ABSTRACT
Molar incisor hypomineralization (MIH) is a developmental defect affecting teeth. High prevalence rates of MIH and its clinical implications are significant for both the patients and clinicians. A wide variation in defect prevalence (2.4-40.2%) is reported. It seems to differ with regions and various birth cohorts. Some of the recent prevalence studies are tabulated. Patient implications include hypersensitive teeth, rapid progression of caries, mastication impairment due to rapid attrition, and esthetic repercussions. Implications for clinicians include complexity in treatment planning and treatment implementation, poor prognosis of the restorations, difficulty in achieving pain control during treatment, and behavior management problems. Intention of this paper is to review the etio-pathogenesis, prevalence, clinical features, diagnostic features, and eventually present a sequential treatment approach, i.e., in accordance with current clinical practice guidelines.
Subject(s)
Dental Enamel Hypoplasia/pathology , Incisor/pathology , Molar/pathology , Dental Enamel Hypoplasia/epidemiology , Dental Enamel Hypoplasia/etiology , Dental Enamel Hypoplasia/therapy , Humans , PrevalenceABSTRACT
In the south of France, Leishmania infantum is responsible for numerous cases of canine leishmaniasis (CanL), sporadic cases of human visceral leishmaniasis (VL) and rare cases of cutaneous and muco-cutaneous leishmaniasis (CL and MCL, respectively). Several endemic areas have been clearly identified in the south of France including the Pyrénées-Orientales, Cévennes (CE), Provence (P), Alpes-Maritimes (AM) and Corsica (CO). Within these endemic areas, the two cities of Nice (AM) and Marseille (P), which are located 150 km apart, and their surroundings, concentrate the greatest number of French autochthonous leishmaniasis cases. In this study, 270 L. infantum isolates from an extended time period (1978-2011) from four endemic areas, AM, P, CE and CO, were assessed using Multi-Locus Microsatellite Typing (MLMT). MLMT revealed a total of 121 different genotypes with 91 unique genotypes and 30 repeated genotypes. Substantial genetic diversity was found with a strong genetic differentiation between the Leishmania populations from AM and P. However, exchanges were observed between these two endemic areas in which it seems that strains spread from AM to P. The genetic differentiations in these areas suggest strong epidemiological structuring. A model-based analysis using STRUCTURE revealed two main populations: population A (consisting of samples primarily from the P and AM endemic areas with MON-1 and non-MON-1 strains) and population B consisting of only MON-1 strains essentially from the AM endemic area. For four patients, we observed several isolates from different biological samples which provided insight into disease relapse and re-infection. These findings shed light on the transmission dynamics of parasites in humans. However, further data are required to confirm this hypothesis based on a limited sample set. This study represents the most extensive population analysis of L. infantum strains using MLMT conducted in France.
Subject(s)
Dog Diseases/parasitology , Genetic Variation , Leishmania infantum/isolation & purification , Leishmaniasis, Visceral/parasitology , Leishmaniasis, Visceral/veterinary , Microsatellite Repeats , Multilocus Sequence Typing/methods , Animals , Dog Diseases/diagnosis , Dogs , France , Genotype , Humans , Leishmania infantum/classification , Leishmania infantum/genetics , Leishmaniasis, Visceral/diagnosis , Molecular Sequence Data , PhylogenyABSTRACT
Microsatellite markers have been used for Leishmania genetic studies worldwide, giving useful insight into leishmaniasis epidemiology. Understanding the geographic distribution, dynamics of Leishmania populations, and disease epidemiology improved markedly with this tool. In endemic foci, the origins of antimony-resistant strains and multidrug treatment failures were explored with multilocus microsatellite typing (MLMT). High genetic variability was detected but no association between parasite genotypes and drug resistance was established. An association between MLMT profiles and clinical disease manifestations was highlighted in only three studies and this data needs further confirmation. At the individual level, MLMT provided information on relapse and reinfection when multiple leishmaniasis episodes occurred. This information could improve knowledge of epidemiology and guide therapeutic choices for active chronic visceral leishmaniasis, the disease form in some HIV-positive patients.
Subject(s)
Leishmania/classification , Microsatellite Repeats/genetics , Multilocus Sequence Typing , AIDS-Related Opportunistic Infections/parasitology , Antiprotozoal Agents/pharmacology , DNA, Protozoan/genetics , Drug Resistance/genetics , Endemic Diseases , Genetic Variation , Humans , Leishmania/drug effects , Leishmania/genetics , Leishmania/isolation & purification , Predictive Value of Tests , RecurrenceABSTRACT
Molecular technologies offer the greatest potential for laboratories in resource-rich countries because they have the highest sensitivity and specificity. Continued use of new technologies will be crucial in elucidating the true epidemiology and pathogenesis of a disease, including the less well studied diseases. Continued development of affordable, sensitive, and specific diagnostic tools will be required for use in resource-poor settings, where the incidence of disease is highest.
