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- Serum IgG Antibody Levels to Periodontal Microbiota Are Associated with Incident Alzheimer Disease. [JOURNAL ARTICLE]
- PLoS One 2014; 9(12):e114959.
Periodontitis and Alzheimer disease (AD) are associated with systemic inflammation. This research studied serum IgG to periodontal microbiota as possible predictors of incident AD.Using a case-cohort study design, 219 subjects (110 incident AD cases and 109 controls without incident cognitive impairment at last follow-up), matched on race-ethnicity, were drawn from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a cohort of longitudinally followed northern Manhattan residents aged >65 years. Mean follow-up was five years (SD 2.6). In baseline sera, serum IgG levels were determined for bacteria known to be positively or negatively associated with periodontitis (Porphyromonas gingivalis, Tannerella forsythia, Actinobacillus actinomycetemcomitans Y4, Treponema denticola, Campylobacter rectus, Eubacterium nodatum, and Actinomyces naeslundii genospecies-2). In all analyses, we used antibody threshold levels shown to correlate with presence of moderate-severe periodontitis.Mean age was 72 years (SD 6.9) for controls, and 79 years (SD 4.6) for cases (p<0.001). Non-Hispanic Whites comprised 26%, non-Hispanic Blacks 27%, and Hispanics 48% of the sample. In a model adjusting for baseline age, sex, education, diabetes mellitus, hypertension, smoking, prior history of stroke, and apolipoprotein E genotype, high anti-A. naeslundii titer (>640 ng/ml, present in 10% of subjects) was associated with increased risk of AD (HR = 2.0, 95%CI: 1.1-3.8). This association was stronger after adjusting for other significant titers (HR = 3.1, 95%CI: 1.5-6.4). In this model, high anti-E. nodatum IgG (>1755 ng/ml; 19% of subjects) was associated with lower risk of AD (HR = 0.5, 95%CI: 0.2-0.9).Serum IgG levels to common periodontal microbiota are associated with risk for developing incident AD.
- Performance of the 47kDa protein membrane versus DNA polymerase I genes for detection of Treponema pallidum by polymerase chain reaction in ulcers. [JOURNAL ARTICLE]
- J Clin Microbiol 2014 Dec 17.
Treponema pallidum PCR (Tp-PCR) is a direct diagnostic method for primary and secondary syphilis, but there is no recommendation regarding the best target gene. We sequentially tested 272 specimens from sexually-transmitted ulcers with Tp-PCR targeting tpp47 then polA genes. The two methods showed similar accuracy and an almost perfect agreement.
- Recombinant Treponema pallidum Protein Tp0965 Activates Endothelial Cells and Increases the Permeability of Endothelial Cell Monolayer. [JOURNAL ARTICLE]
- PLoS One 2014; 9(12):e115134.
The recombinant Treponema pallidum protein Tp0965 (rTp0965), one of the many proteins derived from the genome of T. pallidum subsp. pallidum, shows strong immunogenicity and immunoreactivity. In this study, we investigated the effects of rTp0965 on the endothelial barrier. Treatment of human umbilical vein endothelial cells (HUVECs) with rTp0965 resulted in increased levels of ICAM-1, E-selectin, and MCP-1 mRNA and protein expression. These increases contributed to the adhesion and chemataxis of monocytes (THP-1 cells) to HUVECs preincubated with rTp0965. In addition, rTp0965 induced reorganization of F-actin and decreased expression of claudin-1 in HUVECs. Interestingly, inhibition of the RhoA/ROCK signal pathway protected against rTp0965-induced higher endothelial permeability as well as transendothelial migration of monocytes. These data indicate that Tp0965 protein may play an important role in the immunopathogenesis of syphilis.
- Subgingival microbial profile and production of proinflammatory cytokines in chronic periodontitis. [Journal Article]
- Folia Med (Plovdiv) 2014 Jul-Sep; 56(3):152-60.
This review examines literature data concerning the bacterial findings in chronic periodontitis depending on pocket depth, and presents the latest published information on the presence of proinflammatory factors in periodontal environment. It has been found that chronic periodontitis affects as much as 80% of the middle-aged population; by comparison, the prevalence of aggressive periodontitis reaches up to 1-1.5%. It is accepted that this social disease is multifactorial in etiology, but the evidence in the literature suggests that the levels of specific Gram-negative organisms in subgingival plaque biofilm play a major role in the initiation and progression of the disease. Of the many bacterial species inhabiting the periodontal environment, three types--Porphyromonas gingivalis (PG), Treponema denticola (TD), Tannerella forsythia (TF)--are strongly associated with the initiation and progression of periodontitis. Microbiological studies suggest that Porphyromonas gingivalis should be considered a major etiologic agent. Currently, Porphyromonas gingivalis is strongly associated with the pathogenesis of chronic periodontitis. On the other hand, the presence of Aggregatibacter actinomycetemeomitans in patients with chronic periodontitis may be related to the severity of the disease and thus modify the therapeutic plan. The increased amount of periodontal pathogens in the subgingival area can activate a cascade of defense mechanisms of the body associated with the production of factors causing inflammation and destruction, which suggests a correlation between the bacterial findings and the body response implemented by enhancing the local cytokine expression. Studies in the literature show that the presence of certain micro-organisms in the periodontal environment is associated to increased levels of proinflammatory cytokines in the gingival fluid and gingival tissue. These levels have been associated with destructive tissues response. There is little evidence in the literature on the correlation of the levels of periodontal pathogens of sites with different pocket depth with periodontal disease activity defined by the degree of the proinflammatory cytokine expression such as tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6).
- Investigate the correlation between clinical sign and symptoms and the presence of P. gingivalis, T. denticola, and T. forsythia individually or as a "Red complex" by a multiplex PCR method. [Journal Article]
- J Conserv Dent 2014 Nov; 17(6):555-60.
The aim of this study was to investigate the correlation between endodontic clinical signs and symptoms and the presence of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia or their association by Multiplex polymerase chain reaction assay.Microbial samples were taken from 30 cases with necrotic pulp tissues in primary infections. DNA was extracted from the samples, which were analyzed for the presence of three endodontic pathogens by using species-specific primers.P. gingivalis, T. denticola, T. forsythia, and Red Complex were present in 11, 17, 4, and 2 canals, respectively. Clinical and statistically significant relationships were found between T. forsythia and mobility and between T. denticola and swelling. (P < 0.05). Presence of other Red complex bacteria shows clinical association with presence of signs and symptoms but no statistically significant relationship.The high prevalence of P. gingivalis, T. denticola, and T. forsythia in the examined samples suggests that these bacteria are related to the etiology of symptomatic periradicular diseases.
- Yellowish dots in the retina: a finding of ocular syphilis? [JOURNAL ARTICLE]
- Arq Bras Oftalmol 2014 Oct; 77(5):324-326.
Here we report the occurrence of pale yellowish perivascular preretinal dots in 12 patients with ocular syphilis. A case series of these patients was examined between March and October 2012 at the Uveitis Sector of Universidade Federal de São Paulo. After diagnostic confirmation of syphilis, fundus photographs and optical coherence tomography (OCT) were performed to verify the localization of the dots, and patients were treated with IV crystalline penicillin for 14 days. The study comprised 11 men (91.6%), 19 eyes, median presentation age of 38.1 years, and panuveitis as the main clinical manifestation (seven patients, 58.3%), being bilateral in four. Ten patients were taking oral prednisone (83.3%). Serum panels performed by the Venereal Disease Research Laboratory (VDRL) showed positive results in eight patients (66.7%), whereas VDRL cerebrospinal fluid (CSF) tests were negative in seven of nine collected (77.8%). However, serum FTA-Abs was positive in 100% of patients, and eight patients (66.7%) had HIV infection. The best corrected visual acuity (BCVA) presented after treatment improved in 10 eyes (55.6%), did not change in seven eyes (38.9%), and worsened in one eye (5.6%). Although not yet acknowledged in the literature as a typical manifestation of ocular syphilis, these are very common findings in clinical practice. We believe that preretinal dots are due to perivasculitis secondary to treponema infection. It is important recognize them and remember that syphilis can present in several forms, including the one presented in this study.
- [Male circumcision from an infectiological point of view.] [JOURNAL ARTICLE]
- Hautarzt 2014 Dec 10.
In May 2012 a German regional court (Cologne) declared circumcision on religious grounds in minor boys an illegitimate bodily harm. This led to substantial political and religious discussions, because Jews as well as Muslims consider circumcision as an indispensable element of their religion. Still in 2012 a "circumcision law" was passed by the Federal Council of Germany, which continues to allow circumcision in boys "performed under strict medical conditions".How male circumcision is assessed in terms of infectiology (pros and cons)?Electronic databases were searched for articles about the infection risks of foreskin surgery, and the efficacy of circumcision in reducing the risks of sexual transmission of HIV, herpes viruses, HPV, treponema pallidum, chlamydia, hemophilus ducrey and Neisseria gonorrhoeae.Contra circumcision: The highest risk of neonatal circumcision is hemorrhage (35 %). Among infections surgical wound infection (10 %), meatitis urethrae (8-20 %) and urinary tract infections (2 %) are frequent (depending on the surgical technique). Severe complications like penile necrosis or lethal sepsis are rare (1:20,000). Pro circumcision: Circumcised boys have a reduced risk for urinary tract infections in childhood (1:10). Compared to uncircumcised men circumcised adults have a 50-60 % reduced risk of becoming infected with viral sexually transmitted infections (STIs; HIV, HPV and HSV). This advantage of circumcision is also discussed for the transmission of bacterial STIs (e.g. syphilis and chancroid), but the analysis of different clinical studies is still controversial.Neonatal circumcisions (and circumcision in early childhood) are irreparable interventions in the physical integrity, with very few medical indications. The risk of complications is dependent on the education of the circumciser (ritual, medical), analgesia and hygiene. Circumcisions should be performed under optimal surgical and hygienic conditions in informed and self-determined young men only. In adolescents and adults circumcision reduces the risk of the transmission of viral STIs (HIV, HSV, HPV) and there is also probably some effect on the sexual transmission of treponema pallidum and hemophilus ducreyi (insufficient, controversial data). The role of circumcision as an effective procedure to reduce the transmission of STIs is still under discussion, because important additional factors like sexual risk behavior (e.g. unprotected sexual intercourse, promiscuity) have a strong influence on STI epidemiology.
- Syphilis testing, typing, and treatment follow-up: a new era for an old disease. [JOURNAL ARTICLE]
- Curr Opin Infect Dis 2014 Dec 6.
The past 15 years have seen a dramatic increase in syphilis diagnoses in several regions including China, North America, Western Europe and Australia. Worldwide, the disease remains prevalent, contributing to substantial adult morbidity and neonatal mortality. Testing and treatment strategies are largely informed by data from the early antibiotic era, but increasing use of molecular diagnostics and new screening strategies could improve the management of syphilis substantially.The review explores new testing strategies for syphilis, including the importance of screening test selection and advances in point-of-care diagnostics. It then examines molecular studies of Treponema pallidum, covering typing; macrolide resistance; association between genotype and phenotype and the use of PCR in testing and monitoring strategies.Clinicians should be aware of testing strategies employed by their laboratories to ensure optimal sensitivity and specificity. Locally available T. pallidum PCR assays may improve the diagnosis of early disease and inform antibiotic choice. Robust serologic follow-up is still required, but predictors of potential treatment failure, including PCR-measured bacterial load, have been identified. Re-treatment should be considered for patients in the serofast state. The publication of T. pallidum genomes would allow further and more detailed study of strains and disease pathogenesis.
- [Urticarial syndrome related to Treponema infection]. [English Abstract, Journal Article]
- Rev Alerg Mex 2014 Oct-Dec; 61(4):363-7.
There are cases of patients having urticaria that do not respond satisfactorily to antihistamine treatment suggested by guidelines. In order to expand the search for associated factors, research about possible related infections have been performed. This paper describes the case of two patients evaluated in our center for hives resistant to standard treatment in which syphilis was diagnosed, with remission of urticaria when specific antibiotic treatment was established.