ABSTRACT
Opportunistic viral infections are common in kidney transplant recipients. They are mainly caused by cytomegalovirus, which in addition to causing infection, can increase immunosuppression and facilitate colonization by other pathogens. This study presents the clinical case report of a kidney transplant recipient affected by cytomegalovirus who presented oral lesions caused by Pseudomonas aeruginosa. A 55-year-old male patient with gingival burning and chewing pain presented whitish areas in his gums in the region from element 22 to 24, surrounded by erythematous areas. Culture examination and biopsy revealed the presence of the bacteria P. aeruginosa, confirmed by blood culture. After seven days of antibiotic therapy, a significant improvement was observed in his oral condition. Thus, it was concluded that the oral cavity was the infection site in this kidney transplant patient, demonstrating the importance of a dentist in a multidisciplinary team to perform early diagnosis of oral lesions, and thus prevent possible systemic complications that may culminate in graft rejection. (AU)
Infecções virais oportunistas são comuns em transplantados renais, principalmente causadas pelo citomegalovírus, que além de causar infecção, pode aumentar a imunossupressão e facilitar a colonização por outros patógenos. Nós apresentamos aqui o relato de caso clínico de um transplantado renal acometido por citomegalovírus que apresentou lesões bucais causadas por P. aeruginosa. Paciente do sexo masculino, 55 anos, com ardência gengival e dor à mastigação, apresentava áreas esbranquiçadas em gengiva na região do 22 ao 24 circundadas por áreas eritematosas. Exame de cultura e biópsia revelaram a presença da bactéria P. aeruginosa, confirmada na hemocultura. Após sete dias de antibioticoterapia, observamos melhora significativa da condição bucal. Assim, concluímos que a cavidade bucal foi o sítio da infecção no paciente transplantado renal demonstrando a importância do dentista em equipe multidisciplinar para realizar diagnóstico precoce de lesões bucais e assim prevenir possíveis complicações sistêmicas que possam culminar com a rejeição do enxerto. (AU)
ABSTRACT
OBJECTIVE: This study tested the hypothesis that a relationship exists between periodontal disease status and ventilator-associated pneumonia (VAP) in patients admitted to an intensive care unit (ICU). MATERIALS AND METHODS: The periodontal status of 60 individuals admitted to the ICU of the Dutra University Hospital was determined, including measurement of visible plaque, gingival bleeding, and clinical attachment level. Data were analyzed by Chi-square or Fisher's exact tests, unpaired Student's t-test and multivariate logistic regression. RESULTS: Patients with VAP showed higher prevalence of periodontitis (25%) than those in the control group (12.5%), but without statistical difference (p = 0.22). After multivariate analysis, risk factors for ventilator-associated pneumonia included diabetes mellitus (OR = 27.76, 95% CI = 1.95-393, p = 0.014), and mechanical ventilation for longer than 10 days (OR = 12.1, 95% CI = 1.65-87.9, p = 0.014). CONCLUSION: Within the limits of this study, no association between periodontitis and ventilator-associated pneumonia was found. The presence of diabetes and invasive mechanical ventilation duration (> 10 days) were risk factors for pneumonia even after the adjustment of variables.
