ABSTRACT
OBJECTIVE: Epidemiological, biological and clinical links between periodontal and cardiovascular diseases are now well established. Several human studies have detected bacterial DNA corresponding to periodontal pathogens in cardiovascular samples. Intraplaque hemorrhage has been associated with a higher risk of atherosclerotic plaque rupture, potentially mediated by neutrophil activation. In this study, we hypothesized that plaque composition may be related to periodontal pathogens. METHODS: Carotid culprit plaque samples were collected from 157 patients. Macroscopic characterization was performed at the time of collection: presence of blood, lipid core, calcification and fibrosis. Markers of neutrophil activation released by carotid samples were quantified (myeloperoxidase or MPO, cell-free DNA and DNA-MPO complexes). PCR analysis using specific primers for Porphyromonas gingivalis, Aggregatibacter actinomycetemcommitans, Treponema denticola, Prevotella intermedia and Tannerella forsythia was used to detect DNA from periodontal pathogens in carotid tissues. In addition, bacterial lipopolysaccharide (LPS) and Immunoglobulins G against T. forsythia were quantified in atherosclerotic carotid conditioned medium. RESULTS: Intraplaque hemorrhage was present in 73/157 carotid samples and was associated with neutrophil activation, reflected by the release of MPO, cell-free DNA and MPO-DNA complexes. LPS levels were also linked to intraplaque hemorrhage but not with the neutrophil activation markers. Seventy-three percent of the carotid samples were positive for periodontal bacterial DNA. Furthermore, hemoglobin levels were associated with the detection of T. forsythia and neutrophil activation/inflammation markers. CONCLUSION: This study suggests a potential role of periodontal microorganisms, especially T. forsythia, in neutrophil activation within hemorrhagic atherosclerotic carotid plaques.
Subject(s)
Carotid Artery Diseases/microbiology , Carotid Artery Thrombosis/microbiology , Dental Plaque/microbiology , Neutrophils/physiology , Periodontitis/microbiology , Aged , Aged, 80 and over , Antibodies, Bacterial/analysis , Bacteroidaceae/immunology , Bacteroidaceae/isolation & purification , Bacteroidaceae/pathogenicity , Carotid Artery Diseases/complications , Carotid Artery Diseases/immunology , Carotid Artery Diseases/surgery , Carotid Artery Thrombosis/complications , Carotid Artery Thrombosis/immunology , Carotid Artery Thrombosis/surgery , DNA, Bacterial/blood , Endarterectomy, Carotid , Extracellular Traps , Female , Fibrin/analysis , Hemorrhage/etiology , Humans , Lipids/analysis , Male , Middle Aged , NF-kappa B/metabolism , Neutrophil Infiltration , Periodontitis/complications , Peroxidase/analysis , Plaque, Atherosclerotic/chemistry , Respiratory BurstABSTRACT
We describe a healthy, young adult male patient who developed isolated carotid artery thrombosis and occlusion following acute pharyngitis due to Fusobacterium necrophorum. We believe this is the first case of isolated occlusion of internal carotid artery (ICA) with F.necrophorum without associated internal jugular vein (IJV) thrombosis. Lemierre's syndrome (LS) is characterized by a history of recent oropharyngeal infection in previously healthy individuals, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of anaerobic pathogens, mainly F.necrophorum. We discuss literature on this rare, previously unreported, variant of LS.
Subject(s)
Carotid Artery Thrombosis/microbiology , Fusobacterium Infections/complications , Fusobacterium necrophorum , Pharyngitis/complications , Pharyngitis/microbiology , Stroke/microbiology , Anti-Bacterial Agents/therapeutic use , Brain/blood supply , Brain/pathology , Carotid Artery Thrombosis/pathology , Carotid Artery Thrombosis/physiopathology , Carotid Artery, Internal/microbiology , Carotid Artery, Internal/pathology , Carotid Artery, Internal/physiopathology , Cerebral Angiography , Disease Progression , Fatal Outcome , Fusobacterium Infections/drug therapy , Humans , Infarction, Middle Cerebral Artery/microbiology , Infarction, Middle Cerebral Artery/pathology , Infarction, Middle Cerebral Artery/physiopathology , Magnetic Resonance Imaging , Male , Paresis/etiology , Paresis/pathology , Paresis/physiopathology , Pharyngitis/physiopathology , Pharynx/blood supply , Pharynx/microbiology , Respiratory Distress Syndrome/microbiology , Respiratory Distress Syndrome/pathology , Respiratory Distress Syndrome/physiopathology , Stroke/pathology , Stroke/physiopathology , Tomography, X-Ray Computed , Treatment Failure , Young AdultABSTRACT
INTRODUCTION: Mucormycosis is a rare and acute fungal infection which is frequently lethal. The rhinocerebral form is usually seen in diabetics, but other localizations may occur in severely immunocompromised subjects. OBSERVATION: We report the case of a sphenoidal sinusitis associated with a probable cavernous sinus thrombosis and carotid artery thrombosis with middle cerebral artery territory infarction. Diagnosis was made on histological examination following sphenoidotomy. Early medical and surgical treatment led to a good outcome. CONCLUSION: The diagnosis of rhinocerebral mucormycosis should be considered in the clinical setting of necrotic sinusitis and acute neurologic deficit in diabetic patients. Early diagnosis and treatment are crucial factors leading to a good outcome.
Subject(s)
Brain Diseases/pathology , Mucormycosis/pathology , Nose Diseases/pathology , Rhizopus , Aged , Brain Diseases/microbiology , Carotid Artery Thrombosis/etiology , Carotid Artery Thrombosis/microbiology , Female , Humans , Infarction, Middle Cerebral Artery/etiology , Infarction, Middle Cerebral Artery/microbiology , Mucormycosis/microbiology , Nose Diseases/microbiology , Sinus Thrombosis, Intracranial/etiology , Sinus Thrombosis, Intracranial/microbiology , Sinusitis/etiology , Sinusitis/microbiologyABSTRACT
This case illustrates the correlation between Magnetic Resonance Imaging (MRI) and the pathological findings in a case of cavernous sinus (CS) aspergilloma.
Subject(s)
Aspergillosis/microbiology , Aspergillus fumigatus , Cavernous Sinus Thrombosis/microbiology , Cavernous Sinus/microbiology , Granuloma/microbiology , Opportunistic Infections/microbiology , Abducens Nerve Diseases/microbiology , Abducens Nerve Diseases/pathology , Adrenal Cortex Hormones/adverse effects , Aged , Aspergillosis/complications , Aspergillosis/pathology , Carotid Artery Thrombosis/microbiology , Carotid Artery Thrombosis/pathology , Carotid Artery, Internal/microbiology , Carotid Artery, Internal/pathology , Cavernous Sinus/pathology , Cavernous Sinus Thrombosis/pathology , Disease Progression , Fatal Outcome , Female , Granuloma/pathology , Humans , Immunosuppressive Agents/adverse effects , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/pathology , Magnetic Resonance Imaging , Ophthalmoplegia/microbiology , Ophthalmoplegia/pathology , Opportunistic Infections/pathology , Pain/microbiology , Pain/pathology , Pancytopenia/complications , Pancytopenia/drug therapyABSTRACT
Lemierre's syndrome, also known as postanginal sepsis, is a rare condition that presents as an increasing sore throat due to acute pharyngitis or tonsillitis and progresses to sepsis, due to suppurative thrombophlebitis of the internal jugular vein. We present an atypical case of Lemierre's syndrome complicated by carotid thrombosis. The etiological factors and the diagnostic and therapeutic measures are discussed.
