Tuberculosis of the oral cavity: a systematic review.

The recent increase in the incidence of tuberculosis, combined with an emerging global resistance to antituberculous drugs, warrants an increased awareness of the involvement of Mycobacterium tuberculosis in persistent or atypical lesions in the oral cavity. We sought to review the published reports of mycobacterial infection of the oral cavity found in the literature in otherwise uncompromised patients, from 1950 to the present day, and analyzed the documented manifestations. M. tuberculosis infects all parts of the mouth (soft and hard palate, uvula, buccal mucosa, gingivae, lips, tongue, maxilla, and mandible) more often in men than in women, appearing predominantly in the form of ulcerative lesions. It was found as a secondary infection in 58% (54% pulmonary, 4% extrapulmonary) of patients and as a primary infection in 42% of patients. Carcinomas are found to co-exist in the same lesion site in 3% of patients. In approximately 50% of patients, an oral manifestation of TB has led to the diagnosis of a previously unknown systemic infection, which resulted in a timely and effective treatment. The investigation for tuberculosis should therefore be actively pursued in the dental surgery. Diagnostic work-up for systemic involvement and control of healthcare-associated spread is important, while therapeutic options are still considered adequate.

Prevalence of hepatitis B, hepatitis C, and HIV infections among patients in a psychiatric hospital in Greece.

OBJECTIVE: Psychiatric patients are considered to be at increased risk of infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV. METHODS: This study retrospectively assessed the seroprevalence of these infections among psychiatric patients who were referred for laboratory testing over a 24-month period in a 415-bed tertiary care psychiatric hospital in Greece. RESULTS: More than two-thirds of the 805 unique tested patients received care in short-term hospitalization units (patients receiving treatment for substance-related disorders were excluded from this analysis). Two percent tested positive for having the hepatitis B surface antigen, 9% for the HCV antibody, and 1% for HIV. Males were more likely than females to test positive for the HCV antibody (p=.04). CONCLUSIONS: Compared with rates in the general population, in this study population the rate of HCV was more than ten times as high, the rate of HIV was three times as high, and the rate of HBV was comparable.

Outcome of antimicrobial therapy in documented biofilm-associated infections: a review of the available clinical evidence.

Numerous laboratory findings indicate that microbial biofilms may be encountered in several types of human infections, affecting the activity of antimicrobial agents. We evaluated the clinical evidence regarding the effectiveness of antimicrobial therapy for infections documented to be biofilm-associated, by performing a review of 15 relevant studies, excluding dental and eye infections. In a clinical trial, a significant difference was noted in the effectiveness of antibacterial agents used for catheter-related urinary tract infections in which substantial bacterial adherence on uroepithelial cells was observed. In case series and case reports, 28 patients with biofilm-associated infections documented by electron microscopy scanning were identified. Infection sites included ear, urinary tract, CNS, bloodstream and foreign body implantation site. Pseudomonas and Staphylococcus spp. were the predominant microorganisms among the bacterial or fungal causative pathogens. In 24 cases, infections related to the presence of foreign bodies. Treatment failure or recurrence was noted in all eight patients in whom targeted antimicrobial therapy was instituted before foreign body removal. Foreign body removal coupled with antimicrobial therapy was effective in all ten relevant cases. In four cases of native tissue urinary tract infections, the outcome of the initial antimicrobial therapy was poor. The limited available relevant clinical evidence indicates that conventional antimicrobial therapy alone is not adequately effective against documented biofilm-associated infections. Although some regimens might be more appropriate in this setting, further research on novel therapeutic strategies is needed to improve the outcome of patients with biofilm-associated infections.

Infectious complications of monoclonal antibodies used in cancer therapy: a systematic review of the evidence from randomized controlled trials.

The introduction of monoclonal antibodies (MoAbs) into the treatment of cancer has led to improvements in patient survival. However, to the authors' knowledge, little attention has been paid to the infectious complications associated with their use. The authors performed a systematic review of the literature to identify randomized controlled trials (RCTs) that included in their outcomes a comparison of the infectious complications of a MoAb plus chemotherapy or radiotherapy versus the therapy regimen given without the addition of a MoAb. Twenty RCTs with relevant data regarding the use of MoAbs in patients with hematologic malignancies (10 RCTs) and solid tumors (10 RCTs) were retrieved. Six RCTs compared rituximab in conjunction with the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) versus CHOP alone for the treatment of B-cell non-Hodgkin lymphoma (NHL). No significant increase in the incidence of infections was observed with the addition of rituximab to chemotherapy (based on data from 5 RCTs). However, in patients who were seropositive for the human immunodeficiency virus (HIV), a 12% increase in infection-related deaths and a rate of higher opportunistic infections was associated with the rituximab-containing regimen (data taken from 1 RCT). Five RCTs either compared trastuzumab plus chemotherapy versus chemotherapy alone or trastuzumab monotherapy versus observation in patients with breast cancer. The addition of trastuzumab to the various chemotherapy regimens was found to cause a slight increase in the frequency of high-grade infections while bevacizumab caused a negligible increase in Grade III/IV infections compared with the same regimens given of chemotherapy alone. Based on a single trial, a higher comparable increase in the rate of high-grade infections was noted with the use of cetuximab in addition to chemotherapy compared with chemotherapy alone. MoAbs added to chemotherapy appear to have infectious complications that are comparable to the chemotherapy-alone regimen when administered for the treatment of NHL, with the exception of HIV-seropositive patients. Trastuzumab, which is reported to have a clear benefit in the prognosis of breast cancer patients, was found to cause a small increase in Grade III/IV infectious complications; however, there was no apparent difference in the rate of infection-related death.