A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

OBJECTIVES

Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials.

DESIGN

A descriptive observational study.

SETTINGS

A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.

PARTICIPANTS

All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study.

INCLUSION CRITERIA

written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician.

EXCLUSION CRITERIA

patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.

METHODS

Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.

RESULTS

Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens.

CONCLUSIONS

This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

[Endocytosymbiosis of microorganisms in mammal eukaryotic cells and factors of its regulation]

Morphofunctional equivalents of the process of long-term intracellular prokaryotes--eukaryotes interaction were studied by light and electron microscopy. The mechanisms for adaptation, elaborated in the course of evolution of bacteria-host interaction, were analysed on the ultrastructural level. A concept on the role of hypothalamic nonapeptides, as factors of regulation of intracellular persistence and symbiosis of prokaryotes, is discussed.

Pseudomembranous candidosis in nephrotic syndrome: a case report

A 33-year-old male presented for evaluation of several large, recently discovered white oral lesions of unknown duration. Clinical examination revealed multiple white plaques on the soft palate, uvula, buccal mucosa, and tongue. These lesions could be wiped away, leaving an erythematous base. The lesions were asymptomatic, and the patient did not report difficulty in swallowing. The patient's medical history was noteworthy for several significant diagnoses within the previous 6 months: type 2 diabetes mellitus, mild systolic hypertension, gastroesophageal reflux disease, and adult idiopathic nephrotic syndrome, determined by kidney biopsy to be caused by focal segmental glomerulosclerosis. A provisional diagnosis of pseudomembraneous candidosis was made, and the patient responded to a 14-day course of clotrimazole, administered in 10-mg troches, five times a day. Management of nephrotic syndrome predisposes patients to recurrent fungal infections, and the disease has implications for the selection of systemic antifungal agents.

Detection of Corynebacterium kutscheri from the oral cavity of rats

A simple and useful method for the detection of C. kutscheri from the oral cavity of living rats was devised. In 10 sacrificed rats from two naturally and subclinically infected conventional colonies, 10(4.28) or 10(3.84) CFU/ml C. kutscheri were isolated from upper incisor swab extractions, while 10(1.38) or 10(1.58) and < 10 or 10(1.56) CFU/ml from the upper soft palate and pharynx, respectively. In another survey with 26 living animals, which were reared on the same rack, organisms were detected from the upper incisor and gingival swabs in 15 of 26 rats (57.7%). The results were reproducible at a second survey 10 days later. No organisms were isolated from any sites of the orally negative rats. These results indicated that culture of swab specimens from the upper incisors and gingivae of incisors is useful for the detection of C. kutscheri infection in living rats.

Effects of intranasal inoculation with Bordetella bronchiseptica, porcine reproductive and respiratory syndrome virus, or a combination of both organisms on subsequent infection with Pasteurella multocida in pigs

OBJECTIVE

To determine effects of intranasal inoculation with porcine reproductive and respiratory syndrome virus (PRRSV) or Bordetella bronchiseptica on challenge with nontoxigenic Pasteurella multocida in pigs.

ANIMALS

Seventy 3-week-old pigs.

PROCEDURE

In experiment 1, pigs were not inoculated (n= 10) or were inoculated with PRRSV (10), P. multocida (10), or PRRSV followed by challenge with P. multocida (10). In experiment 2, pigs were not inoculated (n = 10) or were inoculated with B. bronchiseptica (10) or PRRSV and B. bronchiseptica (10); all pigs were challenged with P. multocida. Five pigs from each group were necropsied 14 and 21 days after initial inoculations.

RESULTS

Pasteurella multocida was not isolated from tissue specimens of pigs challenged with P. multocida alone or after inoculation with PRRSV. However, in pigs challenged after inoculation with B. bronchiseptica, P. multocida was isolated from specimens of the nasal cavity and tonsil of the soft palate. Number of bacteria isolated increased in pigs challenged after coinoculation with PRRSV and B. bronchiseptica, and all 3 agents were isolated from pneumonic lesions in these pigs.

CONCLUSIONS AND CLINICAL RELEVANCE

Infection of pigs with B. bronchiseptica but not PRRSV prior to challenge with P. multocida resulted in colonization of the upper respiratory tract and tonsil of the soft palate with P. multocida. Coinfection with PRRSV and B. bronchiseptica predisposed pigs to infection of the upper respiratory tract and lung with P. multocida. Porcine reproductive and respiratory syndrome virus and B. bronchiseptica may interact to adversely affect respiratory tract defense mechanisms, leaving pigs especially vulnerable to infection with secondary agents such as P. multocida.

[Effect of carnosine on the morphofunctional state of mucosal cells of the soft palate of rats in staphylococcal infection]

The influence of carnosine on the morphofunctional state of mucosal cells of the soft palate of rats in experimental staphylococcal infection has been studied. Morphological changes in muscular and connective tissue cells of the mucosa of the soft palate of rats have been found to occur. The suppressive effect of carnosine with respect to the pathogen and its positive influence on the processes of the regeneration of eukaryotic tissues.

[Necrotizing mucosal ulcers cause by anaerobic bacteria. Fusiform bacterial and spirochete infections]

Vincent's angina (Plaut-Vincent) is the most prominent disease caused by coinciding infections from fusibacteria and spirochaeta both belonging to obligate anaerobic bacteria. A possible symbiotic infection of both anaerobics may become manifest on the mucous membranes of the oral cavity and the oropharynx beside the tonsillas. The clinical outcome may be different and pose difficulties in the differential diagnosis. We report the case of a 29 year old female patient with necrotizing ulcera of the soft palate suspicious for stomatitis ulceromembranacea. In case necrotizing inflammations of the oral cavity area were to be found infections due to anaerobic bacteria should be considered mostly occurring as mixed infections. The correct identification by cultivation turns out to be difficult in that it requires special conditions. Furthermore, reliable detection of these bacteria necessitates careful collection and transport of patients specimens. In case of Fusospirochaetosis (Fusotreponematose) a specimen should be prepared for microscopic examination beside setting up a special culture. This is because the staining is the most suitable procedure for bacteril identification to support the clinical diagnosis of stomatitis ulceromembranacea.

[Vasculitis caused by Pseudomonas: a case report]

Pseudomona vasculitis is an exceptional disease. Only a few cases have been reported, non with oropharyngeal involvement. The case of a 30-year-old, HIV-positive man who suddenly developed septicemia and necrotizing lesions with tissue destruction of the oropharynx is reported. Histological study confirmed vasculitis. Pseudomona aeruginosa was isolated in peripheral blood and in the biopsy of the palatal lesion. Antibiotic treatment produced satisfactory results.

Primary multiplication site of the vaccinia-rabies glycoprotein recombinant virus administered to foxes by the oral route

The primary multiplication site of VVTGgRAB, a recombinant vaccinia virus (VV) expressing the rabies virus G glycoprotein, was studied in comparison with that of the parental VV Copenhagen strain, after oral administration to foxes. Foxes were fed with 10(8) TCID50 of either VVTGgRAB or VV and were sacrificed 12, 24, 48 or 96 h after inoculation. Both viruses were detected by viral isolation in the tonsils during the first 48 h after inoculation at titres between 10(2) and 10(4.3) TCID50/ml. Indirect immunofluorescence confirmed the presence of the virus in tonsils of some of the foxes. The polymerase chain reaction allowed the detection of VVTGgRAB in the tonsils of both of two foxes tested after 24 h, three of three foxes after 48 h, in the buccal mucosa of one of two foxes tested after 24 h and two of three foxes after 48 h and in the soft palate of one of two foxes tested after 24 h and one of three foxes after 48 h. VV was detected in the tonsils of one fox tested after 48 h, in the buccal mucosa of another fox tested after 24 h, and in the first fox after 48 h by the same reaction. Foxes were inoculated with virus isolated from fox tonsils 24 h after oral administration (with or without cell culture amplification) to perform back passages. No virus could be isolated in either case after this passage. The innocuity of VVTGgRAB was also demonstrated when foxes were inoculated with passaged virus.

Adherence in the colonization of Streptococcus pneumoniae in the nasopharynx in children

The adherence of Streptococcus pneumoniae to epithelial cells in mucus and to the epithelial lining of the nasopharynx in children was studied with the aid of FITC-labelled anti-sera and Omni-serum. By using acridine orange as a counterstain, other bacteria could be visualized as well. S. pneumoniae was seen to adhere more frequently to desquamated cells in mucus than to squamous cells from the nasopharyngeal wall which were obtained by scraping the dorsal side of the soft palate. No bacteria were found to be attached to the ciliated and metaplastic cells collected from the adenoid surface. Although S. pneumoniae appeared in small numbers in most patients and established microcolonies which were predominantly attached to desquamated cells in mucus, signs of an ecological shift were also observed, with S. pneumoniae constituting the majority of the bacteria present. In such cases many S. pneumoniae could also be seen lying free in mucus.

Bacterial adherence to epithelial cells in the nasopharynx in children

The presence of attached bacteria to epithelial cells from the nasopharyngeal surface of the soft palate, from the adenoid surface and from the secretions covering the adenoid was studied in 10 children undergoing adenoidectomy. Large numbers of bacteria were seen to attach to mature normal squamous epithelial cells from the soft palate and in the secretions, whereas attachment to adenoid epithelial cells was rare. Using differential interference contrast microscopy, bacteria-carrying epithelial cells were seen to have their surface covered by microridges characteristic of normal mature squamous epithelial cells. Sections of adenoid tissue showed bacterial infiltration of adenoid tissue to be virtually nonexistent in the patient group.