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Fukuda H, Hayakawa A, Takahashi Y, Komatsu Y, Kawamura M, Kubo R, Tokue H, Kominato Y, Sano R. Acute subdural hematoma caused by rupture of a mycotic aneurysm due to meningitis associated with infectious endocarditis: comparison of autopsy findings with postmortem computed tomography. Forensic Sci Med Pathol 2024; 20:657-663. [PMID: 37222902 DOI: 10.1007/s12024-023-00640-3] [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] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
Forensic pathologists often encounter cases of acute subdural hematoma (SDH) due to trauma, whereas those attributable to endogenous causes are rare. Here, we report a case of the latter type in a 42-year-old man who was found dead at home after several months of fever and malaise. Postmortem computed tomography (PMCT) and autopsy were undertaken to clarify the cause of death. PMCT images revealed a fatal SDH and a localized hyper-density area in the right parietal lobe; macroscopic and microscopic examinations revealed SDH due to rupture of a mycotic aneurysm (MA) associated with meningitis. The PMCT images also indicated thickening and calcification of the mitral valve, while autopsy demonstrated infective endocarditis (IE). In addition, PMCT demonstrated a low-density area in the spleen, which was shown to be a splenic abscess at autopsy. PMCT also demonstrated tooth cavities. Based on the findings of autopsy, the cause of death was considered to be SDH due to rupture of the MA resulting from meningitis with IE and splenic abscess. Although PMCT was unable to clarify the significance of any individual feature, a retrospective review of the PMCT images might have suggested IE, bacteremia, or ruptured MA leading to SDH. This case suggests that, instead of interpreting individual features demonstrated on PMCT images, integrated interpretation of overall PMCT findings might provide clues for identifying causes of death, despite the fact that PMCT lacks diagnostic accuracy for infectious diseases such as IE and meningitis.
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MESH Headings
- Humans
- Male
- Adult
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/pathology
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/pathology
- Aneurysm, Ruptured/pathology
- Aneurysm, Ruptured/diagnostic imaging
- Tomography, X-Ray Computed
- Autopsy
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnostic imaging
- Endocarditis, Bacterial/pathology
- Mitral Valve/pathology
- Mitral Valve/diagnostic imaging
- Endocarditis/pathology
- Endocarditis/diagnostic imaging
- Endocarditis/complications
- Meningitis/microbiology
- Postmortem Imaging
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Affiliation(s)
- Haruki Fukuda
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan.
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Yuka Komatsu
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
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Praveen T, Kotrashetti VS, Nayak RS, Naik SS, Bhat K, Kugaji MS. Polymerase chain reaction-based identification of various serotypes of Streptococcus mutans in adults with and without dental caries. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:315-320. [PMID: 38634021 PMCID: PMC11019802 DOI: 10.4103/jcde.jcde_312_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 04/19/2024]
Abstract
Background Dental caries is a multistep process which initiates the development of plaque' defined as a structured biofilm containing microbial communities. Teeth provide unique surfaces for bacterial colonization. Serotypes of Streptococcus mutans implicate the development of dental caries. Aim The aim of the study was to determine the prevalence and association of serotypes of S. mutans in groups with and without dental caries. Materials and Methods One hundred and fifty adults aged between 18 and 35 years were included in the study. Supragingival plaque samples were collected, followed by deoxyribonucleic acid extraction. Polymerase chain reaction was performed to identify S. mutans and its serotypes. Proportions of S. mutans and its serotypes were correlated with caries-active (CA) and caries-free (CF) groups. Results CA group showed 66.7% positivity for S. mutans and CF group showed only 42.7% of positivity. Serotype C showed a higher proportion followed by E' F, and K in the CA group, whereas in the CF group, higher proportion was observed with K followed by C' E, and F. 70.8% cases showed single serotype in the CA group and 83.3% in CF group. Multiple serotypes were seen in 29.2% in the CA group and 16.7% in the CF group. Conclusions The study clearly established variation in proportions of S. mutans and its serotypes between CA and CF groups. Positive correlation was observed in the CA group for S. mutans and its serotypes.
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Affiliation(s)
- Tanakanti Praveen
- Department of Oral Pathology and Microbiology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Vijayalakshmi S. Kotrashetti
- Department of Oral Pathology and Microbiology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Ramakant S. Nayak
- Department of Oral Pathology and Microbiology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Sachita Shrikant Naik
- Department of Periodontology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Kishore Bhat
- Department of Microbiology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Manohar Suresh Kugaji
- Department of Microbiology, Maratha Mandal’s NGH Institute of Dental Sciences, Belagavi, Karnataka, India
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Mitov G, Kilgenstein R, Partenheimer P, Ricart S, Ladage D. Infective endocarditis: prevention strategy and risk factors in an animal model. Folia Med (Plovdiv) 2023; 65:788-799. [PMID: 38351762 DOI: 10.3897/folmed.65.e99682] [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: 01/06/2023] [Accepted: 02/22/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Infective endocarditis is a serious infection of the endocardium, especially the heart valves, which is associated with a high mortality rate. It generally occurs in patients with altered and abnormal cardiac architecture combined with exposure to bacteria from trauma and other potentially high-risk activities with transient bacteremia.
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Affiliation(s)
- Gergo Mitov
- Danube Private University, Krems an der Donau, Austria
| | | | | | - Serge Ricart
- Danube Private University, Krems an der Donau, Austria
| | - Dennis Ladage
- Danube Private University, Krems an der Donau, Austria
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Maeda K, Hirai Y, Nashi M, Yamamoto S, Taniike N, Takenobu T. Clinical features and antimicrobial susceptibility of oral bacteria isolated from the blood cultures of patients with infective endocarditis. J Dent Sci 2022; 17:870-875. [PMID: 35756779 PMCID: PMC9201522 DOI: 10.1016/j.jds.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background/purpose The epidemiology of infective endocarditis (IE) is under constant change due to the aging society and increases in antimicrobial-resistant pathogens. However, IE remains severe. This study aimed to review the current clinical characteristics of IE and the antimicrobial susceptibility of oral bacteria (OB) isolated from blood cultures to implement appropriate antimicrobial prophylaxis. Materials and methods We retrospectively investigated the clinical features of 180 patients with IE in whom OB and pathogens except OB (eOB) were identified as causative microorganisms via blood cultures. The susceptibility of the OB group to eight antibiotics was examined by broth microdilution. Results Among causative microorganisms, the isolation rate of staphylococci was slightly higher than that of OB; however, the difference was not significant (36.7% vs. 33.8%, p = 0.3203). The number of patients with underlying cardiac disease was significantly higher in the OB group than in the eOB group (53.7% vs. 34.1%, p = 0.0113). Only one ampicillin-resistant OB was detected (2.0%). OBs were significantly less susceptible to clarithromycin and azithromycin than to ampicillin (98.0% vs. 66.7% and 98.0% vs. 60.0%, p = 0.0003 and p = 0.0003, respectively). Moreover, OBs were significantly less susceptible to clarithromycin and azithromycin than to clindamycin (66.7% vs. 88.2% and 60.0% vs. 88.2%, p = 0.0301 and p = 0.0217, respectively). Conclusion OBs were susceptible to ampicillin. However, the susceptibility of OBs to clarithromycin and azithromycin was significantly lower than that to ampicillin and clindamycin. These results are important and should help decisions regarding guide antimicrobial prophylaxis.
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Affiliation(s)
- Keigo Maeda
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
- Department of Fixed Prosthodontics and Occlusion, Osaka Dental University, Osaka, Japan
| | - Yuzo Hirai
- Department of Oral and Maxillofacial Surgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Masanori Nashi
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Yamamoto
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoki Taniike
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshihiko Takenobu
- Department of Oral and Maxillofacial Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Gupta R, Kaushal V, Goyal A, Kumar P, Gupta D, Tandon R, Mahajan A, Singla S, Singh G, Singh B, Chhabra ST, Aslam N, Wander GS, Gupta V, Mohan B. Changing microbiological profile and antimicrobial susceptibility of the isolates obtained from patients with infective endocarditis - The time to relook into the therapeutic guidelines. Indian Heart J 2021; 73:704-710. [PMID: 34736905 PMCID: PMC8642651 DOI: 10.1016/j.ihj.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/12/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
The microbiological profile, associated risk factors and demographic characteristics of patients with IE has changed in the recent times. In the present study, the antibiotic susceptibility profile of 66 isolates (40 from IDU and 26 from non IDU) recovered over a period of three years from the patients with definitive diagnosis of IE along with their absolute minimum inhibitory concentrations (MIC-μg/ml) was determined as per CLSI, 2017 guidelines. Staphylococcus aureus was found to be the predominant pathogen associated with IE out of which 90.2% isolates were MRSA, although none of the isolates were found resistant to vancomycin, teicoplanin, daptomycin and linezolid. Pseudomonas aeruginosa isolates were 100% susceptible to carbapenams, however variable resistance was observed against other antimicrobials. All Enterococci were found to be 100% susceptible to linezolid and daptomycin, whereas vancomycin resistant enterococci phenotype was observed in 25% of the Enterococcal isolates. A noticeable difference in the antimicrobial susceptibility profile and their MICs were observed in the present study, as compared to published literature across the globe and within the country. However, no statistically significant difference (λ 2 test, p > 0.01)in the AST pattern of isolates from IDU vs. Non IDU was observed. After reviewing the local antibiogram it seems that we need to have our own regional guidelines, which may partially replace the currently prevailing AHA/ESC guidelines.
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Affiliation(s)
- Rama Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Vandana Kaushal
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Pawan Kumar
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Dinesh Gupta
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Rohit Tandon
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | | | - Sonaal Singla
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Gurbhej Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Bhupinder Singh
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Shibba Takkar Chhabra
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Naved Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Gurpreet S Wander
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, India.
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Nitta M, Shimizu S, Kaneko M, Fushimi K, Ueda S. Outcomes of women with congenital heart disease admitted to acute-care hospitals for delivery in Japan: a retrospective cohort study using nationwide Japanese diagnosis procedure combination database. BMC Cardiovasc Disord 2021; 21:409. [PMID: 34452599 PMCID: PMC8393443 DOI: 10.1186/s12872-021-02222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background The number of women with congenital heart disease (CHD) who are of childbearing age is increasing due to advancements in medical management. Nonetheless, data on the outcomes of delivery in women with CHD remain limited. Therefore, we conducted a retrospective cohort study using a nationwide database of deliveries by women with CHD. Methods Deliveries by women with CHD discharged from acute-care hospitals between April 2017 and March 2018 were identified based on the Diagnosis Procedure Combination database which covers almost all acute-care hospitals in Japan. By using this database, we tried to include relatively high-risk deliveries by women with CHD. Subjects were divided into three groups according to the underlying disease complexity: simple, moderate, and great complexity. The clinical characteristics and incidence of peripartum cardiovascular events were compared among the three groups. Results A total of 249 deliveries from 107 hospitals were included. The largest facility had 29 deliveries per year. Given the uncertainty of underlying cardiac anomalies, 48 women were excluded, and the remaining 201 women (median age, 32 years) were analyzed. In-hospital maternal death, use of extracorporeal membrane oxygenation, intra-aortic balloon pump, pacemaker, and direct current cardioversion were not observed. Nine patients (4.5%) required intravenous diuretic administration. However, the difference in the frequency of diuretic use was not significant among the three groups (simple, 1.9%; moderate, 7.2%; great, 6.9%; P = 0.204). One participant required valve replacement surgery at 22 days after a successful cesarean section. As the disease complexity increased, deliveries occurred more frequently at university hospitals (simple, 41.7%; moderate, 52.2%; great, 72.4%; P = 0.013) and the length of hospitalization was significantly longer, with median durations of 9.0 (interquartile range [IQR] 7.0–11.0) days, 10.0 (IQR 8.0–24.0) days, and 11.0 (IQR 8.0–36.0) days in the simple, moderate, and great complexity groups, respectively (P = 0.002). Conclusions Appropriate patient selection and management by specialized tertiary institutions may contribute to positive outcomes in pregnancies in women with CHD. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02222-z.
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Affiliation(s)
- Manabu Nitta
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan. .,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, 236-0004, Japan.
| | - Sayuri Shimizu
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
| | - Makoto Kaneko
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan
| | - Shinichiro Ueda
- Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027, Japan
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Osako R, Matsuda Y, Itohara C, Sukegawa-Takahashi Y, Sukegawa S, Okuma S, Furuki Y, Kanno T. Relationship between Oral Bacterial Count and Postoperative Complications among Patients with Cardiovascular Disease Treated by Surgery: A Retrospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9070850. [PMID: 34356228 PMCID: PMC8304811 DOI: 10.3390/healthcare9070850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022] Open
Abstract
In this retrospective observational study, we evaluated the relationship between perioperative oral bacterial counts and postoperative complications in cardiovascular disease (CVD) patients. From April 2012 to December 2018, all patients scheduled for surgery received perioperative oral management (POM) by oral specialists at a single center. Tongue dorsum bacterial counts were measured on the pre-hospitalization day, preoperatively, and postoperatively. Background data were collected retrospectively. Among the 470 consecutive patients, the postoperative complication incidence rate was 10.4% (pericardial fluid storage, n = 21; postoperative pneumonia, n = 13; surgical site infection, n = 9; mediastinitis, n = 2; and seroma, postoperative infective endocarditis, lung torsion, and pericardial effusion, n = 1 each). Oral bacterial counts were significantly higher in the pre-hospitalization than in the pre- and postoperative samples (p < 0.05). Sex, cerebrovascular disease, and operation time differed significantly between complications and no-complications groups (p < 0.05). Multivariate analysis with propensity score adjustment showed a significant association between postoperative oral bacterial count and postoperative complications (odds ratio 1.26; 95% confidence interval, 1.00–1.60; p = 0.05). Since the development of cardiovascular complications is a multifactorial process, the present study cannot show that POM reduces complications but indicates POM may prevent complications in CVD patients.
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Affiliation(s)
- Rie Osako
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine & Oral Care Center, Shimane University Hospital, Izumo 693-8501, Japan; (R.O.); (Y.M.); (C.I.); (S.O.)
| | - Yuhei Matsuda
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine & Oral Care Center, Shimane University Hospital, Izumo 693-8501, Japan; (R.O.); (Y.M.); (C.I.); (S.O.)
| | - Chieko Itohara
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine & Oral Care Center, Shimane University Hospital, Izumo 693-8501, Japan; (R.O.); (Y.M.); (C.I.); (S.O.)
| | - Yuka Sukegawa-Takahashi
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan; (Y.S.-T.); (S.S.); (Y.F.)
| | - Shintaro Sukegawa
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan; (Y.S.-T.); (S.S.); (Y.F.)
| | - Satoe Okuma
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine & Oral Care Center, Shimane University Hospital, Izumo 693-8501, Japan; (R.O.); (Y.M.); (C.I.); (S.O.)
| | - Yoshihiko Furuki
- Department of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu 760-8557, Japan; (Y.S.-T.); (S.S.); (Y.F.)
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine & Oral Care Center, Shimane University Hospital, Izumo 693-8501, Japan; (R.O.); (Y.M.); (C.I.); (S.O.)
- Correspondence: ; Tel.: +81-853-20-2301
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8
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Nishikawa M, Honda M, Kimura R, Kobayashi A, Yamaguchi Y, Hori S, Kobayashi H, Kawamura H, Nakayama Y, Todate Y, Takano Y, Yamaguchi H, Hamada K, Iketani S, Seto I, Izumi Y, Seto K. The effects of intensive oral care before surgery for gastric cancer patients. Oral Dis 2020; 27:1847-1853. [PMID: 33191579 DOI: 10.1111/odi.13722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Oral function management has been recognized as important strategy for preventing postoperative complications. In this historical cohort study, we focused on the patients who planed gastrectomy, and investigated the appropriate duration and frequency of preoperative oral care to prevent complications after surgery. METHODS Patients who planed surgery for gastric cancer between 2012 and 2018 were enrolled. We defined intensive oral care (IOC) as initial intervention at least three weeks before surgery and follow-up intervention within a week before surgery. As the primary outcome, the incidence of postoperative infectious complications was compared between the IOC and non-intensive oral care groups. RESULTS A total of 576 patients were enrolled, including 66 with IOC. The incidence of infectious complications was 2/66 (3.0%) in the IOC group and 64/510 (12.5%) in the non-intensive oral care group. After adjusting for confounding factors, patients with IOC exposure had a lower chance of developing postoperative infectious complications (odds ratio; 0.217, 0.051-0.927). CONCLUSIONS Intensive oral care can help prevent postoperative infectious complications after gastrectomy. These findings suggest that appropriate preoperative oral care includes at least two interventions: three weeks or more before and within one week before surgery.
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Affiliation(s)
- Mao Nishikawa
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Ryosuke Kimura
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Ayaka Kobayashi
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yuji Yamaguchi
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Soshi Hori
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Hiroshi Kobayashi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Hidetaka Kawamura
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yujiro Nakayama
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yukitoshi Todate
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Susumu Iketani
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Ichiro Seto
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Yuichi Izumi
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Kanichi Seto
- Department of Oral and Maxillofacial Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
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Fukushima S, Hagiya H, Mizuta Y, Nakano Y, Takahara M, Okamoto K, Hayashi Y, Yamada K, Hasegawa K, Otsuka F. Multiple Deep-seated Dentofacial Abscesses Caused by Multidrug-resistant Viridans Group Streptococci. Intern Med 2020; 59:2067-2070. [PMID: 32389944 PMCID: PMC7492120 DOI: 10.2169/internalmedicine.4283-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Odontogenic infections, generally caused by dental caries and periodontal disease, can result in fatal illness. We herein report a 71-year-old Japanese woman with type 2 diabetes and hemodialysis who suffered from multiple dentofacial abscesses mainly caused by multidrug-resistant Streptococcus oralis. She complained of pain and swelling of her face, with an extraoral fistula from the left cheek. Following 3 surgical debridement procedures and partial mandibulectomy, in addition to 12 weeks of antimicrobial therapy, the multiple dentofacial abscesses were ameliorated. A combination of surgical and antimicrobial treatments following an early diagnosis is essential for reducing further complications.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuki Mizuta
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Masahiro Takahara
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kayo Okamoto
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuko Hayashi
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kiyoshi Yamada
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kou Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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10
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Contribution of Severe Dental Caries Induced by Streptococcus mutans to the Pathogenicity of Infective Endocarditis. Infect Immun 2020; 88:IAI.00897-19. [PMID: 32312765 DOI: 10.1128/iai.00897-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/11/2020] [Indexed: 02/02/2023] Open
Abstract
Streptococcus mutans, a major pathogen of dental caries, is regarded as a causative agent of infective endocarditis (IE), which mainly occurs in patients with underlying heart disease. However, it remains unknown whether severe dental caries that extend to pulp space represent a possible route of infection. In the present study, we evaluated the virulence of S. mutans for IE development using rats with concurrent severe dental caries and heart valve injury. Dental caries was induced in rats through the combination of a caries-inducing diet and the administration of S. mutans into the oral cavity. Then, the heart valves of a subset of rats were injured using a sterile catheter and wire under general anesthesia. The rats were euthanized at various times with various stages of dental caries. The number of teeth affected by dental caries with pulp exposure was increased in the rats in a time-dependent manner. S. mutans was recovered from injured heart tissue, which was mainly observed in rats with higher number of S. mutans bacteria in mandibular bone and a larger number of teeth in which caries extended to pulp. Dental caries was more severe in rats with heart injury than in rats without heart injury. Sequencing analysis targeting 16S rRNA revealed that specific oral bacteria appeared only in rats with heart injury, which may be related to the development of dental caries. Our findings suggest that dental caries caused by the combination of S. mutans infection and sucrose intake may contribute to S. mutans colonization in injured heart tissue.
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11
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Vandersluis YR, Suri S. Infective endocarditis and orthodontic implications in children: A review of the literature. Am J Orthod Dentofacial Orthop 2020; 157:19-28. [DOI: 10.1016/j.ajodo.2019.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/30/2022]
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12
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Yamada SI, Hasegawa T, Soutome S, Yoshimura H, Miyakoshi M, Ueda N, Okamoto K, Hishida S, Rokutanda S, Nakahara H, Fujita S, Akashi M, Kitagawa Y, Kirita T, Shibuya Y, Umeda M, Kurita H. Prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction on warfarin therapy: a multicenter retrospective study in Japan. Odontology 2019; 108:462-469. [PMID: 31705338 DOI: 10.1007/s10266-019-00474-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/26/2019] [Indexed: 11/26/2022]
Abstract
Postoperative hemorrhage after tooth extraction is a critical and clinically important issue for clinicians and patients receiving anticoagulants. The purpose of the present study was to investigate the prevalence of and risk factors for postoperative hemorrhage after lower third molar extraction in Japanese patients receiving warfarin therapy. A total of 142 patients who underwent lower third molar extraction between January 2010 and December 2016 were included, and their medical records were retrospectively reviewed. The prevalence of and risk factors for postoperative hemorrhage were investigated. The prevalence of postoperative hemorrhage after lower third molar extraction was significantly higher in patients receiving warfarin than in healthy subjects (21.8% vs 0.7%, P < 0.001). The cutoff value for PT-INR was 2.11 based on a receiver-operating characteristic analysis. A multivariate analysis indicated that an elevated PT-INR value [hazard ratio (HR) 3.798, 95% confidence interval (CI) 1.400-10.467, P < 0.01], preoperative antibiotic administration (HR 4.434, 95% CI 1.591-14.775, P < 0.01), difficulties with intraoperative hemostasis (HR 16.298, 95% CI 2.986-110.677, P < 0.01), and higher serum creatinine levels (HR 7.465, 95% CI 1.616-39.576, P < 0.05) are significant predictors of postoperative hemorrhage after lower third molar extraction. Multivariate correlations were observed between risk factors including an elevated PT-INR value, preoperative antibiotic administration, and higher serum creatinine levels, and postoperative hemorrhage after lower third molar extraction in patients receiving warfarin therapy. Clinicians need to consider these risk factors for postoperative hemorrhage after the lower third molar extraction and monitor PT-INR in patients receiving warfarin therapy.
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Affiliation(s)
- Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sakiko Soutome
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hitoshi Yoshimura
- Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaaki Miyakoshi
- Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Kenjiro Okamoto
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Sumiyo Hishida
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Rokutanda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirokazu Nakahara
- Department of Dentistry and Oral Surgery, Osaka City University Graduate School of Medicine, Osaka City, Japan
| | - Shigeyuki Fujita
- Department of Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Kitagawa
- Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Yasuyuki Shibuya
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan
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Nakagawa T, Mori M, Tada H, Ohira M, Iino K, Hayashi K, Takemura H, Yamagishi M, Kawashiri MA. Unusual Aorto-mitral Discontinuity Caused by Infective Endocarditis. Intern Med 2019; 58:2373-2376. [PMID: 31118390 PMCID: PMC6746643 DOI: 10.2169/internalmedicine.2629-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aorto-mitral discontinuity is considered a relatively rare complication of infective endocarditis, usually requiring invasive surgical procedures, including double valve replacement in addition to aortic root replacement/repair. In the present case report, images were produced using transthoracic echocardiograms and transesophageal echocardiograms, which may assist in the planning of surgical procedures. The images captured using real-time three-dimensional transesophageal echocardiograms revealed aorto-mitral discontinuity and a perforated mitral valve aneurysm of the anterior leaflet.
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Affiliation(s)
- Tamami Nakagawa
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Mika Mori
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Hayato Tada
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Miho Ohira
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Kenji Iino
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University Graduate School of Medicine, Japan
| | - Kenshi Hayashi
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University Graduate School of Medicine, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Masa-Aki Kawashiri
- Division of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
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14
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Clinical impact of periodontal disease on postoperative complications in gastrointestinal cancer patients. Int J Clin Oncol 2019; 24:1558-1564. [PMID: 31332612 DOI: 10.1007/s10147-019-01513-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effectiveness of perioperative oral management in gastrointestinal surgery remains unclear. To elucidate the clinical significance of oral care, we investigated the relationship between the oral environment and postoperative infectious complications (POICs) in patients undergoing gastrointestinal surgery. METHODS This was a single-institute and historical cohort study of 341 patients. The participants were isolated from consecutive patients undergoing planned radical resection for gastrointestinal carcinoma from January 2016 to June 2017. Dentists assessed the oral environment for periodontal disease, hygiene status, dry mouth, fur on tongue, and tooth stumps. All patients received scaling and tooth brushing instructions. A stepwise logistic regression analysis was conducted to identify risk factors for POICs among the different oral statuses. RESULTS The surgical procedures performed were gastrectomy in 123 (36.1%), colorectal resection in 185 (54.2%), and pancreatoduodenectomy or others in 38 (11.1%). POICs occurred in 48 patients (14.1%), including deep organ space infection in 20, surgical site infection in 11, anastomotic leakage in 5, urinary tract infection in 4, pneumonia in 2, and others in 6. After adjusting for confounding factors, periodontal disease was isolated as an independent risk factor for POICs (odds ratio 2.091, p = 0.037, 95% confidence interval 1.045-4.183). Other variables of oral environment such as hygiene status, dry mouth, fur on tongue, and tooth stumps did not have a significant impact on POICs. CONCLUSIONS Periodontal disease is a risk factor for infectious complications after gastrointestinal surgery.
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Kokomoto K, Nomura R, Ohara T, Nakatani S, Ooshima T, Nakano K. Current knowledge among pediatric dentistry specialists in Japan regarding prevention of infective endocarditis. PEDIATRIC DENTAL JOURNAL 2018. [DOI: 10.1016/j.pdj.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nomura R, Kokomoto K, Ohara T, Nakatani S, Ooshima T, Nakano K. Current knowledge among Japanese experienced general dentists regarding prevention of infective endocarditis. Odontology 2018; 106:297-305. [PMID: 29435864 DOI: 10.1007/s10266-018-0344-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/27/2017] [Indexed: 12/25/2022]
Abstract
Infective endocarditis (IE), a life-threatening condition predominantly occurring in patients with underlying heart disease, is mainly caused by bacteremia induced by invasive dental treatment. However, the amount of related information shared between cardiologists and dentists appears to be inadequate. In the present study, a survey regarding prevention of IE, composed of 13 major questions, 2 of which also allowed free comments, was sent to approximately 3000 dentists belonging to a prefectural dental association in Japan. Of the 13.6% who returned the forms, more than 80% were general dentists with more than 20 years of experience. Approximately, 55% of the responders reported that they had opportunities to prescribe antibiotics prior to performing treatments with risk of IE, though noted difficulties with designation of which patients with heart disease were at risk. Most of the dentists considered that oral surgery procedures have a high risk for IE, whereas less invasive procedures were considered to be not associated with the disease. Approximately, 35% selected oral amoxicillin, with a dose of 2.0 g (20%) or 500 mg (27%) prescribed for adults, and 50 mg (10%) or 30 mg (12%) per kg of body weight for children. However, the timing of the antibiotics administration varied. The present results reveal current knowledge regarding prevention of IE among general dentists in Japan, and should be valuable for construction of a protocol to establish consensus between dentists and cardiologists.
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Affiliation(s)
- Ryota Nomura
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuma Kokomoto
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Ooshima
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kazuhiko Nakano
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, 1-8 Yamada-oka, Suita, Osaka, 565-0871, Japan.
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17
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Nagai T, Takase Y, Hamabe A, Tabata H. Observational Study of Infective Endocarditis at a Community-based Hospital: Dominance of Elderly Patients with Comorbidity. Intern Med 2018; 57:301-310. [PMID: 29225254 PMCID: PMC5827306 DOI: 10.2169/internalmedicine.9274-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective The purpose of this study was to present the recent clinical profiles and the real-world management of infective endocarditis (IE). Methods All medical records of patients with IE were reviewed retrospectively for their clinical data, including clinical presentation, laboratory results, blood cultures, echocardiographic findings, treatments and complications. Using the clinical data collected, we calculated the EuroSCORE II, the European risk score for adult cardiac surgery, the Charlson Comorbidity Index as a surrogate of comordibity, and the Katz Index as a surrogate of frailty. Results Thirty-eight patients were identified as having IE (24 men, age: 71.8±13.1 years). Congestive heart failure occurred in 16 patients (42%), stroke in 14 (50%), and systemic embolism in 5 (13%). The EuroSCORE II and Charlson Comorbidity Index were high (7.7±5.8% and 5.5±2.8%, respectively). The Katz Index was fair (5.5±1.4) before the onset but deteriorated to 2.8±2.7 at the time of establishing the diagnosis of IE (p<0.001). Early surgery was performed in 22 cases (61%). In-hospital death occurred in 10 cases (26%). A EuroSCORE II ≥9%, Staphylococcus aureus etiology, and a Charlson Comorbidity Index were suggested as determinants of in-hospital death (hazard ratios: 173.60, 9.31, 1.57, respectively). In contrast, early surgery was suggested as a determinant of the survival (hazard ratio: 0.04). The Charlson Comorbidity Index was also suggested as a determinant for selecting conservative management (odds ratio: 1.40). Conclusion Comorbidity may influence the treatment selection and outcome of elderly patients with IE.
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Affiliation(s)
- Tomoo Nagai
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Japan
| | - Yoshiyuki Takase
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Japan
| | - Akira Hamabe
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Japan
| | - Hirotsugu Tabata
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Japan
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18
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Contribution of Streptococcus mutans Strains with Collagen-Binding Proteins in the Presence of Serum to the Pathogenesis of Infective Endocarditis. Infect Immun 2017; 85:IAI.00401-17. [PMID: 28947650 DOI: 10.1128/iai.00401-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/18/2017] [Indexed: 12/31/2022] Open
Abstract
Streptococcus mutans, a major pathogen of dental caries, is considered one of the causative agents of infective endocarditis (IE). Recently, bacterial DNA encoding 120-kDa cell surface collagen-binding proteins (CBPs) has frequently been detected from S. mutans-positive IE patients. In addition, some of the CBP-positive S. mutans strains lacked a 190-kDa protein antigen (PA), whose absence strengthened the adhesion to and invasion of endothelial cells. The interaction between pathogenic bacteria and serum or plasma is considered an important virulence factor in developing systemic diseases; thus, we decided to analyze the pathogenesis of IE induced by S. mutans strains with different patterns of CBP and PA expression by focusing on the interaction with serum or plasma. CBP-positive (CBP+)/PA-negative (PA-) strains showed prominent aggregation in the presence of human serum or plasma, which was significantly greater than that with CBP+/PA-positive (PA+) and CBP-negative (CBP-)/PA+ strains. Aggregation of CBP+/PA- strains was also observed in the presence of a high concentration of type IV collagen, a major extracellular matrix protein in serum. In addition, aggregation of CBP+/PA- strains was drastically reduced when serum complement was inactivated. Furthermore, an ex vivo adherence model and an in vivo rat model of IE showed that extirpated heart valves infected with CBP+/PA- strains displayed prominent bacterial mass formation, which was not observed following infection with CBP+/PA+ and CBP-/PA+ strains. These results suggest that CBP+/PA-S. mutans strains utilize serum to contribute to their pathogenicity in IE.
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Abstract
Since the reclassification of the genus Bartonella in 1993, the number of species has grown from 1 to 45 currently designated members. Likewise, the association of different Bartonella species with human disease continues to grow, as does the range of clinical presentations associated with these bacteria. Among these, blood-culture-negative endocarditis stands out as a common, often undiagnosed, clinical presentation of infection with several different Bartonella species. The limitations of laboratory tests resulting in this underdiagnosis of Bartonella endocarditis are discussed. The varied clinical picture of Bartonella infection and a review of clinical aspects of endocarditis caused by Bartonella are presented. We also summarize the current knowledge of the molecular basis of Bartonella pathogenesis, focusing on surface adhesins in the two Bartonella species that most commonly cause endocarditis, B. henselae and B. quintana. We discuss evidence that surface adhesins are important factors for autoaggregation and biofilm formation by Bartonella species. Finally, we propose that biofilm formation is a critical step in the formation of vegetative masses during Bartonella-mediated endocarditis and represents a potential reservoir for persistence by these bacteria.
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20
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Isoshima D, Yamashiro K, Matsunaga K, Shinobe M, Nakanishi N, Nakanishi I, Omori K, Yamamoto T, Takashiba S. Assessment of pathogenesis of infective endocarditis by plasma IgG antibody titer test against periodontal bacteria. Clin Case Rep 2017; 5:1580-1586. [PMID: 29026549 PMCID: PMC5628203 DOI: 10.1002/ccr3.1066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/02/2017] [Indexed: 12/02/2022] Open
Abstract
Oral bacteria cause infective endocarditis (IE), so severe periodontitis is thought to be high risk for IE. We suggest the identification of high-risk patients by an IgG antibody titer test against periodontal bacteria might become common screening test.
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Affiliation(s)
- Daichi Isoshima
- Department of Pathophysiology‐Periodontal ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐choKita‐kuOkayama700‐8525Japan
| | - Keisuke Yamashiro
- Department of Pathophysiology‐Periodontal ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐choKita‐kuOkayama700‐8525Japan
| | - Kazuyuki Matsunaga
- Department of Pathophysiology‐Periodontal ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐choKita‐kuOkayama700‐8525Japan
| | | | - Nagako Nakanishi
- Miyoshi Renal Clinic3‐13‐2 Miyoshi‐choFuchu‐shiTokyo183‐0045Japan
| | - Izumi Nakanishi
- Machidakeisen Hospital2‐1‐47 Minami‐machidaMachida‐shiTokyo194‐0005Japan
| | - Kazuhiro Omori
- Department of Periodontics and EndodonticsOkayama University Hospital2‐5‐1 Shikata‐choKita‐kuOkayama700‐8558Japan
| | - Tadashi Yamamoto
- Department of Periodontics and EndodonticsOkayama University Hospital2‐5‐1 Shikata‐choKita‐kuOkayama700‐8558Japan
| | - Shogo Takashiba
- Department of Pathophysiology‐Periodontal ScienceOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐choKita‐kuOkayama700‐8525Japan
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Hasegawa T, Yanamoto S, Tachibana A, Kojima Y, Koyama Y, Maeda M, Komori T. The risk factors associated with postoperative hemorrhage after tooth extraction: a multi-center retrospective study of patients receiving oral antithrombotic therapy. Oral Maxillofac Surg 2017; 21:397-404. [PMID: 28879623 DOI: 10.1007/s10006-017-0645-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/23/2017] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to retrospectively investigate the multivariate relationships between specific risk factors and postoperative hemorrhage after tooth extraction in patients who were prescribed oral antithrombotic therapy. Risk factors for postoperative hemorrhage after tooth extraction were evaluated using univariate and multivariate analyses. Patient characteristics such as age and gender; the presence or absence of known comorbidities such as diabetes mellitus, hypertension, cerebral infarction, and alcohol consumption; and perioperative diarrhea were assessed. The drug used for antithrombotic therapy, preoperative blood test results, the presence or absence of preoperative antibiotics or nonsteroidal anti-inflammatory drug (NSAID) administration, the total number of extracted teeth, and the type of surgical procedures were also evaluated. We found that the preoperative administration of antibiotics (odds ratio (OR) = 2.52), an increased prothrombin time international normalized ratio (PT-INR) value (OR = 1.94), and the extraction of multiple teeth (OR = 2.10) were significantly associated with postoperative hemorrhage. There was no significant association between postoperative hemorrhage and any other demographic factors or comorbidities, including concomitant alcohol use. We demonstrated the multivariate relationship between the risk factors and postoperative hemorrhage after tooth extraction in patients receiving oral antithrombotic therapy. Surgeons should be aware of these risks and monitor the PT-INR of anticoagulated patients.
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Affiliation(s)
- Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akira Tachibana
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Yuka Kojima
- Department of Dentistry and Oral Surgery, Kansai Medical University Hospital, Hirakata, Japan
| | - Yoshito Koyama
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Michinori Maeda
- Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Yanamoto S, Hasegawa T, Rokutanda S, Komori S, Tachibana A, Kojima Y, Koyama Y, Shibuya Y, Kurita H, Komori T, Umeda M. Multicenter Retrospective Study of the Risk Factors of Hemorrhage After Tooth Extraction in Patients Receiving Antiplatelet Therapy. J Oral Maxillofac Surg 2017; 75:1338-1343. [DOI: 10.1016/j.joms.2017.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/27/2016] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
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Vogkou CT, Vlachogiannis NI, Palaiodimos L, Kousoulis AA. The causative agents in infective endocarditis: a systematic review comprising 33,214 cases. Eur J Clin Microbiol Infect Dis 2016; 35:1227-45. [PMID: 27170145 DOI: 10.1007/s10096-016-2660-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/24/2016] [Indexed: 12/22/2022]
Abstract
Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term "infective endocarditis". All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3 % of studies (N = 57) (and in 55.4 % of studies using Duke's criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6 %) suggest the need to revisit IE prophylaxis and diagnostic strategies.
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Affiliation(s)
- Christiana T Vogkou
- Society of Junior Doctors, Athens, Greece.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos I Vlachogiannis
- Society of Junior Doctors, Athens, Greece.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Palaiodimos
- Society of Junior Doctors, Athens, Greece. .,Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Antonis A Kousoulis
- Society of Junior Doctors, Athens, Greece.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Lamas CC, Fournier PE, Zappa M, Brandão TJD, Januário-da-Silva CA, Correia MG, Barbosa GIF, Golebiovski WF, Weksler C, Lepidi H, Raoult D. Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases. Infection 2015; 44:459-66. [PMID: 26670038 DOI: 10.1007/s15010-015-0863-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the clinical characteristics of blood culture-negative endocarditis (BCNE) and how it compares to those of blood culture-positive endocarditis (BCPE) cases and show how molecular tools helped establish the etiology in BCNE. METHODS Adult patients with definite infective endocarditis (IE) and having valve surgery were included. Valves were studied by polymerase chain reaction (PCR). Statistical analysis compared BCNE and BCPE. RESULTS One hundred and thirty-one patients were included; 53 (40 %) had BCNE. The mean age was 45 ± 16 years; 33 (62 %) were male. BCNE was community-acquired in 41 (79 %). Most patients were referred from other hospitals (38, 73 %). Presentation was subacute in 34 (65 %), with fever in 47/53 (90 %) and a new regurgitant murmur in 34/42 (81 %). Native valves were affected in 74 %, mostly left-sided. All echocardiograms showed major criteria for IE. Antibiotics were used prior to BC collection in 31/42 (74 %). Definite histological diagnosis was established for 35/50 (70 %) valves. PCR showed oralis group streptococci in 21 (54 %), S. aureus in 3 (7.7 %), gallolyticus group streptococci in 2 (5.1 %), Coxiella burnetii in 1 (2.5 %) and Rhizobium sp. in 1 (2.5 %). In-hospital mortality was 9/53 (17 %). Fever (p = 0.06, OR 4.7, CI 0.91-24.38) and embolic complications (p = 0.003, OR 3.3, CI 1.55-6.82) were more frequent in BCPE cases, while new acute regurgitation (p = 0.05, OR 0.3, CI 0.098-0.996) and heart failure (p = 0.02, OR 0.3, CI 0.13-0.79) were less so. CONCLUSIONS BCNE resulted mostly from prior antibiotics and was associated with severe hemodynamic compromise. Valve histopathology and PCR were useful in confirming the diagnosis and pointing to the etiology of BCNE.
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Affiliation(s)
- Cristiane C Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. .,Unigranrio, Rio de Janeiro, Brazil.
| | | | - Monica Zappa
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | - Didier Raoult
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
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Li L, Wang H, Wang L, Pu J, Zhao H. Changing profile of infective endocarditis: a clinicopathologic study of 220 patients in a single medical center from 1998 through 2009. Tex Heart Inst J 2014; 41:491-8. [PMID: 25425980 DOI: 10.14503/thij-13-3468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The epidemiologic profile of infective endocarditis has changed substantially over the past few years, especially in industrialized countries. Our study evaluates the clinical and pathologic characteristics of infective endocarditis patients treated by cardiac surgery in China during a 12-year period. We retrospectively evaluated 220 surgically treated infective endocarditis patients and analyzed their changes from the beginning of 1998 through 2009. The mean age of the patients increased from 36.9 to 42.7 years during those 12 years (P=0.036). The chief predisposing disease was congenital heart disease (32.8%), rather than rheumatic heart disease (13.2%); this rate did not change significantly during the 12 years. The prevalent congenital lesion was bicuspid aortic valve, the rate of which (55.6%) increased significantly over the 3 time intervals studied (P=0.016). The frequency of infective endocarditis after non-dental surgical and nonsurgical intervention was significantly greater (23.3%) during 1998 through 2001, compared with the 2 intervals that followed (9%; P=0.019). Streptococcus viridans was the most frequent causative agent overall (25.6%). Forty-seven of the 220 patients (21.4%) carried the clinical diagnosis of some other form of heart disease before surgery, but at surgery they were found to have infective endocarditis as the fundamental disease process. Of 47 patients, 33 (70.2%) had either very small or no vegetations but had focal necrosis and inflammation of valve tissue that supported the diagnosis of infective endocarditis.
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Siciliano RF, Mansur AJ, Castelli JB, Arias V, Grinberg M, Levison ME, Strabelli TMV. Community-acquired culture-negative endocarditis: clinical characteristics and risk factors for mortality. Int J Infect Dis 2014; 25:191-5. [DOI: 10.1016/j.ijid.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/01/2023] Open
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Nakagawa T, Wada H, Sakakura K, Yamada Y, Ishida K, Ibe T, Ikeda N, Sugawara Y, Ako J, Momomura SI. Clinical features of infective endocarditis: Comparison between the 1990s and 2000s. J Cardiol 2014; 63:145-8. [DOI: 10.1016/j.jjcc.2013.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/05/2013] [Accepted: 06/19/2013] [Indexed: 11/24/2022]
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Baek JE, Park SJ, Woo SB, Choi JY, Jung JW, Kim NK. Changes in patient characteristics of infective endocarditis with congenital heart disease: 25 years experience in a single institution. Korean Circ J 2014; 44:37-41. [PMID: 24497888 PMCID: PMC3905114 DOI: 10.4070/kcj.2014.44.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 11/05/2013] [Accepted: 12/20/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The profile of infective endocarditis (IE) has changed and is now showing an increasing prevalence of IE among congenital heart disease (CHD) patients. We studied the change of clinical profiles of IE over the past 25 years in patients with CHD at a single institution. SUBJECTS AND METHODS We reviewed medical records retrospectively for 325 patients diagnosed with IE between January 1, 1987, and March 31, 2012. We analyzed and compared the differences in patient characteristics and outcomes between 1987-2000 (group A) and 2001-2012 (group B). RESULTS Over the 25-year period, 93 cases of IE in CHD patients were diagnosed (59 cases in group A and 34 cases in group B). Ventricular septal defect was the most common underlying cardiac disease observed during the entire period. The most common causative pathogen was Streptococcus in both groups. Group A contained 16 cases (27.1%) that had undergone cardiac surgery, whereas this number was 19 (55.8%) in group B. The number of patients who had undergone palliative care or surgery using prosthetic materials was higher among group B patients (p<0.001). Surgical procedures due to uncontrolled infection were performed in three cases in group A and 10 cases in group B. CONCLUSION Infective endocarditis and CHD show a close correlation, and the profile of IE patients can change in line with an increase in the survival rate of patients with complex CHD and the improvement of surgical techniques. Ongoing reassessment and the systematic management of these patients is crucial in the prevention and treatment of IE.
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Affiliation(s)
- Jae Eun Baek
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Park
- Department of Pediatric Cardiology, Sejong General Hospital, Bucheon, Korea
| | - Saet Byul Woo
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyun Kim
- Division of Pediatric Cardiology, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, Figueredo VM. Infective endocarditis epidemiology over five decades: a systematic review. PLoS One 2013; 8:e82665. [PMID: 24349331 PMCID: PMC3857279 DOI: 10.1371/journal.pone.0082665] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/25/2013] [Indexed: 01/04/2023] Open
Abstract
AIMS To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades. METHODS AND RESULTS We searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011. DATA FROM Einstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over each of the last 5 decades (p<0.001) and Staphylococcus aureus (SA) in the last decade (21% to 30%; p<0.05). Streptococcus viridans (SV) and culture negative (CN) IE frequency decreased over time (p<0.001), while enterococcal IE increased in the last decade (p<0.01). Patient age and male predominance increased over time as well. In subgroup analysis, SA frequency increased in North America, but not the rest of the world. This was due, in part, to an increase in intravenous drug abuse IE in North America (p<0.001). Among population-based studies (n=18; 3,477 patients) no significant changes were found. CONCLUSION Important changes occurred in IE epidemiology over the last half-century, especially in the last decade. Staphylococcal and enterococcal IE percentage increased while SV and CN IE decreased. Moreover, mean age at diagnosis increased together with male:female ratio. These changes should be considered at the time of decision-making in treatment of and prophylaxis for IE.
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Affiliation(s)
- Leandro Slipczuk
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - J. Nicolas Codolosa
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Carlos D. Davila
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Abel Romero-Corral
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Jeong Yun
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Pulmonary and Critical Care Medicine Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Gregg S. Pressman
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Vincent M. Figueredo
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
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Kojima A, Nomura R, Naka S, Okawa R, Ooshima T, Nakano K. Aggravation of inflammatory bowel diseases by oral streptococci. Oral Dis 2013; 20:359-66. [PMID: 23679203 DOI: 10.1111/odi.12125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 04/18/2013] [Accepted: 04/20/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Streptococcus mutans can aggravate colitis in mice. We evaluated the virulence of colitis using type strains as well as blood isolates of several oral streptococcal species. MATERIALS AND METHODS We investigated the susceptibility of blood isolates of several oral streptococci to phagocytosis, adhesion to and invasion of hepatic cells and interferon-γ secretion. A mouse model of dextran sodium sulphate-induced colitis was used to evaluate bacterial aggravation of colitis. In addition, interferon-γ antibody was administered to mice with prominent aggravation of colitis. RESULTS In vitro analyses showed that Streptococcus sanguinis ATCC 10556 was a possible virulent strain among type strains of several oral streptococci, and that analysis of blood isolates of S. sanguinis TW289 revealed a potential virulent strain. Intravenous administration of ATCC 10556 and TW289 caused prominent aggravation of dextran sodium sulphate-induced colitis, and histopathological examinations showed that interferon-γ secretion due to infection of hepatic cells caused colitis aggravation. Administration of interferon-γ antibody suppressed TW289-induced colitis. CONCLUSION These results suggest that some virulent oral streptococcal strains are associated with the aggravation of colitis induced by enhanced secretion of interferon-γ when they invade the bloodstream.
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Affiliation(s)
- A Kojima
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Matsui N, Ito M, Kuramae H, Inukai T, Sakai A, Okugawa M. Infective endocarditis caused by multidrug-resistant Streptococcus mitis in a combined immunocompromised patient: an autopsy case report. J Infect Chemother 2012; 19:321-5. [PMID: 22965841 DOI: 10.1007/s10156-012-0465-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
An autopsy case of infective endocarditis caused by multidrug-resistant Streptococcus mitis was described in a patient with a combination of factors that compromised immune status, including autoimmune hemolytic anemia, post-splenectomy state, prolonged steroid treatment, and IgA deficiency. The isolated S. mitis strain from blood culture was broadly resistant to penicillin, cephalosporins, carbapenem, macrolides, and fluoroquinolone. Recurrent episodes of bacterial infections and therapeutic use of several antibiotics may underlie the development of multidrug resistance for S. mitis. Because clinically isolated S. mitis strains from chronically immunocompromised patients have become resistant to a wide spectrum of antibiotics, appropriate antibiotic regimens should be selected when treating invasive S. mitis infections in these compromised patients.
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Affiliation(s)
- Natsuko Matsui
- Department of Pathology and Laboratory Medicine, Kariya Toyota General Hospital, 5-15 Sumiyoshi, Kariya, Aichi, Japan
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Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nation-wide survey in Japan. Int J Cardiol 2012; 167:2688-94. [PMID: 22805554 DOI: 10.1016/j.ijcard.2012.06.117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/30/2012] [Accepted: 06/24/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The benefit of early surgery for IE is yet to be determined in non-Western countries. We conducted this study to evaluate the role of early surgery in infective endocarditis (IE) in Japan. METHODS IE admissions in Japan were prospectively registered using a nation-wide WEB-based registration system (CArdiac Disease REgistration, CADRE). The impact of early surgery on in-hospital mortality was assessed in native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Risk factors for in-hospital death were assessed by multiple logistic regression analysis. The propensity score for early surgery was calculated to adjust the impact of early surgery. RESULTS From September 2006 to May 2009, 348 NVE and 81 PVE were registered. In NVE, early surgery was preferable in every quartile stratified with the propensity score and the summary odds ratio (OR) and 95% confidence interval (CI) was 0.12 (0.05-0.31). The predictors of in-hospital death were Staphylococcus aureus infection (OR 3.5, 95% CI 1.26-9.7), heart failure (OR 6.74, 95% CI 2.43-18.7) and early surgery (OR 0.07, 95% CI 0.03-0.2). In PVE, the predictors of in-hospital death were age (OR 1.09, 95% CI 1.01-1.18), S. aureus infection (OR 5.8, 95% CI 1.4-24.01) and heart failure (OR 7.44, 95% CI 1.81-30.67), whereas early surgery was not (OR 0.51, 95% CI 0.12-2.16). CONCLUSION Early surgery for NVE is associated with improved survival in a wide range of clinical subgroups in Japan. In PVE a survival benefit of early surgery is not clear.
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Fukumitsu K, Suzuki Y. [A septic pulmonary embolism associated with right-sided infective endocarditis and a ventricular septal defect in a patient with atopic dermatitis]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2012; 86:282-6. [PMID: 22746050 DOI: 10.11150/kansenshogakuzasshi.86.282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 30-year-old woman was admitted to our hospital with high fever and chest pain. She had a ventricular septal defect, but was asymptomatic and had not undergone surgical repair. She also had had atopic dermatitis since childhood that had not been adequately treated. Chest computed tomography showed multiple peripheral nodules and infiltrates in both lungs. A transthoracic echocardiogram detected vegetation on the wall of the right ventricle, and Staphylococcus aureus was cultured from a peripheral blood sample. She was diagnosed as having a septic pulmonary embolism associated with right-sided infective endocarditis caused by S. aureus. She was treated with Cefazolin, resulting in gradual improvement of laboratory and chest radiographic findings. Recent studies have revealed that atopic dermatitis is one of the risk factors for infective endocarditis. In this case, uncontrolled atopic dermatitis might have caused the right-sided infective endocarditis.
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Nomura R, Nakano K, Naka S, Nemoto H, Masuda K, Lapirattanakul J, Alaluusua S, Matsumoto M, Kawabata S, Ooshima T. Identification and characterization of a collagen-binding protein, Cbm, in Streptococcus mutans. Mol Oral Microbiol 2012; 27:308-23. [DOI: 10.1111/j.2041-1014.2012.00649.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masuda K, Nemoto H, Nakano K, Naka S, Nomura R, Ooshima T. Amoxicillin-resistant oral streptococci identified in dental plaque specimens from healthy Japanese adults. J Cardiol 2012; 59:285-90. [DOI: 10.1016/j.jjcc.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/07/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
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Lodha A, Sadiq A, Shani J, Enakpene E, Haran M. Bacterial pericarditis caused by infected trichilemmal cyst. J Infect Chemother 2012; 18:251-4. [DOI: 10.1007/s10156-011-0304-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/28/2011] [Indexed: 10/17/2022]
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Yamamoto S, Hosokawa N, Sogi M, Inakaku M, Imoto K, Ohji G, Doi A, Iwabuchi S, Iwata K. Impact of infectious diseases service consultation on diagnosis of infective endocarditis. ACTA ACUST UNITED AC 2011; 44:270-5. [DOI: 10.3109/00365548.2011.638317] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nemoto H, Nakano K, Masuda K, Wada K, Ardin AC, Nomura R, Ooshima T. Distribution of oral streptococci highly resistant to amoxicillin in dental plaque specimens from Japanese children and adolescents. J Med Microbiol 2011; 60:1853-1859. [DOI: 10.1099/jmm.0.027615-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hirotoshi Nemoto
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Kazuhiko Nakano
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Katsuhiko Masuda
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Koichiro Wada
- Department of Pharmacology, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Arifah Chieko Ardin
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Ryota Nomura
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Takashi Ooshima
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
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Comparative molecular and microbiological diagnosis of 19 infective endocarditis cases in which causative microbes were identified by PCR-based DNA sequencing from the excised heart valves. J Infect Chemother 2011; 18:318-23. [PMID: 22045162 DOI: 10.1007/s10156-011-0332-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 10/11/2011] [Indexed: 10/16/2022]
Abstract
Infective endocarditis (IE) is traditionally diagnosed by microbiological analysis of blood cultures, following which therapeutic antibiotics are chosen based on antimicrobial sensitivity tests. However, such conventional techniques do not always lead to an accurate etiological diagnosis. Recently, PCR analysis of the 16S rRNA gene has been employed to identify organisms isolated from excised heart valves. In this study, we analyzed 19 valve samples from patients with confirmed IE, as identified by Duke's criteria. Using broad-range PCR amplification, followed by direct gene sequencing, pathological agents were identified in all samples. Although blood cultures yielded negative results in 4 cases, PCR analysis of valve samples showed positive identification of causative organisms. In 3 cases, there was a difference between blood culture and PCR in identification of pathological agents, which are likely to be misidentified by the conventional method based on the phenotypic database. Postoperative antibiotics were chosen considering the severity of lesions and the results of PCR, Gram staining, and valve cultures. All patients were cured without relapse. The broad-range PCR method was therefore beneficial for the management of IE because it enabled us to identify pathogens directly from the site of infection, even organisms that were difficult to culture or likely to be misidentified by the conventional culture method. Identification of the agents provided precise knowledge of the microbiological spectrum involved in the cases of IE.
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Nishiyama H, Shirayama H, Asami S, Ikegami S, Murakami I, Yamagishi H, Yuasa N, Oba T, Ohkusu K, Ohta M. Infective Endocarditis Due to Optochin-ResistantStreptococcus pneumoniae. Lab Med 2011. [DOI: 10.1309/lmnsg654nthjyufi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Totsugawa T, Kuinose M, Yoshitaka H, Tsushima Y, Ishida A, Chikazawa G, Katayama K, Hiraoka A. Intraoperative direct hemoperfusion with a polymyxin-B immobilized fiber column for treatment of infective endocarditis. Gen Thorac Cardiovasc Surg 2011; 59:98-104. [PMID: 21308435 DOI: 10.1007/s11748-010-0700-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 08/30/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE Endotoxin adsorption treatment (direct hemoperfusion using a polymyxin-B immobilized fiber column, or PMX-DHP) is now considered a useful option for treating severe sepsis. However, the efficacy of PMX-DHP for infective endocarditis (IE), in which the causative microorganisms are usually gram-positive cocci, remains unclear. In the present study, we investigated the impact of intraoperative PMX-DHP on clinical parameters during the treatment of IE. METHODS From November 2006 to December 2009, a total of 11 patients with active IE underwent emergent surgery using intraoperative PMX-DHP. The perioperative courses of these patients were compared with those of seven patients who underwent emergent surgery for active IE with the conventional method from January 2003 to October 2006. RESULTS PMX-DHP was associated with a significant decrease in the postoperative catecholamine dose and duration. Intubation time and intensive care unit length of stay for the PMX-DHP group was significantly shorter than that for the conventional therapy group. There was also a significant difference in the number of failed organs postoperatively between the two groups. CONCLUSION Intraoperative PMX-DHP demonstrated several positive effects, such as a drastic decrease in the doses of inotropic agents and shortening of the duration of mechanical ventilation, in patients who underwent emergent surgery for active IE. Intraoperative PMX-DHP can be a useful option for the treatment of critically ill patients with IE.
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Affiliation(s)
- Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-1-10 Marunouchi, Okayama 700-0823, Japan.
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Common knowledge regarding prevention of infective endocarditis among general dentists in Japan. J Cardiol 2011; 57:123-30. [DOI: 10.1016/j.jjcc.2010.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/25/2010] [Accepted: 09/03/2010] [Indexed: 11/23/2022]
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Nomura R, Naka S, Nakano K, Taniguchi N, Matsumoto M, Ooshima T. Detection of oral streptococci with collagen-binding properties in saliva specimens from mothers and their children. Int J Paediatr Dent 2010; 20:254-60. [PMID: 20536586 DOI: 10.1111/j.1365-263x.2010.01047.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately 10-20% of Streptococcus mutans strains have been reported to possess collagen-binding properties, whereas other species in the oral cavity with those properties remain to be elucidated. Aim. To identify strains with collagen-binding properties and analyse their characteristics in comparison with S. mutans. DESIGN A total of 110 expectorated saliva specimens were collected from 55 pairs of mothers and their children. Bacterial strains with collagen-binding properties were isolated and the species specified. In addition, strains with collagen-binding properties isolated from mother-child pairs were analysed using molecular biological approaches. RESULTS The detection frequency of strains with collagen-binding properties was shown to be 40.9%, among which S. salivarius was the most frequently detected, followed by S. mutans. The collagen-binding activity of the S. mutans group was the highest, followed by S. salivarius. In addition, S. mutans and S. salivarius strains from 3 and 1 mother-child pairs, respectively, were shown to be the same clones. CONCLUSIONS Our results indicate that S. mutans and S. salivarius are major species with collagen-binding properties in the oral cavity, and that strains with such properties may be related to mother-child transmission.
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Affiliation(s)
- Ryota Nomura
- Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
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Lu J, Zhang W, Hao Y, Zhu Y. Defect of cell wall construction may shield oral bacteria's survival in bloodstream and cause infective endocarditis. Med Hypotheses 2009; 73:1055-7. [PMID: 19539433 DOI: 10.1016/j.mehy.2009.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/05/2009] [Accepted: 05/10/2009] [Indexed: 11/26/2022]
Abstract
Infective endocarditis (IE) is a rare but life-threatening infection. Bacteremia with organisms known to cause IE occurs commonly in association with invasive dental origin. Despite daily oral activities as well as professional dental treatments inducing bacteremia and the dental bacteremia as a risk factor of IE, the details of dental bacteria in the pathogenesis of IE are far from elucidation to date. How do a few microorganisms survive host defenses or escape from antibiotic attacking to seed target organs and cause distant infections? Why are Gram-positive bacteria more frequently detected than Gram-negative bacteria in IE? Cell wall-deficient bacteria (CWDB) were traditionally defined as bacteria with altered morphology and consistent with damaged or absent cell wall structures identified by EM. A number of case reports and laboratory studies suggest that CWDB may be found in the peripheral blood of patients with IE, and may also be demonstrated in vegetations on the valves of patients with IE. CWDB, in vitro, are resistant to antibiotics that act on cell wall biosynthesis. Recent studies indicate that the Streptococcus mutans (S. mutans) strains, the major cariogenic bacterium, isolated from the infected valve were deficient in some wall-associated proteins which are main cariogenic virulence of S. mutans, and the deficient stains exhibited less susceptible to antibiotics that act on cell wall biosynthesis. Further, the cloned deficient mutans were less susceptible to phagocytosis by human polymorphonuclear leukocytes but to possess higher platelet aggregation properties than their parent strains. As outlined above, we hypothesize that defect of cell wall construction may shield oral bacteria's survival in bloodstream and cause IE.
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Affiliation(s)
- Junjun Lu
- State Key Laboratory of Oral Diseases, Sichuan University, No 14, 3rd Section Renmin South Road, Chengdu, Sichuan 610041, China
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Nomura R, Nakano K, Nemoto H, Mukai T, Hata H, Toda K, Yoshioka H, Taniguchi K, Amano A, Ooshima T. Molecular analyses of bacterial DNA in extirpated heart valves from patients with infective endocarditis. ACTA ACUST UNITED AC 2009; 24:43-9. [PMID: 19121069 DOI: 10.1111/j.1399-302x.2008.00474.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIMS Infective endocarditis (IE) is caused by a microbial infection of the endothelial surface of the heart. Although blood culture examinations are commonly used to determine the associated bacterial species, molecular techniques, which enable rapid identification of targeted bacterial species, have recently been applied in clinical cases. METHODS Nine heart valve specimens from IE patients (six subacute cases and three acute cases) were extirpated and collected, then bacterial DNA was extracted. Bacterial species in the specimens were determined by two different molecular methods and the results were compared with those from a conventional blood culture technique. In addition, a comparison between the two molecular methods was carried out using known numbers of six streptococcal species. RESULTS The conventional blood culture method revealed the bacterial species in eight cases, while one was found to be negative. Multiple species were identified in most of the cases by both molecular methods; however, those specified by one method were not always consistent with those specified by the other. Furthermore, the species determined by the blood culture technique were not always identified by the molecular methods. We also found that the two molecular methods used in the present study were extremely sensitive to detect from 1 to 100 cells of individual oral streptococcal species. CONCLUSION Our results suggest that species specified by molecular methods may have disseminated incidentally into the bloodstream, so interpretation of such results should be carefully undertaken in clinical situations.
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Affiliation(s)
- R Nomura
- Department of Pediatric Dentistry, Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
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Ohara-Nemoto Y, Haraga H, Kimura S, Nemoto TK. Occurrence of staphylococci in the oral cavities of healthy adults and nasal–oral trafficking of the bacteria. J Med Microbiol 2008; 57:95-99. [DOI: 10.1099/jmm.0.47561-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Y. Ohara-Nemoto
- Department of Oral Molecular Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - H. Haraga
- Department of Oral Microbiology, Iwate Medical University School of Dentistry, Morioka 020-8505, Japan
| | - S. Kimura
- Department of Oral Microbiology, Iwate Medical University School of Dentistry, Morioka 020-8505, Japan
| | - T. K. Nemoto
- Department of Oral Molecular Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
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Hanai M, Hashimoto K, Mashiko K, Sasaki T, Sakamoto Y, Shiratori K, Tanaka K, Yoshitake M, Naganuma H, Shinohara G. Active Infective Endocarditis Management and Risk Analysis of Hospital Death From 24 Years' Experience. Circ J 2008; 72:2062-8. [DOI: 10.1253/circj.cj-08-0224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Makoto Hanai
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Kazuhiro Hashimoto
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Kenoh Mashiko
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Tatsuumi Sasaki
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Yoshimasa Sakamoto
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Kazuaki Shiratori
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Kei Tanaka
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Michio Yoshitake
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Hirokuni Naganuma
- Department of Cardiovascular Surgery, Jikei University School of Medicine
| | - Gen Shinohara
- Department of Cardiovascular Surgery, Jikei University School of Medicine
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Nagata E, Okayama H, Ito HO, Semba I, Inoue M, Oho T. Experimental infective endocarditis induced by human supragingival dental plaque in rats. Eur J Oral Sci 2007; 113:499-504. [PMID: 16324140 DOI: 10.1111/j.1600-0722.2005.00258.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Human dental plaque is thought to contribute to disease, not only in the oral cavity but also at other body sites. To investigate the pathogenicity of dental plaque in tissues remote from the mouth, we examined the ability of human supragingival dental plaque to induce infective endocarditis (IE) in rats. In total, 15 out of 27 catheterized rats survived after intravenous injections with human supragingival dental plaque suspensions containing 3 x 10(6) colony-forming units (CFU) of bacterial cells. In surviving rats, infected vegetations were formed in all except one rat. The microbial composition of the infected vegetations was different from that of the respective dental plaque inocula, with Streptococcus oralis comprising the majority of the isolates. In rats affected with endocarditis, the aortic sinus was filled with fibrinous vegetation containing bacteria. Inflammatory cells infiltrated the aortic valve, the aorta adjacent to the valve, and the cardiac muscles. The inoculation of catheterized rats with a cell suspension of S. oralis isolate (5 x 10(6) CFU) was not lethal but capable of inducing endocarditis in all animals. The results suggest that if dental plaque were introduced into the bloodstream, it could serve as a potent source of bacteria causing IE in humans.
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Affiliation(s)
- Emi Nagata
- Department of Preventive Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan.
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