Could polyhexanide and chlorine dioxide be used as an alternative to chlorhexidine? A systematic review

ABSTRACT BACKGROUND: Maintenance of oral microbiota balance is the simplest way to prevent infectious oral diseases, through controlling dental biofilm. Combined use of mouthwash and mechanical removal has been shown to be a very effective way for this. OBJECTIVES: To identify clinical studies comparing the antimicrobial effect and possible adverse effects and/or side effects of chlorhexidine-based mouthwashes with those of mouthwashes containing chlorine dioxide and/or polyhexanide, for controlling oral microbiota. DESIGN AND SETTING: Systematic review designed by the stomatology sector of postgraduation in applied dental sciences of Bauru Dentistry School, University of São Paulo, Brazil. METHODS: A systematic review was conducted using online databases (PubMed, Embase, Web of Science and Science Direct) up to April 8, 2020. The search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: The studies included comprised eight articles published between 2001 and 2017. A total of 295 young adults, adults and elderly people were evaluated (males 44.75% and females 55.25%). Three articles compared polyhexanide with chlorhexidine and five articles compared chlorine dioxide with chlorhexidine. No studies comparing all three mouthwashes were found. The concentrations of the study solutions were quite varied, and all rinses had an antimicrobial effect. In four studies, it was stated that no side effects or adverse effects had been found. Three studies did not address these results and only one study addressed side effects and/or adverse effects. CONCLUSION: Mouthwashes containing chlorine dioxide and polyhexanide are viable alternatives to chlorhexidine, since they reduce oral biofilm and have little or no reported side or adverse effects.

Prevalence and antimycotic susceptibility profile of Candida species in the oral cavities of HIV/AIDS patients and pregnant women in Nsukka, Nigeria

Aims@#The present study determined Candida species occurrence in the mouth of HIV/AIDS, pregnant women and healthy individuals, and Candida susceptibility to antimycotics.@*Methodology and results@#A cross-sectional study of the Candida species occurrence and their in vitro sensitivity to nystatin, clotrimazole, ketoconazole and fluconazole was studied. Oral swabs were taken from the dorsum of the tongue of 63 HIV/AIDS patients, 38 pregnant women and 53 apparently healthy humans served as control. All participants gave their consent. The samples were cultured for isolation of Candida species. The susceptibility of commonly used antimycotics against Candida species was determined using agar-well and disc-diffusion methods. The broth dilution method was adopted in the determination of the minimum inhibitory concentration of the drugs. The rate of Candida species colonization in HIV/AIDS patients was higher than that among pregnant women and apparently healthy humans. Candida albicans had the highest frequency. Candida species displayed higher sensitivity to nystatin and clotrimazole than ketoconazole and fluconazole. Candida albicans exhibiting low sensitivity to fluconazole were found in the mouth of AIDS patients, pregnant women and apparently healthy humans.@*Conclusion, significance and impact of study@#Candida species prevalence was highest among HIV patients. Candida albicans had the highest frequency among the study groups and had reduced susceptibility to fluconazole. The findings of the study underscore the need for regular surveillance and susceptibility testing of Candida isolates before prescription of antimycotics, especially in cases of chronic infection, as well as the development of safe and efficacious treatment alternatives since Candida isolates are becoming less susceptible to fluconazole.

Efecto antimicrobiano in vitro de extractos de Caesalpinia Spinosa (algarrobo) sobre patógenos orales / In vitro antimicrobial effect of Caesalpinia Spinosa (carob tree) extracts on oral pathogens

La resistencia antimicrobiana es un problema de sa-lud pública mundial. Las infecciones por microorga-nismos resistentes pueden ser altamente transmisi-bles e incluso causar la muerte. Este hecho genera grandes costos para los pacientes y para los servi-cios de salud. El objetivo del presente trabajo fue de-terminar el efecto antimicrobiano in vitro de extractos etanólicos de Caesalpinia spinosa sobre el crecimien-to de Enterococcus faecalis, Staphylococcus aureus y Candida albicans. Se recolectaron y certificaron muestras de C. spinosa. Se obtuvieron extractos de hojas, vainas y semillas en concentraciones de 100%, 75%, 50% y 25%. Mediante Kirby - Bauer, se cargaron los discos con los extractos y se depositaron en el medio inoculado con cepas de E. faecalis, S. aureus y C. albicans; junto a un CP (antimicrobiano), y un CN (etanol). Las placas se incubaron a 370°C durante 24 horas, y posteriormente se midieron los halos de inhi-bición con un vernier digital. Destaca el valor del halo de extracto de vainas; superó al de Ampicilina 10mg, sobre el E. faecalis. El extracto de vainas presentó ma-yor diámetro de inhibición (19mm), el de semillas pre-sentó el más bajo (1mm). ANOVA arrojó diferencia es-tadísticamente significativa entre los datos obtenidos para todos los extractos. En conclusión, los extractos etanólicos de Caesalpinia spinosa tienen efecto anti-microbiano in vitro sobre Enterococcus faecalis, Sta-phylococcus aureus y Candida albicans. La actividad antimicrobiana del extracto es directamente propor-cional a su concentración. Los extractos de C. spinosa podrían ser utilizados como coadyuvantes en el trata-miento contra Enterococcus faecalis, Staphylococcus aureus, Candida albicans, que están relacionados con patologías orales (AU)

Antimicrobial resistance is a global public health problem. Infections with resistant microorganisms can be highly transmissible and even cause death. This fact generates great costs for patients and for health services. The objective of this work was to determine the in vitro antimicrobial effect of ethanolic extracts of Caesalpinia spinosa on the growth of Enterococcus faecalis, Staphylococcus aureus and Candida albicans. Samples of C. spinosa were collected and certified. Leaf, pod and seed extracts were obtained at concentrations of 100%, 75%, 50% and 25%. Using Kirby-Bauer, the disks were loaded with the extracts and deposited in the medium inoculated with strains of E. faecalis, S. aureus and C. albicans; together with a CP (antimicrobial), and a CN (ethanol). The plates were incubated at 370°C for 24 hours, then the inhibition halos were measured with a digital vernier. The value of the pod extract halo stands out, surpassing that of Ampicillin 10mg, over E. faecalis. The pod extract presented the greatest diameter of inhibition (19mm), the seed extract presented the lowest (1mm). ANOVA showed a statistically significant difference between the data obtained for all the extracts. In conclusion, the ethanolic extracts of Caesalpinia spinosa have an in vitro antimicrobial effect on Enterococcus faecalis, Staphylococcus aureus and Candida albicans. The antimicrobial activity of the extract is directly proportional to its concentration. C. spinosa extracts could be used as adjuvants in the treatment against Enterococcus faecalis, Staphylococcus aureus, Candida albicans, which are related to oral pathologies (AU)

Oral health management in children with acute lymphoblastic leukemia / 口腔疾病防治

@#Acute lymphoblastic leukemia is the most common type of leukemia in children. In recent years, the treatment and prognosis of acute lymphoblastic leukemia in children have improved significantly. However, acute lymphoblastic leukemia itself and treatment measures can lead to a variety of adverse oral complications and affect further treatment. These complications have a significant effect on patients and affect further treatment. To improve the quality of life of children, this article reviews the oral health status and oral health management of children with acute lymphoblastic leukemia for clinical reference. The literature review shows that the oral health management measures for children with acute lymphoblastic leukemia mainly include oral health education, active prevention of oral diseases, timely oral treatment before the start of antitumor treatment, elimination of potential sources of infection after blood examination and risk assessment, treatment of oral mucosal problems during therapy, oral emergency during antitumor therapy should be carried out under the guidance of hematologists and regular oral inspection and oral care. However, current studies have found that there is still a lack of effective prevention and treatment measures for oral mucositis. As a common oral disease in children with acute lymphoblastic leukemia, the prevention and treatment of oral mucositis remain to be further studied.

Papillomavirus infections in the oral and genital mucosa of asymptomatic women

Abstract Human papillomavirus (HPV) has been found in several regions of the body, including the oral cavity. Recently, this virus has been associated with oropharyngeal cancer, but little is known about HPV transmission to the oral cavity. We carried out a study to investigate concurrent oral and cervical infections in 76 asymptomatic women attending a healthcare program. Demographic and behavior data were obtained through a structured questionnaire. Oral and cervical mucosa scrapings were collected and stored for DNA extraction. HPV DNA amplification was performed by polymerase chain reaction assay (PCR) using both primers My09/My11 and FAP59/64, followed by HPV typing with restriction fragment length polymorphism analysis (RFLP) and sequencing. The data collected revealed no risk factors for HPV infection in these 76 women. HPV prevalence of 9.2 and 5.3% was found in cervical and oral mucosa, respectively. Concurrent infections by discordant types were detected in one case only. Sequencing procedures allowed us to detect a new putative HPV 17 subtype from the Betapapillomavirus genus. Our results support the view that cervical and oral HPV infections are independent events. The observed low prevalence of both oral and cervical HPV infections could be associated with attendance in a healthcare program.

Distribution of Oral Pathogenic Bacteria and Analysis of Drug Resistance in the Infective Patients after Orthodontic Treatment in a Hospital from 2011 to 2016 / 中国药房

OBJECTIVE:To provide reference for clinical rational drug use and the prevention and treatment of drug-resistance bacteria.METHODS:A total of 148 patients with oral infection after orthodontic treatment were selected from a hospital during Jul.2011-Jul.2016.The distribution of pathogenic bacteria and drug resistance were analyzed retrospectively.RESULTS:Among 148 patients with oral infection,275 clinical specimens were detected,including 209 positive specimens with positive rate of 76.00％.A total of 332 pathogenic bacteria were detected,including 85 Gram-positive bacteria (25.60％) and 247 Gram-negative bacteria (74.40％).Top 7 isolated bacteria in the list of quantity were Actinobacillus pleuropneumoniae (54 strains,16.27％),Porphyromonas gingivalis (41 strains,12.35 ％),Tannerella forsythia (37 strains,11.14 ％),Streptococcus oralis (33 strains,9.94％),Klebsiella pneumoniae (30 strains,9.04％),Staphylococcus aureus (26 strains,7.83％) and Pseudomonas aeruginosa (25 strains,7.53％).Resistance rates of S.aureus to penicillin G,gentamicin,ciprofloxacin,oxacillin and tetracycline were all in high level (resistance rate＞50％),but it was sensitive to vancomycin and teicoplanin (resistance rate of 0).Enterococcus faecalis showed high resistance to penicillin G,erythromycin and oxacillin (resistant rate＞50％),but was sensitive to vancomycin and rifampicin (resistant rate of 0).K.Pneumoniae showed high resistance to gentamicin,ciprofloxacin,levofloxacin and cefazolin (resistant rate＞ 50％),but was sensitive to imipenem,ceftazidime,cefepime,ampicillin sodium and sulbactarn sodium,amoxicillin and clavulanate potassium (resistant rate＜ 10 ％).Resistant rates of P aeruginosa to gentamicin and levofloxacin were ≥ 80 ％,but it was sensitive to aztreonam (resistant rate of 8.00 ％).Resistant rate of Escherichia coli to piperacillin was 84.21％,but it was sensitive to imipenem and ampicillin sodium and sulbactam sodium (resistance rate of 5.26％).CONCLUSIONS:After orthodontic treatment,the pathogens of oral infection are various,mainly Gram-negative bacteria,and their drug resistance is not optimistic.The drugs with high sensitivity to the main pathogens include vancomycin,imipenem and enzyme inhibitor complex preparations,etc.Clinical attention should be paid to the cultivation of pathogenic bacteria and drag sensitivity test;according to the results of drug sensitivity test,targeted antibiotics should be selected to improve the antibacterial effect and delay the emergence of drug-resistant bacteria.

Effect of strengthening use of alkaline mouthwash in preventing of oral infection in patients with fever / 中国实用护理杂志

Objective To compare the different ways of alkaline mouthwash slobber use in preventing the oral infection in patients with fever. Methods The patients who satisfied the requirements were involved and randomly divided into A, B and C group. A group did not use alkaline mouthwash; B group prescribed alkaline mouthwash slobber following the doctor's advice; C group received propaganda and demonstration of intensive use of the alkaline mouthwash, and then used the slobber in right way under the surveillance of nurses. The infection rates of oral ulcer and oral leukoplakia were compared and analyzed among the three groups. Results The incidence rates of oral ulcer and oral leukoplakia gradually decreased among the three groups and the differences had statistical significance (χ2=9.243,P=0.010;χ2=6.495,P=0.033).Compared with A group, there was no significant differences in the rates of oral ulcers and oral leukoplakia between Group A and B(OR=0.486, 95%CI:0.113-2.087;OR=0.557, 95%CI: 0.120-2.583), but the incidence rates of oral ulcers and oral leukoplakia gradually decreased(OR=0.024, 95%CI:0.002-0.293;OR=0.036, 95%CI:0.003-0.448)in C group. Conclusions Strengthening use of alkaline mouthwash slobber is more effective in preventing oral infection in patients with fever compared with the routine way of mouthwash use.

Direct economic loss due to oral infection in acute leukemia patients / 中国感染控制杂志

Objective To investigate the direct economic loss caused by oral infection in patients with acute leuke-mia.Methods Acute leukemia patients with oral infection in a tertiary first-class hospital in Shandong Province be-tween January 2011 and December 2013 were investigated,the 1 :1 matched case-control method was used for com-paring hospitalization expense and length of hospital stay between oral infected (case group)and uninfected patients (control group ).Results A total of 994 patients with acute leukemia were monitored,277 had healthcare-associated infection,17 (5.56%)of whom were with oral infection.The median hospitalization expense of patients in case group and control group was￥37 327 and￥13 176 respectively,the total hospitalization expense of patients in case group was 2.83 times more than control group,difference was statistically significant (Z = -3.621 ,P <0.001).Each hospitalization expense of case group was higher than control group,especially expense for medicine, blood transfusion,laboratory examination,and therapy.The median length of hospital stay in case group and con-trol group were 17 days and 11 days respectively,rank sum test showed that difference in median length of hospital stay between two groups was statistically significant (Z =-3.627,P < 0.001 ).Conclusion Acute leukemia pa-tients with oral infection have increased hospitalization expense,prolonged length of hospital stay,and increased the financial burden.

Susceptibility of Aedes flavopictus miyarai and Aedes galloisi mosquito species in Japan to dengue type 2 virus

Objective: To evaluate the potential of local mosquitoes to act as vectors for dengue transmission in Japan. Methods: Serotype 2 ThNH28/93 was used to test the dengue susceptibility profiles of Aedes flavopictus miyarai (Ae. f. miyarai), Aedes galloisi (Ae. galloisi) and Aedes albopictus (Ae. albopictus), which were collected in Japan. We used Aedes aegypti from Thailand as a positive control. The mosquitoes were infected with the virus intrathoracically or orally. At 10 or 14 days post infection, the mosquitoes were dissected and total RNA was extracted from their abdomens, thoraxes, heads and legs. Mosquito susceptibility to dengue virus was evaluated using RT-PCR with dengue virus-specific primers. Differences in the infection and mortality rates of the different mosquito species were tested using Fisher's exact probability test. Results: The infection rates for dengue virus administered intrathoracically to Ae. f. miyarai, Ae. galloisi and Aedes aegypti mosquitoes were identical by RT-PCR on Day 10 post infection. All of the body parts we tested were RT-PCR-positive for dengue virus. For the orally admin-istered virus, the infection rates in the different body parts of the Ae. f. miyarai mosquitoes were slightly higher than those of Ae. albopictus mosquitoes, but were similar to the control mosquitoes (P>0.05). The mortality rates for Ae. f. miyarai and Ae. albopictus mosquitoes were similar (P=0.19). Our data indicated that dengue virus was able to replicate and disseminate to secondary infection sites in all of the four mosquito species (Japanese and Thai). Conclusions: Ae. albopictus is a well-known candidate for dengue transmission in Japan. However, our data suggest that Ae. f. miyarai from Ishigaki Island (near Okinawa Island) and Ae. galloisi from Hokkaido (Northern Japan) should also be regarded as potential vectors for dengue transmission in these regions. Further studies on these mosquitoes should be conducted.

Susceptibility of Aedes flavopictus miyarai and Aedes galloisi mosquito species in Japan to dengue type 2 virus

Objective: To evaluate the potential of local mosquitoes to act as vectors for dengue transmission in Japan. Methods: Serotype 2 ThNH28/93 was used to test the dengue susceptibility profiles of Aedes flavopictus miyarai (Ae. f. miyarai), Aedes galloisi (Ae. galloisi) and Aedes albopictus (Ae. albopictus), which were collected in Japan. We used Aedes aegypti from Thailand as a positive control. The mosquitoes were infected with the virus intrathoracically or orally. At 10 or 14 days post infection, the mosquitoes were dissected and total RNA was extracted from their abdomens, thoraxes, heads and legs. Mosquito susceptibility to dengue virus was evaluated using RT-PCR with dengue virus-specific primers. Differences in the infection and mortality rates of the different mosquito species were tested using Fisher's exact probability test. Results: The infection rates for dengue virus administered intrathoracically to Ae. f. miyarai, Ae. galloisi and Aedes aegypti mosquitoes were identical by RT-PCR on Day 10 post infection. All of the body parts we tested were RT-PCR-positive for dengue virus. For the orally administered virus, the infection rates in the different body parts of the Ae. f. miyarai mosquitoes were slightly higher than those of Ae. albopictus mosquitoes, but were similar to the control mosquitoes (P > 0.05). The mortality rates for Ae. f. miyarai and Ae. albopictus mosquitoes were similar (P = 0.19). Our data indicated that dengue virus was able to replicate and disseminate to secondary infection sites in all of the four mosquito species (Japanese and Thai). Conclusions: Ae. albopictus is a well-known candidate for dengue transmission in Japan. However, our data suggest that Ae. f. miyarai from Ishigaki Island (near Okinawa Island) and Ae. galloisi from Hokkaido (Northern Japan) should also be regarded as potential vectors for dengue transmission in these regions. Further studies on these mosquitoes should be conducted.

A quitosana como biomaterial odontológico: estado da arte / Chitosan as a dental biomaterial: state of the art

A impossibilidade de erradicar completamente os microrganismos da cavidade oral ou dos canais radiculares estimula a procura de novos materiais que permitam cada vez mais eficazmente, controlar ou prevenir o aparecimento de infeções. A quitosana é um biopolímero com uma estrutura química e características únicas que permitem que apresente excelente biocompatibilidade e que seja facilmente processado. A panóplia de aplicações é tão fascinante como ainda mal conhecida. A constatação do potencial e do valor industrial deste biopolímero conduziu à sua utilização em muitas aplicações de interesse tecnológico e, de uma forma acentuada, na área biomédica. As suas propriedades anti-oxidantes, anti-microbianas, anti-inflamatórias, cicatrizante e de inibição da formação de biofilmes tornam a sua aplicação na odontologia particularmente interessante. Com este trabalho pretendeu-se rever a literatura existente sobre aplicações da quitosana na área odontológica.

The impossibility to completely eradicate the microorganisms from the oral cavity or from root canals has stimulated the search for new materials that efficiently prevent infections. Chitosan is a biopolymer with a unique chemical structure that renders it with outstanding biocompatibility and easy processing characteristics. The array of applications available is fascinating, as well as poorly understood. The industrial possibilities led to its use in several applications of varied technological interests, and especially in the biomedical area. Furthermore, its anti-oxidant, anti-microbial, anti-inflammatory, wound healing and biofilm inhibiting properties make it especially attractive to be used in the odontological arena. In this review, we address the state of the art on chitosan-based applications for odontology.

Oral coinfection can stress peripheral lymphocyte to inflammatory activity in leprosy

INTRODUCTION: This study evaluated the intracellular profile of interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10) and interferon-γ (IFN-γ) in peripheral blood mononuclear cells (PBMCs) from leprosy patients based on oral infections presence to determine whether these coinfections could be associated with pro-inflammatory activity in leprosy. METHODS:Leprosy patients regardless of clinical form and specific leprosy treatment (n=38) were divided into two groups: Group I - leprosy patients with oral infections (n=19), and Group II - leprosy patients without oral infections (n=19). Non-leprosy patients presenting oral infections were assigned to the control Group (n=10). Intracellular IL-2, IL-4, IL-10 and IFN-γ production was evaluated by flow cytometry (FACS) before and 7 days after controlling the oral infection in the Group I, before and 7 days after dental prophylaxis in the Group II, and during oral infection process in control Group. RESULTS: Low percentages of CD3+ lymphocytes bearing IL-2, IL-10 and IFN-γ were observed in the Group I and Group II at baseline and 7 days after therapy or prophylaxis compared to controls. Group I showed reduced percentages of IL-4 at baseline and 7 days after therapy compared to controls, or at baseline of Group II, and the Group II showed reduced percentages of CD3+ cells bearing IL-4 compared to control. An increase of the percentages of CD3+cells bearing IL-4 was observed in the Group I after the oral infections treatment. CONCLUSIONS: The occurrence of oral infections favors the intracellular cytokines expression and, probably, the inflammatory reaction operating as a stimulatory signal triggering the leprosy reactions.

Post-operative oral care procedure for patients with oral cavity cancer / 中华临床感染病杂志

Objective To establish an effective post-operative oral care procedure for patients with oral cavity cancer.Methods Eighty five post-operational patients with oral cavity cancer admitted to Sichuan Cancer Hospital during March 2011 and March 2013 were randomly divided into control group (42cases) and study group (43 cases).Patients in control group were given routine oral care,and those in study group received a special care procedure:normal saline washing + dioxogen cleaning + normal saline washing + normal saline gargle.Oral cleanliness,oral and lung infections were observed in both groups,and SPSS 17.0 was used for statistical analysis.Results Oral cleanliness,rates of oral infection and lung infection at d3 after operation,time of infections,the delayed wound healing and operating comfort were improved in the study group (Z/t/x2 =-2.48,4.57,4.64,2.36,2.25,-2.51,4.18,respectively; all P ＜ 0.05).Conclusion The oral care procedure containing normal saline washing + dioxogen cleaning +normal saline washing + normal saline gargle can improve oral cleanliness early after operation,reduce complications and increase the operating comfort.

Destructive Intestinal Translocation of Vibrio vulnificus Determines Successful Oral Infection

Vibrio vulnificus causes primary septicemia as a result of the consumption of contaminated seafood. The intestinal epithelial layer is the first host barrier encountered by V. vulnificus upon oral intake; however, epithelial translocation (invasion) of V. vulnificus has not been extensively studied. In this study, we investigated in vivo translocation of V. vulnificus using clinical (CMCP6) and environmental isolates (96-11-17M). And we analyzed physiological changes of intestinal epithelium concurrent with bacterial translocation by using polarized HCA-7 transwell culture system. The efficiency of epithelial translocation of 97-11-17M strains was significantly lower than that of pathogenic clinical isolate CMCP6 in a murine ligated ileal loop model. In an oral infection model, the survival rate was reciprocally related with efficacy of in vivo epithelial translocation. These results indicate that efficient translocation of V. vulnificus through intestinal epithelium is highly correlated with successful oral infection. We determined translocation of the bacteria from upper to lower chamber, changes of transepithelial electric resistance (TER) and cytotoxicity of the polarized HCA-7 cells to understand general features of V. vulnificus invasion. Bacterial translocation was accompanied by big decrease of TER (about 90%) and about 50% cytotoxicity of the epithelial cells. Taken together, these results indicate that V. vulnificus actively translocates the epithelium by destruction of epithelium and the efficiency of intestinal invasion by V. vulnificus is critical for successful oral infection. From this result, it is suggested that integrity of intestinal barrier is an important factor for susceptibility to oral infection of V. vulnificus.

Leprosy reactions: coinfections as a possible risk factor

OBJECTIVE: This study aimed to determine the frequency of coinfections in leprosy patients and whether there is a relationship between the presence of coinfections and the development of leprosy reactional episodes. METHOD: A cross-sectional study based on an analysis of the medical records of the patients who were treated at the Leprosy Clinics of the Ribeirão Preto Medical School, University of São Paulo, was conducted from 2000 to 2010. Information was recorded regarding the age, sex, clinical status, WHO classification, treatment, presence of reactions and coinfections. Focal and systemic infections were diagnosed based on the history, physical examination, and laboratory tests. Multinomial logistic regression was used to evaluate the associations between the leprosy reactions and the patients' gender, age, WHO classification and coinfections. RESULTS: Two hundred twenty-five patients were studied. Most of these patients were males (155/225 = 68.8%) of an average age of 49.31±15.92 years, and the most prevalent clinical manifestation was the multibacillary (MB) form (n = 146), followed by the paucibacillary (PB) form (n = 79). Erythema nodosum leprosum (ENL) was more prevalent (78/122 = 63.9%) than the reversal reaction (RR) (44/122 = 36.1%), especially in the MB patients (OR 5.07; CI 2.86-8.99; p<0.0001) who exhibited coinfections (OR 2.26; CI 1.56-3.27; p,<0.0001). Eighty-eight (88/225 = 39.1%) patients exhibited coinfections. Oral coinfections were the most prevalent (40/88 = 45.5%), followed by urinary tract infections (17/88 = 19.3%), sinusopathy (6/88 = 6.8%), hepatitis C (6/88 = 6.8%), and hepatitis B (6/88 = 6.8%). CONCLUSIONS: Coinfections may be involved in the development and maintenance of leprosy reactions.

Antimicrobial and Antiinflammatory Potential of the Swedish Herbs Extract.

Oral conditions that produce the greatest damage on individuals are cavities and periodontal disease, hence non-expensive and effective solutions are immediately required, particularly for communities with no access to dental services. The antimicrobial and anti-inflammatory potential of the Swedish bitter herbal extract was evaluated, using pure microbial cultures and clinical samples of 29 patients. It was observed that the extract caused significant (p<0.05) in vitro growth inhibition of up to 29%, 17%, 15%, and 50% against Prevotella intermedia, Bacteroides forsythus, Porphyromonas gingivalis and Streptococcus intermedius, respectively. In addition, the extract significantly (p<0.05) inhibited oral flora growth in patient samples showing MICs of < 7.8 μg/ml in 21% of the patients, 15.6μg/ml in 17% of the patients, 31.2 μg/ml in 10% of the patients, 62.5 μg/ml in 17% of the patients, 125 μg/ml in 3% of the patients, and 250 μg/ml in 7% of the patients, and induced a maximum of 75% growth inhibition, as measured by the MTT reduction assay. The extract was also observed to significantly suppress production of the inflammatory marker nitric oxide by LPS-treated murine peritoneal macrophages. The Swedish herbal extract may be considered in the clinics to prevent or treat bacterial oral infections and at the same time reducing inflammation.

Could leprosy reaction episodes be exacerbated by oral infections? / Episódios reacionais da hanseníase podem ser exacerbados por infecções orais?

INTRODUCTION: This study evaluated whether leprosy reactions could be associated with oral infection. METHODS: Leprosy patients (n = 38) with (Group I) and without (Group II) oral infections were selected. Reactions were identified from the clinical and histopathological features associated with serum C-reactive protein (CRP) and10kDa interferon-gamma-induced protein (IP-10) levels, determined before and after elimination of the foci of infection. RESULTS: Group I presented more reactions than group II did, and improvement of the reactions after dental treatment. Serum CRP and IP-10 did not differ before and after the dental treatment, but differed between the groups. CONCLUSIONS: Oral infection could be an exacerbating factor in leprosy reactions.

INTRODUÇÃO: Este estudo avaliou se as reações hansênicas podem estar associadas a infecções orais. MÉTODOS: Pacientes com hanseníase (n=38) com (Grupo I) e sem (Grupo II) infecções orais foram selecionados. As reações foram identificadas pelas características clínicas, histopatológicas, associadas a proteína-C-reativa (PCR) e proteína indutora de interferon-gamma de 10kDa (IP-10) séricos determinados antes e após a eliminação dos focos de infecção. RESULTADOS: Grupo I apresentou mais reações que o grupo II, e melhora das reações após o tratamento odontológico. PCR e IP-10 séricos não diferiram antes e após o tratamento odontológico, entretanto diferiram entre os grupos. CONCLUSÕES: As infecções orais podem ser exacerbadores das reações hansênicas.

Helicobacter pylori detection in gastric biopsies, saliva and dental plaque of Brazilian dyspeptic patients

Helicobacter pylori is an important human pathogen that causes chronic gastritis and is associated with the development of peptic ulcer disease and gastric malignancies. The oral cavity has been implicated as a potential H. pylori reservoir and may therefore be involved in the reinfection of the stomach, which can sometimes occur following treatment of an H. pylori infection. The objectives of this paper were (i) to determine the presence of H. pylori in the oral cavity and (ii) to examine the relationship between oral H. pylori and subsequent gastritis. Gastric biopsies, saliva samples and dental plaques were obtained from 78 dyspeptic adults. DNA was extracted and evaluated for the presence of H. pylori using polymerase chain reaction and Southern blotting methods. Persons with gastritis were frequently positive for H. pylori in their stomachs (p < 0.0001) and there was a statistically significant correlation between the presence of H. pylori in gastric biopsies and the oral cavity (p < 0.0001). Our results suggest a relationship between gastric infection and the presence of this bacterium in the oral cavity. Despite this, H. pylori were present in the oral cavity with variable distribution between saliva and dental plaques, suggesting the existence of a reservoir for the species and a potential association with gastric reinfection.

The recurrence of leprosy reactional episodes could be associated with oral chronic infections and expression of serum IL-1, TNF-á, IL-6, IFN-ã and IL-10

The aim of this study was to determine whether the presence of leprosy reactional episodes could be associated with chronic oral infection. Thirty-eight leprosy patients were selected and divided into 2 groups: group I - 19 leprosy patients with oral infections, and group II - 19 leprosy patients without oral infections. Ten patients without leprosy, but presenting oral infections, were assigned to the control group. Leprosy patients were classified according to Ridley and Jopling classification and reactional episodes of the erythema nodosum type or reversal reaction were identified by clinical and histopathological features associated with serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels. These analyses were performed immediately before and 7 days after the oral infection elimination. Patients from group I presenting oral infections reported clinical improvement of the symptoms of reactional episodes after dental treatment. Serum IL-1, TNF-?, IL-6, IFN-? and IL-10 levels did not differ significantly before and after dental treatment as determined by the Wilcoxon test (p>0.05). Comparison of the 2 groups showed statistically significant differences in IL-1 and IL-6 at baseline and in IL-1, IL-6 and IL-10 on the occasion of both collections 7 days after therapy. Serum IL-6 and IL-10 levels in group I differed significantly at baseline compared to control (Mann-Whitney test; p<0.05). These results suggest that oral infection could be involved as a maintenance factor in the pathogenesis of leprosy reactional episodes.

O objetivo deste estudo foi determinar se os episódios reacionais da hanseníase podem estar associados a infecções orais crônicas. Trinta e oito pacientes com hanseníase foram selecionados e divididos em dois grupos: grupo I & 19 pacientes com hanseníase apresentando infecções orais, e grupo II & 19 pacientes com hanseníase sem infecções orais. Os pacientes foram classificados, quanto à forma clínica da doença, de acordo com Ridley and Jopling, e os episódios reacionais, tipo eritema nodoso e reação reversa, foram identificados pelas características clínicas, histopatológicas associadas à quantificação no soro de IL-1, TNF-?, IL-6, IFN-? e IL-10. Estas analises foram realizadas imediatamente antes e 7 dias após a resolução dos focos de infecção. Pacientes do grupo I aprentando infecções orais relataram melhora clínica dos sintomas dos episódios reacionais após o tratamento odontológico. Os níveis séricos de IL-1, TNF-?, IL-6, IFN-? e IL-10 não diferiram significantemente antes e após o tratamento odontológico, como determinado pelo teste Wilcoxon (p>0,05). As comparações entre os grupos mostrou diferenças estatisticamente significantes nos níveis de IL-1 e IL-6 na coleta inicial e nos níveis de IL-1, IL-6 e IL-10 nas duas coletas 7 dias após o tratamento (teste Mann-Whitney; p<0,05). Estes resultados sugerem que infecções orais estão envolvidas na patogênese dos episódios reacionais da hanseníase, como fatores mantenedores.

Molecular mechanisms of Trypanosoma cruzi infection by oral route

Frequent reports on outbreaks of acute Chagas' disease by ingestion of food contaminated with parasites from triatomine insects illustrate the importance of this mode of transmission. Studies on oral Trypanosoma cruzi infection in mice have indicated that metacyclic trypomastigotes invade the gastric mucosal epithelium. A key molecule in this process is gp82, a stage-specific surface glycoprotein that binds to both gastric mucin and to target epithelial cells. By triggering Ca2+ signalling, gp82 promotes parasite internalisation. Gp82 is relatively resistant to peptic digestion at acidic pH, thus preserving the properties critical for oral infection. The infection process is also influenced by gp90, a metacyclic stage-specific molecule that negatively regulates the invasion process. T. cruzi strains expressing high gp90 levels invade cells poorly in vitro. However, their infectivity by oral route varies considerably due to varying susceptibilities of different gp90 isoforms to peptic digestion. Parasites expressing pepsin-susceptible gp90 become highly invasive against target cells upon contact with gastric juice. Such is the case of a T. cruzi isolate from an acute case of orally acquired Chagas' disease; the gp90 from this strain is extensively degraded upon short period of parasite permanence in the gastric milieu. If such an exacerbation of infectivity occurs in humans, it may be responsible for the severity of Chagas' disease reported in outbreaks of oral infection.