Aortic vascular graft infection caused by Cardiobacterium valvarum: a case report.

A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly.

Virulence of major periodontal pathogens and lack of humoral immune protection in a rat model of periodontal disease.

OBJECTIVE: This study was designed to test the hypothesis that periodontal pathogens Tannerella forsythia and Porphyromonas gingivalis are synergistic in terms of virulence potential using a model of mixed-microbial infection in rats. MATERIALS AND METHODS: Three groups of rats were infected orally with either T. forsythia or P. gingivalis in mono-bacterial infections or as mixed-microbial infections for 12 weeks and a sham-infected group were used as a control. This study examined bacterial infection, inflammation, immunity, and alveolar bone loss changes with disease progression. RESULTS: Tannerella forsythia and P. gingivalis genomic DNA was detected in microbial samples from infected rats by PCR indicating their colonization in the rat oral cavity. Primary infection induced significantly high IgG, IgG2b, IgG1, and IgG2a antibody levels indicating activation of mixed Th1 and Th2 immune responses. Rats infected with the mixed-microbial consortium exhibited significantly increased palatal horizontal and interproximal alveolar bone loss. Histological examinations indicated significant hyperplasia of the gingival epithelium with moderate inflammatory infiltration and apical migration of junctional epithelium. The results observed differ compared to uninfected controls. CONCLUSION: Our results indicated that T. forsythia and P. gingivalis exhibit virulence, but not virulence synergy, resulting in the immuno-inflammatory responses and lack of humoral immune protection during periodontitis in rats.

[Association between phenytoin-induced gingival hyperplasia and periodontopathic bacteria in institutionalized patients with severe motor and intellectual disabilities].

The association between phenytoin-induced gingival hyperplasia (PIGH) and five major periodontopathic bacteria was investigated by real-time PCR in 12 subjects (30.6 +/- 7.95 years of age) with severe motor and intellectual disabilities. The subjects had not received antibiotics or periodontal therapy within three months. A healthy gingival site or a site with the lowest gingival hyperplasia score (minimum site), and a site with the maximum score of gingival hyperplasia (maximum site) on each subject were selected for investigation. The clinical parameters were measured after microbial sampling. The following results were obtained: 1. The detection rates of both Treponema denticola and Porphyromonas gingivalis were 75% (9/12) at the maximum sites, and that of Tannerella forsythia was 33.3% (4/12). The detection rate of Prevotella intermedia was 58.3% (7/12), but no significant correlation was observed between this bacterium and the other types of bacteria in quantitative analysis. 2. The detection rate of P. gingivalis with type II fimA was 25% (1/4) at the minimum sites, and 83.3% (5/6) at the maximum sites. 3. The samples were divided into three groups; namely, those with no detection of P. gingivalis at either the minimum sites or the maximum sites, no detection at the minimum sites but detection at the maximum sites, and detection at both sites. In conclusion, 1) the detection rates of T. denticola and P. gingivalis were the highest at the maximum sites. In particular, the detection rate of P. gingivalis with type II fimA was high in the present study, and 2) the subgingival microflora was diverse because of the diverse severity of gingival inflammation associated with PIGH.

Molecular identification of an invasive gingival bacterial community.

A woman with neutropenia developed gingival hyperplasia. Biopsy showed invasion of gingival tissue with mats of filamentous organisms, and molecular analysis by polymerase chain reaction and fluorescence in situ hybridization revealed Capnocytophaga sputigena, Leptotrichia species, and Fusobacterium nucleatum. Oral bacterial flora may cause invasive gingival disease with hyperplasia in immunocompromised patients.

The subgingival microflora in phenytoin-induced gingival hyperplasia.

OBJECTIVES: Microbial flora and gingival conditions were compared between a group of patients with phenytoin-induced gingival hyperplasia as a test group, a control group of patients who were administered phenytoin without gingival hyperplasia and a blank group who took no phenytoin and no gingival hyperplasia in mentally retarded patients. MATERIALS AND METHODS: Subgingival plaque samples were collected from a PHT-induced overgrown gingival pocket and microbiological experiments were performed by culture and PCR methods. RESULTS: The predominant genera in total cultivable bacteria from subgingival plaque samples were streptococcus and actinomyces with recovery ranges of 37.6-42.1% and 23.4-25.5% of total bacteria, respectively, in all groups. The test group showed a significantly higher level of obligate Gram-negative rods than the control and blank groups. Black-pigmented obligate anaerobic Gram-negative rods were detected in 10.3% of total cultivable bacteria in the test group. The black-pigmented rods were predominantly Prevotella intermedia in the test group and Prevotella nigrescens in the control and blank groups. Porphyromonas gingivalis and Porphyromonas endodontalis were also detected in the test group with small values. CONCLUSIONS: These results suggested that black-pigmented rods, particularly P. intermedia, could be habitable in the environment of gingival hyperplasia.

Superinfecting microorganisms in patients under treatment with cyclosporin-A and its correlation to gingival overgrowth.

The aim of this study was to identify the presence of superinfecting microorganisms (Gram-negative enteric rods and Candida sp.) in heart transplant patients and correlate this with gingival overgrowth. Thirty patients (10 females, 20 males--mean age 45 years) were examined. All were under cyclosporin-A (CsA) therapy. Patients who had taken any antibiotics 3 months prior the study or had been submitted to periodontal therapy were not enrolled. Patients were required to have at least 6 teeth. The plaque index (PI), gingival index (GI), pocket depth (PD) and clinical attachment level (CAL) were recorded. Microbiological samples were taken from sulcus/pocket (s/p) and from stimulated saliva (ss) and submitted to analysis. Patients were divided into two groups: the ones with gingival overgrowth (GO) and those without gingival overgrowth (WGO). After statistical analysis (chi-square test, Student's t-test, Fisher test, p < or = 0.05), we concluded that there was no statistical difference between groups in the parameters of gender, CsA dosage, time since transplantation, PI, GI, PD and CAL. Gram-negative rods from either the sulcus/pocket or saliva samples were not found. Candida sp. was detected (s/p-30% and ss-30%). Stimulated saliva samples analysis determined that the presence of Candida sp. was associated with patients without gingival overgrowth.

Clinical and microbiological analysis of periodontally diseased sites after renal transplant.

This study compared the clinical and microbiological status of periodontally diseased sites in 42 patients who had a renal transplant and were undergoing immunosuppressive therapy (21 taking azathioprin and corticosteroids [Az-C] and 21 taking cyclosporin-A [Cy-A] with those of 21 systemically healthy matched controls. Probing pocket depth (PPD), bleeding on probing (BOP) and gingival hyperplasia (GH) were measured at 339 sites. Subgingival plaque samples were analyzed for the presence of Porphyromonas gingivalis, Treponema denticola and/or Bacteroides forsythus using the BANA test. Our findings suggest that immunosuppressed patients showed significantly less inflammation and fewer putative anaerobic pathogens using the BANA test, and that patients undergoing therapy with cyclosporin-A have a higher frequency of sites with gingival hyperplasia when compared with patients medicated with azathioprin or corticosteroids.

Oral manifestation of sporotrichosis in AIDS patients.

A wide spectrum of oral lesions has been associated with human immunodeficiency viral infection (HIV), or AIDS. This report describes the case of an HIV-infected patient who developed a case of disseminated sporotrichosis whose first clinical sign was the presence of orofacial lesions. A histopathological study of this patient's biopsy specimens taken from the oropharyngeal lesions revealed a number of rounded and/or oval free-spore forms of Sporothrix schenkii, the identification of which was corroborated by culturing skin lesion exudate on Sabouraud's glucose agar. To the best of our knowledge to date, this is the first time a case of the oral manifestation of sporotrichosis in association with HIV infection has been described in the dental literature.

Oral manifestations of cytomegalovirus infection.

Disease caused by cytomegalovirus is reported with increasing frequency. Cytomegalovirus is an important pathogen in immunocompromised and immunosuppressed patients. The most common manifestation of cytomegalovirus infection of the gastrointestinal tract including the oral mucosa is ulceration. The role of cytomegalovirus in xerostomia, Sjögren's syndrome, and Kaposi's sarcoma is continuing to be investigated. This article reviews the oral manifestations of cytomegalovirus, including recently reported oral manifestations.

[Clinical aspects of gingival hyperplasia]. / Die Klinik der Gingivahyperplasie.

This paper demonstrates the clinical variety of gingival enlargement. An increase of the number of individuals who suffer from local or general enlargement caused by microbial gingival inflammation or different drugs can be demonstrated. All imbalances of leukopoesis or homeostasis require particular diagnostic attention by dentists, because early diagnosis is decisive for patient prognosis.

Phenytoin-induced gingival overgrowth in rats infected with Streptococcus sobrinus 6715.

Inbred Fischer rats were fed a high sucrose diet (No. 2000) containing phenytoin (5,5-diphenyl-hydantoin) for 52 days, which produced serum and salivary PHT levels of 13-14 and 2.6-2.7 micrograms/ml, respectively. Gingival overgrowth was induced in the molar region of all PHT-treated rats but was more severe in Streptococcus sobrinus 6715-infected rats than in non-infected rats, which had lower plaque scores. No significant overgrowth was found in rats infected with Strep. sobrinus and fed the same diet without PHT. Thus dental plaque accumulation enhanced, but was not essential for the development of the PHT-induced gingival overgrowth. Histological examination showed that the density of fibroblasts and connective tissue fibres was similar in all groups. This experimental model could serve as a useful means of understanding the pathogenesis of PHT-induced gingival overgrowth.

Actinomycosis of the jaws. 2 case reports.

The diagnosis of actinomycosis is not always straightforward. It has been described as a masquerader, and 2 cases are presented which exemplify this. Their mode of presentation and natural history are contrasted.