Amigdalitis unilateral: angina de Plaut-Vincent / Unilateral tonsillitis: Plaut-Vincent angina

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Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis.

AIM: This study was designed to investigate the clinical and microbiological parameters with photochemotherapy (PCT) against conventional debridement (CD) among patients with necrotizing ulcerative gingivitis (NUG). MATERIALS AND METHODS: Patients with a diagnosis of NUG were divided into two groups: 'Group-PCT' that underwent indocyanine green-mediated PCT with adjunctive mechanical debridement, and Group-CD that underwent mechanical debridement with adjunctive 3 % hydrogen peroxide/chlorhexidine rinse. Clinical inflammatory gingival parameters including full-mouth plaque scores (FMPS), bleeding scores (FMBS), and probing depth (PD) were measured. Counts of Treponema microdentium, Fusobacterium nucleatum and Prevotella intermedia were assessed using polymerase chain reaction technique. All assessments were done at baseline, 3 weeks and 6 weeks. RESULTS: Twenty-six participants were contacted and agreed to participate in the trial. The mean age of participants in group-PCT was 24.5 years while the mean age of patients in group-CD was 26.7 years. FMPS showed significant but equal reduction in both the groups at 3 weeks and 6 weeks (p < 0.01). The reduction in mean FMBS was higher in the group-PCT at 6 weeks follow-up (p < 0.05). All bacterial levels reduced from baseline to follow-up with both PCT and CD groups (p < 0.05). Group-PCT showed significantly reduced counts of T. microdentium and F. nucleatum at 3 weeks and 6 weeks compared with group-CD (p = 0.024). Equal reduction was shown for P. intermedia between both the groups at 3 and 6 weeks, respectively. CONCLUSION: Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.

Identification of bacteria present in ulcerative stomatitis lesions of captive sea turtles Chelonia mydas.

Anthropogenic activities, predation, and diseases have contributed to a decrease in the sea turtle population in recent years. Ulcerative stomatitis is a condition that occurs in both wild and captive populations. The etiology of this condition is associated with bacteria such as E. coli, Citrobacter diversus, Klebsiella spp., Pseudomonas spp., Flavobacter calcoaceticus, Staphylococcus spp., and Flavobacterium spp. Some of these microorganisms are part of the oral microbiota of turtles, but alterations in the immune response can disturb the homeostatic relationship and cause an increase in the population of microorganisms, which in turn can cause disease. This work presents results on the isolation and identification of bacteria present in ulcerative stomatitis lesions in captive C. mydas turtles. Oral mucosa samples from 20 clinically healthy turtles and ten animals with ulcerative stomatitis lesions were studied. The samples were cultivated in enriched and differential media, and the identification was made using an automated method. The results showed a great diversity of bacteria in animals with ulcerative stomatitis with a higher prevalence of S. lentus and C. braakii was higher (60 and 50%, respectively) than in healthy animals. E. faecium was identified in 40% of diseased animals and 55% healthy animals. Turtles in this study had a diverse oral microbiota, and S. lentus and C. braakii may be involved in the etiopathogenesis of ulcerative stomatitis.

Acute periodontal lesions.

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.

The phylum Synergistetes in gingivitis and necrotizing ulcerative gingivitis.

The clinical manifestation of necrotizing ulcerative gingivitis (NUG) is distinct from that of common gingivitis in that it is characterized by local necrosis of the gingival tissues, rapid onset, pain and extensive bleeding. The phylum Synergistetes is a novel bacterial phylum consisting of Gram-negative anaerobes, with evidence of presence in biofilms associated with periodontal and endodontic infections. To date, the involvement of members of this phylum in NUG has not been investigated. This study aimed to evaluate the presence and levels of known human oral Synergistetes bacterial clusters in dental plaque from patients with NUG and compare them with those found in gingivitis. Marginal dental plaque samples from 21 NUG and 21 gingivitis patients were analysed quantitatively by fluorescent in situ hybridization and microscopy for members of two oral Synergistetes clusters (A and B) and for Jonquetella anthropi. Synergistetes cluster A bacteria were detected in all samples but at higher levels (9.4-fold) and proportions (2.5-fold) in NUG patients than in gingivitis patients. However, with regard to Synergistetes cluster B bacteria, there were no differences between NUG and gingivitis patients. J. anthropi was detected in only half of the samples and at lower levels than the other taxa. In conclusion, these data demonstrate that Synergistetes cluster A bacteria, but not cluster B bacteria or J. anthropi, are more strongly associated with NUG than with gingivitis.

Necrotizing periodontal diseases in HIV-infected Brazilian patients: a clinical and microbiologic descriptive study.

OBJECTIVE: Nowadays, necrotizing periodontal diseases have a low prevalence; however, a better understanding of the etiopathogenesis of these diseases is necessary for determining more adequate preventive and therapeutic strategies. METHOD AND MATERIALS: From a pool of 1,232 HIV-infected patients, 15 presented with necrotizing periodontal diseases, which were evaluated by full-mouth periodontal clinical measurements. Subgingival biofilm samples were collected from necrotizing lesions of six of these individuals. The presence and levels of 47 bacterial species were determined by checkerboard DNA-DNA hybridization. RESULTS: All 15 patients (10 had severe immunodeficiency) had been infected sexually. Thirteen patients were taking antiretroviral medication (66.7% undergoing highly active antiretroviral therapy). Regarding necrotizing periodontal diseases, necrotizing ulcerative gingivitis (60%) was more prevalent than necrotizing ulcerative periodontitis (40%). The frequency of supragingival biofilm and bleeding on probing ranged from 11.5% to 59.2% and 3.0% to 54.0%, respectively, whereas the mean probing depth and clinical attachment level were between 1.48 and 2.61 mm and 1.30 and 2.62 mm, respectively. Species detected in high prevalence and/or counts in necrotizing lesions included Treponema denticola, Eikenella corrodens, Dialister pneumosintes, Enterococcus faecalis, Streptococcus intermedius, Aggregatibacter actinomycetemcomitans, and Campylobacter rectus. In contrast, Parvimonas micra, Prevotella melaninogenica, Fusobacterium nucleatum, Eubacterium nodatum, and Helicobacter pylori were observed in the lowest mean prevalence and/or counts. CONCLUSION: Necrotizing periodontal disease lesions in HIV-infected patients present a microbiota with high prevalence and/or counts of classical periodontal pathogens, in particular T denticola, as well as species not commonly considered as periodontal pathogens, such as E faecalis and D pneumosintes. In addition, these individuals with necrotizing periodontal disease frequently display severe immunodeficiency and AIDS-defining diseases such as tuberculosis.

Invasive oral aspergillosis in a patient with acute myeloid leukaemia.

Aspergillosis (a fungal infection by an organism of the Aspergillus species) of the oral cavity is an uncommon condition which most frequently occurs in immunocompromised patients, such as those with haematological malignancies. In such patients, prolonged neutropenia secondary to chemotherapeutic agents enables the spread of invasive aspergillosis, which is unaffected by anatomical barriers. Early detection and treatment of the condition is essential to avoid more serious complications, such as disseminated infection, which results in increased morbidity and mortality. This case report describes a patient with acute myeloid leukaemia who developed localized invasive Aspergillus flavus of the palate. High-dose antifungal therapy was instituted along with surgical removal of the involved tissues. Aspergillosis of the palate was successfully eradicated with no long-term ill effects from the treatment. Management of invasive aspergillosis includes early aggressive antifungal medication combined with surgical removal of the involved tissues.

Borrelia tonsillitis: common symptoms but uncommon organism.

We present a severe case of acute tonsillitis caused by Borrelia vincenti. B. vincenti does not only cause Plaut-Vincent's angina, but also a more localised infection of the tonsil.

Necrotizing periodontal diseases in HIV-seropositive subjects: pathogenic mechanisms.

Necrotizing gingivitis (NG) is a well-known periodontal condition characterized by marginal gingival necrosis, bleeding and pain. Necrotizing periodontitis is an extension of NG into the periodontal attachment apparatus, and the two stages are referred to collectively as necrotizing periodontal diseases (NPD). Necrotizing periodontal diseases in HIV-seropositive subjects are similar with regard to the spectrum of periodontopathic bacteria, the clinical manifestations, the natural course and the response to treatment when compared to NPD in HIV-seronegative subjects. However, in the former group, there is an increase in the prevalence of candidal species and herpesviruses in the subgingival plaque and gingival biopsy specimens. In the periodontal tissues, spirochaetes, activated herpesviruses, Candida species and HIV have the capability of deregulating host innate and adaptive immune responses and of stimulating host inflammatory reactions, and may therefore explain the greater prevalence of NPD in HIV-seropositive subjects compared to immunocompetent subjects.

Gingivitis úlcero-necrosante y su relación con el VIH/SIDA / Necrotizing ulcerative gingivitis and its relationship with HIV/AIDS

En el presente trabajo se realizó una revisión de la literatura, con el fin de compartir con la comunidad odontológica la información recolectada sobre la Gingivitis Ulcero Necrosante (GUN) y su relación con el Virus de Inmunodeficiencia Humana y el Síndrome de Inmunodeficiencia Adquirida (VIH/SIDA).

This paper reports a literature review which shares the gathered information with the Dental community about Necrotizing Ulcerative Gingivitis associated to opportunistic infections related to the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (HIV /AIDS).

Bacteria in the mouth.

There are many infectious agents found within the oral cavity. Bacteria form an important group of micro-organisms found in both healthy and diseased mouths. The current article will discuss those bacteria resident within the mouth and review the oral diseases with which they are associated.

Necrotizing ulcerative periodontal diseases in children and young adults in Medellín, Colombia, 1965--2000.

Previous findings that necrotizing ulcerative gingivitis (NUG) is a precursor to noma or cancrum oris were confirmed by the follow-up of these clinical conditions in a study of 45 Colombian patients: necrotizing ulcerative gingivitis (NUG, n = 29), necrotizing ulcerative periodontitis (NUP, n = 7) and noma (n = 9). Patients were diagnosed at the outpatient clinic of the School of Dentistry at the University of Antioquia, at the University Hospital Saint Vincent of Paul, at the Luz Castro de Gutierrez University Hospital, at the Red Cross Hospital and at the private office of one of the authors (Jiménez L., M) in Medellín, Colombia, from 1965 until 2000. Almost all the patients came from low socioeconomic groups and presented with predisposing and/or contributing factors, such as acute herpetic gingivostomatitis, measles, and leukemia (including acute lymphoblastic and chronic lymphoid leukemia). Malnutrition and poor oral hygiene were associated with the necrotizing process and favored progression from the gingiva to deeper periodontal tissues and other structures within the oral cavity or the facial tissues. No patients had human immunodeficiency virus (HIV) or AIDS, which makes these findings different from other reports. Noma can be prevented by vaccinating children against infectious diseases, by controlling malnutrition and by improving their oral hygiene. It is arrested by mechanical lesion debridement, improving oral hygiene and antibiotic therapy. Necrotizing ulcerative gingivitis may progress in some cases to ulcerative necrotizing stomatitis, necrotizing ulcerative periodontitis, and, finally, to noma. Microbial studies among new Colombian NUG, NUP and noma patients are necessary, using bacterial culturing and identification methods and molecular techniques such as PCR for viruses and bacteria, in order to establish the exact nature of these lesions.

Acute necrotizing ulcerative gingivitis and bacteremia caused by Stenotrophomonas maltophilia in an immunocompromised host.

An 8-year-old girl with leukemia developed acute necrotizing ulcerative gingivitis with Stenotrophomonas maltophilia and herpes simplex virus. Progression to bacteremia with pathologic evidence of osteomyelitis occurred despite appropriate antimicrobial therapy. This case highlights the importance of prompt recognition, debridement and appropriate therapy in immunocompromised patients with acute necrotizing ulcerative gingivitis.

Necrotising periodontal diseases.

Necrotizing gingivitis (NG) or necrotising ulcerative gingivitis (NUG) is considered to be an acute opportunistic gingival infection caused by bacterial plaque. It appears more frequently in undernurished children and young adults as well as patients with immunodeficiency. In its pathogenesis, there are factors related to the oral microbiota with invasion processes on the one hand, and on the other hand, factors associated with the host, such as signs of capillary and immunological disorders as well as undernurishment. The disease is characterized by pain, bleeding and papillary necrosis with tendency to relapse. Diagnosis is made by a simple clinical examination. However, complementary tests ought to be performed in order to eliminate the possibility of illnesses systemic or immunodeficiency. Early and sustained treatment is strongly recommended. Lesions of the gums (craters in the interdental papillae) as an aftermath of the disease is a possibility, or if there is necrotizing periodontitis there will be loss of attachment tissue.

Fusospirochetosis causing necrotic oral ulcers in patients with HIV infection.

Under certain permissive circumstances, normally occurring fusiform bacteria and Borrelia spirochetes can result in a symbiotic overgrowth that leads to necrotic oral ulcers (stomatitis), gingivitis, and periodontitis. These lesions are collectively known as oral fusospirochetosis and may be under-appreciated in patients with HIV infection and AIDS. Fusospirochetal oral ulcers in patients with HIV are often large, necrotic, and malodorous; they respond completely to penicillin. We report 3 patients with HIV infection and fusospirochetal ulcerative stomatitis and review the clinical presentation, microbiologic diagnosis, potential pathogenesis, and treatment of these lesions.

Treponema putidum sp. nov., a medium-sized proteolytic spirochaete isolated from lesions of human periodontitis and acute necrotizing ulcerative gingivitis.

So far, little phenotypic heterogeneity has been detected in cultured oral treponemes with trypsin-like proteolytic activity, and all have been assigned to the species Treponema denticola. However, comparisons of protein patterns and antigen expression in our collection of proteolytic oral treponemes occasionally identified isolates with a unique phenotype; e.g. strain OMZ 830 (=ATCC 700768), which qualified as a 'pathogen-related oral spirochaete' due to the presence of a approximately 37 kDa protein reactive with the Treponema pallidum FlaA-specific mAb H9-2. In addition to such single isolates, a homogeneous group of seven independent strains is described that were highly motile, medium-sized, proteolytic but asaccharolytic spirochaetes and were cultured from human gingivitis, periodontitis and acute necrotizing ulcerative gingivitis in medium OMIZ-Pat supplemented with 1% human serum and antibiotics. Growth of these spirochaetes in OMIZ-Pat was not dependent on, but was stimulated by, human or bovine serum. Carbohydrates were neither required nor stimulatory for growth. The protein and antigen patterns of total cell extracts of these organisms separated by SDS-PAGE were distinct from those of all previously cultured spirochaetes, with highest similarity to T. denticola. The novel spirochaete has a 2 : 4 : 2 arrangement of the periplasmic flagella, similar to T. denticola. However, the flagellin pattern as detected by immunostaining or glycan staining of Western blots readily distinguished the novel group from T. denticola. Also, distinct from reference strains of T. denticola, none of the novel isolates displayed sialidase or dentilisin activities, both of which are expressed by most strains of T. denticola. Trypsin-like activity and other enzymes as detected by API ZYM test were similar to those of T. denticola. The status of a novel species is supported by the 16S rRNA gene sequence, with 98.5% similarity to its closest cultured relative, T. denticola. The name Treponema putidum sp. nov. is proposed (type strain OMZ 758T=ATCC 700334T=CIP 108088T).

Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy.

PURPOSE: The effectiveness of amphotericin B oral suspension versus nystatin oral suspension for the prevention of oral colonization by Candida in hematopoietic cell transplant (HCT) patients was examined. METHODS: Prior to hematopoietic cell infusion, 40 patients receiving systemic fluconazole for prophylaxis were randomized to receive either amphotericin B oral suspension or nystatin oral suspension, q.i.d. The study continued to day 21 or until the patient was discharge from the hospital or withdrawn from the study. Oral examinations were conducted twice weekly, and adverse events and compliance were recorded. Cultures were taken for quantitative counts and species identification. Candida isolates were assessed for resistance to the oral antifungal agents. Blood was collected for assessment of amphotericin B levels. RESULTS AND DISCUSSION: Ulcerative mucositis occurred in 84.6% of patients undergoing HCT, and no correlation was observed between the severity of mucositis and the presence of oral Candida and the severity of mucositis. Systemic and topical antifungal treatment resulted in a decrease in the number of colonized patients (54.8% before treatment; 23.1% during treatment); however, oral colonization was not eliminated. Tolerability of the oral rinse products was limited, with greater noncompliance in the amphotericin B than the nystatin group. Reports of altered taste appeared to be greater in the amphotericin B group. Minimal absorption of amphotericin B was seen following oral rinsing (serum levels 0.12-0.50 microg/ml), and no consistent changes in organism susceptibility to polyenes were seen. The results suggest that topical antifungal rinses may further control oropharyngeal colonization by Candida in patients on systemic antifungals receiving HCT, but the effect is limited by tolerability and reformulation and should be considered in order to increase compliance.

Gingival crevice microbiota from Chinese patients with gingivitis or necrotizing ulcerative gingivitis.

The objective of this study was to quantitatively compare the bacterial population structure in plaque from the gingival margin of two groups of 21 Chinese patients with gingivitis or necrotizing ulcerative gingivitis (NUG). Subjects were recruited in four dental clinics in Eastern China. Samples were quantitatively assessed by immunofluorescence and fluorescent in situ hybridization for taxa known to be associated with periodontal diseases. The analyses showed that the fusiform taxa (Fusobacterium nucleatum/Fusobacterium periodonticum, Leptotrichia buccalis, Tannerella forsythensis, and Capnocytophaga sp.), Campylobacter rectus, Prevotella intermedia, Prevotella nigrescens, Selenomonas sputigena, and treponemes were present in both groups with high prevalence. Porphyromonas gingivalis and Actinomyces gerencseriae were much more prevalent in the NUG group. Quantitatively, most taxa, including P. gingivalis, F. nucleatum and the treponemes, accounted, on average, for < 3% of the total bacterial cell number. Only P. intermedia/P. nigrescens, P. gingivalis, S. sputigena, A. gerencseriae, and the sum of all monitored suspected periodontal pathogens were significantly increased in the NUG group. The present study demonstrates for both groups a highly diverse plaque composition and suggests that, etiologically, the overall concentration and the concerted effects of the entire group of opportunistic pathogens thriving in NUG-associated plaque are of prime importance.