Ivete Pomarico Ribeiro de Souza

Oral Candida colonization and its relation with predisposing factors in HIV-infected children and their uninfected siblings in Brazil: the era of highly active antiretroviral therapy.

OBJECTIVES To evaluate predisposing factors such as orofacial manifestations, immunosuppression status and antiretroviral therapy in relation to oral colonization by Candida spp. in Brazilian HIV-infected children and their uninfected siblings in the era of highly active antiretroviral therapy (HAART). METHODS Whole stimulated saliva was collected from 65 HIV-infected children (HIV+) and 40 uninfected siblings (HIV-), followed by assessment of orofacial manifestation, caries indexes and the number of cavitated dentinal carious teeth (CDT). The salivary samples were cultured and the colonies were counted. After which they were identified by sugar assimilation and fermentation (API 20C). Data was analyzed using chi-square, Mann-Whitney, Spearman tests and logistic regression. RESULTS Regarding positive growth, HIV+ presented 80% (52/65) and HIV- 57.5% (23/40) (P = 0.013). Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). Mean CD4%, immune-status and history of recurrent oral candidiasis (OC) had no influence on Candida isolation. Mixed Candida spp. cultures were observed in HIV+ (40%) and HIV- (52%): C. albicans was more frequently found in both groups, with a higher prevalence in HIV+ (P = 0.05); other non-albicans species were isolated in HIV+ and HIV-. Low prevalence of orofacial manifestations was observed in HIV+ (10.7% of OC). There was an association between means of CDT and Candida growth (P < 0.05) and a positive correlation between number of CDT and Candida cfu-counts in HIV+ and HIV-. Mean CD4% and immune-status had no influence on Candida isolation. Absence of antiretroviral therapy and HAART increased the probability of Candida isolation (P < 0.05). CONCLUSIONS The HIV infected children had a significantly higher prevalence of oral Candida spp. compared to their uninfected siblings. Absence of HAART and presence of dentinal carious teeth increased significantly Candida spp. colonization in these children.

Relaçäo entre biofilme, atividade de cárie e gengivite em crianças HIV+

A utilizacao de terapia medicamentosa em criancas infectadas pelo HIV (HIV+) vem promovendo a diminuicao na prevalencia de manifestacoes bucais em tecidos moles ao longo dos anos. Entretanto, observa-se uma constância na experiencia de carie e gengivite desta populacao, sobretudo devido a influencia cronica de alguns fatores envolvidos no processo da infeccao pelo HIV, como uso prolongado de medicamentos liquidos acucarados, dieta rica em carboidratos e repetidos episodios de internacao. Assim, o objetivo do presente estudo foi avaliar se a qualidade e quantidade de biofilme representam um fator importante na atividade da doenca carie e gengivite neste grupo em especial. Apos exame do biofilme (indice de biofilme; Ribeiro23, 2000), da atividade de carie e gengivite de 56 criancas, de 0 a 14 anos, pacientes com diagnostico definitivo de infeccao pelo HIV, observou-se que somente 7 (12,5%) nao apresentavam biofilme visivel clinicamente e 33 (58,9%) apresentavam gengivite, com, em media, 4,44 superficies com sangramento. Quanto a doenca carie, 73,2% das criancas apresentavam lesoes cariosas ativas. Verificou-se ainda a correlacao entre o indice de biofilme, o estado gengival e a atividade das lesoes cariosas (teste de correlacao de Spearman, rs = +0,57 e rs = +0,49, respectivamente). Conclui-se, que nas criancas HIV+ avaliadas, a qualidade e quantidade de biofilme sobre a superficie dental representam um importante fator na etiologia da atividade das doencas carie e gengivite, podendo e devendo este ser trabalhado para que seja possivel restabelecer a saude bucal destas criancas.

Mother-to-child transmission of Streptococcus mutans: A systematic review and meta-analysis

OBJECTIVES A systematic review was performed with the aim of determining whether there is scientific evidence of the transmission of Streptococcus mutans from mother to child. DATA The eligibility criteria, based on the PECO strategy, were the following: observational human studies whose subjects were mother and child pairs (P) contaminated by S. mutans (E); comparison according to the presence or absence of S. mutans (C); and whether there is transmission (O). The qualitative analysis was performed by assessing the risk of bias of the included studies, while quantitative synthesis was performed through comprehensive Meta-Analysis software (p<0.05). SOURCES Two reviewers performed the database search of studies published between January 1950 and May 2014. The strategy included observational studies that assessed the vertical transmission of S. mutans from mothers to children through analyzing genetic strains. STUDY SELECTION It was found 166 non-duplicated studies. However, after reviewing the articles in full and applying the eligibility criteria, 36 papers were selected for qualitative analysis and 19 for quantitative analysis. The cumulative meta-analysis demonstrated vertical transmission of S. mutans from mother to child (p<0.001). CONCLUSIONS The present systematic review and meta-analysis demonstrated evidence of vertical transmission of S. mutans from mother to child because there was an association between S. mutans n mothers and their respective children. CLINICAL SIGNIFICANCE The knowledge of the S. mutans strains is important because the virulence of the microorganisms is varied; also, the virulence affects the dental caries evolution rate, being more or less aggressive.

Associations among the use of highly active antiretroviral therapy, oral candidiasis, oral Candida species and salivary immunoglobulin A in HIV-infected children

OBJECTIVES The aim was to examine the impact of antiretroviral therapy on the prevalence of oral candidiasis, recovery of oral Candida spp. , and salivary levels of total secretory immunoglobulin A (SIgA) and Candida-specific SIgA in human immunodeficiency virus (HIV)-infected children. STUDY DESIGN Sixty-six HIV+ and 40 HIV- children were cross-sectionally examined for the presence of oral lesions. Whole stimulated saliva samples were collected for the identification of Candida spp. using culture and measurement of total and specific SIgA using enzyme-linked immunosorbent assay (ELISA). RESULTS The HIV+ children had a higher prevalence of oral candidiasis (P < .05), higher frequency of detection of Candida spp. (P < .05), and higher levels of total (P < .05) and Candida-specific SIgA (P < .001) than the HIV- children. Among the HIV+ subjects, antiretroviral users had lower viral loads (P < .001) and lower levels of Candida spp. (P < .05) and total SIgA (P < .05) compared with antiretroviral nonusers. CONCLUSIONS The use of antiretroviral therapy was associated with decreases in the prevalence of oral candidiasis. This diminished exposure to Candida spp. was accompanied by decreases in levels of total and Candida-specific SIgA.

Effect of serine-type protease of Candida spp. isolated from linear gingival erythema of HIV-positive children: critical factors in the colonization

BACKGROUND   There are several kinds of oral soft tissue lesions that are common manifestations observed in human immunodeficiency virus (HIV)-infected children; for example, linear gingival erythema (LGE) that is a distinctive fiery red band along the margin of the gingivae. The etiology and pathogenesis of LGE are questionable, but a candidal origin has been suggested. Proteases are key virulence attributes produced by a variety of pathogenic fungi, including Candida. The objective of the present study is to identify the protease production in Candida species including, C. albicans (n=5), C. dubliniensis (n=1) and C. tropicalis (n=1), isolated directly from typical LGE lesions observed in six HIV-positive children, and also to test the effect of a serine protease inhibitor on the interaction of Candida spp. and epithelial cells in vitro. METHODS The ability of Candida strains to release proteases in the culture supernatant fluids was visualized by gelatin-SDS-PAGE. Gel strips containing 30-fold concentrated supernatant (1.5×10(8) yeasts) were incubated at 37°C for 48 h in 50 mM sodium phosphate buffer, pH 5.5. The concentrated supernatants were also incubated with fibronectin, laminin, immunoglobulin G, bovine serum albumin and human serum albumin. The effect of serine protease inhibitor on the interaction of Candida spp. and epithelial cells (MA 104) was measured after pre-treatment of fungi with the inhibitor (phenylmethylsulphonyl fluoride, PMSF). RESULTS All the extracellular proteases were completely inhibited by PMSF, identifying these activities as serine-type proteases. Interestingly, a common 62-kDa serine protease was observed in all Candida strains. The culture supernatants, rich in serine protease activities, cleaved several soluble proteinaceous substrates. Additionally, we demonstrated that pre-treatment of C. albicans, C. dubliniensis and C. tropicalis with PMSF diminished the interaction with epithelial cells. CONCLUSIONS Collectively, our results show that Candida spp. isolated from LGE lesions produced and secreted serine proteases and these enzymes may be involved in the initial colonization events.

O impacto da saúde bucal na qualidade de vida de crianças infectadas pelo HIV: revisão de literatura

Em busca de uma melhora da saude de pacientes sistemicamente comprometidos e um maior entendimento do impacto de doencas nas suas vidas, grande interesse tem sido dado a qualidade de vida relacionada a saude, principalmente em criancas com doencas cronicas. Neste sentido, a qualidade de vida relacionada a saude bucal tem sua importância haja vista que a mesma e um componente indissociavel da saude geral e tambem pela relevância dos problemas orais na vida destes pacientes. Assim, a avaliacao de qualidade de vida relacionada a saude bucal em pacientes infantis infectados pelo HIV pode ser de grande relevância uma vez que estas apresentam alta prevalencia de doenca carie e periodontal, alem da presenca de manifestacoes orais da propria infeccao pelo virus. Dessa forma, o objetivo deste artigo e, atraves de uma revisao de literatura, apresentar alguns conceitos relacionados a qualidade de vida e utilizacao de instrumentos de avaliacao da mesma, bem como analisar o impacto da saude bucal na qualidade de vida de criancas infectadas pelo HIV.The search for improvement of the health of systemically compromised patients and for a better knowledge about the impact of diseases on their lives has brought great interest for health-related quality of life, mainly in children with chronic diseases. The quality of life related to oral health is thus relevant, not only for being an inseparable component of the general health but also due to the importance of oral problems in the lives of these patients. The evaluation of oral health-related quality of life in HIV infected children can be of great importance seen that these patients show high prevalence of caries and periodontal diseases besides the oral manifestations of the virus infection itself. The aim of this article is to present some concepts about quality of life and the use of instruments for its evaluation on the basis of a literature review as well as to analyze the impact of oral health on the quality of life of HIV infected children.

Current status of herpesvirus identification in the oral cavity of HIV-infected children

INTRODUCTION Some viruses of the Herpesviridae family are frequently the etiologic agents of oral lesions associated with HIV. The aim of this study was to identify the presence of herpes simplex virus types 1 and 2 (HSV-1, HSV-2), Varicella Zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus type 6, type 7 and type 8 (HHV-6, HHV-7 and HHV-8) in the oral cavity of HIV-infected children/adolescents and verify the association between viral subtypes and clinical factors. METHODS The cells of oral mucosa were collected from 50 HIV infected children/adolescents, 3-13 years old (mean age 8.66). The majority (66%) of selected were girls, and they were all outpatients at the pediatric AIDS clinic of a public hospital in Rio de Janeiro. Nested-PCR was used to identify the viral types. RESULTS Absence of immunosuppression was observed in 66% of the children. Highly active antiretroviral therapy (HAART) was used by 72.1% of selected and moderate viral load was observed in 56% of the children/adolescents. Viral types were found in 86% of the children and the subtypes were: HSV-1 (4%), HSV-2 (2%), VZV (4%), EBV (0%), HCMV (24%), HHV6 (18%), HHV-7 (68%), HHV8 (0%). CONCLUSIONS The use of HAART has helped to reduce oral lesions, especially with herpes virus infections. The health professionals who work with these patients should be aware of such lesions because of their predictive value and the herpes virus can be found circulating in the oral cavity without causing lesions.

Cessation of dental development in a child with idiopathic hypoparathyroidism: a 5-year follow-up

Idiopathic hypoparathyroidism is a rare endocrinopathy whose origin is unknown, and which is characterized by a deficiency of parathyroid hormone causing low serum calcium and high serum phosphorus concentrations. Disorders of ectodermal tissues are common in this pathology, and enamel hypoplasia is the most frequently found dental pathology. This article describes the case of a 9-year-old child with hypoparathyroidism that had gone undiagnosed for 6 years. The permanent dentition showed enamel hypoplasia, delayed eruption, and cessation of root formation (i.e., shortened roots), resulting from nontreated hypocalcemia during the developmental phase of the dentition.

Salivary microbiota of HIV‐positive children and its correlation with HIV status, oral diseases, and total secretory IgA

AIM This study aimed to investigate the prevalence and levels of salivary microorganisms in HIV-positive children, and their correlation to HIV status, oral lesions, and salivary IgA levels. DESIGN Forty-two HIV-positive and 36 control children were clinically examined, had their saliva collected and processed for the microbiological analysis of 38 bacterial taxa by the checkerboard method, and salivary IgA quantification by ELISA. RESULTS The majority of the species tested were more prevalent in control children than in the HIV group. Mean concentration of total salivary IgA was similar in both groups. High levels of Veillonella parvula were found in children with cheilitis and herpes. Tannerella forsythia, Eikenella Corrodens, and Propionibacterium acnes were prevalent in children with gingivitis, while Fusobacterium periodonticum, Streptococcus gordonii, and Streptococcus oralis were significantly more frequent in children with no oral lesions. Significant negative correlations between salivary IgA levels and Eubacterium nodatum and oral streptococci were observed (P < 0.05). CONCLUSION HIV-seropositive children presented significantly lower prevalence and levels of several bacterial species in saliva; HIV-positive children are able to mount a mucosal immune response; HIV-seropositive children under highly active antiretroviral therapy presented low prevalence of oral lesions.

The relationship between unspecific s-IgA and dental caries: a systematic review and meta-analysis.

OBJECTIVES This systematic review and meta-analysis is focused on evaluating the possible association of s-IgA levels and dental caries. DATA The inclusion criteria comprised the clinical investigations with case and control groups, a caries diagnostic method, and evaluation of unspecific s-IgA concentration by using tests for both groups in humans, healthy subjects, and with statistical analyses. Quality assessment and data extraction of the included articles were performed. Meta-analysis of pooled data was performed through RevMan software after a sensitivity analysis. SOURCES An electronic and manual search was performed in PubMed, ISI Web of Science, Scopus, Cochrane Library, and Lilacs, with a supplemental hand search of the references of retrieved articles. STUDY SELECTION From 314 abstracts, 14 fulfilled the inclusion criteria. After reading the full articles, one of them was excluded due to the lack of a control group. Seven studies were included in the meta-analysis, and the heterogeneity among the studies (I(2)) was 41%. The pooled meta-analysis demonstrated higher levels of s-IgA in the caries active group (p<0.00001) than in the control group with a mean difference and confidence interval of 0.27 [0.17-0.38]. CONCLUSIONS Based on these findings, there is evidence that supports the presence of increased s-IgA levels in caries-active subjects. CLINICAL SIGNIFICANCE Dental caries is a multifactorial disease that comprehends intrinsic and extrinsic factors. The risk factors and events related to dental caries are overlooked in the literature. Additionally, it is also important to understand the host response against this disorder. Since the studies are contradictory in this field, we conducted a systematic review followed by meta-analysis to present the immunological host response evidence-based.