RESUMO
OBJECTIVE: Epidemiological, biological and clinical links between periodontal and cardiovascular diseases are now well established. Several human studies have detected bacterial DNA corresponding to periodontal pathogens in cardiovascular samples. Intraplaque hemorrhage has been associated with a higher risk of atherosclerotic plaque rupture, potentially mediated by neutrophil activation. In this study, we hypothesized that plaque composition may be related to periodontal pathogens. METHODS: Carotid culprit plaque samples were collected from 157 patients. Macroscopic characterization was performed at the time of collection: presence of blood, lipid core, calcification and fibrosis. Markers of neutrophil activation released by carotid samples were quantified (myeloperoxidase or MPO, cell-free DNA and DNA-MPO complexes). PCR analysis using specific primers for Porphyromonas gingivalis, Aggregatibacter actinomycetemcommitans, Treponema denticola, Prevotella intermedia and Tannerella forsythia was used to detect DNA from periodontal pathogens in carotid tissues. In addition, bacterial lipopolysaccharide (LPS) and Immunoglobulins G against T. forsythia were quantified in atherosclerotic carotid conditioned medium. RESULTS: Intraplaque hemorrhage was present in 73/157 carotid samples and was associated with neutrophil activation, reflected by the release of MPO, cell-free DNA and MPO-DNA complexes. LPS levels were also linked to intraplaque hemorrhage but not with the neutrophil activation markers. Seventy-three percent of the carotid samples were positive for periodontal bacterial DNA. Furthermore, hemoglobin levels were associated with the detection of T. forsythia and neutrophil activation/inflammation markers. CONCLUSION: This study suggests a potential role of periodontal microorganisms, especially T. forsythia, in neutrophil activation within hemorrhagic atherosclerotic carotid plaques.
Assuntos
Doenças das Artérias Carótidas/microbiologia , Trombose das Artérias Carótidas/microbiologia , Placa Dentária/microbiologia , Neutrófilos/fisiologia , Periodontite/microbiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/análise , Bacteroidaceae/imunologia , Bacteroidaceae/isolamento & purificação , Bacteroidaceae/patogenicidade , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/imunologia , Doenças das Artérias Carótidas/cirurgia , Trombose das Artérias Carótidas/complicações , Trombose das Artérias Carótidas/imunologia , Trombose das Artérias Carótidas/cirurgia , DNA Bacteriano/sangue , Endarterectomia das Carótidas , Armadilhas Extracelulares , Feminino , Fibrina/análise , Hemorragia/etiologia , Humanos , Lipídeos/análise , Masculino , Pessoa de Meia-Idade , NF-kappa B/metabolismo , Infiltração de Neutrófilos , Periodontite/complicações , Peroxidase/análise , Placa Aterosclerótica/química , Explosão RespiratóriaRESUMO
We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F.necrophorum without associated internal jugular vein (IJV) thrombosis. Lemierre's syndrome (LS) is characterized by a history of recent oropharyngeal infection in previously healthy individuals, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly F.necrophorum. We discuss literature on this rare, previously unreported, variant of LS.
Assuntos
Trombose das Artérias Carótidas/microbiologia , Infecções por Fusobacterium/complicações , Fusobacterium necrophorum , Faringite/complicações , Faringite/microbiologia , Acidente Vascular Cerebral/microbiologia , Antibacterianos/uso terapêutico , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Trombose das Artérias Carótidas/patologia , Trombose das Artérias Carótidas/fisiopatologia , Artéria Carótida Interna/microbiologia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/fisiopatologia , Angiografia Cerebral , Progressão da Doença , Evolução Fatal , Infecções por Fusobacterium/tratamento farmacológico , Humanos , Infarto da Artéria Cerebral Média/microbiologia , Infarto da Artéria Cerebral Média/patologia , Infarto da Artéria Cerebral Média/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Paresia/etiologia , Paresia/patologia , Paresia/fisiopatologia , Faringite/fisiopatologia , Faringe/irrigação sanguínea , Faringe/microbiologia , Síndrome do Desconforto Respiratório/microbiologia , Síndrome do Desconforto Respiratório/patologia , Síndrome do Desconforto Respiratório/fisiopatologia , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Tomografia Computadorizada por Raios X , Falha de Tratamento , Adulto JovemRESUMO
INTRODUCTION: Mucormycosis is a rare and acute fungal infection which is frequently lethal. The rhinocerebral form is usually seen in diabetics, but other localizations may occur in severely immunocompromised subjects. OBSERVATION: We report the case of a sphenoidal sinusitis associated with a probable cavernous sinus thrombosis and carotid artery thrombosis with middle cerebral artery territory infarction. Diagnosis was made on histological examination following sphenoidotomy. Early medical and surgical treatment led to a good outcome. CONCLUSION: The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome.
Assuntos
Encefalopatias/patologia , Mucormicose/patologia , Doenças Nasais/patologia , Rhizopus , Idoso , Encefalopatias/microbiologia , Trombose das Artérias Carótidas/etiologia , Trombose das Artérias Carótidas/microbiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/etiologia , Infarto da Artéria Cerebral Média/microbiologia , Mucormicose/microbiologia , Doenças Nasais/microbiologia , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/microbiologia , Sinusite/etiologia , Sinusite/microbiologiaRESUMO
This case illustrates the correlation between Magnetic Resonance Imaging (MRI) and the pathological findings in a case of cavernous sinus (CS) aspergilloma.
Assuntos
Aspergilose/microbiologia , Aspergillus fumigatus , Trombose do Corpo Cavernoso/microbiologia , Seio Cavernoso/microbiologia , Granuloma/microbiologia , Infecções Oportunistas/microbiologia , Doenças do Nervo Abducente/microbiologia , Doenças do Nervo Abducente/patologia , Corticosteroides/efeitos adversos , Idoso , Aspergilose/complicações , Aspergilose/patologia , Trombose das Artérias Carótidas/microbiologia , Trombose das Artérias Carótidas/patologia , Artéria Carótida Interna/microbiologia , Artéria Carótida Interna/patologia , Seio Cavernoso/patologia , Trombose do Corpo Cavernoso/patologia , Progressão da Doença , Evolução Fatal , Feminino , Granuloma/patologia , Humanos , Imunossupressores/efeitos adversos , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Imageamento por Ressonância Magnética , Oftalmoplegia/microbiologia , Oftalmoplegia/patologia , Infecções Oportunistas/patologia , Dor/microbiologia , Dor/patologia , Pancitopenia/complicações , Pancitopenia/tratamento farmacológicoRESUMO
Lemierre's syndrome, also known as postanginal sepsis, is a rare condition that presents as an increasing sore throat due to acute pharyngitis or tonsillitis and progresses to sepsis, due to suppurative thrombophlebitis of the internal jugular vein. We present an atypical case of Lemierre's syndrome complicated by carotid thrombosis. The etiological factors and the diagnostic and therapeutic measures are discussed.
