RESUMEN
BACKGROUND: Osteomyelitis (OM) of the jaw is a rare medical condition. In this review, we provide a descriptive analysis of the experience with this condition at a single tertiary health care centre in Canada over 10 years. MATERIALS AND METHODS: We conducted a retrospective chart review of adult patients aged ≥ 18 years presenting with OM of the jaw at the University of Manitoba Health Sciences Centre between January 2009 and May 2019. We included cases with consistent clinical symptoms and radiographic and/or microbiologic evidence of OM of the jaw. Excluded were cases with a previous history of head and neck cancer, radiation therapy in the head and neck regions and use of anti-resorptive medications. RESULTS: Of the 37 patients who met our criteria, the mean age was 44 years (standard deviation [SD] ± 16 years), 21 (56.8%) were male, 16 (43.2%) were diagnosed with acute OM and 21 (57.8%) with chronic OM. Underlying comorbidities, such as diabetes mellitus and chronic kidney diseases, were reported in 6 (16.2%) and 3 patients (8.1%), respectively. Traumatic injuries to the facial skeleton were the most common predisposing factor (11 patients [29.7%]). The most commonly isolated infective organisms were viridans group streptococci (VGS; 75.8%), followed by Prevotella spp. (45.4%). Results showed a higher level of resistance to penicillin of the isolated organisms in chronic OM compared with acute OM. CONCLUSIONS: This description of acute and chronic forms of OM of the jaw will enable clinicians to better understand OM patient profiles, leading to early diagnosis, improved patient care and better outcomes.
Asunto(s)
Enfermedades Maxilomandibulares , Osteomielitis , Centros de Atención Terciaria , Humanos , Osteomielitis/microbiología , Osteomielitis/epidemiología , Estudios Retrospectivos , Masculino , Adulto , Femenino , Enfermedades Maxilomandibulares/microbiología , Enfermedades Maxilomandibulares/epidemiología , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Manitoba/epidemiología , Canadá/epidemiología , Anciano , Factores de RiesgoRESUMEN
The phrase "no drainable fluid collection" harbors implicit management guidelines that may be inappropriate in regard to acute odontogenic infection. For many emergency department physicians, these words trigger a treatment plan involving antibiotics without drainage. However, many odontogenic infections require immediate drainage even when an abscess is not visible on imaging. As such, the phrase "no drainable fluid collection" should not be used when reporting on imaging performed for odontogenic infection.
Asunto(s)
Absceso/diagnóstico por imagen , Diagnóstico por Imagen , Drenaje/métodos , Infecciones/diagnóstico por imagen , Enfermedades Maxilomandibulares/diagnóstico por imagen , Humanos , Enfermedades Maxilomandibulares/microbiologíaRESUMEN
BACKGROUND: Infective lesions of the jaws and adjacent tissues (lumpy jaw disease, LJD) have been recognized as one major cause of death of captive macropods. Fusobacterium necrophorum and Actinomyces species serve as the main source of LJD in kangaroos and wallabies. Currently, little is reported about LJD or similar diseases in opossums. CASE PRESENTATION: Here we report a case of actinomycosis resembling the entity lumpy jaw disease in a gray four-eyed opossum, caused by a novel species of Schaalia. A 2.8 year old male Philander opossum was presented with unilateral swelling of the right mandible. After an initial treatment with marbofloxacin, the opossum was found dead the following day and the carcass was submitted for necropsy. Postmortem examination revealed severe mandibular skin and underlying soft tissue infection with subsequent septicemia as the cause of death. Histological examination demonstrated Splendore-Hoeppli phenomenon, typically seen in classical cases of actinomycosis. Bacteriology of liver and mandibular mass yielded a previously undescribed species of Schaalia, whose 16 S rRNA gene sequence was 97.0 % identical to Schaalia canis. Whole genome sequencing of the opossum isolate and calculation of average nucleotide identity confirmed a novel species of Schaalia, for which no whole genome sequence is yet available. CONCLUSIONS: The herewith reported Schaalia infection in the gray four-eyed opossum resembling classical actinomycosis gives a novel insight into new exotic animal bacterial diseases. Schaalia species may belong to the normal oral microbiome, as in macropods, and may serve as a contributor to opportunistic infections. Due to the lack of current literature, more insights and improved knowledge about Schaalia spp. and their pathogenicity will be useful to choose appropriate therapy regimens and improve the treatment success rate and outcome in exotic and endangered species.
Asunto(s)
Actinomycetaceae/aislamiento & purificación , Actinomicosis/microbiología , Actinomicosis/veterinaria , Zarigüeyas/microbiología , Actinomycetaceae/genética , Animales , Enfermedades Maxilomandibulares/microbiología , Enfermedades Maxilomandibulares/veterinaria , Masculino , Secuenciación Completa del GenomaAsunto(s)
Antiinfecciosos , Enfermedades Transmisibles , Enfermedades Maxilomandibulares , Antiinfecciosos/administración & dosificación , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Bacterias/efectos de los fármacos , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/microbiología , Humanos , Enfermedades Maxilomandibulares/tratamiento farmacológico , Enfermedades Maxilomandibulares/microbiología , Pruebas de Sensibilidad MicrobianaRESUMEN
Osteomyelitis is an infection and inflammation associated with the bone structures: bone marrow, cortical bone, periosteum, blood vessels and nerves. Although it does not have a frequent presentation, it can sometimes lead to complications such as pathological fractures or even septicemia. We present a clinical case study, to assess the relationship between osteomyelitis of the jaw and pathological fractures, after the extraction of an impacted wisdom tooth. This case highlights a rare complication following the surgical removal of mandibular third molar; a slow evolution of the pathology following an extraction should lead to close monitoring of the patient both clinically and radiographically, albeit osteomyelitis is a rare complication, it should be included as one of the differential diagnosis of persistent post-extraction pain.
Asunto(s)
Enfermedades Maxilomandibulares/etiología , Fracturas Mandibulares/complicaciones , Tercer Molar/cirugía , Osteomielitis/etiología , Extracción Dental/efectos adversos , Diente Impactado/cirugía , Antibacterianos/uso terapéutico , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/terapia , Humanos , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/microbiología , Enfermedades Maxilomandibulares/terapia , Masculino , Fracturas Mandibulares/diagnóstico , Fracturas Mandibulares/microbiología , Fracturas Mandibulares/terapia , Reconstrucción Mandibular/métodos , Persona de Mediana Edad , Tercer Molar/microbiología , Osteomielitis/diagnóstico , Osteomielitis/microbiología , Osteomielitis/terapia , Peptostreptococcus/aislamiento & purificación , Diente Impactado/microbiologíaAsunto(s)
Histoplasmosis/microbiología , Enfermedades Maxilomandibulares/microbiología , Úlceras Bucales/microbiología , Antifúngicos/uso terapéutico , Biopsia , Histoplasma , Histoplasmosis/tratamiento farmacológico , Humanos , Inmunocompetencia , Itraconazol/uso terapéutico , Enfermedades Maxilomandibulares/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Úlceras Bucales/tratamiento farmacológico , Radiografía PanorámicaRESUMEN
Sickle cell anaemia (SCA) is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a well-documented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Enfermedades Maxilomandibulares/microbiología , Osteomielitis/microbiología , Adolescente , Adulto , Enfermedad Crónica , Humanos , Enfermedades Maxilomandibulares/diagnóstico por imagen , Masculino , Omán , Osteomielitis/diagnóstico por imagen , Adulto JovenRESUMEN
As a result of cliniko-microbiological research the data testifying to substantial improvement of efficiency of antimicrobictherape at inclusion in a complex of medical actions at alveolitis and the limited osteomyelitis of a jow ozone therapy in a combination with a light-emettinf diode irradiation of the hole extracted teeth red ( 630 nanometers) are obtained by light.
Asunto(s)
Alveolo Seco/microbiología , Enfermedades Maxilomandibulares/cirugía , Láseres de Semiconductores/uso terapéutico , Osteomielitis/cirugía , Ozono/uso terapéutico , Adolescente , Adulto , Anciano , Bacterias/efectos de los fármacos , Bacterias/efectos de la radiación , Alveolo Seco/radioterapia , Alveolo Seco/cirugía , Hongos/efectos de los fármacos , Hongos/efectos de la radiación , Humanos , Enfermedades Maxilomandibulares/microbiología , Persona de Mediana Edad , Osteomielitis/microbiología , Ozono/farmacología , Extracción Dental/efectos adversos , Adulto JovenRESUMEN
Medication-related osteonecrosis of the jaw (MRONJ) represents a complication of bisphosphonate treatment that responds poorly to standard treatment. In a retrospective cohort study we investigated a possible role of Actinomyces spp. in the pathogenesis of MRONJ. Deep biopsies of necrotic bone were collected during surgical treatment of MRONJ and evaluated by histology and microbiology for the presence of Actinomyces spp. Microbiological, demographic and clinicpathological data were analyzed for risk of Actinomyces-associated MRONJ. Between 2005 and 2014, 111 patients suffering from histologically-confirmed MRONJ were identified. Actinomyces spp. were detected in 99 cases (89%) by histology and in six further patients by microbiological culture. A diverse microbial flora was found in all specimens without association with Actinomyces spp. Demographic and clinicopathological characteristics did not separate significantly Actinomyces-positive from Actinomyces-negative cases. Our observations confirm previous reports of a high prevalence of Actinomyces spp. in MRONJ in the single largest cohort available up to now. The high prevalence of Actinomyces spp. and the lack of clinicopathological risk factors underline the prominent role of Actinomyces spp. in MRONJ and may change the current understanding of MRONJ. Established prolonged antimicrobial treatment regimens against Actinomyces spp. infection could therefore be a mainstay of future MRONJ management.
Asunto(s)
Actinomyces/patogenicidad , Difosfonatos/efectos adversos , Enfermedades Maxilomandibulares/inducido químicamente , Osteonecrosis/inducido químicamente , Actinomyces/aislamiento & purificación , Anciano , Femenino , Humanos , Enfermedades Maxilomandibulares/microbiología , Masculino , Persona de Mediana Edad , Osteonecrosis/microbiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
A large subcutaneous mass, formed on the left lower jaw of a 4-month-old Japanese Black male calf, was partially excised for histological and bacteriological examinations. Antibiotic treatment resulted in a good prognosis. Bacteria isolated from the excised material were characterized by weak hemolysis and positive reactions for catalase and oxidase, and were 99% identical to Mannheimia granulomatis strains. The presence of the leukotoxin gene product was demonstrated by polymerase chain reaction amplification. Histological examination showed that the excised material was composed of dense fibrous connective tissue with sparsely distributed eosinophilic granulomas or abscesses. These foci frequently contained Splendore-Hoeppli material with rod-shaped Gram-negative bacteria. Except for the absence of lymphangitis and the presence of basophils and mast cells, the histology of this lesion resembled that of lechiguana associated with coinfection of M. granulomatis and Dermatobia hominis. Leukotoxin was demonstrated by immunohistochemistry within Splendore-Hoeppli material and was judged to be responsible for its formation.
Asunto(s)
Enfermedades de los Bovinos/patología , Granuloma Eosinófilo/veterinaria , Mannheimia , Infecciones por Pasteurellaceae/veterinaria , Animales , Bovinos , Enfermedades de los Bovinos/diagnóstico , Enfermedades de los Bovinos/microbiología , Granuloma Eosinófilo/diagnóstico , Granuloma Eosinófilo/microbiología , Granuloma Eosinófilo/patología , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/microbiología , Enfermedades Maxilomandibulares/patología , Enfermedades Maxilomandibulares/veterinaria , Masculino , Infecciones por Pasteurellaceae/diagnóstico , Infecciones por Pasteurellaceae/microbiología , Infecciones por Pasteurellaceae/patologíaRESUMEN
The aim of the present study was to evaluate the reliability and effectiveness of directly determining endotoxin activity in plasma samples from kangaroos with lumpy jaw disease (LJD, n=15) and healthy controls (n=12). Prior to the present study, the ability of the commercially available automated handheld portable test system (PTS(TM)) to detect endotoxin activity in kangaroo plasma was compared with that of the traditional LAL-kinetic turbidimetric (KT) assay. Plasma samples, which were obtained from endotoxin-challenged cattle, were diluted 1:20 in endotoxin-free water and heated to 80°C for 10 min. The performance of the PTS(TM) was not significantly different from that of the traditional LAL-based assay. The data obtained using PTS(TM) correlated with those using KT (r(2)=0.963, P<0.001). These findings indicated that the PTS(TM) is applicable as a simplified system to assess endotoxin activity in macropods. In the present study, we demonstrated the diagnostic value of plasma endotoxin activity in kangaroos with systemic inflammation caused by oral necrobacillosis and identified plasma endotoxin activity as a sensitive marker of systemic inflammation in kangaroos with LJD. Based on ROC curves, we proposed a diagnostic cut-off point for endotoxin activity of >0.22 EU/ml for the identification of LJD. Our results indicate that the assessment of plasma endotoxin activity is a promising diagnostic tool for determining the outcome of LJD in captive macropods.
Asunto(s)
Endotoxinas/sangre , Infecciones por Fusobacterium/veterinaria , Enfermedades Maxilomandibulares/veterinaria , Macropodidae/microbiología , Enfermedades de la Boca/veterinaria , Animales , Infecciones por Fusobacterium/sangre , Infecciones por Fusobacterium/diagnóstico , Enfermedades Maxilomandibulares/sangre , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/microbiología , Macropodidae/sangre , Enfermedades de la Boca/sangre , Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/microbiología , Reproducibilidad de los Resultados , Espectrofotometría/instrumentación , Espectrofotometría/métodos , Espectrofotometría/veterinariaAsunto(s)
Enfermedades Maxilomandibulares/diagnóstico , Músculo Masetero/microbiología , Mycobacterium tuberculosis , Trismo/diagnóstico , Tuberculosis/diagnóstico , Adulto , Femenino , Humanos , Enfermedades Maxilomandibulares/etiología , Enfermedades Maxilomandibulares/microbiología , Trismo/etiología , Trismo/microbiología , Tuberculosis/etiología , Tuberculosis/microbiología , Adulto JovenRESUMEN
Chronic osteomyelitis of the jaw (COMJ) is one of the most intractable diseases among head and neck infections. Antimicrobial agents are routinely administered for COMJ without sufficient bacterial information, resulting in frequent treatment failures. To improve our knowledge of the bacterial aetiology of COMJ and to assist in the development of effective treatments, we performed a comprehensive analysis of the microbiome. Sixteen patients with four clinical types of COMJ (four with suppurative osteomyelitis, three with osteoradionecrosis of the jaw, four with primary chronic osteomyelitis, and five with bisphosphonate-related osteonecrosis of the jaw) were enrolled in this study. Bone samples were subjected to bacterial community comparisons by 16S rRNA gene pyrosequencing. As a result, we clarified that COMJ was caused by a far greater range of bacterial species (12 phyla and 163 genera) than previously reported. Moreover, the bacterial structures in COMJ changed dramatically with disease stage and the condition of the affected bone. Multiple correlation analyses revealed that sequestration and bone exposure could affect the community structure. On the basis of these factors, we reclassified COMJ into three clinical stages: I, inflamed or sclerotic bone without exposure; II, sequestrum without exposure; and III, exposed sequestrum. In stage II, the bacterial diversity was significantly lower, and the anaerobe genera Fusobacterium, Tannerella (formerly Bacteroides) and Porphyromonas were more abundant, than observed during other stages. Because these bacteria habitually reside in any clinical stage, they were considered to constitute the core microbiome of COMJ. Targeting these bacteria should lead to the development of effective preventive measures and cures.
Asunto(s)
Enfermedades Maxilomandibulares/microbiología , Microbiota , Osteomielitis/microbiología , Osteorradionecrosis/microbiología , Anciano , Anciano de 80 o más Años , Bacteroides/aislamiento & purificación , Osteonecrosis de los Maxilares Asociada a Difosfonatos/microbiología , Enfermedad Crónica , ADN Bacteriano/análisis , Femenino , Fusobacterium/aislamiento & purificación , Humanos , Masculino , Microbiota/genética , Persona de Mediana Edad , Filogeografía , Porphyromonas/aislamiento & purificación , ARN Ribosómico 16S/genéticaRESUMEN
Gingivitis and lumpy jaw are diseases of polymicrobial aetiology. Although Fusobacterium necrophorum has been associated with these diseases in macropods, little is known about other organisms associated with these diseases in this animal species. PCR-DGGE analysis revealed the potential pathogens associated with gingivitis and lumpy jaw in macropods. PCR-DGGE profile comparison between the healthy and disease groups indicated a shift in the oral bacterial community structures with similarity coefficients of 48% and 35% for gingivitis and lumpy jaw respectively. Moreover, gingivitis was associated with increase in bacterial diversity (Shannon index = 2.87; PL curve = 45%) while lumpy jaw resulted in a decline in bacterial diversity (Shannon index = 2.47; PL curve = 74%). This study suggest that the establishment of gingivitis and lumpy jaw diseases follows the ecological plaque hypothesis. This forms the basis for an expanded investigation in an epidemiological scale and suggests the need for the appropriate choice of antimicrobial agent(s) and for the effective management and control of polymicrobial diseases.
Asunto(s)
Gingivitis/veterinaria , Enfermedades Maxilomandibulares/veterinaria , Macropodidae/microbiología , Boca/microbiología , Animales , Animales de Zoológico/microbiología , Bacterias/genética , ADN Bacteriano/genética , Electroforesis en Gel de Gradiente Desnaturalizante/veterinaria , Gingivitis/microbiología , Enfermedades Maxilomandibulares/microbiología , Microbiota/genética , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/veterinariaRESUMEN
OBJECTIVE: Cost analysis of deep neck space infections from odontogenic origin and review of the morbidity of potentially preventable complications. STUDY DESIGN: Case series with chart review. SETTING: Level 1 trauma center and academic safety net hospital. SUBJECTS AND METHODS: Patients treated for deep neck space infections due to an odontogenic source between 2001 and 2010 were reviewed. Two hundred patients were included in the study. Ninety-eight patients required inpatient admission. Twelve percent of these patients had difficult airways, and 16% had at least 1 day in the intensive care unit. Cost data were available only for the later 3.5 years of the study period. RESULTS: The overall cost of treatment for these 71 individuals exceeded $1.1 million. CONCLUSION: The cost of treatment for odontogenic infections is staggering. Based on assumptions of the percentage of infections in the metropolitan area captured at Hennepin County Medical Center, extrapolation to the total national cost of inpatient care approaches $200 million annually. This study highlights the importance of access to medical and preventative dental care for the general population and demonstrates the cost benefit that could be achieved through prevention of disease and, therefore, avoidance of its complications.
Asunto(s)
Costo de Enfermedad , Costos de la Atención en Salud , Enfermedades Maxilomandibulares/complicaciones , Enfermedades Maxilomandibulares/microbiología , Infecciones de los Tejidos Blandos/economía , Infecciones de los Tejidos Blandos/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitalización/economía , Humanos , Enfermedades Maxilomandibulares/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones de los Tejidos Blandos/terapia , Resultado del Tratamiento , Adulto JovenAsunto(s)
Actinomicosis/diagnóstico , Actinomicosis/terapia , Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Enfermedades Maxilomandibulares/diagnóstico , Enfermedades Maxilomandibulares/terapia , Actinomicosis/microbiología , Anciano de 80 o más Años , Osteonecrosis de los Maxilares Asociada a Difosfonatos/microbiología , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Maxilomandibulares/microbiologíaRESUMEN
While the most common presentation of actinomycosis is cervicofacial disease, or "lumpy jaw syndrome," Actinomyces meyeri has a predilection for pulmonary disease as well as dissemination to distant organs. We describe a 61-year-old Caucasian male with a relapsing-remitting mandibular sinus tract who would go on to develop weight loss, dyspnea, and a cough productive of malodorous sputum. Imaging revealed a right lower lobe pneumonia and a large left sided empyema. He underwent thoracotomy and decortication on the left side, and 1 L of foul-smelling purulent fluid was drained. Culture grew Actinomyces meyeri. He completed an extended antibiotic course and had his teeth extracted with good clinical outcome.
Asunto(s)
Actinomyces/aislamiento & purificación , Actinomicosis/microbiología , Empiema/microbiología , Enfermedades Maxilomandibulares/microbiología , Neumonía Bacteriana/microbiología , Humanos , Masculino , Persona de Mediana Edad , Extracción DentalRESUMEN
The results of the present study give evidence of the well-apparent sanation effect of balneotherapy with the use of therapeutic mineral water (MW) extracted at the Klyuchi health resort. Irrigation of the oral cavity with this mineral water was shown to reduce the number of the strains of opportunistic microorganisms and their virulence potential. It is concluded that the proposed method may be recommended for the treatment and prevention of dysbiosis in the oral cavity of the patients presenting with acquired jaw defects.
Asunto(s)
Balneología , Colonias de Salud , Enfermedades Maxilomandibulares/terapia , Maxilares/lesiones , Aguas Minerales/administración & dosificación , Femenino , Humanos , Maxilares/ultraestructura , Enfermedades Maxilomandibulares/microbiología , Enfermedades Maxilomandibulares/patología , Masculino , Boca/microbiología , Boca/ultraestructuraRESUMEN
In recent years, many authors have reported that bisphosphonate-related osteonecrosis of the jaw(BRONJ)is a side effect of bisphosphonate therapy. However, clinicians have been confused by these reports, as no definitive criteria or treatment guidelines for BRONJ exist. In this paper, we report a patient who had BRONJ(stage 0)after dental extraction. She was successfully treated with sitafloxacin(STFX). A 73-year-old female had been taking 35 mg of alendronate per week for 24 months for the treatment of osteoporosis. She had a 1-month history of pain, suppuration, and a mandibular socket that would not heal after a left molar tooth extraction, despite the administration of antibiotics. A diagnosis of BRONJ(stage 0)was made without exposed bone, and she started 200 mg of STFX per day for 2 weeks, which was reduced to 100 mg per day for a week thereafter. After 3 weeks of STFX treatment, the mandibular wound healed. Furthermore, antimicrobial susceptibility testing against all of the organisms isolated from the pus indicated that STFX exhibited the most potent antimicrobial activity of all the agents. The results of these data suggested that STFX may be an effective antibiotic for BRONJ.