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Objective Type I plasminogen deficiency (Plgdef) is an uncommon chronic inflammation of mucous membranes. Gingival enlargements usually proceed with progressive periodontal destruction and tooth-loss. Plasmin(ogen)-independent enzymatic mechanisms for fibrin clearance have already been discussed in the literature. Our primary objective was to verify, immunohistochemically, the occurrence of different enzymatic factors involved in tissue breakdown of inflamed compared to healthy gingiva. Secondly, we tried to find out, if these patients have a similar microbiological profile to the patients with known gingivitis and periodontitis. Materials and methods Immunohistochemical analysis of enzymes elastase, plasminogen (plg), cathepsin G, matrix-metalloproteinase (MMP)-3 and MMP-7 and of glycoprotein fibrinogen were performed with gingival tissues from 3 healthy controls, 8 patients with Plgdef and 3 patients with gingivitis and periodontitis. Furthermore, plaque from 5 patients with plasminogen deficiency were also obtained to determine the microbiological profile. Results Significantly high numbers of elastase positive leukocytes were detected in all samples. Staining for MMP-3 and MMP-7 was seen in samples with gingivitis and periodontitis with a stronger staining in samples with periodontitis by Plgdef. Fibrinogen was detectable in all samples. Staining for plg was stronger in samples with periodontitis than in other samples. Staining for cathepsin G was weak in gingivitis and periodontitis. Subgingival microbial flora showed elevated colony forming units of Prevotella intermedia/nigrescens , Fusobacterium spp., Eikenella corrodens , Porphyromonas gingivalis and viridans streptococci . Conclusion Strong staining of elastase, MMP-3 and MMP-7 and weak staining of plg in Plgdef samples supports the plasmin(ogen) – independent fibrin clearance. Similar subgingival microbiological flora was observed in periodontitis with Plgdef as in other periodontal diseases. Further investigations should determine the exact pathomechanism and focus on effective treatment methods of this entity.

Background Acute and chronic sinusitis in children and adults can spread to the orbit. Oral flora has been seen in orbital infections, but the extent of synergy between pathogens in such infections remains unknown. Methods A retrospective case series of patients with complicated sinusitis that involved the orbit from acute sinusitis who were admitted to a tertiary care hospital from January 2000 to December 2014 and who had surgical cultures obtained. Patients were identified by the International Classification of Diseases, Ninth Revision code for periorbital cellulitis, subperiosteal abscess, or orbital abscess. Results Sixteen patients underwent surgical drainage via external drainage or endoscopic sinus surgery of an orbital infection associated with sinusitis and had cultures obtained. Nine patients (56%) grew organisms that exist in oral flora, whereas seven patients (44%) grew common respiratory pathogens. The most common organisms recovered were viridans group streptococcus (VGS) (50%), Staphylococcus aureus (31%), Eikenella corrodens (25%), and Prevotella species (19%). Oral flora anaerobes were cultured alongside a VGS species in seven of eight patients (88%) as opposed to the respiratory pathogens, which were less frequently associated with concomitant VGS infection (29%) (p = 0.04). Conclusion There are two main sources for infectious orbital complications from acute sinusitis: respiratory pathogens and oral flora. The high prevalence of concurrent anaerobic oral flora and VGS infection supports a suspected synergy between VGS and other oral organisms.

The HACEK group, referring to Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae, is a rare cause of infective endocarditis (IE). It causes the majority of Gram-negative endocarditis cases and has an excellent prognosis and simple management if properly identified. However, delay in diagnosis and associated complications can render the infection fatal.Over the past few decades, there have been tremendous advancements in understanding the manifestations and progression of HACEK endocarditis (HE). This review tackles the epidemiology of HE, the microbiological characteristics of each organism in the HACEK group, the methods used to diagnose HE, the clinical manifestations, complications, and mortality of patients with HE, as well as the recommended treatment and preventive methods. Expert Commentary: The lack of robust randomized controlled trials in diagnosis and treatment of HE makes it difficult to determine the optimal management of such infections. Nevertheless, advancements in culturing methods have shown progress in isolating and identifying these fastidious organisms. Positive blood cultures for any of the HACEK organisms in the setting of no definite focus of infection is highly suggestive of HE. In such cases, treatment with ceftriaxone or a fluoroquinolone, even without obtaining antibiotic susceptibilities, should be initiated. Moreover, the decision to proceed with surgical intervention should be individualized. As is the case for other IE, HE requires the collaboration of a multidisciplinary team consisting of the infectious disease specialist, cardiologist, cardiothoracic surgeon, and the microbiologist.

To assess the prevalence and occurrence of eleven periodontopathogens in subgingival biofilm of banded and bonded molars during the first period of fixed orthodontic treatment. Subjects were selected from patients referred to orthodontic treatment and were divided in two groups: group A comprised fifteen patients (14.4±2.45 years of age) who received orthodontic bands on first permanent molars and group B of ten patients (15.7±1.87 years of age) with directly bonded tubes on the labial surface of the same teeth. Subgingival sample collection was performed before bands and tubes application and 4-7 weeks after attachment placement. DNA-strip tehnique was used to assess the presence of eleven putative periodontopathogens at each time point. Fusobacterium nucleatum, Eikenella corrodens and Capnocytophaga spp. were found in a large number of samples, other periodontopathogens were present in a smaller rate. The 4-7 weeks after attachment placement a slight increase of putative species was observed in both groups. The presence of orthodontic tubes and bands influence the accumulation and composition of subgingival microbiota. Higher level of oral hygiene should be achieved before and during orthodontic treatment in order to prevent any side effects on periodontal tissues.

Objectives Despite the input of microbiome research, a group of 20 bacteria continues to be the focus of periodontal diagnostics and therapy. The aim of this study was to compare three commercial kits and laboratory-developed primer pairs for effectiveness in detecting such periodontopathogens. Materials and methods Fourteen bacterial mock communities, consisting of 16 randomly assembled bacterial strains, were used as reference standard for testing kits and primers. Extracted DNA from mock communities was analyzed by PCR in-house with specific primers and forwarded for analysis to the manufacturer’s laboratory of each of the following kits: ParoCheck®Kit 20, micro-IDent®plus11, and Carpegen® Perio Diagnostik. Results The kits accurately detected Fusobacterium nucleatum, Prevotella intermedia/Prevotella nigrescens, Parvimonas micra, Aggregatibacter actinomycetemcomitans, Campylobacter rectus/showae, Streptococcus mitis, Streptococcus mutans, and Veillonella parvula. The in-house primers for F.nucleatum were highly specific to subtypes of the respective periopathogen. Other primers repeatedly detected oral pathogens not present in the mock communities, indicating reduced specificity. Conclusions The commercial kits used in this study are reliable tools to support periodontal diagnostics. Whereas the detection profile of the kits is fixed at a general specificity level, the design of primers can be adjusted to differentiate between highly specific strains. In-house primers are more error-prone. Bacterial mock communities can be established as a reference standard for any similar testing. Clinical relevance The tested kits render good results with selected bacterial species. Primers appear to be less useful for routine clinical diagnostics and of limited applicability in research. Basic information about the periodontopathogens identified in this study supports clinical decision-making.

Context: Knowledge of the microbial composition of abscessed primary tooth is limited. Aim: The aim was to investigate the presence of 10 oral bacterial species in samples from abscessed primary tooth root canals using microarray technology and to determine their association with clinical findings. Subjects and Methods: The samples were collected from root canals of 20 primary molars with acute primer infection. The bacterial composition of the samples was semi-quantitatively defined using a microarray system (ParoCheck®). Clinical parameters included the presence of spontaneous pain, mobility, percussion sensitivity and swelling. Statistical Analysis: Data were statistically analyzed by Student' t-test, Fisher's exact Chi-square test, Freeman–Halton–Fisher's exact test, and Spearman's rho correlation analysis. Results: All the tested species were detected in the samples. Fusobacterium nucleatum was the most frequent bacterium (100%), followed by Parvimonas micra (65%), Provetella intermedia (45%), and Treponema denticola (45%). According to paired bacterial combinations, F. nucleatum was significantly positively correlated with P. intermedia and P. micra (P < 0.05). T. denticola was significantly positively correlated with Porphyromonas gingivalis, Tannerella forsythia, Campylobacter rectus, and P. micra, while it was negatively correlated with Eikenella corrodens (P < 0.05). No statistically significant relationships were found between the presence of any bacteria and clinical findings. Conclusion: Microarray technology used in this study has demonstrated the presence of various bacteria with varying proportions in the root canals of abscessed primary teeth. The results regarding the high rate of certain bacterial combinations suggest the enhanced pathogenicity due to additive or synergistic effects of these microbial combinations.

Objectives: The study aimed to describe the epidemiological, microbiological, and clinical features of a population sample of 17 patients with HACEK infective endocarditis (HACEK-IE) and to compare them with matched control patients with IE caused by viridans group streptococci (VGS-IE). Methods: Cases of definite (n = 14, 82.2%) and possible (n = 3, 17.6%) HACEK-IE included in the Infective Endocarditis Hospital Clinic of Barcelona (IE-HCB) database between 1979 and 2016 were identified and described. Furthermore, a retrospective case–control analysis was performed, matching each case to three control subjects with VGS-IE registered in the same database during the same time period. Results: Seventeen out of 1209 IE cases (1.3%, 95% confidence interval 0.69–1.91%) were due to HACEK group organisms. The most frequently isolated HACEK species were Aggregatibacter spp (n = 11, 64.7%). Intracardiac vegetations were present in 70.6% of cases. Left heart failure (LHF) was present in 29.4% of cases. Ten patients (58.8%) required in-hospital surgery and none died during hospitalization. In the case–control analysis, there was a trend towards larger vegetations in the HACEK-IE group (median (interquartile range) size 11.5 (10.0–20.0) mm vs. 9.0 (7.0–13.0) mm; p = 0.068). Clinical manifestations, echocardiographic findings, LHF rate, systemic emboli, and other complications were all comparable (p > 0.05). In-hospital surgery and mortality were similar in the two groups. One-year mortality was lower for HACEK-IE (1/17 vs. to 6/48; p = 0.006). Conclusions: HACEK-IE represented 1.3% of all IE cases. Clinical features and outcomes were comparable to those of the VGS-IE control group. Despite the trend towards a larger vegetation size, the embolic event rate was not higher and the 1-year mortality was significantly lower for HACEK-IE. Keywords: Endocarditis, HACEK, Viridans group streptococci, epidemiology, clinical characteristics, outcome, case-control

We present a case of a right perirenal Eikenella corrodens abscess in a patient with chronic pancreatitis and poor dental hygiene. Endoscopic Retrograde CholangioPancreaticography (ERCP) revealed a pancreatic fistula draining to the right perirenal loge. The patient was treated with broad-spectrum antibiotics, percutaneous drainage and endoscopic stenting of the duct of Wirsung, stopping the supply of the fistula. A full recovery in our patient was observed. Considering the uncommon location of the abscess, a review of the different aetiologies of perirenal abscesses and their distrubution patterns, and the endoscopic treatment of symptomatic pancreatic fistulas seemed worthwhile.

Suppression of periodontal pathogens in the oral cavity of periodontally healthy individuals may lower the risk for periodontal or periimplant diseases. Therefore, the present study aimed to analyze the effect of supragingival debridement (SD) with adjunctive full mouth glycine powder air polishing (FM-GPAP) on the prevalence of periodontal pathogens in periodontally healthy individuals. Eighty-seven systemically and periodontally healthy intraoral carriers of red complex bacteria, i.e., Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola or other periodontal pathogens including Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Eikenella corrodens were enrolled into the study and randomly assigned to receive SD with adjunctive FM-GPAP (test, n = 42) or SD alone (control, n = 45). In the first observation period, microbiological samples were obtained prior to, and 2, 5, and 9 days following intervention. If one of these periodontal pathogens could still not be identified, additional microbial sampling was performed after 6 and 12 weeks. The prevalence of red complex bacteria was significantly reduced in the test compared to the control group following treatment (p = 0.004) and at day 9 (p = 0.031). Intragroup comparison showed a significant (test, p

Omadacycline was tested against 125 isolates recovered from infected cat and dog bites in humans. Its activity was similar to that of other compounds in the tetracycline class, and it was active against strains exhibiting tetracycline resistance. Against anaerobic isolates, resistance to tetracyclines was more prominent and omadacycline was the most active of the group. All isolates had omadacycline MICs of Eikenella corrodens , which showed reduced susceptibility to the entire tetracycline group.

Objectives: Bacteria with common microbiological and clinical characteristics are often recognized as a particular group. The acronym HACEK stands for five fastidious genera associated with infective endocarditis (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella). Data on the epidemiology of HACEK are sparse. This article reports a 6-year nationwide study of HACEK bacteraemia in Denmark. Methods: Cases of HACEK bacteraemia occurring during the years 2010–2015 were retrieved from the national Danish microbiology database, covering an average surveillance population of 5.6 million per year. Results: A total of 147 cases of HACEK bacteraemia were identified, corresponding to an annual incidence of 0.44 per 100 000 population. The annual incidence for males was 0.56 per 100 000 and for females was 0.31 per 100 000. The median age was 56 years (range 0–97 years), with variation among the genera. One hundred and forty-three isolates were identified to the species level and six to the genus level: Haemophilus spp, n = 55; Aggregatibacter spp, n = 37; Cardiobacterium spp, n = 9; Eikenella corrodens n = 21; and Kingella spp, n = 27. Conclusions: This is the first study on the incidence of HACEK bacteraemia in a large surveillance population and may inspire further studies on the HACEK group. Haemophilus spp other than Haemophilus influenzae accounted for most cases of HACEK bacteraemia in Denmark, with Aggregatibacter spp in second place. Keywords: Epidemiology, Incidence, Age, Sex, Haemophilus, Aggregatibacter

Stingrays are found worldwide in tropical and subtropical waters.1 The fish are equipped with a barbed spine on their tail, and human injury most frequently occurs when a victim steps on it, resulting in the fish impaling its spine into the victim’s foot or ankle. Morbidity is associated with both the direct injury inflicted from the spine and with venom diffusing from secreting cells on the spine.2 Inspired by movies or because of common superstition, stingvictims are sometimes treated on-site with an attempt to suck out the venom. Here, we report a case where such traditional treatment of stingray envenomation caused severe infection by oral flora bacteria.

12 pags., 4 figs., 3 tabs., Objectives: Poor oral hygiene during treatment with fixed appliances results in plaque accumulation. The presence of bacteria in the gingival crevice triggers an inflammatory reaction in the gingival tissues. The aim of this study was to compare the impact of two preventive treatments, photodynamic therapy (PDT), and ultrasonic scaler (US), on gingival health in patients under fixed orthodontic treatment. Methods: Twenty orthodontic patients were randomly allocated to two groups: PDT or US. Each group received seven sessions [days 0, 15, 30, 45, 90 (3-months follow-up), 180 (6-months follow-up), 270 (9-months follow-up)] of experimental interventions, and clinical parameters [Plaque index(PI); gingival index(GI); probing depth(PD)], periodontopathogens [Agreggatibacter actinomycetemcomitans; Porphyromonas gingivalis; Prevotella intermedia; Micromonas micros; Fusobacterium nucleatum; Tannerella forsythia; Campylobacter rectus; Eikenella corrodens; Capnocytopaga sp.] and protein markers [IL-1β;IL-1ra;IL-6;IL-10;TNF-α;FGF-2/FGF basic] were monitored at baseline and at 3, 6, and 9 months. ANOVA, Student's t-test with Bonferroni correction and ANOVA with multiple rank test were used to identify differences between groups (P < 0.05). Results: Clinical assessments [PI, GI, and PD] yielded no differences (P > 0.05) between groups, which showed a major decrease at the start of the trial. Reductions in total colony forming units (log CFU reduction) were observed with both treatments, although to a greater extent in the PDT group, but with no differences between groups (P > 0.05). Similar reductions in log CFU counts of P. gingivalis, P. intermedia, and F. nucleatum were observed in both groups (P > 0.05). The two groups also showed similar trends for inflammatory mediators with decreased levels of IL-1β, IL-10, and TNF-α, whereas IL-6 and IL-1ra levels remained stable and those of FGF-2 were increased after both interventions, with no differences (P > 0.05) between groups. Conclusion: Both PDT and US methods proved similar effectiveness for the treatment of gingival inflammation induced by fixed orthodontic appliances. Lasers Surg. Med. 51:256–267, 2019. © 2018 Wiley Periodicals, Inc.

This case report describes a 38-year-old female presenting with a thigh abscess caused by Eikenella corrodens, Actinomyces sp., and α-hemolytic Streptococcus following an intramuscular vitamin B12 injection administered at an outpatient clinic. After failure to improve clinically with intravenous daptomycin and after visualization of the abscess with gas bubbles on CT scan, she was taken to the operating room for three separate surgical irrigation and debridement procedures. Treatment also included intravenous ampicillin/sulbactam followed by oral amoxicillin/clavulanic acid therapy. She remained symptom free and without infection at nine months following hospitalization. It was suspected that poor hygiene played a role in the infection, but a definitive cause was not identified.

Objectives: The purpose of the study is to investigate the quantitative detection of periodontal pathogens before and after scaling by real-time polymerase chain reaction. Methods: Participants were voluntarily recruited at D university, and saliva samples were extracted before and after scaling. Multiple real-time polymerase chain reactions were used to analyze characteristics and the amount of nine kinds of periodontal pathogens; Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, and Eikenella corrodens. Results: After scaling, most periodontal pathogens except Eikenella corrodens were significantly decreased in all subjects(p

Lysine, a nutritionally essential amino acid, enters the oral cavity in gingival crevicular fluid (GCF). During oral hygiene restriction (OHR), lysine decarboxylase (LDC) in dento-gingival biofilms converts lysine to cadaverine. Lysine depletion impairs the dental epithelial barrier to bacterial proinflammatory products. Antibodies to LDC from Eikenella corrodens (Ecor-LDC) inhibit LDC activity and retard gingival inflammation in beagle dogs. Whether E. corrodens is the major source of LDC in dental biofilms and whether the lysine analog tranexamic acid (TA) inhibits LDC activity, biofilm accumulation, and GCF exudation in a human gingivitis model were examined.Antibodies raised in goats to LDC-rich extracts from E. corrodens cell surfaces were used to inhibit Ecor-LDC and detect it in biofilm extracts using Western blots. Ecor-LDC activity was measured at pH 4.0 to 11.0 and its TA dissociation constant (Ki) at pH 7.0. Young adults used a 5% or 10% TA mouthwash three times daily during OHR for 1 week.Ecor-LDC antibodies and TA inhibited biofilm LDC. Ki of TA for Ecor-LDC was 940 μM. TA reduced plaque index (PI) by downshifting the PI correlation with biofilm lysine content after OHR without TA. GCF was correspondingly suppressed. However, greater TA retention in saliva partially relieved GCF suppression but not biofilm lysine depletion.TA slightly inhibits LDC but strongly reduces biofilm by inhibiting bacterial lysine uptake. Unfortunately, TA may impair dental epithelial attachments by also inhibiting lysine transporter uptake. Ecor-LDC inhibitors other than lysine analogs may maintain sufficient lysine levels and attachment integrity to prevent periodontal inflammation.

Made available in DSpace on 2019-09-12T16:56:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2015 Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: There are few studies on periodontal status related to microbiologic and immunologic profiles among individuals not or occasionally using alcohol and those with alcohol dependence. The aim of this study is to determine the effect of alcohol consumption on the levels of subgingival periodontal pathogens and proinflammatory cytokines (interleukin [IL]-1 beta and tumor necrosis factor [TNF]-alpha) in the gingival fluid among individuals with and without periodontitis. Methods: This observational analytic study includes 88 volunteers allocated in four groups (n = 22): individuals with alcohol dependence and periodontitis (ADP), individuals with alcohol dependence and without periodontitis (ADNP), individuals not or occasionally using alcohol with periodontitis (NAP), and individuals not or occasionally using alcohol without periodontitis (NANP). Levels of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum were determined by real-time polymerase chain reaction on the basis of the subgingival biofilm, and IL-1 beta and TNF-alpha were quantified by enzyme-linked immunosorbent assay in gingival fluid samples. Results: Individuals with alcohol dependence showed worse periodontal status and higher levels of P. intermedia, E. corrodens, F. nucleatum, and IL-1 beta than non-users. No significant correlations between TNF-alpha and bacterial levels were observed. However, in the ADP group, higher levels of E. corrodens were correlated with higher levels of IL-1 beta. Conclusion: A negative influence of alcohol consumption was observed on clinical and microbiologic periodontal parameters, as well as a slight influence on immunologic parameters, signaling the need for additional studies. [Lages, Eugenio J. P.; Costa, Fernando O.; Cota, Luis O. M.; Cyrino, Renata Magalhaes; Lages, Elizabeth M. B.; Brito, Joao A. R.; Gomez, Ricardo S.] Univ Fed Minas Gerais, Dept Dent Clin Oral Pathol & Dent Surg, Fac Dent, BR-31270901 Belo Horizonte, MG, Brazil [Cortelli, Sheila C.; Cortelli, Jose R.; Nobre-Franco, Gilson C.] Universidade de Taubaté (Unitau), Periodont Res Div, Dept Dent, Sao Paulo, Brazil

Intraventricular abscesses are very rare and usually result from secondary rupture of a brain abscess. In the few published cases, clinical presentation was subacute and different pathogens were found. The diagnosis might be mistaken as an intraventricular tumor. This is a case of a 10-year-old girl suffering from cyanotic heart disease that was presented with subacute onset of headache, vomiting, and some signs of inflammation. Symptoms lead to early brain imaging (CT/MRI) demonstrating left ventricular horn lesion affecting adjacent brain structures. Neuroradiologists suspected an intraventricular tumor, but cardiac history and signs of inflammation led to lumbar puncture and evidence of CNS infection, and intraventricular abscess was suspected. Navigated aspiration was performed, and multi-sensitive Eikenella corrodens was cultivated. Broad antibiotic treatment and dexamethasone were initiated, and symptoms disappeared. Follow-up imaging demonstrated gradual regression of the intraventricular abscess. The girl underwent regular professional teeth cleaning which was discussed as possible cause of infection. Although an isolated intraventricular abscess is a very rare event, typical predisposing cardiac history together with central nervous symptoms and an intracranial contrasting mass should always lead to the differential diagnosis of a brain abscess and be biopsied first. E. corrodens is a typical organism of the mouth flora, but a rare cause for a brain abscess. Harmless teeth cleaning procedures may cause hematogenic spread and lead to CNS infections, e.g., in patients with predisposing diseases. To our knowledge, there are only six previous reports of primary intraventricular brain abscess.

Cardiobacterium valvarum is a newly described HACEK ( Haemophilus spp., Aggregatibacter spp ., Cardiobacterium spp., Eikenella corrodens , and Kingella spp.) organism causing endocarditis. We report the second case of bioprosthetic aortic valve infective endocarditis, review the current literature, and investigate the phylogenetic relationships among clinical isolates of C. valvarum.

Brain abscesses are rare but potentially deadly complications of odontogenic infections. This phenomenon has been described mainly in the form of case reports, as large-scale studies are difficult to perform. We compiled a total of 60 previously published cases of such a complication to investigate the predisposing factors, microbiology, and clinical outcomes of intracranial abscesses of odontogenic origin. A systematic review of the literature using the PubMed database was performed. Men accounted for 82.1% of cases, and the mean age was 42.1 years. Caries with periapical involvement and periodontitis were the two most common intra-oral sources, and wisdom tooth extraction was the most common preceding dental procedure. In 56.4% of cases, there were obvious signs of dental disease prior to development of intracranial infection. Commonly implicated microorganisms included Streptococcus viridans (especially the anginosus group), Actinomyces, Peptostreptococcus, Prevotella, Fusobacterium, Aggregatibacter actinomycetemcomitans and Eikenella corrodens. There was an 8.3% mortality rate. Intracranial abscesses can form anywhere within the brain, and appear unrelated to the side of dental involvement. This suggests that hematogenous spread is the most likely route of dissemination.

Uncommon microorganisms are increasingly being recognized as causative agents of paediatric infectious endocarditis (IE). We report a 4-year old girl with congenital heart disease, who suffered from 2 IE episodes secondary to Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus) and Staphylococcus lugdunensis, both rarely reported pathogens in this age group. The patient was initially successfully treated with prolonged intravenous antibiotic courses, however removal of the Contegra valved conduit during the second episode was required due to recurrence of fever and development of pulmonary embolism despite completion of antibiotic therapy. A. aphrohilus is a member of the fastidious gram negative microorganisms of the HACEK group (Haemophilus spp., Aggregatibacter spp, Cardiobaterium hominis, Eikenella corrodens and Kingella kingae), that colonize the oropharynx and are a recognised cause of IE. Prognosis of children with IE due to HACEK group members varies, half of them suffering from complications and mortality rates of 10-12.5%. Although S. lugdunensis belongs to coagulase negative staphylococci (CONS), it behaves more like S. aureus species rather than CONS. This microorganism is a well-described cause of endocarditis in adult patients, associated with high requirements of surgical procedures and mortality (42-78%). In conclusion, paediatric IE can be caused by uncommon microorganisms associated with severe complications and potential fatality. The isolation of S. lugdunensis or A. aphrophilus in febrile patients should be considered clinically relevant and cardiac involvement must be ruled out. Those patients with proved IE will require prolonged intravenous antibiotic courses and in complicated cases surgical intervention.

We present a case of postoperative septic arthritis with Eikenella corrodens and Streptococcus mitis following an arthroscopic anterior cruciate ligament reconstruction in an adolescent male with no pertinent medical history. The patient presented to the emergency department nine days after the operation with fever, an elevated white blood cell count, knee pain, and effusion. Arthrocentesis of the knee yielded purulent fluid that tested positive for S. mitis. Repeat intraoperative cultures revealed E. corrodens. In addition to antibiotics, the patient's treatment course included arthroscopic irrigation and debridement in the operating room as well as removal of graft material and fixation devices. To our knowledge, this is the first case of a polymicrobial infection of E. corrodens and S. mitis causing septic arthritis in a teenager following arthroscopic anterior cruciate ligament reconstruction.

Haemophilus parainfluenzae , which belongs to the HACEK ( Haemophilus ssp , Actinobacillus actinomycetemcomitans , Cardiobacterium hominis , Eikenella corrodens , and Kingella kingae ) group, is a rare cause of subacute endocarditis and may lead to ischemic stroke. A 65-year-old female patient previously diagnosed with rheumatic valve disease was submitted to surgical mitral valve repair in 1996. Physical examination did not reveal any murmurs; physical examination of the lungs and abdomen was normal. The patient was admitted to hospital with progressive dyspnea, dry cough, and fever. Transesophageal echocardiogram revealed an approximately 8-mm filamentous image with chaotic motion in the ventricular face of the anterior mitral valve leaflet compatible with vegetation. Treatment with ceftriaxone and gentamicin was initiated. Haemophilus parainfluenzae grew in five blood culture samples. Along the hospital stay, the patient’s level of consciousness decreased, and she was diagnosed with ischemic stroke of cardioembolic etiology. The patient developed septic shock refractory to the prescribed treatment and died 12 days after admission. Even though the patient started being treated for endocarditis before the infectious agent was identified, the prompt use of antimicrobials hindered the growth of Haemophilus parainfluenzae and made its isolation difficult. J Clin Med Res. 2017;9(1):71-73 doi: https://doi.org/10.14740/jocmr2703w

We report 2 cases of Kingella kingae endocarditis leading to valvular mitral perforation in previously healthy children. Kingella kingae belongs to the HACEK (Haemophilus aphrophilus, Actiobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and K. kingae) group of organisms known to cause endocarditis.

Animal bite wounds affect more than 5 million Americans annually, resulting in 300,000 emergency department visits, 10,000 hospitalizations, and an untold number of physician office visits. Various forms of topical therapy are empirically self-employed by many patients prior to seeking medical attention. Pexiganan, a 22-amino-acid synthetic cationic analogue of the peptide magainin II, acts by selectively damaging bacterial cell membranes. We determined the MICs for pexiganan and other antimicrobial agents often used for treatment of bite wounds. Most isolates were from U.S. patients, and ∼10% were from European and Canadian patients. The comparator antimicrobials studied were penicillin, amoxicillin-clavulanate, piperacillin-tazobactam, meropenem, clindamycin, doxycycline, moxifloxacin, ceftriaxone, linezolid, and metronidazole. The MIC 90 s of pexiganan were 32 μg/ml (against Pasteurella multocida subsp. multocida ), 16 μg/ml ( P. multocida subsp. septica , Pasteurella canis , and Pasteurella dagmatis ), 8 μg/ml ( Pasteurella stomatis ), 8 μg/ml ( Eikenella corrodens ), 2 μg/ml ( Neisseria weaveri , Neisseria zoodegmatis , and Moraxella canis-Moraxella lacunata group), 16 μg/ml ( Bergeyella zoohelcum ), 64 μg/ml ( Bacteroides pyogenes ), 4 μg/ml ( Fusobacterium russii ), 32 μg/ml ( Fusobacterium canifelinum ), and 64 μg/ml ( Prevotella heparinolytica ). The concentration of pexiganan in the cream used was 8,000 μg/ml, more than 60 to 100 times the highest MIC obtained. Pexiganan exhibited a broad range of antimicrobial activity, showing potential for treating animal bite infections. A clinical trial seems warranted.

Presence of epithelial desquamation, erythema, and erosions on gingival tissue is usually described in the literature as desquamative gingivitis (DG). A wide range of autoimmune/dermatologic disorders can manifest as DG, although the two more common are oral lichen planus and mucous membrane pemphigoid. The aim of this study is to investigate prevalence of 11 periodontopathogenic microorganisms in patients with DG and to compare it with the microbiologic status of individuals affected by plaque-induced gingivitis (pGI).Cross-sectional clinical and microbiologic data were obtained from 66 patients (33 in each group). Subgingival plaque samples were analyzed using semiquantitative polymerase chain reaction analysis.Statistically significant difference, but with little clinical significance, was observed in gingival conditions between the two groups, probably due to the worse home control hygiene of patients with DG. Prevalence and levels of Aggregatibacter actinomycetemcomitans, Eikenella corrodens, and Fusobacterium nucleatum/periodonticum were statistically higher in samples from patients with DG than in those with pGI. In multivariate regression models, subgingival colonization of A. actinomycetemcomitans and F. nucleatum/periodonticum was not statistically associated with DG, whereas, high levels of E. corrodens were associated with 13-fold increased odds for DG.Microbiologic differences were found in subgingival plaque for patients with DG and pGI. This may suggest possible association between periodontal pathogens and DG.

Infective endocarditis of the tricuspid valve (TVE) occurs predominantly in selected groups of patients including intravenous drug users (IVDUs). The most often cultured pathogen in IVDUs is Staphylococcus aureus. Eikenella corrodens, normally existing as a commensal in the mouth and the upper respiratory tract, is identified as an etiologic pathogen of endocarditis very rarely. The authors describe a case of a 27-year-old male with a past history of staphylococcal TVE readmitted to hospital after 5 months due to progression of right-sided heart failure. Bacteriological work-up revealed typical features and growth of E. corrodens. In echocardiography large vegetations on the damaged tricuspid valve and massive tricuspid regurgitation were seen. The prognosis of the disease, despite introduction of appropriate antibiotic therapy, was poor as he refused to undergo cardiac surgery.

Aim: Periodontal diseases are chronic, inflammatory and infectious diseases. Therefore, periodontal treatment aims to eliminate periodontopathogenic bacteria causing periodontal diseases. The aim of present study was to evaluate the effect of a bacterial end metabolite, acetic acid, on periodontopathogenic bacteria, Streptococcus gordonii and Eikenella corrodens.Material and Method: In present research, Eikenella corrodens (ATCC® 23834™) and Streptococcus gordonii (NCTC 7870) were tested. Acetic acid was used in 5% concentration dissolved in distilled water. Negative control agent was distilled water and positive control agents were 0.012% chlorhexidine, penicillin, tetracycline and ciprofloxacin. The antibacterial efficacy of acetic acid against bacteria was tested via disc-diffusion method, MIC test and minimum bactericidal concentration tests.Results: The inhibition zone of ciprofloxacin, penicillin, tetracycline, CHX and acetic acid against Eikenella corrodens and Streptococcus gordonii were 32 and 37 mm, 16 and 14 mm, 21 and 16 mm, 13 and 17 mm, and 14 and 11 mm respectively. Ciprofloxacin and penicillin inhibited bacterial growth in MIC and MBC tests against both bacteria. MIC tests of acetic acid and chlorhexidine against Eikenella corrodens revealed inhibitory effect at 7.81 µl/mL and 0.97 µl/mL concentrations, respectively. Against Streptococcus gordonii, MIC of acetic acid and chlorhexidine were 1.95 µl/mL and 3.90 µl/mL, respectively.Conclusion: Acetic acid is a bacterial end product and has a daily consumption as vinegar. Due to the antibacterial efficacy against periodontopathogenic bacteria, it can be useful in adjunction to periodontal treatment. Further studies to evaluate clinical use of acetic acid as mouthwash, dentifrice, gel and/or irrigation agent are necessary.Keywords: Acetic Acid; Oral Health; Periodontopathogenic Bacteria; Short Chain Fatty Acids.

Background: The aim of the study was to analyze how metabolic control of type 1 diabetes is related to clinical and micro- biological periodontal parameters. Material/Methods: The study involved 56 subjects aged from 19 to 50 years divided into 2 groups: healthy subjects (the H group), and diabetic (type 1 diabetes) patients with chronic untreated generalized periodontitis (the DM group). The gly- cosylated hemoglobin value (HbA1c) was determined using the UniCel DxC 800 SYNCHRON System (Beckman Coulter, USA), and the concentration in blood was measured by the turbidimetric immunoinhibition method. A molecular genetic assay (Micro-IDent plus, Germany) was used to detect periodontopathogenic bacteria in plaque samples. Periodontitis was confirmed by clinical and radiological examination. Results: Fusobacterium nucleatum, Capnocytophaga species, and Eikenella corrodens were the most frequently found bacteria in dental plaque samples (77.8%, 66.7%, and 33.4%, respectively), whereas Aggregatibacter actinomy- cetemcomitans was identified 40.7% less frequently in the DM group than in the H group. The strongest rela - tionship was observed between the presence of 2 periodontal pathogens - F. nucleatum and Capnocytophaga spp. - and poorer metabolic control in type 1 diabetes patients (HbA1c) and all clinical parameters of periodon- tal pathology. Conclusions: Periodontal disease was more evident in type 1 diabetic patients, and the prevalence of periodontitis was great- ly increased in subjects with poorer metabolic control.

Spinal infections with Eikenella corrodens are rare. We report a unique case of infection caused by E. corrodens diagnosed more than two years after cervical surgery. All other published cases of spinal infections caused by E. corrodens were searched. Characteristics of this bacterium, its challenging diagnosis and therapy are discussed.

We retrospectively examined medical records of 87 patients with bacteraemia caused by members of the HACEK group (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Aggregatibacter paraphrophilus, Cardiobacterium spp., Eikenella corrodens and Kingella spp.) to determine whether endocarditis was present, as defined by the Duke criteria. The overall positive predictive value (PPV) of HACEK bacteraemia for endocarditis was 60 %. The PPV varied with different HACEK species from 0 % (E. corrodens) to 100 % (A. actinomycetemcomitans).

Background: This study investigates the association between detectable plasmatic human immunodeficiency virus (HIV) viral load (HVL) and high levels of periodontal- and non-periodontal-related microorganisms in the subgingival microbiota of individuals with HIV. Methods: Thirty-seven individuals with HIV were divided into two groups: 1) detectable HVL (n = 15); and 2) undetectable HVL (n = 22). Subgingival biofilm samples were obtained, and the levels of 35 microbial species were determined by the checkerboard DNA–DNA hybridization method. Periodontal clinical measures and laboratory and sociodemographic data were also registered. x2 test, Fisher exact test, and Mann-Whitney U test were used to compare groups. Multilevel ordinal regression models were used to test the association between HVL and the levels of 35 microbial species in subgingival biofilm, adjusted for confounders. Results: Of the 35 species studied, 11 (31.4%) showed higher mean levels in the detectable HVL group than undetectable HVL group (P

The microflora in the periodontal pockets can affect the dental pulp and cause endodontic-periodontal lesions or retrograde pulpitis. Here we report an endodontic-periodontal lesion together with its bacterial profile. The lesion occurred in the maxillary right first molar of a 40-year-old woman who presented at our hospital complaining of a violent toothache since the previous night. Clinically, the tooth was caries-free and an electric pulp test showed it to be vital. The tooth showed signs of advanced periodontitis and the periodontal pocket was deep, reaching the apex of the palatal root. The clinical diagnosis was an endodontic-periodontal lesion with primary periodontal disease. Subsequent endodontic treatment comprised pulp extirpation and root canal filling, followed by periodontal treatment consisting of scaling and root planing. The tooth was finally restored with a full metal crown. No further signs of periodontal disease or periapical lesions have been observed to date. Bacteria were sampled from the root canal and periodontal pocket for a microbiological assessment using 16S rRNA gene-based PCR. Microbiologically, the profile of the bacterial species from the palatal root canal was similar to that from the periodontal pocket of the palatal root. Porphyromonas gingivalis, Fusobacterium nucleatum and Eikenella corrodens were detected in both samples. The occurrence of bacteria common to both sites in this patient further supports the proposition that periodontal disease is the definitive source of root canal infections. The present results suggest that a bacterial examination would be helpful in confirming and supporting the clinical diagnosis in such lesions.

Overproduction of interleukin (IL)-6 may play a pathologic role in rheumatoid arthritis (RA) and chronic periodontitis (CP). The present study assesses IL-6 receptor (IL-6R) inhibition therapy on the periodontal condition of patients with RA and CP.The study participants were 28 patients with RA and CP during treatment with IL-6R inhibitor, and 27 patients with RA and CP during treatment without IL-6R inhibitor. Periodontal and rheumatologic parameters and serum levels of cytokine and inflammatory markers and immunoglobulin G against periodontopathic bacteria were examined after medication with IL-6R inhibitor for 20.3 months on average (T1) and again 8 weeks later (T2).No differences were observed between the groups in any parameter values at T1, except for serum IL-6 levels. The anti-IL-6R group showed a significantly greater decrease in gingival index, bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and serum levels of IL-6 and matrix metalloproteinase (MMP)-3 from T1 to T2 than the control group (P0.05). A significant correlation was found between changes in serum anticyclic citrullinated peptide levels and those in PD and CAL in the anti-IL-6R group (P0.05), whereas both groups exhibited a significant association between changes in serum MMP-3 levels and those in BOP (P0.05).Changes in periodontal and serum parameter values were different between the patients with RA and CP during treatment with and without IL-6R inhibitor.

A 45-year-old- man presented with left chest wall pain, swelling and cough. Over a 2-month period he developed abscesses in the right foot, right anterior thigh, left buttock and left chest. Incision and drainage of the soft tissue abscesses and video-assisted thoracoscopic surgery to drain the loculated empyema contiguous with the chest wall abscess were performed as surgical management. Gram stain showed beaded Gram-positive rods and the culture initially grew Aggregatibacter actinomycetemcomitans and Eikenella corrodens. Pathological evaluation of the pleura showed sulfur granules and organisms consistent with Actinomyces spp. on Gomori methenamine silver stain; Actinomyces israelii was recovered in culture with extended incubation. The patient was treated for 3 weeks with ceftriaxone and oral metronidazole, followed by oral amoxicillin. Culture of A. actinomycetemcomitans with other findings consistent with actinomycosis warrants 6–12 months of antibiotic therapy.