[Rectal lesions and liver lesions caused by syphilis]. / In de luren gelegd door lues.

BACKGROUND: Syphilis is a sexually transmitted disease, caused by the spirochete Treponema Pallidum. Many different manifestations exist, which can complicate diagnosis. CASE: A 36-year-old man with a known HIV infection, presented himself with rectal blood loss and abdominal pain. Abdominal ultrasound and abdominal CT were suspicious for malign liver metastases. During subsequent colonoscopy, benign looking rectal lesions were found, possibly caused by either lymphogranuloma venereum or syphilis. Additional diagnostics confirmed an active syphilis infection. After treatment with benzylpenicillin, patient's complaints resolved, as well as the lesions in rectum and liver. CONCLUSION: We describe a rare case of a patient with secondary syphilis, presenting with rectal lesions and liver lesions suspicious for malign metastases.

From a case-control survey to a diagnostic viral gastroenteritis panel for testing of general practitioners' patients.

OBJECTIVE: To evaluate the pathogenicity of a broad range of 11 possible gastroenteritis viruses, by means of statistical relationships with cases vs. controls, or Ct-values, in order to establish the most appropriate diagnostic panel for our general practitioner (GP) patients in the Netherlands (2010-2012). METHODS: Archived stool samples from 1340 cases and 1100 controls were retested using internally controlled multiplex real-time PCRs for putative pathogenic gastroenteritis viruses: adenovirus, astrovirus, bocavirus, enterovirus, norovirus GI and GII, human parechovirus, rotavirus, salivirus, sapovirus, and torovirus. RESULTS: The prevalence of any virus in symptomatic cases and asymptomatic controls was 16.6% (223/1340) and 10.2% (112/1100), respectively. Prevalence of astrovirus (adjusted odds ratio (aOR) 10.37; 95% confidence interval (CI) 1.34-80.06) and norovirus GII (aOR 3.10; CI 1.62-5.92) was significantly higher in cases versus controls. Rotavirus was encountered only in cases. We did not find torovirus and there was no statistically significant relationship with cases for salivirus (aOR 1,67; (CI) 0.43-6.54)), adenovirus non-group F (aOR 1.20; CI 0.75-1.91), bocavirus (aOR 0.85; CI 0.05-13.64), enterovirus (aOR 0.83; CI 0.50-1.37), human parechovirus (aOR 1.61; CI 0.54-4.77) and sapovirus (aOR 1.15; CI 0.67-1.98). Though adenovirus group F (aOR 6.37; CI 0.80-50.92) and norovirus GI (aOR 2.22, CI: 0.79-6.23) are known enteropathogenic viruses and were more prevalent in cases than in controls, this did not reach significance in this study. The Ct value did not discriminate between carriage and disease in PCR-positive subjects. CONCLUSIONS: In our population, diagnostic gastroenteritis tests should screen for adenovirus group F, astrovirus, noroviruses GI and GII, and rotavirus. Case-control studies as ours are lacking and should also be carried out in populations from other epidemiological backgrounds.

Infection of lung cavitations in a young dog owner with Hodgkin's lymphoma caused by Pasteurella multocida, without a dog bite: confirmed zoonotic transmission by tagmentation microbiome analysis.

Pasteurella multocida is a known pathogen in humans, mostly reported after animal bite incidents. Atraumatic infections have been described, especially in immunocompromised patients. A 20-year-old patient with a history of stage IV Hodgkin's lymphoma with cavitating pulmonary lesions presented with a bilateral pneumonia. Shortly after finishing antibiotic treatment, she quickly developed the same symptoms of pneumonia. Bronchoscopy showed a large cavity in the right upper lobe and P. multocida was isolated from all bronchial cultures. The transmission route of P. multocida via the patient's dog was confirmed by sampling the full genome of the dog's mouth, which matched the unique P. multocida sequences found in the patient. This case demonstrates the importance of accurately determining the aetiology of the patient's symptoms, and Pasteurella infection should be considered in all immunocompromised patients with domestic animal contact, even without a bite incident.

Clinical sensitivity and specificity of the Check-Points Check-Direct ESBL Screen for BD MAX, a real-time PCR for direct ESBL detection from rectal swabs.

Objectives: To determine the diagnostic accuracy of the Check-Direct ESBL Screen for BD MAX (ESBL qPCR) and an ESBL culture method to identify ESBLs directly from rectal swabs. Methods: Rectal swabs were obtained from clinical patients by performing cross-sectional (point)prevalence measurements in three regional hospitals. Rectal swabs were analysed by direct culture (ChromID ESBL agar) and with the ESBL qPCR. Suspected ESBL-producing isolates were confirmed with the combination disc method and analysed by WGS. Results: Out of 354 rectal swabs and 351 patients, 21 rectal swabs and 20 patients were positive for ESBL-producing isolates, resulting in a regional ESBL colonization prevalence of 5.7%. One rectal swab was false negative with the ESBL qPCR (blaTEM-12) and not covered by the ESBL qPCR. Eight ESBL qPCR-positive rectal swabs could not be confirmed by culture and were classified as false ESBL qPCR positive. The sensitivity and specificity of the ESBL qPCR were 95.2% (n = 20) and 97.6% (n = 323), respectively. When an optimal cycle threshold cut-off value of 37 was used, the ESBL qPCR displayed a sensitivity and specificity of 95.2% (n = 20) and 98.8% (n = 327), respectively (AUC = 0.975, 95% CI = 0.922-1). Conclusions: This ESBL qPCR offers rapid direct detection of the most prevalent ESBL types (blaCTX-M group and blaSHV group) from rectal swabs. The relatively high false-positive rate renders this test the most suitable as a screening test in high-prevalence regions or in an outbreak setting where a fast result is essential.

Effect of an oxygenating agent on oral bacteria in vitro and on dental plaque composition in healthy young adults.

UNLABELLED: Oral bacteria live in symbiosis with the host. Therefore, when mouthwashes are indicated, selective inhibition of taxa contributing to disease is preferred instead of broad-spectrum antimicrobials. The potential selectivity of an oxygenating mouthwash, Ardox-X® (AX), has not been assessed. The aim of this study was to determine the antimicrobial potential of AX and the effects of a twice-daily oral rinse on dental plaque composition. MATERIAL AND METHODS: In vitro, 16 oral bacterial strains were tested using agar diffusion susceptibility, minimum inhibitory and minimum bactericidal concentration tests. A pilot clinical study was performed with 25 healthy volunteers. Clinical assessments and microbiological sampling of supragingival plaque were performed at 1 month before the experiment (Pre-exp), at the start of the experiment (Baseline) and after the one-week experimental period (Post-exp). During the experiment individuals used AX mouthwash twice daily in absence of other oral hygiene measures. The microbiological composition of plaque was assessed by 16S rRNA gene amplicon sequencing. RESULTS: AX showed high inter-species variation in microbial growth inhibition. The tested Prevotella strains and Fusobacterium nucleatum showed the highest sensitivity, while streptococci and Lactobacillus acidophilus were most resistant to AX. Plaque scores at Pre-exp and Baseline visits did not differ significantly (p = 0.193), nor did the microbial composition of plaque. During a period of 7-days non-brushing but twice daily rinsing plaque scores increased from 2.21 (0.31) at Baseline to 2.43 (0.39) Post-exp. A significant microbial shift in composition was observed: genus Streptococcus and Veillonella increased while Corynebacterium, Haemophilus, Leptotrichia, Cardiobacterium and Capnocytophaga decreased (p ≤ 0.001). CONCLUSION: AX has the potential for selective inhibition of oral bacteria. The shift in oral microbiome after 1 week of rinsing deserves further research.

In vitro invasion and survival of Porphyromonas gingivalis in gingival fibroblasts; role of the capsule.

Porphyromonas gingivalis is a Gram-negative, anaerobic bacterium involved in periodontitis and peri-implantitis that can invade and survive inside host cells in vitro. P. gingivalis can invade human gingival fibroblasts (GF), but no data are available about the role of P. gingivalis' capsule in GF invasion. In the current study, we aimed to determine the ability of three strains of P. gingivalis (encapsulated wild type W83, non-encapsulated HG91 and the non-encapsulated insertional isogenic knockout mutant of W83, ΔEpsC) to invade GF and the ability of internalized P. gingivalis to survive in vitro antibiotic treatment. The ability of P. gingivalis strains to invade GF was tested using an antibiotic protection assay at multiplicity of infection (MOI) 100 and 1000. The survival of internalized P. gingivalis cells was further analyzed by subsequent in vitro treatment with either metronidazole or amoxicillin alone or a combination of metronidazole and amoxicillin and anaerobic culture viability counts. All strains of P. gingivalis used in this study were able to invade GFs. The non-encapsulated mutant of W83 (ΔEpsC mutant) was significantly more invasive than the wild type W83 at MOI 100 (p value 0.025) and MOI 1000 (p value 0.038). Furthermore, internalized P. gingivalis was able to resist in vitro antibiotic treatment. As demonstrated by the differences in invasion efficiencies of P. gingivalis strain W83 and its isogenic mutant ΔEpsC, the capsule of P. gingivalis makes it less efficient in invading gingival fibroblasts. Moreover, internalized P. gingivalis can survive antibiotic treatment in vitro.

High-throughput multilocus sequence typing: bringing molecular typing to the next level.

Multilocus sequence typing (MLST) is a widely used system for typing microorganisms by sequence analysis of housekeeping genes. The main advantage of MLST in comparison to other typing techniques is the unambiguity and transferability of sequence data. However, a main disadvantage is the high cost of DNA sequencing. Here we introduce a high-throughput MLST (HiMLST) method that employs next-generation sequencing (NGS) technology (Roche 454), to generate large quantities of high-quality MLST data at low costs. The HiMLST protocol consists of two steps. In the first step MLST target genes are amplified by PCR in multi-well plates. During this PCR the amplicons of each bacterial isolate are provided with a unique DNA barcode, the multiplex identifier (MID). In the second step all amplicons are pooled and sequenced in a single NGS-run. The MLST profile of each individual isolate can be retrieved easily using its unique MID. With HiMLST we have profiled 575 isolates of Legionella pneumophila, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pneumoniae in mixed species HiMLST experiments. In conclusion, the introduction of HiMLST paves the way for a broad employment of the MLST as a high-quality and cost-effective method for typing microbial species.

Adjunctive effect of a water-cooled Nd:YAG laser in the treatment of chronic periodontitis.

OBJECTIVES: To test whether use of a water-cooled Nd:YAG laser adjunctive to supra- and subgingival debridement (SRP) with hand and ultrasonic instruments results in greater clinical improvement than SRP alone. Another objective was to investigate the reduction in the number of microorganisms. METHODS: This study was an examiner-blind, randomized and controlled clinical trial using a split-mouth design. Nineteen subjects with moderate-to-severe generalized periodontitis were selected. Immediately following SRP in two randomly chosen contra-lateral quadrants, all pockets 4 mm were additionally treated with the Nd:YAG laser (1064 nm, 6 W, 400 mJ). Clinical assessments (Plaque index, bleeding on pocket probing, probing pocket depth) were performed pre-treatment and at 3 months post-treatment. In each quadrant, one site was sampled for microbiological evaluation at pre-treatment, immediately post-instrumentation and 3 months post-treatment. RESULTS: At the 3-month visit, the clinical parameters had significantly improved for both regimens. No significant differences between treatment modalities were observed for any of the clinical parameters at any time. Immediately following instrumentation, the total colony forming units for both groups were significantly reduced as compared with pre-instrumentation. No significant differences between treatment modalities were observed. CONCLUSIONS: Three months after SRP, no additional advantage was achieved with the additional use of the Nd:YAG laser. Microbiological findings reflect these clinical results.

Microbiota around teeth and dental implants in periodontally healthy, partially edentulous patients: is pre-implant microbiological testing relevant?

This study aimed to assess the prevalence of seven periodontal marker pathogens, before implant placement and 1 yr after loading, in periodontally healthy individuals and to assess the long-term effectiveness of pre-implant reduction of pathogens to below threshold levels. In 93 individuals needing single tooth replacement, pooled subgingival microbiological samples from standard sites were cultured and analyzed before implant treatment and 1 yr after loading. Threshold levels commonly used in periodontology to predict periodontal breakdown were applied. Subjects with levels of pathogens above these thresholds received initial periodontal treatment including systemic antibiotics when indicated. At baseline, 49.5% of periodontally healthy subjects harboured one or more marker pathogens above threshold levels. Periodontal treatment reduced the pathogen levels below threshold values in 78.3% of these initially colonized subjects. In all cases Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were reduced to below threshold. At 1 yr after loading, periodontal pathogens were present above threshold levels in 74.1% of all subjects. It is concluded that in almost half of periodontal healthy individuals the subgingival biofilm harbours periodontal pathogens above threshold values. Long-term effectiveness of pre-implant reduction of the selected marker pathogens appeared limited in our patient population, making pre-implant reduction unpredictive for post-implant levels of these pathogens. Thus, considering the applied microbiological criteria, generalized pre-implant microbiological testing is not contributory in periodontally healthy subjects.

Phylogenetic variation of Aggregatibacter actinomycetemcomitans serotype e reveals an aberrant distinct evolutionary stable lineage.

The periodontal pathogen Aggregatibacter actinomycetemcomitans that comprises six serotypes (a-f), is often identified by PCR-based techniques targeting the 16S rRNA gene. In this study, 16S rRNA gene sequence analysis revealed an aberrant cluster of 19 strains within serotype e, denoted as serotype e'. The 16S rRNA gene sequence similarities found between serotype e' strains ranged from 99.7% to 100.0%, whereas 96.8-97.5% sequence similarity was obtained with members of the other serotypes, indicating that the serotype e' strains might not be true members of A. actinomycetemcomitans. However, DNA-DNA hybridizations between a representative serotype e' strain and representative strains of serotypes b, d and e of A. actinomycetemcomitans revealed 68-75% DNA-DNA relatedness, demonstrating that the serotype e' strains do belong to the species A. actinomycetemcomitans. AFLP analysis of 33 A. actinomycetemcomitans strains, representing all serotypes (a-f), but mainly serotype e' strains, showed that the latter form a distinct cluster, demonstrating that these strains are also closely related on the whole genome level. Moreover, the serotype e' strains were unable to ferment starch and glycogen in contrast to almost all other A. actinomycetemcomitans strains tested. Overall, the data obtained in this study suggest that the serotype e' strains form an evolutionary relatively stable distinct subgroup within A. actinomycetemcomitans.

Feasibility and therapeutic strategies of vaccines against Porphyromonas gingivalis.

Periodontitis is a chronic infectious disease that is highly prevalent worldwide and is characterized by inflammation of the gums, and loss of connective tissue and bone support. The Gram-negative anerobic bacterium Porphyromonas gingivalis is generally accepted as the main etiological agent for chronic periodontitis. The objective of this paper is to elucidate the feasibility of achieving protection against periodontitis though immunization against P. gingivalis. Until now, animal studies have showed no complete protection against P. gingivalis. However, current knowledge about P. gingivalis structures could be applicable for further research to develop a successful licensed vaccine and alternative therapeutic strategies. This review reveals that a multicomponent vaccine against P. gingivalis, which includes structures shared among P. gingivalis serotypes, will be feasible to induce broad and complete protection.

Java project on periodontal diseases: serotype distribution of Aggregatibacter actinomycetemcomitans and serotype dynamics over an 8-year period.

OBJECTIVE: To investigate the serotype distribution and stability of Aggregatibacter actinomycetemcomitans over an 8-year period in untreated Indonesian subjects. MATERIAL AND METHODS: Clinical periodontal status and the presence of A. actinomycetemcomitans were established in 1994 and 2002 in 107 subjects from an Indonesian tea estate deprived from dental care. On an average, 3.6 isolates per patient were subcultured and serotyped using specific PCR reactions. RESULTS: In 1994, the predominant serotype was b (53.7%), whereas a and c occurred in 17.1% and 14.6% of the subjects, respectively. In 2002, a reduction in serotypes a (7.5%) and b (30.2%) occurred. Serotypes c and e increased in prevalence from 14.6% to 35.8% and 2.4% to 9.4%, respectively. Multiple serotypes were found in 12.2% in 1994 and 17% in 2002. From 24 subjects who were positive at both time points, 14 (58.3%) had the same serotype, whereas in 10 subjects (41.7%), a different serotype was found. Mean clinical attachment loss had increased from 0.74 mm in 1994 to 1.96 mm in 2002 but could not be related to subgingival presence of A. actinomycetemcomitans. CONCLUSIONS: A. actinomycetemcomitans serotypes distribution in Indonesian young adults shifts from predominantly serotype b to a more equal prevalence of serotypes b and c. This shift suggests an opportunistic character of A. actinomycetemcomitans.

Feasibility and influence of the microgap of two implants placed in a non-submerged procedure: a five-year follow-up clinical trial.

BACKGROUND: The aim of this study was to evaluate the feasibility of using a two-piece implant system in a non-submerged procedure and to study the impact of the microgap between the implant and abutment. METHODS: Sixty edentulous patients (Cawood Class V-VI) participated in this study. After randomization, 20 patients received two two-piece implants placed in a non-submerged procedure, 20 patients received two two-piece implants placed in the traditional submerged procedure, and 20 patients were treated with two one-piece dental implants placed in the traditional non-submerged procedure. The implants were placed in the mandible for overdenture treatment. A standardized clinical evaluation was performed and radiographs were taken immediately after denture insertion and yearly up to 5 years. Peri-implant samples were collected 12, 36, and 60 months after loading with sterile paper points and analyzed for the presence of putative periodontal pathogens using culture techniques. RESULTS: One two-piece implant of the non-submerged group and one two-piece implant of the submerged group were lost after 6 and 12 months, respectively. After 5 years of functioning, no significant clinical, radiological, or microbiological differences were found between the three groups. No association was found between the level of the microgap and the amount of bone loss. CONCLUSIONS: The results of this study indicate that dental implants designed for a submerged implantation procedure can also be used in a non-submerged procedure and may be as predictable as when used in a submerged procedure or as one-piece implants. The microgap at the crestal level in two-piece implants does not appear to have an adverse effect on the amount of peri-implant bone loss.

prtH in Tannerella forsythensis is not associated with periodontitis.

BACKGROUND: It has been suggested that prtH in Tannerella forsythensis encodes for a cystein proteinase that is associated with its pathogenic potential and can discriminate between periodontal health and disease. The aim of this investigation was to further establish this potentially important observation. METHODS: A group of 33 consecutive adult patients with periodontitis (mean age: 47.6 +/- 10.1 years) harboring T. forsythensis was selected to investigate the presence of prtH by polymerase chain reaction (PCR). The T. forsythensis strains were isolated by anaerobic culture techniques. To investigate the association of this gene with periodontitis, a group of 14 age-matched subjects (mean age: 56.4 +/- 6.9 years) without any signs of periodontal disease (probing depths <3 mm and no radiographic attachment loss) was tested for comparison. Pure isolates and crude subgingival plaque samples were used as a template for the PCR. RESULTS: In the group of 33 T. forsythensis-positive patients, we found two T. forsythensis isolates to be prtH negative. Despite repeated analyses, testing of the whole subgingival plaque samples revealed only 17 of 33 samples to be prtH positive. The T. forsythensis isolates from the 14 periodontally healthy subjects were all prtH positive. The odds ratio of the presence of prtH in T. forsythensis in periodontitis patients versus healthy controls is 1.06 (P >0.05). CONCLUSIONS: On the basis of our data, we conclude that the presence of prtH in T. forsythensis is not discriminative for patients with T. forsythensis-associated periodontitis compared to healthy carriers of T. forsythensis. In addition, the use of whole subgingival plaque samples to test for the prevalence of prtH in bacteria appeared unreliable. Culture of the microorganism is an important condition to receive a sufficient amount of template DNA to detect the specific locus of the genome.

Microbiota around root-form endosseous implants: a review of the literature.

Although high success rates for root-form endosseous implants have been reported, failures occasionally occur, and these implants must be removed. At least 10% of the failures have been suggested to be the result of peri-implantitis. There is some evidence that periodontal pathogens, mainly those belonging to the group of gram-negative anaerobic rods, play a role in the etiology of peri-implantitis. This article provides an overview of the literature associated with common peri-implant microbiology and an assessment as to whether bacteria associated with periodontitis exert a possible risk for peri-implant tissue breakdown. The peri-implant area is colonized by a large variety of oral microbial complexes. The microflora of the oral cavity prior to implant placement determines the composition of the microflora in the peri-implant area. Implants involved in peri-implantitis are colonized with large amounts of gram-negative anaerobic bacteria, including Fusobacteria, spirochetes, Bacteroides forsythus, and "black-pigmented bacteria" such as Prevotella intermedia, Prevotella nigrescens, and Porphyromonas gingivalis. Also, Actinobacillus actinomycetemcomitans can be isolated from these lesions. Thus, the microflora of peri-implantitis lesions resembles that of adult or refractory periodontitis. However, the presence of periodontal pathogens does not always lead to a destructive process. Therefore, the etiologic role of specific microorganisms in implant failure related to infection is still not resolved. Controversy remains as to whether organisms recovered from the original microflora cause the failure (and if so to what extent) or merely result from the infection. Nevertheless, there is accumulating evidence that bacteria cause the disease, while the individual's genetic makeup and environmental influences determine the severity of the disease.