Tomoari Kuriyama

An outcome audit of the treatment of acute dentoalveolar infection: impact of penicillin resistance

Objectives The aim of this audit was to measure the outcome of treatment of acute dentoalveolar infection and to determine if this was influenced by choice of antibiotic therapy or the presence of penicillin-resistance.Subjects and methods A total of 112 patients with dentoalveolar infection were included in the audit. All patients underwent drainage, either incisional (n=105) or opening of the pulp chamber (n=7) supplemented with antibiotic therapy. A pus specimen was obtained from each patient for culture and susceptibility. Clinical signs and symptoms were recorded at the time of first presentation and re-evaluated after 48 or 72 h.Results A total of 104 (99%) of the patients who underwent incisional drainage exhibited improvement after 72 h. Signs and symptoms also improved in five of the seven patients who underwent drainage by opening of the root canal although the degree of improvement was less than that achieved by incisional drainage. Penicillin-resistant bacteria were found in 42 (38%) of the 112 patients in this study. Of the 65 patients who were given penicillin, 28 had penicillin-resistant bacteria. There was no statistical difference in the clinical outcome with regard to the antibiotic prescribed and the presence of penicillin-resistant bacteria. Strains of penicillin-resistant bacteria were isolated more frequently in patients who had previously received penicillin (p<0.05).Conclusion Incisional drainage appeared to produce a more rapid improvement compared to drainage by opening of the root canal. The presence of penicillin-resistant bacteria did not adversely affect the outcome of treatment. The observations made support surgical drainage as the first principle of management and question the value of prescribing penicillin as part of treatment.

Detection of Candida in Concentrated Oral Rinse Cultures by Real-Time PCR

ABSTRACT The incidence of oral candidosis has increased in recent years, largely as a result of the emergence of human immunodeficiency virus infection and the more widespread use of immunosuppressive chemotherapy. This development has been associated with a need for more reliable methods for the detection of Candida. The present study assessed the performance of a real-time PCR and two block-based PCRs for the detection of Candida in 193 concentrated oral rinse culture (CRC) specimens. A total of 102 CRC specimens were positive by culture for Candida; and 96, 90, and 75 of these were also positive by real-time, N18-specific, and internal transcribed spacer (ITS)-specific PCRs, respectively. The five false-negative results by the real-time PCR were all non-Candida albicans positive by culture. Of the 91 culture-negative CRC specimens, 20, 41, and 44 were positive by the real-time PCR and the N18- and ITS-specific PCRs, respectively. All three PCRs detected fungal DNA in 8 culture-negative CRC specimens, with a further 30 being positive by two of the three PCRs. A total of 32 CRC specimens were Candida free by all methods. In summary, a real-time PCR that provides a sensitive, specific, and rapid alternative technique for detection of Candida in the mouth is described.

Detection of cfxA and cfxA2, the β-lactamase genes of Prevotella spp., in clinical samples from dentoalveolar infection by real-time PCR

ABSTRACT While most bacteria involved in dentoalveolar infection are highly susceptible to penicillin, some Prevotella strains exhibit resistance to this agent through the production of β-lactamase. The production of β-lactamase by Prevotella spp. is in turn associated with the expression of the genes cfxA and cfxA2. The aim of the present study was to determine the prevalence of cfxA and cfxA2 in Prevotella strains by use of real-time PCR and to assess the performance of this molecular method for the direct detection of the genes in 87 clinical samples (pus and root canal exudates) from dentoalveolar infection. Production of β-lactamase by each isolate was determined using a nitrocefin disk. β-Lactamase production was seen in 31% of Prevotella isolates, while all isolates of other species were β-lactamase negative. The penicillin resistance of isolates strongly correlated with the production of β-lactamase. Real-time PCR was found to detect the cfxA and cfxA2 genes from at least five cells per reaction mixture (5 × 103 CFU/ml of pus). Using real-time PCR, the presence of cfxA and cfxA2 was evident for all 48 β-lactamase-positive Prevotella strains. In contrast, neither β-lactamase-negative Prevotella (n = 91) or non-Prevotella (n = 31) strains were positive for the genes. In this study, 31 of the 87 samples yielded β-lactamase-positive Prevotella results, and cfxA and cfxA2 were detected in all 31 samples. Of the 56 culture-negative samples, 8 (14%) were positive for cfxA and cfxA2 by the real-time PCR. This sensitive and specific molecular method offers a rapid clinical test for aiding in the selection of an appropriate antibiotic for treatment of dentoalveolar infection. Although penicillin remains largely effective in the treatment of dentoalveolar infection, β-lactamase-stable antibiotics should be considered in cases in which β-lactamase-positive Prevotella strains are involved.

The virulence of mixed infection with Streptococcus constellatus and Fusobacterium nucleatum in a murine orofacial infection model

Orofacial infections are usually polymicrobial, and it is the microbial interactions of pathogenic species that cause tissue destruction. In this study, the microbial interaction between Streptococcus constellatus and Fusobacterium nucleatum was characterized using a murine orofacial infection model. A mixture of viable S. constellatus and F. nucleatum cells (both 2 x 10(8) CFU/mouse) was injected into the submandible; as a result, all of the test mice died. In contrast, none of the experimental animals monoinjected with either S. constellatus or F. nucleatum died (P<0.001), indicating that the synergism between the two resulted in the virulence. When a mixture of viable S. constellatus cells and a culture filtrate of F. nucleatum was tested, lethality and the bacterial cell count per lesion were significantly enhanced as compared with monoinjections (P<0.02). However, the virulence of F. nucleatum was not enhanced by infection of a culture filtrate of S. constellatus. The enhancement of virulence was observed even when viable S. constellatus cells and the culture filtrate of F. nucleatum were injected at separate sites. Heat treatment of the culture filtrate of F. nucleatum did not affect the enhancement. These results indicate that a heat-stable substance(s) produced by F. nucleatum contributes to the microbial synergy of S. constellatus and F. nucleatum in orofacial infections.

Association of oral yeast carriage with specific host factors and altered mouth sensation.

OBJECTIVES The aim of this study was to determine if there was a significant association between the presence of altered mouth and taste sensations with oral carriage of yeasts and to assess the factors that influence the yeast carriage. STUDY DESIGN The oral and dental status including unstimulated (USFR) and stimulated (SSFR) whole salivary flow rates of a total of 509 subjects was recorded. Saliva specimens were collected for microbiologic examination. Multiple logistic regression analysis was performed to identify any factors that were significantly associated with the prevalence of oral yeasts. RESULTS Old age, clinical signs of oral dryness, denture wearing, and a reduction in USFR increased the prevalence of yeasts, whereas patient gender, levels of dentition, the sensation of dry or burning mouth, taste disorders, and SSFR were not associated with increased prevalence of oral yeasts. CONCLUSIONS An increased prevalence of oral yeasts was not found to relate to changes in mouth sensation alone. Other factors, most notably patient age, the wearing of dentures, clinical signs of oral dryness, and salivary flow rate under rest conditions, were, however, found to be closely associated with oral yeast carriage.

Proteinase activity of prevotella species associated with oral purulent infection.

Prevotella intermedia and Prevotella nigrescens are often regarded as principal causes of acute dentoalveolar infection; however, other species within the genus are also known to be associated with such infection. The aim of this study was to determine the in vitro proteolytic activity of these different Prevotella species that have been implicated with dentoalveolar infection. A total of 234 strains were obtained from pus specimens from dentoalveolar infection and from the plaque of healthy volunteers. Prevotella loescheii, Prevotella oralis, Prevotella melaninogenica, Prevotella buccae, and Prevotella denticola were all shown to have a proteolytic activity (8.5–10.5 × 10−8 A-units) lower than that of P. intermedia and P. nigrescens (21.1–23.5 × 10−8 A-units). In the case of P. loescheii, P. melaninogenica, and P. intermedia, the level of proteolytic activity for clinical strains was significantly (P < 0.05) higher than that recorded for commensal strains. Proteolytic activity for all species of Prevotella examined was inhibited by N-ethylmaleimide and phenymethylsulfonyl fluoride. This study suggests that Prevotella species associated with oral purulent infection produce cysteine and serine proteinases and that in certain species of Prevotella, the strains involved in infection exhibit higher proteolytic activity when compared with strains from healthy sites.

Antifungal susceptibility of Candida species using the Clinical and Laboratory Standards Institute disk diffusion and broth microdilution methods

Abstract There are conflicting reports on the agreement between the Clinical and Laboratory Standards Institute disk diffusion (M44-A) and reference broth microdilution (M27-A) methods for determination of antifungal susceptibility of yeasts. The antifungal susceptibility of 541 yeasts, the majority of which were from the oral cavity, was determined using these two methods and the accuracy of the disk diffusion method assessed for clinical testing of various Candida species. Of the strains tested, Candida albicans predominated (390 out of 541). The classification of susceptibility determined by the disk diffusion method was largely in concordance with that obtained using the broth dilution method, regardless of species within Candida genus. The overall observed agreement between these two methods was 94.7% for fluconazole and 96.7% for voriconazole was with a ‘very major’ discrepancy level of 1.5% and 1.7% respectively. This study demonstrates a strong agreement of the simple disk diffusion method with the more labour intensive ‘gold standard’ broth microdilution method. These findings would support the use of the disk diffusion method in a routine mycology service.

Antimicrobial Chemotherapy: Significance to Healthcare

Antimicrobial chemotherapy involves the administration of drugs with selective toxicity against pathogens involved in infections, not host cells. Antibiotics, which are agents used to combat bacteria, are among the most common antimicrobials. This chapter discusses the basic concepts of the pharmacology of antimicrobial chemotherapy and pharmacologic properties of clinically important antimicrobial agents. Moreover, clinical considerations of antibiotic therapy including indication of therapy, selection of antibiotic, and likely adverse effects are discussed. Recent years have seen a dramatic increase in the prevalence of antibiotic-resistant micro-organisms which may be a result of inappropriate use of antibiotics. Although antimicrobial chemotherapy is undoubtedly significant in the management of infections, its potential negative effects must be recognized. Proper use of antimicrobial agents maximises the potential of the agents for therapeutic purposes, while minimising their negative effects. A good understanding of basic and clinical concepts of antimicrobial chemotherapy is therefore significant for all healthcare professionals.

Role of biofilms in the oral health of animals

In humans the importance of biofilms in disease processes is now widely recognised together with the difficulties in treating such infections once established. One of the earliest and certainly most studied biofilm in humans is that of dental plaque which is responsible for two of the most prevalent human infections, namely dental caries and periodontal disease. However, comparable studies of dental plaque in animals are relatively limited, despite the fact that similar infections also occur, and in the case of farm animals there is an associated economic impact. In addition, biofilms in the mouths of animals can also be detrimental to human health when transferred by animal bites. As a result, an understanding of both the microbial composition of animal plaque biofilms together with their role in animal diseases is important. Through the use of modern molecular studies, an insight into the oral microflora of animals is now being obtained and, to date, reveals that despite differences in terms of microbial species and relative proportions occurring between humans and animals, similarities do indeed exist. This information can be exploited in our efforts to both manage and treat infections in animals arising from the presence of an oral biofilm. This Chapter describes our current understanding of the microbial composition of animal plaque, its role in disease and how oral hygiene measures can be implemented to reduce subsequent infection.

Study of pathogens of odontogenic infection using an oral floor abscess model in the mouse. Comparison of pathogenicity.

In present study, the pathogenicity of Streptococcus constellatus, Peptostreptococcus micros, Prevotella intermedia, and Fusobacterium nucleatum, which are implicated in odontogenic infection, was determined using an oral floor abscess model in mice. The potential to kill mice, the ability to form an abscess, and the lesion type were used as indices of pathogenicity. The results showed that F. nucleatum was more pathogenic than the other pathogens. It appeared that P. micros and P. intermedia acted aggressively and destructively when the mice were challenged with a sufficient number of these pathogens. Moreover, it appeared that P. intermedia caused a spreading inflammatory lesion that spread to the surrounding tissue via spaces in the oral floor tissue. The present study suggests that pathogens responsible for odontogenic infection differ with respect to pathogenicity.