathogens can be detected in saliva. However, the presence and quantity of Treponema pallidum DNA in patients with syphilis in saliva is unknown. METHODS 234 patients with syphilis with different stages and 30 volunteers were enrolled. Paired saliva and plasma samples were collected from all participants. Consecutive saliva samples from 9 patients were collected every 4 hours following treatment. Treponema pallidum DNA in samples was determined by nested polymerase chain reaction (PCR) and droplet digital PCR targeting polA and Tpp47. RESULTS Treponema pallidum DNA detection rates in saliva and plasma were 31.0% (9/29) and 51.7% (15/29) in primary syphilis (P = .11), 87.5% (63/72) and 61.1% (44/72) in secondary syphilis (P < .001), 25.6% (21/82) and 8.5% (7/82) in latent syphilis (P = .004), and 21.6% (11/51) and 5.9% (3/51) in symptomatic neurosyphilis (P = .021), respectively. Median (range) loads of Tpp47 and polA in saliva were 627 (0-101 200) and 726 (0-117 260) copies/mL, respectively, for patients with syphilis. In plasma, however, loads of Tpp47 and polA were low: medians (range) of 0 (0-149.6) and 0 (0-176) copies/mL, respectively. Loads of T. pallidum DNA in saliva during treatment fluctuated downward; the clearance time was positively correlated with the loads of T. pallidum DNA before treatment. CONCLUSIONS Collection of saliva is noninvasive and convenient. The high loads of T. pallidum DNA in saliva and reduction after treatment indicated that saliva can be not only a diagnostic fluid for syphilis but also an indicator of therapeutic effectiveness.
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Affiliation(s)
- Cuini Wang
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Zhixiang Hu
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xin Zheng
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Meiping Ye
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Chunjie Liao
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, China
| | - Mengya Shang
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, China
| | - Weiming Gong
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Zhifang Guan
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Haikong Lu
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xin Gu
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Mei Shi
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Pingyu Zhou
- STD Institute, Shanghai Skin Disease Hospital, Shanghai, China
- Shanghai Skin Disease Hospital, Clinical School of Anhui Medical University, Shanghai, China
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Gaube G, Armero A, Salmona M, Néré ML, Mahjoub N, Lascoux-Combe C, Gabassi A, Gallien S, Amara A, Molina JM, Delaugerre C, Chaix ML. Characterization of HIV-1 diversity in various compartments at the time of primary infection by ultradeep sequencing. Sci Rep 2020; 10:2409. [PMID: 32051463 PMCID: PMC7016127 DOI: 10.1038/s41598-020-59234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
We used next-generation sequencing to evaluate the quantity and genetic diversity of the HIV envelope gene in various compartments in eight patients with acute infection. Plasma (PL) and seminal fluid (SF) were available for all patients, whole blood (WB) for seven, non-spermatozoid cells (NSC) for four, and saliva (SAL) for three. Median HIV-1 RNA was 6.2 log10 copies/mL [IQR: 5.5-6.95] in PL, 4.9 log10 copies/mL [IQR: 4.25-5.29] in SF, and 4.9 log10 copies/mL [IQR: 4.46-5.09] in SAL. Median HIV-1 DNA was 4.1 log10 copies/106 PBMCs [IQR: 3.15-4.15] in WB and 2.6 log10 copies /106 Cells [IQR: 2.23-2.75] in NSC. The median overall diversity per patient varied from 0.0005 to 0.0232, suggesting very low diversity, confirmed by the clonal aspect of most of the phylogenetic trees. One single haplotype was present in all compartments for five patients in the earliest stage of infection. Evidence of higher diversity was established for two patients in PL and WB, suggesting compartmentalization. Our study shows low diversity of the env gene in the first stages of infection followed by the rapid establishment of cellular reservoirs of the virus. Such clonality could be exploited in the search for early patient-specific therapeutic solutions.
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Affiliation(s)
- Géraldine Gaube
- AP-HP, Hôpital Henri Mondor, Service d'Immunologie et Maladies Infectieuses, Université Paris Est Créteil, Inserm U955, Créteil, France
| | - Alix Armero
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France
| | - Maud Salmona
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France
- INSERM UMR 976, Université de Paris, Paris, France
| | - Marie-Laure Néré
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France
- CNR VIH, Paris, France
| | - Nadia Mahjoub
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France
| | | | | | - Sébastien Gallien
- AP-HP, Hôpital Henri Mondor, Service d'Immunologie et Maladies Infectieuses, Université Paris Est Créteil, Inserm U955, Créteil, France
| | - Ali Amara
- INSERM UMR 944, Université de Paris, Paris, France
| | - Jean Michel Molina
- AP-HP, Hôpital Saint Louis, SMIT, Paris, France
- INSERM UMR 944, Université de Paris, Paris, France
| | - Constance Delaugerre
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France
- CNR VIH, Paris, France
- INSERM UMR 944, Université de Paris, Paris, France
| | - Marie-Laure Chaix
- AP-HP, Hôpital Saint-Louis, Virologie, Paris, France.
- CNR VIH, Paris, France.
- INSERM UMR 944, Université de Paris, Paris, France.
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