Capsular type distribution and susceptibility to antibiotics of Streptococcus pneumoniae clinical strains isolated from Uruguayan children with systemic infections. Pneumococcus Study Group.

Children under 24 months of age are at high risk for serious infection with Streptococcus pneumoniae but they do not elicit effective immune responses to the currently available capsular polysaccharide vaccines. A polysaccharide protein conjugated vaccine involving the most frequent types has become an urgent need. To produce such a vaccine for Latin America, information on type distribution is required. Recently, Uruguay was 1 of the 6 countries in Latin America where surveillance for invasive pneumococcal infections in children under the age of 5 years was carried out. Seventy percent of the 182 invasive S. pneumoniae isolates were recovered from patients under 24 months of age, and 19% were recovered from infants under 6 months. The 7 most frequent types were 14, 5, 1, 6B, 3, 7F, and 19A; representing 80% of invasive isolates. Twenty-one types were identified, 16 in pneumonia and 14 in meningitis. Resistance to penicillin increased during the study period, from 29% in 1994, to 40% in 1995-1996, mainly because of the spread of type 14 strains resistant to penicillin and trimethoprim/sulphamethoxazol (89% of resistant isolates). The high proportion of systemic pneumococcal infections recorded in patients under 24 months of age and the increasing resistance of these agents to first-choice antibiotics point to an urgent need for a capsular polysaccharide protein conjugated vaccine.

[Comparative study of the adherence test and the Petry plaque count test of Streptococcus mutans in saliva]. / Estudio comparativo entre el test de adherencia y el test de recuento en placa Petry de Streptococcus mutans en saliva.

The Streptococcus mutans counts--added to lactobacili depicting test--are an useful instrument in cariology when determining the risk groups. In studies concerning a large number of patients the S. Mutans count in saliva test are the most accesible. Nevertheless, they are very expensive and also complicate to carry out. Simplified techniques which depict S. Mutans on the basis of adherence tests have been perfected. The most suitable from them, taking into account our working conditions, is the Matsukubo test. We deemed it interesting to correlate this test and the Gold medium count. The study has been carried out with three different populations using both techniques at the same time. As per the correlation indices obtained we conclude that the Matsukubo technique and the count have a significant correlation between them. Due to its low cost, the simplicity of its realization, as well as its easy reading it can be effectively used as a primary procedure when studying populations large in number. Through this method selection will be made of the patients to be studied applying more precise microbiological techniques.

[Human acquired immunodeficiency syndrome (AIDS)]. / Síndrome de inmunodeficiencia humana adquirida (SIDA).

PIP: This work, intended primarily for dentists, provides detailed information on the mechanism of action of the AIDS virus, its epidemiology and most common routes of infection, the clinical manifestations of HIV infection, and related oral lesions of relevance to the dentist. The work also recommends ways in which dentists can aid in diagnosis, avoid contaminating patients, and avoid being infected themselves by seropositive patients. The article begins by describing retroviruses and their mode of action and then focuses on the pathogenic mechanism of the HIV virus, which preferentially attacks T4 helper lymphocytes. The lymphocytes are destroyed by the viruses multiplying in their interiors. The decline in the number of T4 lymphocytes results in diminished capacity of the immune system to respond, favoring in turn the appearance of certain tumors and opportunistic infections that eventually prove fatal. The virus may also affect cells of the central nervous system, producing dementia and other disorders. Although AIDS was initially observed primarily in male homosexuals and drug addicts in the US and Europe, it has had a relatively even sex ratio in Africa, where few victims have been homosexuals or drug addicts. The virus is now found in most of the world's countries and is known to be spread primarily through sexual contact. Other routes of transmission are by contaminated hypodermic needles, prenatal infection, and infected blood transfusions. There is still no good evidence that saliva can be a route of contamination. Lesions of the oral cavity that indicate immune deficiency include Candidiasis, gingivostomatitis, necrosing ulcer, Histoplasmosis, Herpes simplex, papillomas and condylomas, Leukoplasia vellosa, Kaposi's sarcoma, some cancers, and non-Hodgkin's lymphoma. European and American studies indicate that 75% of AIDS patients have oral or oral-esophageal candidiasis, which can occur in 3 forms. Most of these oral manifestations are very rare in the general population. The dentist should wear protective clothing to prevent direct transmission and should carefully discard or disinfect used materials and supplies. Tools and the work area should be carefully decontaminated after each patient is seen.^ieng

[Evaluation of oral health status of a preschool group with a predictive test based on mutans group and clinical studies]. / Relevamiento del estado de salud bucal de una población pre-escolar con test predictivo en base al grupo mutans y a estudios clinicos.

A children's population, aged from 2 to 5 years, was studied for three years. Bacteriological and clinical criteria were followed, with a determination of the M. st level in non-stimulated saliva in the age-groups of 3, 4 and 5 years. We found, as Alaluusua did, a correlation between the M. st level in saliva and the number of caries. With this study, a large number of caries-free children had a low M. st level. The largest amount of caries appears in children with a high M. st level. The highest caries incidence in this population appears at the 4 year children group. It has to be remembered that this is an age-group with specific characteristics. Caries is a disease depending on many factors and the M. st level would be very significant to an early detection of risks, but should be evaluated considering all the parameters as a whole. Its predictive value is not sufficient by itself but it has an unquestionable value when detecting risk patients of an early age. Therefore, treatment has to be the result of an etiological diagnosis addressed to prevention after an evaluation of all the factors related with the caries disease.

Caries incidence, effect of preventive measures, and caries prediction in Uruguayan children.

In 1988, 100 12- to 13-year-old children from two neighborhoods in Montevideo with different standards of living were examined. Twenty-three children with large numbers of mutans streptococci, lactobacilli, or decayed surfaces or a combination of these factors were considered to be at high risk of developing caries. Twelve of these 23 children were selected for special preventive measures. A second examination was made 18 months later, at which 81 of the originally 100 children were studied. The clinical and microbiologic variables were tested for their ability to predict caries by calculating their sensitivity, specificity, the positive and negative predictive values. The incidence of new DMFS was significantly higher in the children from the low than in those from the high socioeconomic area. It was also significantly higher in the children considered being at high risk than in those at low risk at the start of the study. Preventive measures reduced the caries risk. The highest sensitivity was obtained with the clinical test, whereas the highest specificity was obtained with the combined clinical and microbiologic tests. The findings indicate that methods for identifying children at risk which started to be used in Scandinavia 20 years ago could be applied in the Uruguayan population of today. It is valuable to know this, as the resources for both treatment and prevention are very limited.

Dental caries and microbial and salivary conditions in Uruguayan children from two different socioeconomic areas.

Dental caries, microbial and salivary conditions, dietary habits, and socioeconomic conditions were studied in 100 12- to 13-year-old children from 2 different socioeconomic areas in Montevideo: Pocitos and Piedras Blancas. The residents of Pocitos had a higher educational level, better housing conditions, and occupations involving higher earnings than those of Piedras Blancas. The caries prevalence in the two areas was about the same, but the children in Piedras Blancas had more decayed surfaces and fewer filled surfaces than the children in Pocitos. The mean values for caries in Piedras Blancas and Pocitos were, DMFT, 4.2 and 4.2; DMFS, 8.1 and 7.8; DS, 4.7 and 2.5; and FS, 1.7 and 4.7, respectively. The differences in DS and FS were statistically significant. The frequency of sugar intake and the salivary secretion rate were similar, but the buffer capacity was significantly higher in Pocitos than in Piedras Blancas. The plaque index was the same, but the distribution of cariogenic microorganisms differed significantly. Fifty-eight per cent of the children in Piedras Blancas had more than 10(6) CFU of mutans streptococci per milliliter saliva, compared with 17% of the children in Pocitos. Similar differences were found with regard to the lactobacilli. The percentage of children with high numbers of mutans streptococci was higher in Piedras Blancas and lower in Pocitos than in previous epidemiologic studies in Scandinavia. It was, however, higher than that recently noted in Finland.