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Gavaruzzi F, Chinello P, Cucinotta G, Oliva G, Capone A, Granata G, Al Moghazi S, Caraffa E, Taglietti F. Streptococcus intermedius Brain Abscess with Lung Abscess and Aortic Valve Endocarditis: A Case Report and Literature Review. Infect Dis Rep 2023; 15:445-453. [PMID: 37623049 PMCID: PMC10454062 DOI: 10.3390/idr15040045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/21/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
Streptococcus intermedius is frequently associated with brain and liver abscesses, while pleuropulmonary infections are considered rarer. Even less frequent is the association of lung and brain abscesses due to this agent with infective endocarditis. We describe the case of a 40-year-old man complaining of cough, fever, and headache who was diagnosed with a brain abscess due to S. intermedius, a concomitant lung abscess, and aortic native valve endocarditis. He was treated with surgical drainage of the brain abscess and a 4-week course of intravenous ceftriaxone, followed by oral amoxicillin/clavulanate, obtaining healing of the lesions without relapse of the infection.
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Affiliation(s)
| | - Pierangelo Chinello
- National Institute for Infectious Diseases “L. Spallanzani”, 00149 Rome, Italy
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Devi OM, Gupta J, Chahal GS, Jain A. Is periodontal infection a risk factor for thromboembolic disease? A systematic review. J Indian Soc Periodontol 2023; 27:238-250. [PMID: 37346852 PMCID: PMC10281308 DOI: 10.4103/jisp.jisp_576_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 06/11/2022] [Accepted: 07/10/2022] [Indexed: 06/23/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a rising major health problem comprising pulmonary embolism (PE) and deep vein thrombosis. It is of concern due to premature mortality, increased morbidity, and associated healthcare costs and hospitalization. Periodontitis can increase the risk of VTE by way of systemic inflammation induced by infection that can contribute to hypercoagulability and platelet aggregation. This systematic review aims to synthesize all the evidence concerning periodontal infection as a risk factor for thromboembolic disease. Materials and Methods A search for articles published from 1967 till December 2020 was conducted in the PubMed (MEDLINE), Scopus, and EMBASE data bases. Results Five hundred and five articles were retrieved after running search strategies in PubMed, Scopus, and EMBASE search databases. Based on the inclusion criteria, three clinical studies, two case series, and ten case reports were included for qualitative analysis. The presence of periodontal disease was reported to influence the occurrence of venous thromboembolic disease with a statistical significance of <0.010. Case series and case reports of septic PE due to periodontal disease showed complete resolution of lung lesions and subsiding of symptoms after dental treatment and antimicrobial therapy. Conclusions The results of this systematic review suggested for an association between periodontal disease and the incidence of thromboembolic disease. As most of the included/available studies are case series and case reports, the strength of evidence is weak. Evidence generated from well-designed longitudinal controlled clinical trials may be helpful to further assess the strength of the association.
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Affiliation(s)
- Oinam Monica Devi
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Jyoti Gupta
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Gurparkash Singh Chahal
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
| | - Ashish Jain
- Department of Periodontology, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, India
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Lemierre Syndrome: Unusual Presentation With Superior Ophthalmic Vein Thrombosis. J Craniofac Surg 2021; 32:1079-1082. [PMID: 33405462 DOI: 10.1097/scs.0000000000007363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT Lemierre syndrome (LS) is a rare, but serious condition most commonly associated with oropharyngeal bacterial infection. Infection results in thrombophlebitis of the internal jugular vein and its tributaries. It usually affects previously healthy young adults. The authors report an unusual case of an elderly patient with penicillin allergy who developed Lemierre syndrome from an odontogenic infection (Streptococcus intermedius) resistant to clindamycin. She developed thrombosis of the internal jugular vein and superior ophthalmic vein resulting in visual changes. Treatment required incision and drainage, intravenous antibiotics and anticoagulation. Antibiotics were tailored to culture and sensitivities after testing response to a beta-lactam. With antibiotic resistance increasing, investigation of penicillin allergies is warranted for severe head and neck infections.
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Nonsurgical Periodontal Therapy in CKD: Findings of the Kidney and Periodontal Disease (KAPD) Pilot Randomized Controlled Trial. Kidney Med 2020; 2:49-58. [PMID: 32734226 PMCID: PMC7380373 DOI: 10.1016/j.xkme.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rationale & Objective Observational studies have suggested that periodontal disease may be a modifiable risk factor for chronic kidney disease (CKD). The Kidney and Periodontal Disease (KAPD) Study was designed to determine the feasibility of conducting a periodontal disease treatment trial among a high-risk (mostly poor and racial/ethnic minority) population and estimate the magnitude and variability of kidney and inflammatory biomarker levels in response to intensive periodontal treatment. Study Design Single-center, unmasked, intention-to-treat, randomized, controlled, pilot trial with 2:1 allocation to the treatment and comparison groups. Setting & Participants English- and Spanish-speaking individuals aged 20 to 75 years receiving primary care within the San Francisco Community Health Network with evidence of both moderate to severe periodontal disease and CKD. Intervention Immediate intensive nonsurgical periodontal treatment versus rescue treatment for progressive disease at baseline and 4, 8, and 12 months. Outcomes Feasibility and process outcomes. Levels of biomarkers of kidney function, kidney injury, and systemic inflammation obtained at baseline and 4 and 12 months. Results KAPD randomly assigned 51 participants to the immediate (34 participants) or rescue (17 participants) groups. 14% dropped out of the study (4 immediate, 3 rescue) and 80% completed all 4 visits of the 12-month protocol (28 immediate, 13 rescue). Fewer than half the teeth recommended for extraction were extracted and 40% of immediate group visits were outside the protocol window. Bleeding on probing and probing depth improved more in the immediate group than in the rescue group; there was no significant separation in periodontal status. Levels of markers of vascular endothelial and systemic injury declined in both groups. Limitations No true control group. Conclusions This 12-month, pilot, randomized, controlled trial successfully recruited and retained a high-risk population but was less successful observing treatment adherence, treatment effect, and variability of biomarker levels. Although KAPD did not meet all of its goals, important lessons learned can be applied to future studies. Funding National Institute of Diabetes and Digestive and Kidney Disease (Bethesda, MD; grant number 1K23DK093710-01A1) and Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation, Princeton, NJ. Funders had no role in study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication. Trial Registration NCT01802216.
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Watanabe T, Yokoe M, Noguchi Y. Septic pulmonary embolism associated with periodontal disease: a case report and literature review. BMC Infect Dis 2019; 19:74. [PMID: 30665352 PMCID: PMC6341628 DOI: 10.1186/s12879-019-3710-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Periodontal disease, including periodontitis, has been reported to be a rare cause of septic pulmonary embolism (SPE). It is however extremely difficult to isolate the causative pathogen of periodontal disease-associated SPE from blood cultures of these patients. Case presentation In this study, an 85-year-old Japanese man was admitted with fever and worsening malaise. He was later noted to have multiple bilateral subpleural pulmonary nodules on chest computed tomography scan. After admission, Parvimonas micra (P. micra) was isolated from his blood culture. This was followed by a meticulous search for the primary source of SPE, focusing on the head and neck areas. Consequently, apical periodontitis and infratemporal fossa abscess were identified as the primary sources of SPE. Although P. micra is one of the most frequently detected bacteria in the infected root canals of teeth with chronic apical periodontitis, it has rarely been proven as a causative pathogen of periodontal disease-associated SPE. Conclusions This case study demonstrated that periodontal disease is an important primary source of SPE and P. micra could be a causative pathogen of SPE.
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Affiliation(s)
- Tsuyoshi Watanabe
- Department of Rheumatology, Chubu Rosai Hospital, 2-10-15, Komei-cho, Minato-ku, Nagoya, Aichi, 468-0008, Japan. .,Department of Rheumatology, Chubu Rosai Hospital, 1-10-6, Komei-cho, Minato-ku, Nagoya, 455-8530, Japan.
| | - Masamichi Yokoe
- Division of General Internal Medicine, Nagoya Red Cross Daini Hospital, Nagoya, Aichi, 466-8650, Japan
| | - Yoshinori Noguchi
- Division of General Internal Medicine, Nagoya Red Cross Daini Hospital, Nagoya, Aichi, 466-8650, Japan
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Noy D, Rachmiel A, Levy-Faber D, Emodi O. Lemierre's syndrome from odontogenic infection: Review of the literature and case description. Ann Maxillofac Surg 2016; 5:219-25. [PMID: 26981474 PMCID: PMC4772564 DOI: 10.4103/2231-0746.175746] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Lemierre's syndrome (LS) is a rare potentially fatal sequel of head and neck infection, classically described as thrombophlebitis of the internal jugular vein (IJV) with cervical space infection extending into the thorax. Our objective was to answer the clinical question: "Does Lemierre syndrome (LS) from odontogenic infection differ from nonodontogenic LS in regard to clinical sequence, treatment, and survival." We reviewed the literature on the management of LS over the last two decades, with a focus on LS from odontogenic infection. Such a case is presented in order to portray the clinical sequence. Only 10 cases met the inclusion criteria (including the case presented). The recorded data were analyzed in comparison to large case series reviewing LS. Our data reflect the moderate differences in regard to IJV thrombosis and bacteriogram. There is an overall rise in published LS cases in the last 20 years. Odontogenic infection leading to LS is scarce, yet with survival rates similar to nonodontogenic LS. Repeated surgical interventions and aggressive wide spectrum antibiotic therapy remain the treatment of choice.
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Affiliation(s)
- Dani Noy
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Dan Levy-Faber
- Department of Cardio-thoracic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Omri Emodi
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
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Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respir Med 2014; 108:1-8. [DOI: 10.1016/j.rmed.2013.10.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/02/2013] [Accepted: 10/08/2013] [Indexed: 11/23/2022]
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Hatani T, Takemura M, Inoue D, Takamatsu K, Ishitoko M, Itotani R, Suzuki S, Matsumoto M, Sakuramoto M, Fukui M. Septic pulmonary embolism due to periodontal disease. Respirology 2013; 18:308-12. [PMID: 23039239 DOI: 10.1111/j.1440-1843.2012.02278.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Septic pulmonary embolism due to periodontal disease (SPE-PD) is rarely reported and little is known about its clinical features. The purpose of this study was to evaluate the clinical and radiological features, as well as outcome, in SPE-PD. METHODS Patients' records were retrospectively reviewed and 12 patients with SPE-PD were identified (10 men, mean age 60.5 years). The patients' demographic features, laboratory data, physical and radiological findings, and clinical outcomes were evaluated. RESULTS All but one patient were smokers. Eight of the 12 patients had comorbidities including hypertension (58%) and/or diabetes mellitus (17%). Prevalent symptoms were fever (67%) and chest pain (58%). Only two patients fulfilled the criteria of systemic inflammatory response syndrome; most of the subjects were not clinically severely ill. Blood cultures were negative in all cases. Contrast-enhanced chest computed tomography (CT) showed multiple peripheral nodules in all 12 patients, wedge-shaped peripheral lesions abutting on the pleura in 10 (83%) and a feeding-vessel sign in 9 (75%). All patients recovered from their illness after antimicrobial therapy concomitant with tooth extraction or periodontal care. The median duration of antibiotic administration was 51 days. CONCLUSIONS Most patients with SPE-PD were not seriously ill. Contrast-enhanced chest CT appeared to be useful to diagnose SPE-PD.
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Affiliation(s)
- Takeshi Hatani
- Respiratory Disease Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital, Ohgimachi, Kita-ku, Osaka, Japan
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Septic Pulmonary Embolism of Unknown Origin in Patients With Staphylococcus aureus Bacteremia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31827f449f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perez-Chaparro PJ, Meuric V, De Mello G, Bonnaure-Mallet M. [Bacteremia of oral origin]. ACTA ACUST UNITED AC 2011; 112:300-3. [PMID: 21940028 DOI: 10.1016/j.stomax.2011.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 02/14/2011] [Accepted: 08/12/2011] [Indexed: 11/28/2022]
Abstract
Transient bacteremia from oral cavity related to oral anaerobic bacteria may occur as a result of dental healthcare procedures but also as a result of daily gestures involving the gums (chewing and oral hygiene). The risk of presenting a transient bacteremia is related to oral cavity bacterial load and to the severity of inflammation in the oral cavity. Although bacteremia is transient, in patients with immunodeficiency or comorbidity, this bacteremia may cause extra-oral infections. The bacteremia rate and the identified bacteria vary from one study to the next, depending on the method used to isolate and identify bacteria. Nevertheless, the risk for bacteremia is determined by the infectious and inflammatory conditions of each patient.
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Affiliation(s)
- P J Perez-Chaparro
- Équipe microbiologie-EA 1254, université de Rennes-1, université européenne de Bretagne, 2 avenue du Professeur-Léon-Bernard, Rennes, France
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Microbiology of odontogenic bacteremia: beyond endocarditis. Clin Microbiol Rev 2009; 22:46-64, Table of Contents. [PMID: 19136433 DOI: 10.1128/cmr.00028-08] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
SUMMARY The human gingival niche is a unique microbial habitat. In this habitat, biofilm organisms exist in harmony, attached to either enamel or cemental surfaces of the tooth as well as to the crevicular epithelium, subjacent to a rich vascular plexus underneath. Due to this extraordinary anatomical juxtaposition, plaque biofilm bacteria have a ready portal of ingress into the systemic circulation in both health and disease. Yet the frequency, magnitude, and etiology of bacteremias due to oral origin and the consequent end organ infections are not clear and have not recently been evaluated. In this comprehensive review, we address the available literature on triggering events, incidence, and diversity of odontogenic bacteremias. The nature of the infective agents and end organ infections (other than endocarditis) is also described, with an emphasis on the challenge of establishing the link between odontogenic infections and related systemic, focal infections.
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Sharma S. Computed tomography for the diagnosis of infectious diseases of the chest. ACTA ACUST UNITED AC 2008; 2:1247-62. [PMID: 23496684 DOI: 10.1517/17530059.2.11.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary infection is a common reason for imaging of the lung in immunocompetent and immunosuppressed patients. Findings on chest radiography are nonspecific and encompass poor sensitivity. The role of computed tomography (CT) has been evolving in the diagnosis of lung infections. OBJECTIVE This paper reviews recent developments in the efficacy and utility of CT in the diagnosis of suspected pulmonary infections in a variety of patient populations. METHODS Recent published literature was reviewed to prepare this treatise on the role of CT. CONCLUSION Knowledge and skills at pattern recognition are crucial for the CT interpretation in lung infections. Computed tomography scan is increasingly used to increase the sensitivity of the radiologic diagnosis of thoracic infections. The greatest value of CT is when the radiograph is normal, findings are equivocal, and to differentiate infection from non-infectious disorders.
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Affiliation(s)
- Sat Sharma
- Professor and Head University of Manitoba, St Boniface General Hospital, Section of Respirology, Department of Internal Medicine, BG034, 409 Tache Avenue, Winnipeg MB, R2H 2A6, Canada +204 237 2217 ; +204 231 1927 ;
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Sakuma H, Nakamura A, Fukuoka Y, Okabe M, Tsurumi K, Yokoi M. Septic Pulmonary Embolism Ascribed to Periapical Periodontitis:. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1348-8643(08)80020-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Arterial Thrombosis after Intravenous Infusion of Oral Bacterium in a Rat Model. Ann Vasc Surg 2008; 22:412-6. [DOI: 10.1016/j.avsg.2008.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 01/08/2008] [Accepted: 01/11/2008] [Indexed: 11/24/2022]
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Makris D, Papaioannou AI, Daenas C, Gourgoulianis KI. Septic embolism with subacute onset. J Infect 2008; 56:294-5. [PMID: 18328569 DOI: 10.1016/j.jinf.2008.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 01/14/2008] [Accepted: 01/16/2008] [Indexed: 10/22/2022]
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Washington L, Palacio D. Imaging of Bacterial Pulmonary Infection in the Immunocompetent Patient. Semin Roentgenol 2007; 42:122-45. [PMID: 17394925 DOI: 10.1053/j.ro.2006.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary infection is a common reason for imaging of the lung and a common incidental finding in immunocompetent patients. Findings on chest radiography are nonspecific in defining acute infection; however, the radiologist should be aware of classically described patterns of infection, including air space, bronchopneumonia, and interstitial patterns. The radiologist must also be aware of potential limitations of the sensitivity of chest radiography. Imaging findings at computed tomography in acute infection have been poorly studied but may be more specific. Aspiration and septic emboli are additional potential radiographic patterns of infection that may be very characteristic in appearance. In the setting of nonresolving pneumonia, the differential diagnosis includes noninfectious causes as well as a variety of atypical infectious agents, specifically, mycobacterial and fungal agents, which have overlapping but distinctive clinical and radiographic presentations.
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Affiliation(s)
- Lacey Washington
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Mattar CS, Keith RL, Byrd RP, Roy TM. Septic pulmonary emboli due to periodontal disease. Respir Med 2006; 100:1470-4. [PMID: 16376534 DOI: 10.1016/j.rmed.2005.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/26/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Septic pulmonary embolization (SPE) is a rare but serious disorder. It is a well-recognized potential problem in the settings of tricuspid valve endocarditis, septic thrombophlebitis, infected central venous catheters, and postanginal septicemia. Less well documented is the occurrence of SPE in patients with periodontal disease without suppurative thrombophlebitis of the great vessels of the neck. We report a patient with SPE in whom periodontal disease was the only identifiable nidus of infection and review the literature regarding the four other patients reported to have suffered this complication.
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Affiliation(s)
- Costy S Mattar
- The Veterans Affairs Medical Center 111-B, P.O. Box 4000, Mountain Home, TN 37684-4000, and Division of Pulmonary Diseases and Critical Care Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Garcia R. A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia: underappreciated risk and a call for interventions. Am J Infect Control 2005; 33:527-41. [PMID: 16260328 DOI: 10.1016/j.ajic.2005.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 02/21/2005] [Indexed: 01/15/2023]
Affiliation(s)
- Robert Garcia
- The Brookdale Hospital Medical Center, Brooklyn, NY 11212, USA.
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Abstract
INTRODUCTION Transient bacteraemias are frequently detected following dental manipulation. Infective endocarditis (IE) can arise in susceptible individuals and antibiotic prophylaxis is routinely performed for certain procedures considered to be "at risk" of IE. Evidence is emerging that periodontal disease may be a significant risk factor for the development of certain systemic diseases such as cardiovascular disease. These systemic conditions could be initiated or detrimentally influenced by the repeated entry of bacteria into the bloodstream. MATERIALS AND METHODS The present study comprised a single blind parallel study of 2 weeks duration. A baseline blood sample was obtained from 30 volunteers with untreated periodontal disease following which a periodontal probing depth chart was collected. A further blood sample was taken following this procedure, and each subject was recalled 2 weeks later. A blood sample was collected, the subject carried out toothbrushing and a further blood sample taken. Full-mouth ultrasonic scaling was then performed and a final blood sample taken. Blood samples were analysed for bacteraemia using conventional microbiological culture and polymerase chain reaction (PCR) using universal bacterial primers that target the 16S ribosomal RNA gene of the vast majority of bacteria. RESULTS Using culture methods, the incidence of bacteraemias was as follows: following ultrasonic scaling (13%), periodontal probing (20%) and toothbrushing (3%). PCR analysis revealed bacteraemia incidences following ultrasonic scaling, periodontal probing and toothbrushing of 23%, 16% and 13%, respectively. CONCLUSION These findings suggest that detectable dental bacteraemias induced by periodontal procedures are at a lower level than previously reported.
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Affiliation(s)
- Denis F Kinane
- University of Louisville School of Dentistry, Louisville, KY 40292, USA.
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Abstract
The oral cavity has long been considered a potential reservoir for respiratory pathogens. Recently, there has been a renewed interest in the relation between oral flora and respiratory infection among "at-risk" patients such as patients from intensive care units or frail older adults. The mechanisms of infection could be colonization of the oral biofilm by respiratory pathogens followed by aspiration. More recent hypotheses relate to the presence in saliva of enzymes and cytokines associated with oral pathogens, and that could modulate the colonization of the respiratory tract or promote infection by respiratory pathogens. It is the aim of this paper to review the recent literature on this topic.
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Milazzo I, Blandino G, Musumeci R, Nicoletti G, Lo Bue AM, Speciale A. Antibacterial activity of moxifloxacin against periodontal anaerobic pathogens involved in systemic infections. Int J Antimicrob Agents 2002; 20:451-6. [PMID: 12458140 DOI: 10.1016/s0924-8579(02)00190-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The in vitro activity of moxifloxacin was compared with that of penicillin G, amoxycillin/clavulanate, cefoxitin, erythromycin, clindamycin and metronidazole against 158 isolates associated with periodontal infections. MIC(50)/MIC(90) values of moxifloxacin were respectively 0.06/0.5 mg/l for Porphyromonas gingivalis (35), for Prevotella spp. (28) and Actinomyces spp. (35), 0.12/0.25 mg/l for Fusobacterium nucleatum (20) and 0.06/0.12 mg/l for Peptostreptococcus spp. (30). The minimum inhibitory concentration (MIC) range of moxifloxacin for Bacteroides forsythus (6) and Campylobacter rectus (4) was 0.06-0.12 mg/l. The minimum bactericidal concentrations were equal to or 2-4 times the MIC values. Moxifloxacin produced a bactericidal effect at 8 h. Our results show that moxifloxacin has good antibacterial activity against periodontal pathogens comparable with that of cefoxitin and amoxycillin/clavulanate, and better than that of clindamycin, metronidazole and penicillin.
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Affiliation(s)
- I Milazzo
- Department of Microbiological and Gynaecological Sciences - Section of Microbiology, University of Catania, Via Androne, 81, 95124 Catania, Italy
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Shiota Y, Arikita H, Horita N, Hiyama J, Ono T, Ohkawa S, Yamakido M. Septic pulmonary embolism associated with periodontal disease: reports of two cases and review of the literature. Chest 2002; 121:652-4. [PMID: 11834686 DOI: 10.1378/chest.121.2.652] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We report two cases of septic pulmonary embolism associated with periodontitis. Chest CT revealed multiple nodular shadows with features characteristic of septic pulmonary embolism in both patients. Both patients had toothache, fever, and chest pain, and showed findings of periodontitis at initial presentation. Antimicrobial agents combined with dental surgery were successful in treatment. While septic pulmonary embolism from the lesions of periodontitis appears to be rare, periodontitis remains important in the differential diagnosis of septic pulmonary embolism.
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Affiliation(s)
- Yutaro Shiota
- Department of Clinical Research, Kure Kyosai Hospital, Kure, Japan.
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Gendron R, Grenier D, Maheu-Robert L. The oral cavity as a reservoir of bacterial pathogens for focal infections. Microbes Infect 2000; 2:897-906. [PMID: 10962273 DOI: 10.1016/s1286-4579(00)00391-9] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dental procedures, but more importantly, oral infections and poor oral health can provoke the introduction of oral microorganisms into the bloodstream or the lymphatic system. The subsequent attachment and multiplication of these bacteria on tissues or organs can lead to focal oral infections. Pathogenic agents may also remain at their primary oral site but the toxins liberated can reach an organ or tissue via the bloodstream and cause metastatic injury. Finally, metastatic inflammation may result from an immunological injury caused by oral bacteria or their soluble products that enter the bloodstream and react with circulating specific antibodies to form macromolecular complexes.
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Affiliation(s)
- R Gendron
- Groupe de recherche en écologie buccale, Faculté de médecine dentaire, Université Laval, Cité universitaire,Québec, Canada
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Limeback H. Implications of oral infections on systemic diseases in the institutionalized elderly with a special focus on pneumonia. ANNALS OF PERIODONTOLOGY 1998; 3:262-75. [PMID: 9722710 DOI: 10.1902/annals.1998.3.1.262] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Systemic infection in the elderly patient living in a chronic care setting presents a significant burden to the health care system. The extent to which oral organisms cause systemic infections through hematogenous dissemination in the institutionalized elderly is still unknown. A more likely and common route of systemic infection by oral microorganisms is through aspiration of oropharyngeal fluids containing oral pathogenic microorganisms, which colonize the lower respiratory tract and cause pneumonia. Respiratory pathogens emerge in the dental plaque of elderly patients with very poor oral hygiene and severe periodontal disease. In the chronic care setting, aspiration of oropharyngeal fluids contaminated with these bacteria occurs in patients with diminished host defenses, resulting in bacterial pneumonia. This is also a problem in intensive care units in the hospital setting. In one study, pre-rinsing with a 0.12% chlorhexidine gluconate mouthwash significantly lowered the mortality rate from postsurgical pneumonia in patients undergoing open heart surgery. Selective digestive decontamination, a technique involving the topical application of antimicrobials to reduce the risk of colonization of the respiratory tract, has been used to reduce the incidence of nosocomial pneumonia in the acute care setting of hospitals. This technique has not been employed in the nursing home setting. Whether improving oral hygiene would also lower the risk in either of these settings has not been studied. A number of obstacles must be overcome in designing studies to investigate the relationship between oral infections and lung infections in the institutionalized elderly. Ethical issues must be addressed, and full collaboration of the medical team is required. Future studies should establish whether reducing the risk for pneumonia in the institutionalized elderly is possible through improved oral health.
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Affiliation(s)
- H Limeback
- Faculty of Dentistry, University of Toronto, Canada.
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