Keratocyst Capnocytophaga superinfection.

INTRODUCTION: Capnocytophaga spp are Gram-negative bacteria that cause severe infections in immunosuppressed patients. This situation is extremely rare in immunocompetent patients. CASE REPORT: This clinical report describes the unusual infection of an immunocompetent patient with Capnocytophaga spp. The imaging studies showed the existence of a cyst in the left jawbone. After treatment and a microbiological study of the content, it was found to be an outbreak of septicaemia. DISCUSSION: Capnocytophaga spp, commensal bacteria of the oral cavity, can lead to serious illness and that is why an empirical treatment is needed until a diagnostic confirmation can be obtained.

Deep neck infection in patients with and without human immunodeficiency virus: a comparison of clinical features, complications, and outcomes.

We retrospectively studied the clinical features, complications, and outcomes of deep neck infections in 31 adult patients with the human immunodeficiency virus (HIV) (HIV group) and 192 patients without (non-HIV group). In the HIV group, the cause was more likely to be odontogenic (21 (68%) compared with 90 (47%); odds ratio (OR) 2.38; 95% CI 1.06 to 5.32). In both groups, the parapharyngeal, submandibular, and masticator spaces, were those most often involved. However, in the HIV group, Ludwig's angina was common, and was the main cause of airway obstruction. Streptococcus pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa were most often isolated in the HIV group. Upper airway obstruction tended to be more common in the HIV group (5/31 compared with 13/192). These patients also had a higher risk of other complications (sepsis, mediastinitis, jugular vein thrombosis, and pneumonia) (6/31 compared with 12/192; OR 3.60; 95% CI 1.24 to 10.45), a higher mortality rate (3/31 compared with 2/192), and longer hospital stay (19days compared with 16 days). Factors associated with an increased risk of complications in this group were an age of 55 years or over and a CD4 count of less than 350 cells/mm3. Deep neck infections in these patients are more severe. Dental health care, appropriate empirical antibiotics, early detection, and management of the airway and complications, may improve outcomes.

Quiste odontogénico inflamatorio: aislamiento de Pseudomonas stutzeri. Relevancia diagnóstica / Isolation of Pseudomonas stutzeri from an odontogenic inflammatory cyst: Diagnostic relevance

Pseudomonas stutzeri se encuentra ampliamente distribuido en el medio ambiente, ocupando diversos nichos ecológicos; pero su aparición en procesos infecciosos de interés clínico es el de patógeno oportunista. El aislamiento de P. stutzeri en un quiste inflamatorio odontogénico es un verdadero hallazgo microbiológico que no presenta antecedentes en la bibliografía científica odontológica. En este caso particular, el aislamiento se obtuvo a partir de material quirúrgico proveniente de un quiste odontogénico inflamatorio ubicado en la pieza dentaria 1.2 con necrosis pulpar concomitante. Se emplearon técnicas diagnósticas complementarias como radiografías, tomografías, estudios anatomopatológicos y microbiológicos. Los resultados permitieron clasificar el proceso como quiste inflamatorio infectado con P. stutzeri. La tipificación y la caracterización del perfil de sensibilidad de la cepa aislada permitieron adecuar la terapéutica antibiótica de manera específica. El análisis microbiológico permitió establecer la etiología del proceso infeccioso, la adecuación del tratamiento y el restablecimiento de los tejidos comprometidos.

Pseudomonas stutzeri is distributed widely in the environment, and occupies different ecological niches. However, it is found in clinically relevant infections as an opportunistic pathogen. Isolation of P. stutzeri from an odontogenic inflammatory cyst is an uncommon microbiological finding that has not been reported to date. In the case presented here, the bacterium was isolated from surgical material obtained from excision of an inflammatory odontogenic cyst located in the tooth 1.2, and presenting with concomitant pulp necrosis. Complementary techniques such as radiographs, CAT scans, and histopathological and microbiological studies were used to establish definitive diagnosis. The obtained results allowed classifying the process as an inflammatory cyst infected by P. stutzeri. Biotyping and characterization of the susceptibility profile of the isolated strain allowed adjusting the antibiotic therapy more specifically. The microbiological studies allowed establishing the etiology of the infectious process, adjusting the treatment plan, and re-establishing tissue integrity.

[Isolation of Pseudomonas stutzeri from an odontogenic inflammatory cyst: Diagnostic relevance]. / Quiste odontogénico inflamatorio: aislamiento de Pseudomonas stutzeri. Relevancia diagnóstica.

Pseudomonas stutzeri is distributed widely in the environment, and occupies different ecological niches. However, it is found in clinically relevant infections as an opportunistic pathogen. Isolation of P. stutzeri from an odontogenic inflammatory cyst is an uncommon microbiological finding that has not been reported to date. In the case presented here, the bacterium was isolated from surgical material obtained from excision of an inflammatory odontogenic cyst located in the tooth 1.2, and presenting with concomitant pulp necrosis. Complementary techniques such as radiographs, CAT scans, and histopathological and microbiological studies were used to establish definitive diagnosis. The obtained results allowed classifying the process as an inflammatory cyst infected by P. stutzeri. Biotyping and characterization of the susceptibility profile of the isolated strain allowed adjusting the antibiotic therapy more specifically. The microbiological studies allowed establishing the etiology of the infectious process, adjusting the treatment plan, and re-establishing tissue integrity.

Action of antimicrobial agents on infected odontogenic cysts.

OBJECTIVE: The treatment of choice for odontogenic cysts is surgery, and when the cysts are infected, preoperative antibiotic coverage is needed. However, the diffusion of antibiotics is a matter of controversy because of the low vascularization of the cystic epithelium. The aim of the present study was to determine the antimicrobial action of amoxicillin and metronidazole on infected odontogenic cysts. METHODS AND MATERIALS: Ten odontogenic root cysts were punctured before and after antibiotic treatment in 2 patient groups. Group 1 consisted of 5 patients treated with 500 mg amoxicillin at 6-hour intervals, and group 2 consisted of 5 patients treated with 400 mg metronidazole at 8-hour intervals, for 7 days. After this period, the patients were submitted to surgery for enucleation. The fluid collected was seeded onto culture media for counts of total bacteria and facultative anaerobic bacteria. RESULTS: The results showed that the amount of bacteria present in the fluid was significantly higher than the amount isolated after antibiotic treatment. Also, most of the microorganisms present in the fluid collected before antibiotic administration were strict anaerobes. CONCLUSIONS: Both antibiotics reduced the number of bacteria in the cystic fluid, showing that they did diffuse into the lesions at sufficient concentrations to exert their antimicrobial action.

[Pathogen and resistance spectrum in intraoral infections of the jaw-facial area with special reference to anaerobic bacteria]. / Erreger- und Resistenzspektrum bei intraoralen Infektionen des Kiefer-Gesichts-Bereichs unter besonderer Berücksichtigung der anaeroben Keimflora.

The aim of the study was to obtain more knowledge about the aerobic and anaerobic species causing maxillofacial infections and their resistance patterns today. Samples of pus or infectious tissue obtained from 110 patients of maxillofacial surgery were investigated microbiologically by means of aerobic and anaerobic cultivation. After incubation, the cultivated species were isolated and identified. The resistance patterns of all bacteria to penicillin, doxycyclin, and clindamycin were determined. Additionally, the resistance of aerobic species to cefuroxim was documented, and the MICs of cefoxitin and metronidazole to the anaerobic species were assessed. The most frequent disease was periodontitis apicalis (70 patients). Aerobic species alone were found in 23% of the samples, 14% of the infections harbored only anaerobes, but 63% were mixed infections caused by aerobic and anaerobic bacteria. In case of detection of aerobic species, streptococci were always identified. Five patients were infected by Staphylococcus aureus and gram-negative aerobic rods were found in eight patients. Most of the anaerobic species were black pigmented prevotella species (62), nonpigmented prevotellae (56), and fusobacteria (37). Metronidazole and clindamycin were highly efficient to gram-negative anaerobic rods. Most of the oral species were resistant to penicillin and doxycyclin. The indication for applying antibiotics should always be noticed and these drugs should only be used after determination of the pathogenic microorganisms and their susceptibility to the antimicrobials.

Mandibular infected buccal cyst and paradental cyst: the same or separate entities?

The WHO classification of odontogenic cysts includes the radicular (residual) and paradental (inflammatory collateral; mandibular infected buccal) cysts as inflammatory odontogenic cysts. Because the paradental group of inflammatory cysts may clinically cause diagnostic and therapeutic problems when they are associated with first and second molar teeth it was decided to review the literature and present an additional case. The aetiology and histological features of the inflammatory collateral cyst, the paradental cyst and the mandibular infected buccal cyst are identical and the differences that exist in their clinical and radiological presentation can be related to the different teeth that are involved and the difference in the ages at which these teeth erupt. These cysts represent the same entity and their treatment is dependent on the tooth involved. With the aid of magnetic resonance imaging (MRI) the distinction between a paradental cyst on the buccal aspect of a molar tooth and a periodontitis can be made.

The role of endotoxin and cytokines in the pathogenesis of odontogenic cysts.

Odontogenic cysts arise from tooth-forming epithelial residues. The stimulus for the formation of radicular cysts is thought to be endotoxin released from the infected necrotic tooth pulp. However, in keratocysts and follicular cysts, such a stimulus is not present. In order to investigate what drives the cyst epithelium to proliferate, explant media and fluids from 16 radicular cysts, eight keratocysts and seven follicular cysts and explant media from four specimens of non-inflamed gingival tissue were examined for the presence of endotoxin and cytokines. Cyst fluids were also cultured for 72 h in anaerobic and aerobic conditions to detect micro-organisms. Endotoxin from three different bacteria, cytokines [interleukin-(IL) 1 alpha, IL-1 beta and IL-6] as well as prostaglandin E2 (PGE2) were tested in an epithelial cell-proliferation assay. As the cyst epithelium is supported by a connective tissue capsule, the effect of fibroblast culture media on epithelial cell proliferation was also investigated. The results showed significantly higher concentrations of endotoxin in radicular cyst fluid than in the keratocyst or the follicular cyst. None of the cyst fluids contained micro-organisms. Immunoassays demonstrated the presence of IL-1 alpha and -6 in all fluids and explants tested; IL-1 beta was only found in the inflammatory radicular cysts. However, reverse transcriptase-polymerase chain reaction showed that mRNAs for IL-1 alpha, -1 beta and -6 were present in all cyst types. Proliferation studies indicated that endotoxin and the cytokines had a mitogenic effect on epithelia at low concentrations; PGE2 had very little effect at low concentrations, and had an inhibitory effect at high concentrations. Cyst fibroblast culture media had a mitogenic effect on the epithelia that was enhanced by the presence of endotoxin.

[Cystic formations of the maxilla. Case report]. / Formaciones quísticas de los maxilares. A propósito de un caso.

The case of a man, 28, addressed to our ENT-Department complaining of pain and swelling of the left half of the face is presented. After X-Ray and tomographic study the diagnosis of an included tooth inside the maxillary sinus, accompanied by one cyst, is evidenced. In addition a canine tooth as well included on the floor of the nose and under the lower homonyme turbinate, is disclosed. Through sinusal approach, via Caldwell-Luc, are removed the lesions encountered. Then, the AA., attempt to classify the group of several cystic structures of maxillary sitting, aiming at unify the nomenclature of this pathology, and made a brief description of each type.

Human papillomavirus type 16 DNA in an odontogenic keratocyst.

DNA was extracted from an odontogenic keratocyst and assayed for the presence of human papilloma virus (HPV) type 16 DNA sequences using high stringency Southern blot hybridization. HPV type 16 homologous DNA sequences were detected at a copy number of 50-100 genome copies per diploid cell. The oral HPV DNA was not identical to the prototype HPV 16 when cleaved with the restriction enzyme Pst-I, since it appeared to lack the Pst-I C fragment (L2/L1 ORFs) and contained "off-sized" high molecular weight fragments suggestive of integration events into the host cell chromosome.

Some observations on the fluids of odontogenic cysts.

The fluids of 44 dental cysts, 19 dentigerous cysts, 36 odontogenic keratocysts, and 12 ameloblastomas have been investigated. The incidence of epithelial cells, inflammatory cells, cholesterol crystals and bacteria was recorded in smears. There was a high incidence of epithelial cells in odontogenic keratocysts and not in other lesions. Cholesterol crystals had a similar incidence in all lesions. The proportion of the soluble proteins and total protein content was determined from cellulose acetate electrophoresis. Dental cysts contained an average of 51.19% albumin, 17.52% beta globulin, 22.04 % gamma globulin, and 6.30 g/100 ml protein. Dentigerous cysts contained an average of 61.35% albumin, 13.98% beta globulin, 12.70% gamma globulin and 5.40 g/100 ml protein. Odontogenic keratocysts contained an average of 78.03% albumin, 7.51% beta globulin, 7.91% gamma globulin, and 2.09 g/100 ml protein. Ameloblastomas contained an average of 67.38% albumin, 12.83% beta globulin, 12.60% gamma globulin and 4.86 g/100 ml protein. The immunoglobulin content was determined by single radial immunodiffusion. Dental cysts contained an average of 488.9 mg/100 ml IgA, 2535.4 mg/100 ml IgG, and 135.6 mg/100 ml IgM. Dentigerous cysts contained an average of 308.4 mg/100 ml IgA, 1618.2 mg/100 ml IgG, and 155.6 mg/100 ml IgM. Odontogenic keratocysts contained an average of 135.6 mg/100 ml IgA, 491.9 mg/100 ml IgG, and 54.1 mg/100 ml IgM. The significance of these findings in the pathogenesis and diagnosis of these lesions is discussed.

[Bacteriological findings in materials from patients with nonspecific odontogenic infections]. / Erregerbefunde im Untersuchungsmaterial von Patienten mit unspezifischen odontogenen Infektionen

The results of bacteriological studies made between 1964 and 1971 by workers at the Varia Laboratory, Institute of Medical Microbiology on 767 patients treated at the Clinic of Gnathofacial Surgery, Department of Medicine, Friedrich Schiller University at Jena, are evaluated. The testees (x=275) were included in groups with specific diagnoses, and a breakdown was made according to the detection of aerobic pus-forming germs. Gram-positive cocci were detected in 92% of the cases and their pathogenetic representatives, 76,5% of the cases. Rodshaped germs (Enterobacteriaceae, Pseudomonas) were observed only in 37,9% of the cases. Staphylococcus aureus, which accounted for 62,5%, was the most frequently observed species. It was followed, in order of frequency of detection, by greening streptococci and Staphylococcus epidermidis. Monoinfection was far more frequently observed than multi-infection. Also, the problems associated with the differentiation of streptococci are pointed out since other investigators found streptococci to be the most frequent agents producing odontogenic infections.