Streptococcus cristatus bacteremia in a patient with poor oral hygiene: a case report.

BACKGROUND: Streptococcus cristatus is a member of the Mitis streptococcus group. Like other members of this group, it resides on mucosal surfaces of the oral cavity. However, little is known about its ability to cause disease as there are only a handful of cases in the literature. Two of these cases involved infective endocarditis with significant complications. However, these cases involved additional microbes, limiting the inferences about the pathogenicity of Streptococcus cristatus. CASE PRESENTATION: A 59-year-old African American male with end-stage cryptogenic cirrhosis and ascites presented with fatigue and confusion. A paracentesis was negative for spontaneous bacterial peritonitis, but two separate blood cultures grew Streptococcus cristatus. Our patient had a history of dental caries and poor oral hygiene, which were likely the source of the infection. Echocardiograms revealed new aortic regurgitation, indicating "possible endocarditis" per the Modified Duke Criteria. However, since his clinical picture and cardiac function were reassuring, we elected against treatment for infective endocarditis. He was treated for bacteremia with a 2-week course of cephalosporins consisting of 8 days of ceftriaxone, transitioning to cefpodoxime after discharge. Despite having end-stage liver disease, our patient did not experience any significant complications from the infection. CONCLUSION: A patient with end-stage cirrhosis and poor oral hygiene developed bacteremia with an oral bacterium called Streptococcus cristatus. Unlike previous cases in literature, our patient did not meet criteria for a definitive diagnosis of infective endocarditis, and he experienced no other complications from the infection. This suggests coinfectants may have been primarily responsible for the severe cardiac sequelae in prior cases, whereas isolated Streptococcus cristatus infection may be relatively mild.

Current SARS-CoV-2 Protective Strategies for Healthcare Professionals.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the Coronavirus disease 2019 (COVID-19). COVID-19 was first reported in China in December 2019. SARS-CoV-2 is highly contagious and spread primarily via an airborne route. Hand hygiene, surgical masks, vaccinations and boosters, air filtration, environmental sanitization, instrument sterilization, mouth rinses, and social distancing are essential infection control measures against the transmission of SARS-CoV-2. This paper aims to provide healthcare professionals with evidence-based protective strategies.

Climate change. Projected increase in lightning strikes in the United States due to global warming.

Lightning plays an important role in atmospheric chemistry and in the initiation of wildfires, but the impact of global warming on lightning rates is poorly constrained. Here we propose that the lightning flash rate is proportional to the convective available potential energy (CAPE) times the precipitation rate. Using observations, the product of CAPE and precipitation explains 77% of the variance in the time series of total cloud-to-ground lightning flashes over the contiguous United States (CONUS). Storms convert CAPE times precipitated water mass to discharged lightning energy with an efficiency of 1%. When this proxy is applied to 11 climate models, CONUS lightning strikes are predicted to increase 12 ± 5% per degree Celsius of global warming and about 50% over this century.

Methicillin-resistant Staphylococcus aureus. A continuing infection control challenge.

The ability of MRSA and other staphylococci to colonize, persist, and adapt to multiple environmental and tissue conditions has allowed for these bacteria to be virtually ubiquitous in their distribution. The effectiveness of commonly used antibiotics, such as penicillin, has continued to decline against infections caused by MRSA and increasingly resistant strains. The challenge for both dental and medical health professionals is to routinely apply proven, evidence-based infection control precautions. As mentioned earlier in this discussion, when compliance with effective aseptic technique practices improves, the patients and environments. Ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and that single-use items are properly discarded. Clean and disinfect clinical contact surfaces that are not barrier-protected by using an environmental protection agency-registered hospital disinfectant with a low- (ie, HIV and HBV label claims) to intermediate-level (ie, tuberculocidal claim) activity after each patient. When the surface is visibly contaminated with blood, an intermediate-incidence of detectable infections can be reduced. Microorganisms will continue to evolve and adapt in order to survive and thrive, sometimes at the expense of susceptible human hosts. The struggle is to constantly remain aware of impending infectious threats which may challenge current precautions, and maintain and improve the quality of infection control to minimize the potential for disease.

Instrument cassettes for office safety and infection control.

The goal of a dental infection control program is to provide a safe working environment that will reduce the risk of health care-associated infections among patients and occupational exposures among staff members. Minimizing the potential for percutaneous sharps injuries is a primary focus for a comprehensive infection control program. This article will review the advantages of using instrument cassettes, as well as provide an overview of engineering and work practice controls and instrument processing, to emphasize how appropriate use of instrument cassettes can improve office safety and infection control.

Aerosols and splatter in dentistry: a brief review of the literature and infection control implications.

BACKGROUND: Aerosols and droplets are produced during many dental procedures. With the advent of the droplet-spread disease severe acute respiratory syndrome, or SARS, a review of the infection control procedures for aerosols is warranted. TYPES OF STUDIES REVIEWED: The authors reviewed representative medical and dental literature for studies and reports that documented the spread of disease through an airborne route. They also reviewed the dental literature for representative studies of contamination from various dental procedures and methods of reducing airborne contamination from those procedures. RESULTS: The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental procedures. CLINICAL IMPLICATIONS: In addition to the routine use of standard barriers such as masks and gloves, the universal use of preprocedural rinses and high-volume evacuation is recommended.

Environmental surface infection control, 2003.

Infection control guidelines address the routine use of disposable covers and cleaning and disinfecting treatment-area surfaces contaminated during patient care. While the rationale and approaches for accomplishing environmental surface disinfection have been considered in many previous infection control recommendations, exaggerated claims have led to some confusion regarding the wide variety of available surface covers and disinfectant products. The Centers for Disease Control and Prevention Guideline for Infection Control in Dental Health-Care Settings, 2003, considers the current state of scientific and clinical knowledge in environmental infection control, reinforce basic principles, and provide updated recommendations aimed at minimizing the potential for microbial cross-contamination and cross-infection from inanimate surfaces.

Infection control compliance issues and questions.

This article uses the 2003 CDC infection control guidelines for dentistry as a framework for discussing representative questions and issues that continue to be raised by dental health care workers. Where applicable, additional supporting evidence will be incorporated to provide appropriate, useful information, to assist in understanding and complying with updated recommendations.