Phenotype of atopic dermatitis subjects with a history of eczema herpeticum.

BACKGROUND: A subset of subjects with atopic dermatitis (AD) are susceptible to serious infections with herpes simplex virus, called eczema herpeticum, or vaccina virus, called eczema vaccinatum. OBJECTIVE: This National Institute of Allergy and Infectious Diseases-funded multicenter study was performed to establish a database of clinical information and biologic samples on subjects with AD with and without a history of eczema herpeticum (ADEH(+) and ADEH(-) subjects, respectively) and healthy control subjects. Careful phenotyping of AD subsets might suggest mechanisms responsible for disseminated viral infections and help identify at-risk individuals. METHODS: We analyzed the data from 901 subjects (ADEH(+) subjects, n = 134; ADEH(-) subjects, n = 419; healthy control subjects, n = 348) enrolled between May 11, 2006, and September 16, 2008, at 7 US medical centers. RESULTS: ADEH(+) subjects had more severe disease based on scoring systems (Eczema Area and Severity Index and Rajka-Langeland score), body surface area affected, and biomarkers (circulating eosinophil counts and serum IgE, thymus and activation-regulated chemokine, and cutaneous T cell-attracting chemokine) than ADEH(-) subjects (P < .001). ADEH(+) subjects were also more likely to have a history of food allergy (69% vs 40%, P < .001) or asthma (64% vs 44%, P < .001) and were more commonly sensitized to many common allergens (P < .001). Cutaneous infections with Staphylococcus aureus or molluscum contagiosum virus were more common in ADEH(+) subjects (78% and 8%, respectively) than in ADEH(-) subjects (29% and 2%, respectively; P < .001). CONCLUSION: Subjects with AD in whom eczema herpeticum develops have more severe T(H)2-polarized disease with greater allergen sensitization and more commonly have a history of food allergy, asthma, or both. They are also much more likely to experience cutaneous infections with S. aureus or molluscum contagiosum.

Maternal periodontal disease is associated with an increased risk for preeclampsia.

OBJECTIVE: To determine if maternal periodontal disease is associated with the development of preeclampsia. METHODS: A cohort of 1,115 healthy pregnant women were enrolled at less than 26 weeks' gestation and followed until delivery. Maternal demographic and medical data were collected. Periodontal examinations were performed at enrollment and within 48 hours of delivery to determine the presence of severe periodontal disease or periodontal disease progression. Preeclampsia was defined as blood pressure greater than 140/90 on two separate occasions, and at least 1+ proteinuria on catheterized urine specimen. The potential effects of maternal age, race, smoking, gestational age at delivery, and insurance status were analyzed, and adjusted odds ratios for preeclampsia were calculated using multivariable logistic regression. RESULTS: During the study period, 763 women delivered live infants and had data available for analysis. Thirty-nine women had preeclampsia. Women were at higher risk for preeclampsia if they had severe periodontal disease at delivery (adjusted odds ratio 2.4, 95% confidence interval 1.1, 5.3), or if they had periodontal disease progression during pregnancy (adjusted odds ratio 2.1, 95% confidence interval 1.0, 4.4). CONCLUSION: After adjusting for other risk factors, active maternal periodontal disease during pregnancy is associated with an increased risk for the development of preeclampsia.

Obstetricians' knowledge and practice behaviors concerning periodontal health and preterm delivery and low birth weight.

INTRODUCTION: Investigators have reported that periodontal disease may be a risk factor for pregnancy complications including preterm delivery (PTD) and low birth weight (LBW). This study assessed obstetricians' knowledge and practice behaviors concerning periodontal disease and its role in adverse pregnancy outcomes. METHODS: One hundred ninety four practicing obstetricians in a 5 county area in central North Carolina were surveyed. Of the 138 eligible physicians, 55 responded yielding a 40% response rate. RESULTS: Most answered correctly when asked about the description of gingivitis (95%). A lower number of respondents were correct when asked about the description of periodontitis (67%). When asked about what causes periodontal disease or what is associated with periodontal disease, most answered correctly with bacteria (94%), although many answered tooth decay (73%), aging (69%), and excess dietary sugar (51%). Most were correct in responding that periodontitis was more serious than gingivitis (80%). Twenty-two percent looked into patients' mouths at initial prenatal examination, 9% periodically, and 48% only when a problem was mentioned by the patient. Forty-nine percent rarely or never recommended a dental examination. Most (84%) considered periodontal disease to be as important a risk factor to adverse pregnancy events as those currently known in obstetrics practice. CONCLUSIONS: Data from this study demonstrate that there is knowledge of periodontal disease and its potential role as a pregnancy risk factor but suggest limited incorporation of dental care into clinical medical practice.

Periodontal disease increases the risk of preterm delivery among preeclamptic women.

BACKGROUND: Preterm births are a major cause of neonatal morbidity and mortality, and represent an important public health issue. About 30% of preterm births are due to medical conditions of the mother or the fetus, among "which preeclampsia plays a major role. We have previously reported that maternal periodontal disease enhances the risk for preterm delivery and preeclampsia. Our current objective was to determine whether maternal periodontal disease increases the risk for preterm delivery among preeclamptic women. METHODS: Women were enrolled prior to their twenty-sixth week of gestation. Periodontal status was assessed at baseline and defined as healthy, mild, or moderate/severe. Repeat examinations were performed at delivery to assess changes in periodontal status. RESULTS: A cohort of 1,020 women was studied, 47 of whom had preeclampsia. A strong association between periodontal disease status at enrollment and rate of premature delivery was observed among preeclamptic women after adjusting for the major risk factors for preterm delivery, including maternal race; age; marital status; WIC (women, infants, children program) or food stamps; insurance; previous preterm delivery; and chorioamnionitis. Among preeclamptic women, 49.3% with mild periodontal disease and 82.6% with moderate to severe disease delivered preterm (hazard ratios [HR] 4.11 and 11.0, respectively). Periodontal disease worsening during pregnancy in preeclamptic women was also associated with an increased risk of preterm births (HR 8.44). CONCLUSION: These results suggest that mothers with preeclampsia may be at greater risk for preterm delivery if periodontal disease is present early in pregnancy or progresses during pregnancy.