Assuntos
Aggregatibacter aphrophilus , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Anuloplastia da Valva Mitral , Valva Mitral/microbiologia , Infecções por Pasteurellaceae/diagnóstico , Infecções por Pasteurellaceae/microbiologia , Aggregatibacter aphrophilus/genética , Aggregatibacter aphrophilus/isolamento & purificação , DNA Bacteriano/genética , Endocardite Bacteriana/patologia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/cirurgia , Infecções por Pasteurellaceae/patologia , Infecções por Pasteurellaceae/cirurgia , Reação em Cadeia da Polimerase , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Taiwan , Resultado do TratamentoRESUMO
We report a case of Aggregatibacter aphrophilus sacroiliitis in a young sportsman, presenting 48 hours after endoscopy and biopsy. Microbiological diagnosis was made only after repeated attempt at joint aspiration. The patient was cured after radiologically guided drainage and a prolonged course of directed antibiotics.
Assuntos
Aggregatibacter aphrophilus/isolamento & purificação , Gastroscopia/efeitos adversos , Infecções por Pasteurellaceae/etiologia , Complicações Pós-Operatórias/microbiologia , Sacroileíte/microbiologia , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Drenagem , Futebol Americano , Humanos , Masculino , Infecções por Pasteurellaceae/tratamento farmacológico , Infecções por Pasteurellaceae/cirurgia , Sacroileíte/tratamento farmacológico , Sacroileíte/cirurgia , Adulto JovemRESUMO
BACKGROUND: A randomized split-mouth controlled clinical trial was conducted to evaluate the efficacy of photodynamic therapy (PDT) in reducing Aggregatibacter actinomycetemcomitans (Aa) in periodontitis patients. METHODS: Twenty patients with periodontitis were recruited for the trial. Following random allocation of either quadrants of the selected jaw to test or control treatment, conventional non-surgical periodontal therapy (NSPT) was performed. In addition, the test side received adjunct photodynamic therapy. Probing depth (PD), clinical attachment level, bleeding on probing (BoP) and plaque scores (PS%) were recorded at phase 0 (baseline), phase 1 (immediately after NSPT), phase 2 (7 days following NSPT), phase 3 (1 month following NSPT) and phase 4 (3 months following NSPT). Subgingival plaque samples for quantification of Aa by real-time polymerase chain reaction was performed at phases 0, 1, 2 and 4. RESULTS: There was a significant clinical improvement at phases 3 and 4 compared with baseline while BoP reduced significantly only in the test group at phase 4. However, no difference in the quantification of Aa was detected between the groups. CONCLUSIONS: Within the limits of the study, PDT adjunct to scaling and root planing does not lead to quantitative reduction of Aa in periodontitis patients.
Assuntos
Aggregatibacter actinomycetemcomitans/isolamento & purificação , Periodontite Crônica/cirurgia , Placa Dentária/microbiologia , Infecções por Pasteurellaceae/cirurgia , Adolescente , Adulto , Periodontite Crônica/tratamento farmacológico , Periodontite Crônica/microbiologia , Terapia Combinada , Índice de Placa Dentária , Raspagem Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/tratamento farmacológico , Infecções por Pasteurellaceae/microbiologia , Índice Periodontal , Fotoquimioterapia , Reação em Cadeia da Polimerase em Tempo Real , Aplainamento Radicular , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The specific advantage of administering systemic antibiotics during initial, non-surgical therapy or in the context of periodontal surgery is unclear. This study assesses the differential outcomes of periodontal therapy supplemented with amoxicillin-metronidazole during either the non-surgical or the surgical treatment phase. METHODS: This is a single-center, randomized placebo-controlled crossover clinical trial with a 1-year follow-up. Eighty participants with Aggregatibacter actinomycetemcomitans-associated moderate to advanced periodontitis were randomized into two treatment groups: group A, antibiotics (500 mg metronidazole plus 375 mg amoxicillin three times per day for 7 days) during the first, non-surgical phase of periodontal therapy (T1) and placebo during the second, surgical phase (T2); and group B, placebo during T1 and antibiotics during T2. The number of sites with probing depth (PD) >4 mm and bleeding on probing (BOP) per patient was the primary outcome. RESULTS: A total of 11,212 sites were clinically monitored on 1,870 teeth. T1 with antibiotics decreased the number of sites with PD >4 mm and BOP per patient significantly more than without (group A: from 34.5 to 5.7, 84%; group B: from 28.7 to 8.7, 70%; P <0.01). Twenty patients treated with antibiotics, but only eight treated with placebo, achieved a 10-fold reduction of diseased sites (P = 0.007). Consequently, fewer patients of group A needed additional therapy, the mean number of surgical interventions was lower, and treatment time in T2 was shorter. Six months after T2, the mean number of residual pockets (group A: 2.8 ± 5.2; group B: 2.2 ± 5.0) was not significantly different and was sustained over 12 months in both groups. CONCLUSION: Giving the antibiotics during T1 or T2 yielded similar long-term outcomes, but antibiotics in T1 resolved the disease quicker and thus reduced the need for additional surgical intervention.
Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Metronidazol/uso terapêutico , Periodontite/terapia , Adulto , Idoso , Aggregatibacter actinomycetemcomitans/efeitos dos fármacos , Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Terapia Combinada , Estudos Cross-Over , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Masculino , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/cirurgia , Infecções por Pasteurellaceae/terapia , Desbridamento Periodontal/métodos , Índice Periodontal , Bolsa Periodontal/cirurgia , Bolsa Periodontal/terapia , Periodontite/microbiologia , Periodontite/cirurgia , Placebos , Retalhos Cirúrgicos/cirurgia , Resultado do TratamentoAssuntos
Aggregatibacter aphrophilus/isolamento & purificação , Empiema Pleural/etiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Pasteurellaceae/complicações , Peptostreptococcus/isolamento & purificação , Alcoolismo/complicações , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Tubos Torácicos , Coinfecção , Drenagem , Quimioterapia Combinada , Empiema Pleural/tratamento farmacológico , Empiema Pleural/microbiologia , Empiema Pleural/cirurgia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Imipenem/uso terapêutico , Linezolida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/tratamento farmacológico , Infecções por Pasteurellaceae/microbiologia , Infecções por Pasteurellaceae/cirurgia , Atelectasia Pulmonar/etiologia , Fatores de Risco , Fumar/efeitos adversosRESUMO
Aggregatibacter actinomycetemcomitans is commonly part of the normal microflora of the human upper respiratory tract. It has been implicated in periodontal disease and various infections, particularly endocarditis. We report here what we believe to be the first case of recurrent infective endocarditis due to A. actinomycetemcomitans in a 44-year-old woman occurring 5 years after the initial episode. Genomic analysis proved that the strains were closely related. Despite efficient antibiotic treatment, surgery was necessary for recovery.
Assuntos
Endocardite Bacteriana/microbiologia , Infecções por Pasteurellaceae/microbiologia , Pasteurellaceae/classificação , Adulto , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Feminino , Genoma Bacteriano , Humanos , Pasteurellaceae/genética , Infecções por Pasteurellaceae/tratamento farmacológico , Infecções por Pasteurellaceae/cirurgia , RecidivaRESUMO
Septic arthritis of the sternoclavicular joint is rare. Its causes have been reported to include immuno-compromizing diseases, intravenous drug abuse, fractures of the clavicle or catheterization of the subclavian vein. We report a case of septic arthritis of the SCJ in a diabetic patient following periarticular injection of steroids in the ipsilateral shoulder, as this route of infection has not been documented, to our knowledge, in the literature to date. We review the literature regarding epidemiology and methods of surgical treatment that have been proposed, and present our own surgical experience. Bacterial infection should always be suspected in cases of SCJ arthritis. If surgery is required, it is important to remember that bony procedures leave vascular structures exposed, making their cover by myoplasty mandatory.