Maxillary Osteomyelitis by Actinomyces in a Child / Osteomielitis Maxilar por Actinomyces en un Niño

ABSTRACT: Actinomycosis is a bacterial infection caused by Actinomyces species, which usually affect the soft tissues of the cervicofacial region of adult males. Clinically, it's characterized by a slow-growing indurated mass, especially in the submandibular area. However, in a few cases, the jaws bones can be affected developing osteomyelitis characteristics. The aim of this paper is to report a rare clinical case of Actinomycotic Osteomyelitis affecting the maxilla of a child, involving the maxillary sinus, orbital and zygomatic areas that was treated by the association of antibiotic therapy and surgical debridement. The patient's 2 years follow-up was uneventful and no signs of the lesion recurrence.

RESUMEN: La actinomicosis es una infección bacteriana causada por la especie Actinomyces, que generalmente afecta los tejidos blandos de la región cervicofacial de los hombres adultos. Clínicamente, se caracteriza por una masa endurecida de crecimiento lento, especialmente en la zona submandibular. Sin embargo, en algunos casos, los huesos de las mandíbulas pueden ser afectados desarrollando características de osteomielitis. El objetivo de este trabajo es reportar un caso clínico poco frecuente de osteomielitis actinomicótica que afecta el maxilar de un niño, envolviendo el área del seno maxilar, y zonas orbitales y cigomáticas que fueron tratadas con la asociación de terapia con antibióticos y desbridamiento quirúrgico. El seguimiento del paciente por 2 años ocurrió sin incidentes y sin signos de recidiva de las lesiones.

A multispecies probiotic reduces oral Candida colonization in denture wearers.

PURPOSE: The prevalence of Candida infections has been rising with an increasingly aging population and a larger population of immunocompromised individuals. The use of probiotics may be an alternative approach to antifungal agents in the prevention and treatment of oral candidiasis. This study aimed to evaluate the short-term effect of probiotics in reducing the infection level of oral Candida in candidiasis-asymptomatic elderly denture wearers. MATERIALS AND METHODS: In a double-blind randomized study, 59 denture wearers harboring Candida spp. in the oral cavity with no clinical symptoms were allocated into two groups: probiotic and placebo. All patients were instructed to clean the denture daily. The probiotic group poured a capsule containing lyophilized Lactobacillus rhamnosus HS111, Lactobacillus acidophillus HS101, and Bifidobacterium bifidum daily on the palatal surface of the maxillary denture, whereas the placebo group was submitted to the same regimen using placebo capsules. Candida spp. infection levels were evaluated in palate mucosa samples obtained before and after a 5-week experimental period. RESULTS: All patients harbored Candida in the palate mucosa at baseline. Fifty-five individuals completed the experimental period. The detection rate of Candida spp. was 92.0% in the placebo group after the experimental period, whereas it was reduced to 16.7% in the probiotic group. The reduction promoted by the probiotic regimen was independent of baseline characteristics such as Candida infection level and colonizing species, age of denture, and other variables. CONCLUSION: The probiotic product was effective in reducing the colonization of the oral cavity with Candida in candidiasis-asymptomatic elderly denture wearers, suggesting that this multispecies probiotic could be used to prevent oral candidiasis. CLINICAL IMPLICATIONS: Colonization of oral surfaces by Candida is considered a risk factor for invasive fungal infections. The use of a product with L. rhamnosus, L. acidophilus, and B. bifidum may represent an alternative treatment for reduction of Candida infections in elderly denture wearers.

Crossover clinical trial of the influence of the use of adhesive on biofilm formation.

STATEMENT OF PROBLEM: Contrasting results have been reported regarding the influence of the use of adhesive on biofilm formation. PURPOSE: The purpose of this study was to evaluate the influence of the use of adhesive on the formation of biofilm on the internal surface of complete dentures and the palatal mucosa of denture wearers. MATERIAL AND METHODS: Thirty participants with well-fitting complete dentures were randomly divided according to the experimental design: protocol 1, adhesive use during the first 15 days, followed by no use of adhesive over the next 15 days; protocol 2, no use of adhesives during the first 15 days, followed by adhesive use over the next 15 days. After each period, material from the mucosa and intaglio of the maxillary dentures was collected. Replicate aliquots were plated onto Petri dishes containing selective media for Candida spp, Streptococcus mutans, and a nonselective culture medium. Colony-forming units were expressed as log (CFU+1)/mL. In addition, the internal surfaces of the maxillary and mandibular complete dentures were stained and photographed. From the photographs, the total internal surface and the surface stained with biofilm were quantified (software ImageTool 3.00), and the percentage of the biofilm-covered area (%) on the maxillary and mandibular dentures was calculated and compared with 2-way ANOVA. For the nonselective culture medium, data were compared with the paired-sample t test, and the Wilcoxon signed rank test was performed to compare the colony counts of Candida spp and Streptococcus mutans (α=.05). RESULTS: Similar colony counts were found with or without the use of adhesive for the mucosa and internal surfaces of maxillary dentures, irrespective of the culture medium (P>.05). The area of dentures covered with biofilm was influenced by the use of adhesive (P=.025), regardless of the type of denture (P=.121). CONCLUSIONS: The use of adhesive did not alter the colony counts of microorganisms from the palatal mucosa and maxillary dentures of complete denture wearers during the 15-day period, but it did influence the area covered with biofilm on the internal surfaces of the complete dentures.

Resposta imune inata na estomatite protética: interação in vitro entre células epiteliais de palato humano e Candida albicans / Innate imune response in denture stomatitis: in vitro interaction between human palatal epithelial cells and Candida albicans

A presença de Candida albicans nos biofilmes microbianos da superfície interna das próteses totais superiores está relacionada com uma doença inflamatória no palato, a estomatite protética. Constituinte da defesa inata do hospedeiro, o epitélio bucal, por sua vez, tem a capacidade de reconhecer e reagir aos fatores fúngicos a fim de evitar a invasão pelo microrganismo. O objetivo deste trabalho foi avaliar in vitro o efeito direto e indireto de C. albicans viável sobre as células epiteliais de palato humano (CEPH) ao longo do tempo. Objetivamos correlacionar os eventos de agressão, apoptose e invasão das CEPH provocados pelo fungo, com as respostas de defesa epitelial mediante produção de óxido nítrico (NO) e expressão gênica do peptídeo antimicrobiano β-defensina 2 (hBD-2). Material e Métodos: As CEPH foram obtidas, parte pelo método explante e parte pelo método enzimático, e mantidas em co-cultivo sobre uma camada de sustentação feederlayer (fibroblastos gengivais humanos mitoticamente inativados). Após desafios das CEPH com C. albicans ATCC 90028 por contato direto fungo-epitélio (D.D.) e indireto pelo sobrenadante da cultura do fungo hifal (D.I.), proporções de desafio de 0,01/1; 0,025/1 e 0,1/1 levedura/queratinócito (FUN/EPI) e tempos experimentais de 3, 6 e 10 h foram determinados; via ensaios de viabilidade celular por imunofluorescência (LIVE/DEAD), e análise qualitativa da invasão celular pelo fungo por meio do método colorimétrico com laranja de acridina. A apoptose epitelial foi determinada pela marcação nuclear fluorescente com Hoechtst 33258. A produção de óxido nítrico (NO) e a expressão de RNAm de hBD-2 foram avaliados por reação colorimétrica de Griess e RT-qPCR, respectivamente. Os resultados foram expressos como média ± desvio padrão e submetidos aos testes estatísticos ANOVA Fatorial, Teste de Contraste; ou Teste de Mann-Whitney (p<0,05). Resultados: Em 3 h, foi detectado aumento da apoptose das células epiteliais em relação ao...

The presence of the fungus Candida albicans in the microbial biofilm underlying maxillary prosthesis is related to an inflammatory reaction of the palatal mucosa, the denture stomatitis. As a component of the host innate defense, the oral epithelium has the ability to recognize and react to fungal factors in order to prevent the microrganism invasion. The aim of this study was to in vitro evaluate the direct and indirect effect of viable C. albicans on the human palatal epithelial cells (HPEC) over time. The aggressive events, such as apoptosis and HPEC invasion by the fungus, were correlated with epithelial defense responses through the nitric oxide (NO) production and antimicrobial peptides β-defensin (hBD-2) mRNA expression. Methods: The HPEC were obtained by explant and enzymatic methods, and were maintained in co-culture on a feeder-layer support (mitotically inactivated human gingival fibroblasts). After the HPEC challenges with C. albicans ATCC 90028 by direct contact fungus-epithelium (D.D.) and indirect contact by supernatant from hyphal fungus (D.I.), defiance ratios of 0.01/1, 0.025/1 and 0.1/1 yeast/keratinocyte (FUN/EPI) and experimental times of 3, 6 and 10 h were determined. These conditions were standardized by cell viability immunofluorescence assay (LIVE/DEAD), and cell invasion qualitative analysis (colorimetric method with acridine orange). The apoptotic cells were determined by fluorescent nuclear staining with Hoechtst 33258. The nitric oxide (NO) production and hBD-2 gene expression were evaluated by Griess colorimetric reaction and RT-qPCR, respectively. The results were expressed as mean ± standard deviation and were analyzed using the factorial ANOVA, Contrast Test; or Mann-Whitney Test (p<0,05). Results: At 3 h, the apoptotic epithelial cells under 0.1/1 FUN/EPI increased compared to epithelium unchallenged (p<0,05) that remained over time with increasing concentration and independent of D.D. and D.I. The onset...

Treatment with probiotics in experimental oral colonization by Candida albicans in murine model (DBA/2).

The aim of this study is to evaluate the oral colonization by Candida albicans in experimental murine immunosuppressed DBA/2 and treatment with probiotic bacteria. To achieve these objectives, 152 DBA/2-immunosuppressed mice were orally inoculated with a suspension of C. albicans containing 10(8) viable yeast cells, the animals were treated with nystatin or with the probiotics (Lactobacillus acidophilus and Lactobacillus rhamnosus). Evaluations were performed by Candida count from oral mucosa swabbing. The oral mucosa colonization by C. albicans started at day 1 after inoculation, remained maximal from day 3 until day 7, and then decreased significantly. Probiotics reduced the C. albicans colonization significantly on the oral mucosa in comparison with the untreated animal group. In the group treated with L. rhamnosus, the reduction in yeast colonization was significantly higher compared with that of the group receiving nystatin. Immunosuppressed animal model DBA/2 is a relevant model for experimental Candida oral colonization, and the treatment with probiotics in this model may be an effective alternative to prevent it.

Oral lesion in leprosy: borderline tuberculoid diagnosis based on detection of Mycobacterium leprae DNA by qPCR.

Oral lesions are rarely reported in paucibacillary forms of leprosy. We report here a case with an erythematous hyposensitive lesion in the palate and no skin lesions. In addition to routine tests, biopsies of the lesion in the palate and of clinically normal surrounding areas were performed and subjected to real-time PCR for detection of Mycobacterium leprae DNA. The biopsy of the oral lesion was positive for bacilli DNA, followed by positive serum anti-PGL-1 and Mitsuda test, but with negative histopathology. The patient was diagnosed with a borderline tuberculoid form. After multidrug therapy the lesion had significantly regressed and the bacilli DNA detection in the former lesion was negative. The bacilli DNA detection in an oral lesion by real-time PCR not only improved leprosy diagnosis, but also helped in the classification of clinical form, and in the establishment of the appropriate therapeutic regime.

Denture stomatitis treated with photodynamic therapy: five cases.

OBJECTIVE: Photodynamic therapy (PDT) is an effective method for Candida spp. inactivation in vitro and in vivo, but as yet, no clinical trial has been conducted. This report describes 5 cases of denture stomatitis (DS) treated with PDT. STUDY DESIGN: Five subjects with clinical and microbiologic diagnosis of DS were submitted to 6 sessions of PDT 3 times a week for 15 days. In each session, patients' dentures and palates were sprayed with 500 mg/L Photogem, and, after 30 minutes of incubation, irradiated by light-emitting diode light source at 455 nm (37.5 and 122 J/cm(2), respectively). Cultures of Candida spp. from dentures and palates and standard photographs of the palates were taken at baseline (day 0), at the end of the treatment (day 15), and at follow-up time intervals (days 30 and 60). RESULTS: Four patients showed clinical resolution of DS (no inflammation) after PDT sessions, and only 1 subject demonstrated reduction in palatal inflammation. Recurrence of DS was observed in 2 patients during the follow-up period. CONCLUSIONS: PDT appears to be an alternative treatment for DS.

Inflammatory papillary hyperplasia of the palate: quantitative analysis of candida albicans and its negative correlation with microscopic and demographic aspects.

Inflammatory papillary hyperplasia of the palate (IPHP) is a tissue-reactive overgrowth characterized by hyperemic mucosa with nodular or papillary appearance in the palate. The exact pathogenesis is still unclear. In this study, the presence of Candida albicans in the epithelial lining was evaluated using the indirect immunofluorescence staining technique. Strongly stained C albicans was observed only in the lesions of the IPHP group. Therefore, the detection of C albicans in almost all samples from IPHP tissue enabled a suggestion as to the microbial etiology of the disease, since the use of dental prostheses was reported.

Oral colonization by Candida species in AIDS pediatric patients.

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.

Oral histoplasmosis associated with HIV infection: a comparative study.

OBJECTIVE: Histoplasmosis is a granulomatous fungal disease caused by Histoplasma capsulatum. The objective of the present paper was to describe the prevalence of oral histoplasmosis (OH) in two services from an endemic area in Argentina between 1991 and 2002 and to compare the clinicopathological profile of OH between HIV-positive and HIV-negative patients. METHODS: About 733 HIV+ (group A) and 14 260 patients (group B) were examined. Clinical diagnosis was confirmed by cytology, biopsy or culture. RESULTS: About 21 (3%) and 10 (0.07%) cases of OH were diagnosed in group A and B respectively. Most patients were male. A total of 90% of patients in group A were <45 years old whereas 70% of group B were more than 45 years old. Palate, gingiva and oropharynx were the most frequent locations. The importance of including histoplasmosis in the differential diagnosis of ulcerated oral lesions in immunocompromised patients was discussed.

Comparison of two cleansing pastes for the removal of biofilm from dentures and palatal lesions in patients with atrophic chronic candidiasis.

The efficacy of 2 oral hygiene products, an experimental toothpaste specific for complete denture cleansing and a regular standard toothpaste, was compared in terms of denture biofilm removal and cure of palatal lesions in patients with atrophic chronic candidiasis. The degree of correlation between presence of biofilm and mucosa erythema was also evaluated. Twenty-four complete denture wearers (45-80 years old) were divided into 2 groups: experimental paste and standard toothpaste (Sorriso-Kolynos, Brazil). Both groups received soft toothbrushes. The internal surfaces of upper dentures were stained using 1% sodium fluorescein and photographed at a 45 masculine angle at 0, 15, 30 and 60 days. The slides were scanned and the areas of interest (denture total area and biofilm area) were measured (Image Tool software). The degree of erythema was evaluated on slides according to the Prosthesis Tissue Index. There was a significant reduction (1%) in the degree of biofilm (ANOVA/Tukey) between the two initial visits (0 and 15 days) and the two final visits (30 and 60 days), and in the average erythema scores (Kruskal-Wallis) between 0 and 60 days, in both groups. The Mann-Whitney test showed a significant difference (1%) between pastes in terms of biofilm degree, but no difference was found for the erythema score. Correlation values between biofilm and erythema degree were 0.3801 (experimental paste) and (0.3678 (standard toothpaste). We may therefore conclude that the experimental product was efficient for the removal of denture plaque biofilm.

[Zygomycosis in childhood. A report of 2 cases]. / Zygomicosis en la edad pediátrica. Informe de dos casos.

Zygomycosis is a fungal infection which shows a definitive predisposition to attack the compromised host. It is usually associated with poorly controlled diabetes mellitus (DM). In the early infancy the cutaneous and gastrointestinal forms are the most frequent, in older children the most recognized form is that in which the primary impact of the infection is upon facial and intracranial structures. We report two cases of zygomycosis, the first patient was a 15 years old girl with a know systemic lupus erythematosus, and the second was a 14 years old boy with a insulin-dependent type I DM. Both were treated with anphotericin B and aggressive surgical intervention. The favorable outcome was attributed to a prompt diagnosis, early initiation of anphotericin B, surgical intervention and a control of the underlying illness.

[Histoplasmosis of the oral cavity]. / Histoplasmosis de la cavidad bucal.

Here is presented a case of a patient with histoplasmosis in the oral cavity a rare disease in our country and whose diagnosis is based upon epidemiological history, serological tests, cultures and hystological study of lymphatic nodes and the hard plate of the palate. Here we will expound upon clinical, diagnostical and therapeutic aspects as applied to our patient.

Adherence of Pseudomonas aeruginosa to respiratory epithelium and the effect of leucocyte elastase.

The tracheobronchial secretions from patients with cystic fibrosis often contain high amounts of free proteases. To evaluate whether human leucocyte elastase (HLE) can favour the persistence of bacterial airways infection, we exposed the frog palate mucosa to HLE and then to radiolabelled Pseudomonas aeruginosa and followed the sequence of events by scanning electronmicroscopy. In response to HLE there was a marked outpouring of mucus and a desquamation of the epithelium. P. aeruginosa was shown to adhere to recently secreted granules of mucus and to the exposed submucosal underlying connective tissues. For the eight different bacterial strains studied, a significative adherence to HLE-injured mucosa was observed only in strains that possessed internal haemagglutinating activity. Neither the presence of fimbriae, nor of the mucoid exopolysaccharide, nor of the bacterial surface haemagglutinating activity could be related to adherence of P. aeruginosa to the injured mucosa. These results support the hypothesis that HLE enhances bacterial infection of the respiratory mucosa both by inducing mucus hypersecretion and by exposing receptors to the microbial adhesins. It is also suggested that P. aeruginosa internal lectins may be implicated in adherence to host tissues.

The frog palate mucosa as a model for studying bacterial adhesion to mucus-coated respiratory epithelium.

Most of the methods proposed to quantify bacterial adherence to respiratory mucosa differ mainly from in vivo conditions in the absence of the mucus blanket and in the exposure of the sub-mucosal connective tissue (SMCT) to the micro-organisms. We propose the frog palate as a model to study bacterial adhesion to the respiratory mucosa, with a system which allows the mucus to be preserved and the bacterial adhesion to be quantified in a standardized mucosal area, where mucociliary transport is still active. In order to evaluate the role of respiratory mucus in bacteria-mucosa interaction, we compared the adhesion of radiolabelled pneumococci to 12 mucus-coated and 10 non-mucus-coated frog palate mucosae. The presence or absence of mucus was controlled by scanning electron microscopy (SEM). After a 10 min incubation period, the bacterial adhesion to mucus-coated palate mucosa was five times greater (P less than 0.01) than that to uncoated mucosa. By SEM, bacteria were never seen attached to ciliated cells but could be detected on small areas where mucus was not totally eliminated. Even after a 120 min contact of bacteria to uncoated mucosa, bacterial adhesion remained only half that to mucus-coated epithelium. In order to ascertain whether the exposure of the SMCT represented a means of attraction to bacteria, we incubated the frog palate mucosa face-down with radiolabelled Pseudomonas aeruginosa. As much as 44 per cent of added bacteria adhered to exposed SMCT and, by SEM, numerous micro-organisms were seen attached to connective tissue. In contrast, only a few bacteria were observed adhering to the mucosa, mainly to granules of mucus.

A new model for studying bacterial adherence to the respiratory epithelium.

The frog palate mucosa was used as a new model for studying bacterial adherence to the respiratory epithelium. The main advantage of this model is that the mucus blanket, normally present on airway mucosa, can be preserved during the assays. The adherence of radiolabeled pneumococci to mucus-coated mucosa was five times higher (P less than 0.001) than the adherence to mucus-depleted mucosa. In the latter case, bacteria were never seen attached to ciliated cells but could be detected on small remaining patches of mucus. These results demonstrate that respiratory mucus plays a major role in bacteria-mucosa interactions.

[Histoplasmosis]. / Histoplasmosis.

Two patients with histoplasmosis who came from the same environment are described. Diagnosis was achieved through biopsy and culture since they had not the common clinical forms but, fundamentally, skin and mucosa lesions. In both cases difficulties in establishing the differential diagnosis with neoplasms, lymphomas, leukosis and tuberculosis were faced. The diagnosis was precised by biopsy and culture. Positive results were obtained from amphotericin B therapy at the doses administered.