Study of Anaerobic Bacteria in Dental Abscess in a Tertiary Care Hospital

Majority of anaerobes involved in dental infections are thought to be endogenous in origin. Due to breech of continuity of pulp chamber bacterial colonization occurs. Responsible pathogens are polymicrobial. If left untreated in early stages, it can act as foci of disseminated infections and spread rapidly to adjacent structures leading to life threatening conditions. Aims: The present study was undertaken to identify different anaerobic organisms and their association with risk factors. Methods: 40 pus samples were collected after mouth wash from patients presented with dental abscess. Samples were processed immediately for aerobic and anaerobic culture. After comparing with the aerobic culture, obligate anaerobes were checked for aero tolerance. Subculture done for identification of species by Gram stain, colony morphology and conventional biochemical tests. Final identification was done by Vitek 2 system. Results: 40 (100%) samples were culture positive. Total 60 bacterial isolates recovered from this 40 samples. Out of which aerobes 36 (60%) and anaerobes 24 (40%) isolated. Aerobes present in 18 (45%), anaerobes present in 12 (30%) cases and mixed aerobic and anaerobic flora in 10 (25 %) cases. Predominant isolates were anaerobic cocci, Peptostreptococcus micros (41.6%) followed by Peptostreptococcus anaerobios (25%).Diabetes mellitus, bad chewing habits, poor oral hygiene found as significant risk factors. Conclusion: This study highlights polymicrobial nature of infections and role of anaerobes play as pathogens. Early diagnosis and interventions are extremely important to prevent systemic complications. One should have a high index of suspicion of anaerobes while dealing with dental infections.

A series on intestinal strongyloidiasis in immunocompetent and immunocompromised hosts.

Background: Strongyloidiasis, endemic in tropical areas, may be asymptomatic in immunocompetent subjects or may cause potentially fatal hyper-infection in immunocompromised patients. Methods: Of the 13,885 patients referred to the parasitology laboratory at our tertiary care referral center for stool microscopy, 15 were diagnosed as strongyloidiasis over a 6 year period. We assessed these patients retrospectively. Results: Most patients were young (median age 32 years, range 3-66) males (12, 80%). Seven patients (46.6%) were immunocompromised. All patients were symptomatic, and symptoms included chronic diarrhea (4, 26.7%), acute diarrhea (1, 6.7%), abdominal pain (6, 40%), weight loss (3, 20%), cough (2, 13.33%), vomiting (1, 6.7%), anemia (10, 66.7%) and eosinophilia (3, 20%). Thirteen patients (86.6%) were diagnosed on first stool microscopy. Duodenal biopsy showed normal histology in twelve (80%) and partial villous atrophy in one (6.7%) patient. Stool microscopy also revealed giardiasis and cryptosporidiosis in one patient each. Nine patients responded well to ivermectin and albendazole, one died and five were lost to followup. Conclusions: In endemic areas, even immunocompetent subjects may suffer from symptomatic strongyloidiasis and associated eosinophilia is uncommon.