Association of Entamoeba gingivalis with Periodontal Disease-Systematic Review and Meta-Analysis.

The oral cavity is a habitat to a diverse range of organisms that make up an essential element of the human microbiota. There are up to 1000 species of micro-organisms capable of colonizing the mouth. Thirty percent of them are uncultivable. The genus Entamoeba includes several species, out of which at least seven of them are able to inhabit the human body (Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, Entamoeba coli, Entamoeba polecki, Entamoeba hartmann, Entamoeba gingivalis). It was shown that only E. gingivalis is able to colonize the oral cavity. The aim of this study was to evaluate the association and prevalence of E. gingivalis in periodontal disease using two electronic database search engines. In order to have a broader view of the subject, a comprehensive manual search was conducted between 15th February 2023 and 1 April 2023 on these content aggregators and the initial search resulted in 277 articles using the keywords "E. gingivalis", "periodontitis", "E. gingivalis", "periodontal disease", "prevalence", and "incidence", in different combinations. The results showed that 755 patients were infected with E. gingivalis out of a total number of 1729 patients diagnosed with periodontal disease, indicating a global prevalence of 43% in the set of patients analyzed. E. gingivalis was prevalent in 58% of the patients that had gingivitis and in 44% of the patients with periodontitis. Prevalence of E. gingivalis based on gender was 43% in female patients and 47% in male patients. The results indicate that the higher incidence of E. gingivalis in people with periodontal disease compared to healthy people is more than just a sign of the disease; it could also be linked to the severity of the condition and the disease propensity to progress.

A new subtype of Entamoeba gingivalis: "E. gingivalis ST2, kamaktli variant".

Entamoeba gingivalis is a protozoan that resides in the oral cavity. Using molecular biology techniques, we identified a novel organism that shares the same ecological niche as E. gingivalis. To differentiate this organism from E. gingivalis, we named it "kamaktli variant." By sequencing the 18S-ITS1-5.8S-ITS2 rRNA region, we demonstrated that kamaktli variant is 89% identical to E. gingivalis. To elucidate the relationship between kamaktli variant and E. gingivalis, we performed a phylogenetic analysis. Both taxa clustered in the same clade with high support, indicating that the amoebas are closely related (98/99/1.00, maximum parsimony/maximum likelihood/MrBayes, respectively). Given this information, we propose that these molecular differences between kamaktli variant and E. gingivalis ST1 are sufficient to distinguish them as independent subtypes, and we name the new subtype "E. gingivalis ST2, kamaktli variant."

Prevalence of two Entamoeba gingivalis ST1 and ST2-kamaktli subtypes in the human oral cavity under various conditions.

Advances in molecular biology have facilitated analyses of the oral microbiome; however, the parasites role is poorly understood. Periodontal disease is a multifactorial process involving complex interactions among microorganisms, the host, and environmental factors. At present, the precise composition of the mouth parasites microbiota is unclear. Two protozoan species have been detected in the oral microbiota: Trichomonas tenax and Entamoeba gingivalis, and a new variant, E. gingivalis-ST2-kamaktli, was recently identified by us. In this study, both E. gingivalis and the new E. gingivalis-ST2-kamaktli variant were detected in the oral cavities of people with healthy periodontium, individuals undergoing orthodontic treatment, and patients with periodontal disease. In the group with healthy periodontium, the prevalence of E. gingivalis-ST1 was 48.6% and that of E. gingivalis-ST2-kamaktli 29.5%, with a combined prevalence of 54.3%. In patients undergoing orthodontics treatment, 81.2% carried both amoebas, with 47.5% having E. gingivalis-ST1 and 73.8% E. gingivalis-ST2-kamaktli. In people with periodontal disease, the prevalence of E. gingivalis-ST1 was 57.8%, and that of E. gingivalis-ST2-kamaktli 50.0%, with a combined prevalence of 73.5%; hence, E. gingivalis-ST1 and E gingivalis-ST2-kamaktli were detected in all three groups. The question arises, what are E. gingivalis-ST1 and E. gingivalis-ST2-kamaktli doing in the oral cavity? Although, the answer remains unclear, our results suggest that each amoeba subtype is genetically distinct, and they exhibit different patterns of infectious behavior. We hypothesize that E. gingivalis-ST1 and E. gingivalis-ST2-kamaktli may represent separate species. Our data contribute to better understanding of the roles of E. gingivalis-ST1 and E. gingivalis-ST2-kamaktli in the oral microbiota.

The Prevalence of Canine Oral Protozoa and Their Association with Periodontal Disease.

Periodontal disease is one of the most important health concerns for companion animals. Research into canine forms of periodontitis has focused on the identification and characterization of the bacterial communities present. However, other microorganisms are known to inhabit the oral cavity and could also influence the disease process. A novel, broad spectrum 18S PCR was developed and used, in conjunction with next-generation sequencing analyses to target the identification of protists. Trichomonas sp. and Entamoeba sp. were identified from 92 samples of canine plaque. The overall prevalence of trichomonads was 56.52% (52/92) and entamoebae was 4.34% (4/92). Next-generation sequencing of pooled healthy, gingivitis, early-stage periodontitis, and severe periodontitis samples revealed the proportion of trichomonad sequences to be 3.51% (health), 2.84% (gingivitis), 6.07% (early periodontitis), and 35.04% (severe periodontitis), respectively, and entamoebae to be 0.01% (health), 0.01% (gingivitis), 0.80% (early-stage periodontitis), and 7.91% (severe periodontitis) respectively. Both genera of protists were statistically associated with plaque from dogs with periodontal disease. These findings provide the first conclusive evidence for the presence of oral protozoa in dog plaque and suggest a possible role for protozoa in the periodontal disease process.

Endoparasite survey of free-swimming baleen whales (Balaenoptera musculus, B. physalus, B. borealis) and sperm whales (Physeter macrocephalus) using non/minimally invasive methods.

A number of parasitic diseases have gained importance as neozoan opportunistic infections in the marine environment. Here, we report on the gastrointestinal endoparasite fauna of three baleen whale species and one toothed whale: blue (Balaenoptera musculus), fin (Balaenoptera physalus), and sei whales (Balaenoptera borealis) and sperm whales (Physeter macrocephalus) from the Azores Islands, Portugal. In total, 17 individual whale fecal samples [n = 10 (B. physalus); n = 4 (P. macrocephalus); n = 2 (B. musculus); n = 1 (B. borealis)] were collected from free-swimming animals as part of ongoing studies on behavioral ecology. Furthermore, skin biopsies were collected from sperm whales (n = 5) using minimally invasive biopsy darting and tested for the presence of Toxoplasma gondii, Neospora caninum, and Besnoitia besnoiti DNA via PCR. Overall, more than ten taxa were detected in whale fecal samples. Within protozoan parasites, Entamoeba spp. occurred most frequently (64.7%), followed by Giardia spp. (17.6%) and Balantidium spp. (5.9%). The most prevalent metazoan parasites were Ascaridida indet. spp. (41.2%), followed by trematodes (17.7%), acanthocephalan spp., strongyles (11.8%), Diphyllobotrium spp. (5.9%), and spirurids (5.9%). Helminths were mainly found in sperm whales, while enteric protozoan parasites were exclusively detected in baleen whales, which might be related to dietary differences. No T. gondii, N. caninum, or B. besnoiti DNA was detected in any skin sample. This is the first record on Giardia and Balantidium infections in large baleen whales.

Prevalence, socio-economic, and associated risk factors of oral cavity parasites in children with intellectual disability from Lorestan province, Iran.

Introduction: Children with intellectual disability (ID) often face challenges in maintaining proper oral hygiene due to their motor, sensory, and intellectual impairments, which can lead to compromised oral health; therefore, there is a need to enhance the oral health status of these populations and establish an effective system for administering preventive interventions. Here, we aimed to evaluate the prevalence of Entamoeba gingivalis and Trichomonas tenax among children with ID in Lorestan province, in Western Iran through parasitological and molecular methods. Methods: The current descriptive investigation involved 215 in children with ID and 215 healthy children (non-ID) who were referred to health facilities in Lorestan province, Iran between October 2022 and March 2024. The prevalence of protozoa in the oral cavity was found through the utilization of both microscopic analysis and conventional polymerase chain reaction (PCR) techniques. Results: The total prevalence of the E. gingivalis and T. tenax in children with ID was found to be 87 (40.5%) and 92 (42.8%) through microscopic and PCR methods, respectively. Among the positive samples, 57 (61.9%) and 35 (38.1%) children tested positive for E. gingivalis and T. tenax, respectively. In contrast, among the 215 non-ID children in the control group, 39 (18.1%) and 42 (19.5%) tested positive by microscopic and PCR methods, respectively. Among positive samples in non-ID children, 23 (54.7%) and 19 (45.3%) children were positive for E. gingivalis and T. tenax, respectively. Multiple logistic regression analysis indicated that residing in urban areas, parental education, monthly family income, and tooth brushing p<0.001) were identified as independent risk factors for oral cavity parasites. Conclusion: This study identified a notable prevalence of oral cavity parasites in children with ID in Lorestan province, Western Iran. It is imperative to recognize the primary risk factors associated with these parasites, particularly inadequate teeth brushing, in order to enhance public and oral health strategies for children with ID. Therefore, pediatric dental professionals should remain vigilant regarding these risk factors to effectively recognize and address oral health issues in this population, thereby mitigating the occurrence of oral diseases and infections.

Use of PCR to detect Entamoeba gingivalis in diseased gingival pockets and demonstrate its absence in healthy gingival sites.

Investigators using light microscopy have identified the protozoan parasite Entamoeba gingivalis from diseased gingival pockets for nearly 100 years. The objective of the present investigation was to develop a molecular biology approach for determining the presence of E. gingivalis in both diseased gingival pockets and healthy gingival sites. For this, a previously developed conventional polymerase chain reaction (PCR) was evaluated and a real-time polymerase chain reaction assay was developed. Paper points were inserted into the base of the sulcus of both diseased gingival pockets and healthy gingival sites. DNA was extracted using the QIAamp DNA mini kit, and subsequently analyzed using conventional and real-time PCR analysis. A previously described primer set specific for the small subunit ribosomal RNA gene (SSU rDNA) of E. gingivalis was used for the conventional PCR. For the real-time PCR, a primer set was designed to amplify a 135-bp fragment inside the SSU rDNA of E. gingivalis. A conventional PCR assay detected E. gingivalis in 27% of diseased gingival pockets. The real-time PCR using a different primer set detected protozoa in 69% of diseased pocket sites. Thus, the latter technique proved more sensitive for detection of E. gingivalis. No E. gingivalis were detected in any of the healthy gingival pocket sites using either type of PCR assay. Results support a concept that the presence of E. gingivalis is associated only with diseased gingival pocket sites. The newly described methodology may also serve to provide a novel eukaryotic cell marker of disease status in gingival pockets.

The first study to detect co-infection of Entamoeba gingivalis and periodontitis-associated bacteria in dental patients in Taiwan.

Periodontitis, an inflammatory disease of the oral cavity, was caused by microbes from bacteria to protozoa. In this study, we detected protozoa, Entamoeba gingivalis and other three common pathogenic bacteria, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia by the Polymerase chain reaction (PCR) on patients.

Response of the human gut and saliva microbiome to urbanization in Cameroon.

Urban populations from highly industrialized countries are characterized by a lower gut bacterial diversity as well as by changes in composition compared to rural populations from less industrialized countries. To unveil the mechanisms and factors leading to this diversity loss, it is necessary to identify the factors associated with urbanization-induced shifts at a smaller geographical scale, especially in less industrialized countries. To do so, we investigated potential associations between a variety of dietary, medical, parasitological and socio-cultural factors and the gut and saliva microbiomes of 147 individuals from three populations along an urbanization gradient in Cameroon. We found that the presence of Entamoeba sp., a commensal gut protozoan, followed by stool consistency, were major determinants of the gut microbiome diversity and composition. Interestingly, urban individuals have retained most of their gut eukaryotic and bacterial diversity despite significant changes in diet compared to the rural areas, suggesting that the loss of bacterial microbiome diversity observed in industrialized areas is likely associated with medication. Finally, we observed a weak positive correlation between the gut and the saliva microbiome diversity and composition, even though the saliva microbiome is mainly shaped by habitat-related factors.

[Entamoeba gingivalis infection among college students in Tangshan].

OBJECTIVE: To investigate the prevalence of Entamoeba gingivalis infection in college students in Tangshan, and analyze the relationship between the infection and human behaviors. METHODS: 551 students of grades 1-3 from six colleges in Tangshan received questionnairing, which covered the oral health state, teeth-brushing, xylitol gum-chewing, diet fondness, and smoking. Specimens were taken from the tooth surface of the lesion or fouling materials by using disinfected toothpicks and the smears were observed microscopically to examine Entamoeba gingivalis infection. RESULTS: The prevalence of Entamoeba gingivalis infection was 28.3% (156/551), 30.4% (55/181) and 24.6% in males and females (91/370) respectively (chi2=2.09, P>0.05). The prevalence in students with or without oral disorders was 41.2% (84/204) and 20.8% (72/347) respectively, with a significant statistical difference (chi2=26.41, P<0.01); it was 22.5% (53/236) and 32.7% (103/315) among students who cleaned their teeth regularly or irregularly (chi2=6.97, P<0.01); it was 18.3% (17/93) and 30.4% (139/458) among those usually with or without chewing xylitol gum (chi2=5.55, P<0.05). CONCLUSION: Entamoeba gingivalis infection is common in the college students in Tangshan and it has a close relation to the oral hygiene habits and the presence of oral disorders.

Development of a new TaqMan PCR assay for the detection of both Entamoeba gingivalis genotypes.

Entamoeba gingivalis is a parasitic protozoan found in the mouth of patients suffering from periodontitis, a widespread oral disease with an underestimated prevalence and major consequences on health. We present the development of the first TaqMan PCR assay targeting both E. gingivalis subtypes. This method has been evaluated on 50 samples from patients diagnosed with periodontitis in comparison with 2 different conventional PCRs, and a real-time SYBR Green PCR. Fifty percent of the samples were found positive for the E. gingivalis ST1 subtype with this new PCR, the SYBR Green PCR and one of the conventional PCRs. Among the 25 remaining samples, 12 (24%) were found positive for the E. gingivalis ST2 kamaktlii variant. This new TaqMan PCR could be used before and after periodontitis treatment to follow its efficacy and measure the parasite load in order to better understand the role of these parasites in oral diseases.

Case Report: Cervicovaginal Co-Colonization with Entamoeba gingivalis and Entamoeba polecki in Association with an Intrauterine Device.

Amoebic trophozoites were identified in the cervicovaginal smear of a U.S. patient without travel history at the time of intrauterine device (IUD) removal. Subsequent morphologic analysis and DNA sequencing identified a mixed cervicovaginal colonization of the female genital tract with both Entamoeba gingivalis and Entamoeba polecki in association with Actinomyces species bacteria. This highlights to the potential for colonization of the genital tract with E. gingivalis, particularly in association with IUD placement, and represents the first report of E. polecki in this context.

Comparative assessment of selected intraoral microorganisms ­ potential factors for peri-surgical management complications

In this research, a comparative analysis of results of investigations involving different human populations, in terms of a relation between the oral cavity health and the species composition of mouth microbiota is reported. The purpose of this analysis was to identify and assess microorganisms that could cause health complications in patients with neoplasm requiring dental problem-related surgical management. The patients with the oral cancer surgically treated and those without neoplasm were assessed for their oral health: status of teeth, gingiva, periodontium, and occurrence of inflammatory processes. From each patient, microorganisms isolated of periodontium, dental plaque, and dental pocket swabs were identified in wet and stained microscopic preparations; standard microbiology in vitro techniques were also applied to determine the fungal and bacterial strains. The comparative analysis of results of direct microscopic examinations and in vitro cultures assessment indicated significant differences in prevalences of fungi, parasitic oral protozoans and bacteriae in particular patient's groups. Yeast-like fungi belonging to Candida genus, mostly of C. albicans group, were identified in 93.75% patients with the oral cancer, while in 25% of individuals assessed without neoplasm. E. gingivalis amoebae were only found in 12.5% patients with the serious disease; no trichomonads were detected in all patients analyzed. Among bacteria species, potentially pathogenic Enterobacteriaceae were found in the patients with oral cancer. The pronounced shift in the microbiota species composition in the patients who needed prolonged treatment due to oral cavity cancer, compared to other generally healthy persons has been showed in this analysis.

Investigation of Entamoeba gingivalis and Trichomonas tenax in Periodontitis or Gingivitis Patients in Kayseri.

OBJECTIVE: The aim of this study was to determine the prevalence of Entamoeba gingivalis and Trichomonas tenax in periodontitis and gingivitis patients. METHODS: The study consisted of 107 periodontitis patients and 68 gingivitis patients. Bacterial plaque samples were collected with a curette from the deepest pocket in each quadrant and placed into separate tubes containing sterile 0.9% saline solution. Samples were examined at a magnification of ×400 by light microscopy. Cultivation for T. tenax was performed using the same samples, and the cultures were examined after 48 hours. RESULTS: E. gingivalis was present in the samples from 38 periodontitis patients, whereas T. tenax was present in samples from only 3 periodontitis patients. Both E. gingivalis and T. tenax were found together in the samples from 2 periodontitis patients. In total, 22 and 2 gingivitis patients were found to be infected with E. gingivalis and with T. tenax, respectively. Only 1 gingivitis patient was found to be infected with both E. gingivalis and T. tenax. CONCLUSION: In our study, oral protozoa were found in a high percentage in periodontitis and gingivitis patients. We believe that the prevalence of E. gingivalis and T. tenax should be determined via new studies and, in particular, the protection principles should be complied with.

Clinical survey of Entamoeba gingivalis by multiple sampling in patients with advanced periodontal disease.

A clinical survey of Entamoeba gingivalis was conducted in patients with advanced periodontal disease. A total of 100 specimens were taken from 10 patients (four females and six males) who were each sampled at 10 disto-facial random sites. The oral hygiene of the persons scored from good to fair to poor and very poor. The age of the test persons ranged from 20 to 68 years. All persons examined harbored E. gingivalis: the minimum prevalence was four sites positive out of 10 and the maximum prevalence was 10 sites positive out of 10 for the protozoan. It is recommended that for reliable testing of the presence of E. gingivalis at least five-10 different sites should be examined within the periodontium of each patient. Data reported earlier in the literature on the incidence of E. gingivalis--obtained after a single sampling per individual--are believed to be on average too low and, therefore, should be interpreted with caution.

Frequency of Entamoeba gingivalis in human gingival scrapings.

A survey was made of gingival scrapings stained by the Papanicolaou method to assess the occurrence of Entamoeba gingivalis, a nonpathogenic-oral amoeba. Positive findings were recorded in 59% of 113 dental patients, and 32% of 96 healthy controls. These figures showed no significant changes during the last 20 years when compared with data published in 1960 and 1963. The existence of E. gingivalis and its rare appearance in the sputum should be known to cytologists because of the morphologic resemblance to Entamoeba histolytica, a pathogenic amoeba. Morphologic features are described to differentiate E. gingivalis from similar structures found in sputum.

Amebae resembling Entamoeba gingivalis in the genital tracts of IUD users.

A total of 2,252 vaginopancervical (Fast) smears were studied as a continuation of an ongoing program to further investigate the occurrence of amebae in the genital tracts of women using intrauterine devices (IUDs). Of the 947 IUD users, 1% harbored trophic amebae. No amebae, however, were found in any of the 1,164 smears from non-IUD wearers. In all instances the amebae were associated with Actinomyces. Both organisms disappeared promptly after removal of the IUD. In preparations stained according to the Papanicolaou, iron-hematoxylin and Gomori-Wheatley trichrome methods, the amebae could be diagnosed as belonging to the genus Entamoeba. These trophozoites failed to stain with fluorescein-labeled anti-Entamoeba-histolytica serum. Although on the basis of the presently available evidence these trophozoites cannot be assigned with certainty to any known species, they appear to share many morphologic characteristics with Entamoeba gingivalis.

[Incidence, morphology and diagnostic studies of Entamoeba gingivalis, Gros, 1849]. / Estudos de freqüência, morfologia e diagnóstico de Entamoeba gingivalis, Gros, 1849.

Entamoeba gingivalis is found only in its trophozoite form and it is postulated that its main transmission mechanism is through the kiss. E. gingivalis is considered pathogenic by some authors and commensal to others. It does not have a defined role in the installation of disease. To address some of this questions we studied a 100 patients who were seen through the Odontological Hospital from the Universidade Federal de Uberlândia in order to determine its frequency in the buccal cavity. The material were collected using swabs from four different buccal sites and the smears were stained by a modified Papanicolaou technique. The results revealed positivity index of 62%. The affinity of the dye to the food vacuole contents and to the ingested bacterias prevents clear visualisation of the central and peripherical chromatin constituents of the parasite's nucleus. Mouth washes with 3ml of saline from 10 patients, were used to evaluate which parasitological method of diagnosis (fresh, iron-haematoxylin stained, Giemsa and Papanicolaou) gives better visualisation of the parasite. The mouth washes sediment from fresh material revealed 100% of positivity and clear visualisation of the free form and locomotion of the trophozoites. No stained technique of the smear showed adequate visualisation, presenting the nucleus partially covered by the food vacuoles. In stained preparations by toluidine blue ultrastructure analysis of the morphology of parasite can be observed.

[A copro-parasitological study on the wrestlers of the national team]. / Millî güresçiler üzerinde kopro - parazitolojik bir arastirma.

This copro-parasitological research was made on the 18 wrestlers of the national team in the Talas training camp in Kayseri, The majority of them came to our laboratory with gastro-intestinal complaint such as nausea colicky pains anorexia and dyspepsia and other complaints such as exhaustion and fatigue and 16 of them were found infested with one or more than one parasites. As a result of our coprologic examination finding parasites and their infection rate were: Entamoeba histolytica (50%), Entamoeba coli (16,6%), iodamoeba bütschlii (16,6%), Endolimax nana (11,1%), Giardia lamblia (11,1%), Enteromonas hominis (11,1%) Ascaris lumbricoides (5,5%) and Hymenolepis nana (5,5%). It has been indicated that, 11 of total wrestlers were found infected with one kind, 4 of them were found infected with two kinds and 1 was found infested with three kinds parasites.

[Morphology and diagnosis of the oral protozoans Trichomonas tenax and Entamoeba gingivalis using the Giemsa-Romanovsky stain]. / Morfológia a diagnostika ústnych prvokov Trichomonas tenax a Entamoeba gingivalis zafarbených podl'a Giemsu-Romanovského.

In the microscopic diagnosis of Trichomonas tenax and Entamoeba gingivalis is the technically and time not demanding native preparation of a culture, in which both protozoans can be detected according to their typical motility, determining. In the permanent preparation of the culture stained according to Giemsa-Romanovsky, which has also documentary character, are all of the characteristic cell organelles stainable, enabling so their detection without their typical motility. Staining according to Giemsa-Romanovsky is technically simple and not time consuming, not very laborious, low cost and the coloration is permanent, that means optimal for the diagnostic of oral protozoans in permanent preparations. (Fig. 5, Ref. 4.)