Virus en patología pulpar y periapical. Revisión de la literatura / Viruses in pulp and peri apical pathosis. Review

Introducción: Las infecciones de origen endodóncico son infecciones polimicrobianas que pueden tener diversas manifestaciones clínicas y radiológicas. La presencia de virus en diferentes patologías pulpares y periapicales está en investigación con el fin de asociar su presencia con las lesiones radiolúcidas apicales y sus sintomatología. El objetivo de este estudio es analizar la evidencia científica disponible en la actualidad que relaciona la presencia de virus en diferentes patologías de endodoncia y sus posibles implicaciones clínicas. Métodos: Se hace una revisión en la base de datos Medline/Publine, utilizando diferentes parámetros de búsqueda, seleccionando posteriormente los artículos más relevantes, que cumplieron con el criterio de búsqueda. De igual manera se hace una búsqueda en Scielo e IME. Resultados: Se incluyeron un total de 21 artículos, de los cuales 17 detectan la presencia del virus en una de las muestras. En tres de los estudios, la presencia viral no se encontró en ninguna de las muestras estudiadas. Los virus que se encontraron con mayor frecuencia fueron el virus de Epstein-Barr y citomegalovirus; sin embargo, en algunos de estos estudios han aparecido agentes virales como el herpes humano 6 y 8 virus. La relación entre presencia viral y sintomatología no es posible detectarla en todos los estudios, y lo mismo sucede con el tamaño de la lesión. Conclusión: Es necesario examinar y comprender la relación microbiológica que se establece en las patologías de origen endodóncico, dando lugar a nuevas opciones terapéuticas y de tratamiento

Introduction: Infections of an endodontic origin are polymicrobiobial infections that can have diverse clinical and radiographic manifestations. Recently, the presence of viruses in different endodontic pathologies is a focus of new research, associating their presence with symptomology and with apical radiolucent lesions. The goal of this study is to analyze the scientific evidence available currently that relates the presence of viruses in different endodontic pathologies and their possible clinical implications. Methods: A revision was carried out of the Medline/Publine database, using different search parameters, subsequently selecting the most relevant articles, which complied with the search criterion. Results: A total of 21 articles were included, and 17 detected the presence of viruses in one of the samples. In 3 of the studies, viral presence was not found in any of the sample studied. The viruses that were most frequently found were the Epstein-Barr and Cytomegaloviruses; however in some of these studies viral agents have appeared such as the human herpes 6 and 8 viruses. The relation between viral presence and symptomology is not possible to detect in all of the studies, which is the same for the relationship with large apical lesions. Conclusion: It is necessary to examine and understand the microbiological relationships that are established in pathologies of endodontic origin, leading to new therapeutic and treatment options

Association of Bartonella species, feline calicivirus, and feline herpesvirus 1 infection with gingivostomatitis in cats.

Feline gingivostomatitis (FGS) is a common syndrome in cats; feline calicivirus (FCV), feline herpesvirus 1 (FHV-1), and Bartonella species are common differential diagnoses. In this study, blood from 70 cats with FGS and 61 healthy control cats was tested for Bartonella species antibodies in serum by enzyme-linked immunosorbent assay and Western blot immunoassay and DNA in blood using a conventional polymerase chain reaction assay. Additionally, fresh oral biopsies from cats with FGS (n=42) and 19 healthy controls were tested for FCV RNA, FHV-1 DNA and Bartonella species DNA. The prevalence rates for Bartonella species antibodies and DNA in the blood and the tissues did not differ between the two groups. FHV-1 DNA was also not significantly different between groups. Only FCV RNA was present in significantly more cats with FGS (40.5%) than control cats (0%). The results suggest that FCV was associated with FGS in some of the cats.

[Oral cavity microbiocenosis in patients with stomatological diseases with disorders in the systems of local immunity]. / Osoblyvosti mikrobiotsenozu rotovoï porozhnyny patsiientiv iz stomatolohichnymy zakhvoriuvanniamy z porushenniamy v systemi mistsevoho imunitetu.

Microflora of oral cavity of people of 45-65 years with removable denture and children with acute herpetic stomatitis, its dependence upon the degree of local immunity, presence and severity of inflammatory process have been studied. Percentage of leucocyte subpopulations activity of bactericide enzymes of granulocytes, average anticolonization ratio, correlation of Gram-positive and Gram-negative bacteria, degree of colonization with Candida fungi have been determined is smear-simprints of mucous membrane. The intensity of growth of optional anaerobic microorganisms has been investigated in bacteriological studies of material taken from mucous membrane. Their identification has been performed using morphological-cultural and biochemical indices. Significant changes in microbiocenosis of oral cavity such as disappearance of autochthonous microflora, appearance and intensive growth of pathogenic and opportunistic microorganisms are to be observed in conditions of decrease of non-specific resistance and presence of inflammatory process in persons with removable denture and acute herpetic stomatitis.

Helicobacter pylori in oral ulcerations.

Helicobacter pylori is an important pathogen involved in the development of gastrointestinal ulcers, but its involvement in oral ulcerous lesions is unclear. As culture is generally recognized as the gold standard for diagnosis of H. pylori infection, we employed this approach to assess the association of H. pylori with oral mucosal ulcerations. Samples were collected from patients with oral mucosal ulcerative disorders: 12 cases of recurrent aphthous stomatitis (RAS), 7 cases of herpes simplex virus (HSV) stomatitis, and 3 cases of erosive lichen planus (LP). Serum IgG antibodies against H. pylori were examined in all cases. All of the RAS and erosive LP cases were culture-negative for H. pylori, while two cases of HSV stomatitis were positive. The two culture-positive cases were also seropositve for the H. pylori antigen. It is suggested that H. pylori might not have a direct association with oral ulcerations. However, H. pylori in the oral cavity might exist in a non-culturable coccoid state without productive infection, and might form colonies only under special conditions such as HSV infection.

[Microbiocenosis study in chronic diseases of the oral mucosa]. / Izuchenie mikrobiotsenoza pri khronicheskikh zabolevaniiakh slizistoi obolochki polosti rta.

Examinations of 18 patients with recurrent aphthous stomatitis, 8 with ulcerative necrotic gingivitis, 10 with lichen planus, 10 with herpetic stomatitis, and of 24 patients without evident clinical symptoms of buccal mucosa involvement but complaining of various stomatogenic sensations, e.g. burning, tightness, pain and pricking in the buccal mucosa, perverted taste, etc., showed that chronic diseases of the buccal mucosa involve expressed shifts in the microbiocenosis, namely, dysbacteriosis of different severity.

Herpes simplex virus and oral mucositis in children with cancer.

The relationship between herpes simplex virus (HSV) and oral mucositis was investigated in children undergoing antineoplastic chemotherapy. HSV culture was performed in 20 children with stomatitis developing after antineoplastic chemotherapy. Viral isolates were typed and susceptibility to acyclovir was investigated. The virus was isolated from oral lesions in 10 of 20 children with severe oral mucositis. Viral reactivation was the most likely explanation in most cases, since HSV was isolated in 9 of 13 seropositive patients (and in 1 patient with unknown anti-HSV serology), but in no seronegative patient. HSV type 1 was isolated more frequently than HSV type 2 (8 versus 2). Acyclovir showed standard in vitro activity against all isolates. Our results suggest that oral mucositis in children receiving antineoplastic treatment is probably multifactorial in origin and that HSV can be an important cofactor, especially in children who are seropositive for HSV. In our Centre, acyclovir remains active in vitro against this opportunistic pathogen and could be employed in prophylaxis and therapy.

Evaluation of a rapid enzyme-linked immunoassay for the diagnosis of herpes simplex virus in cancer patients with oral lesions.

Oral herpes simplex virus infection in immunocompromised cancer patients can have a variety of different clinical appearances, which makes diagnosis difficult, and it can be associated with significant morbidity. Prompt diagnosis is important so that therapy can be started as soon as possible. The standard by which the diagnosis of herpes simplex virus is made is a culture that can take up to 10 days to produce results. In an effort to test a possibly better method, we evaluated a 12-minute, enzyme-linked immunoassay and found the sensitivity, specificity, positive predictive value, and negative predictive value to be 75.9%, 90.0%, 84.6%, and 83.7%, respectively. This test is easy, inexpensive, and can be done in a clinical setting, thus providing a prompt, accurate result so that treatment can be started without delay. This promptness is especially important in the immunocompromised cancer patient.

Rapid detection of human herpes simplex virus type 1 in saliva.

Herpes simplex virus type 1 (HSV1) can be rapidly identified in saliva from patients with acute herpetic gingivostomatitis, by in vitro amplification using the polymerase chain reaction and specific primers. Amplification of DNA results in a product of 110 bp length corresponding to the region 1381-1490 bp of the HSV1 thymidine kinase gene. The specificity of the reaction was demonstrated in three ways: (i) the presence of a Sma 1 restriction enzyme site in the amplified product sequence; (ii) Southern blot using a biotinylated HSV1-specific oligonucleotide probe and (iii) direct sequencing of amplified product. At high titres of virus (> 5 x 10(5) virions/ml saliva), saliva may be added directly to the amplification assay for detection purposes. However, at lower titres of HSV1 viral DNA must be purified from saliva before in vitro amplification. HSV was identified in the saliva from symptomatic patients with acute herpetic gingivostomatitis and was absent in saliva collected from controls.

The natural history of recurrent oral-facial herpes simplex virus infection.

Oral-facial herpes simplex virus infection is a common, worldwide affliction on which neither public health procedures, vaccines, nor antiviral chemotherapy have yet to have a significant clinical impact. Careful examination of the pathogenesis and clinical features of this illness could lead to insights and a rationale for new and more effective preventive and therapeutic measures. The resistance of recurrent herpes simplex labialis to antiviral chemotherapy may be caused in part by inoculation of the skin simultaneously at multiple foci, such that only a few cycles of virus replication are needed before there is coalescence of the foci, destruction of the epidermis, and clinical lesion formation. Studies of herpes simplex labialis induced by ultraviolet radiation have suggested that there is a subpopulation of lesions that develop immediately after irradiation and that are refractory to chemotherapy. The difficulty finding a treatment for herpes simplex labialis may in part be methodological. Clinical trial protocols for antiviral drugs should target susceptible lesion subgroups and specific stages of the disease.

Herpetic gingivostomatitis and teething difficulty in infants.

This investigation was conducted to determine whether primary herpetic gingivostomatitis may be responsible for those signs and symptoms commonly attributed to teething in infants. Twenty infants presenting with a parental diagnosis which indicated teething difficulty were included in this study (Group A). Twenty infants who were in no distress served as controls (Group B). Oral swab samples were obtained from each infant and then processed to ascertain the presence of herpes simplex virus (HSV). Each infant's temperature and oral status also were recorded. Nine subjects in Group A (45%) were positive for HSV. Of these nine, seven had elevated temperatures (less than 100 degrees F) and all had signs of oral infection of varying severity. Of the 11 subjects in Group A who were negative for HSV, five had elevated temperatures, but none showed evidence of oral infection. Subjects in Group B were all negative for HSV, elevated temperature, and signs of oral infection. Results of this study suggest that oral HSV infection should be included in the differential diagnosis of infants presenting with a parental diagnosis of teething difficulty.

Herpes simplex type 1 infections in group day care.

To characterize patterns of herpes simplex virus type 1 infection, illness and transmission among children in group day care, the data for 115 children who had been followed longitudinally from early infancy in a research day care center were examined. By 5 years of age 37% of study children had evidence of herpes simplex virus type 1 infection as demonstrated by virus isolation and/or seroconversion. The incidence of infection was highest among children 1 to 2 years old. Four small clusters of primary infections were observed over the 12-year study period but no cluster involved more than 6 children. Fifty-five percent of primary infections occurred during these small outbreaks; the remainder were sporadic. Gingivostomatitis was observed in 26% of children with primary culture-proved infections; no child with infection identified solely by serologic means had a history of gingivostomatitis. The occurrence of gingivostomatitis did not appear to be associated with increased transmission of herpes simplex virus type 1 infection in this day-care setting.

Herpes simplex virus type 1 and type 2 infection in human oral mucosa in culture.

To examine the sensitivity of human oral mucosa to herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) infection, human gingival mucosa explants were infected with either HSV-1 or HSV-2 in vitro and the expression of virus specific antigen was examined by the immunofluorescent antibody technique. HSV-2 antigen was found in the basement membrane, basal cell layer and lower prickle cell layer. This finding was consistent with the HSV-1 infection. Electron microscopic study revealed the presence of nucleocapsids and enveloped virus particles in the basal cells of HSV-2-infected organ cultures. These findings indicate that human gingival mucosa is sensitive to infection with HSV-2, as well as HSV-1, and that the virus may replicate in the undifferentiated epithelial cells of mucosal epithelium.

[Case of recurrent intra-oral herpes]. / Un cas d'herpès récurrent intra-oral.

A case of severe Secondary Herpes Simplex infection is presented and the possibility of a secondary infection by Enterobacter cloacae is discussed.

Isolation and typing of herpes simplex viruses in the infections of mouth, respiratory and genital tracts.

A total of 60 herpes simplex virus (HSV) isolates obtained from individuals with genital herpes lesions in the mouth or respiratory illness were typed in this study. The HSV isolation rate in genital herpes was 31%. The typing was done by a direct fluorescent monoclonal antibody technique using commercial reagents. All the 60 Vero cell grown isolates were successfully typed without any indeterminate results. Nine isolates were typed as HSV 1 and 51 as HSV 2. The technique was easy to perform and read. HSV 2 was found to predominate in genital infections and HSV 1 in respiratory infections.