The incidence of oral Gram-negative bacteria in patients with Parkinson's disease

Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia?

Pneumonia is a common reason for admission afflicting frail older adults. Those who are the frailest are more likely to be provided with a diagnosis of aspiration pneumonia. This diagnosis has no clear definition and no clinical consensus. It is therefore time to stop attempting to differentiate between pneumonia type and use the term frailty-associated pneumonia.

Changes in Oral Microbial Diversity in a Piglet Model of Traumatic Brain Injury

Dynamic changes in the oral microbiome have gained attention due to their potential diagnostic role in neurological diseases such as Alzheimer's disease and Parkinson's disease. Traumatic brain injury (TBI) is a leading cause of death and disability in the United States, but no studies have examined the changes in oral microbiome during the acute stage of TBI using a clinically translational pig model. Crossbred piglets (4-5 weeks old, male) underwent either a controlled cortical impact (TBI, n = 6) or sham surgery (sham, n = 6). The oral microbiome parameters were quantified from the upper and lower gingiva, both buccal mucosa, and floor of the mouth pre-surgery and 1, 3, and 7 days post-surgery (PS) using the 16S rRNA gene. Faith's phylogenetic diversity was significantly lower in the TBI piglets at 7 days PS compared to those of sham, and beta diversity at 1, 3, and 7 days PS was significantly different between TBI and sham piglets. However, no significant changes in the taxonomic composition of the oral microbiome were observed following TBI compared to sham. Further studies are needed to investigate the potential diagnostic role of the oral microbiome during the chronic stage of TBI with a larger number of subjects.

Oral Health Disorders in Parkinson's Disease: More than Meets the Eye

Despite clinical evidence of poor oral health and hygiene in Parkinson’s disease (PD) patients, the mouth is often overlooked by both patients and the medical community, who generally focus on motor or psychiatric disorders considered more burdensome. Yet, oral health is in a two-way relationship with overall health—a weakened status triggering a decline in the quality of life. Here, we aim at giving a comprehensive overview of oral health disorders in PD, while identifying their etiologies and consequences. The physical (abnormal posture, muscle tone, tremor, and dyskinesia), behavioral (cognitive and neuropsychiatric disorders), and iatrogenic patterns associated with PD have an overall detrimental effect on patients’ oral health, putting them at risk for other disorders (infections, aspiration, pain, malnutrition), reducing their quality of life and increasing their isolation (anxiety, depression, communication issues). Interdisciplinary cooperation for prevention, management and follow-up strategies need to be implemented at an early stage to maintain and improve patients’ overall comfort and condition. Recommendations for practice, including (non-)pharmacological management strategies are discussed, with an emphasis on the neurologists’ role. Of interest, the oral cavity may become a valuable tool for diagnosis and prognosis in the near future (biomarkers). This overlooked but critical issue requires further attention and interdisciplinary research.

Presence of non-oral bacteria in the oral cavity

A homeostatic balance exists between the resident microbiota in the oral cavity and the host. Perturbations of the oral microbiota under particular conditions can contribute to the growth of non-oral pathogens that are hard to kill because of their higher resistance to antimicrobials, raising the probability of treatment failure and reinfection. The presence of these bacteria in the oral cavity has been proven to be associated with several oral diseases such as periodontitis, caries, and gingivitis, and systemic diseases of importance in clinical medicine such as cystic fibrosis, HIV, and rheumatoid arthritis. However, it is still controversial whether these species are merely transient members or unique to the oral cavity. Mutualistic and antagonistic interactions between the oral microbiota and non-oral pathogens can also occur, though the mechanisms used by these bacteria are not clear. Therefore, this review presents an overview of the current knowledge about the presence of non-oral bacteria in the oral cavity, their relationship with systemic and oral diseases, and their interactions with oral bacteria.

Periodontal inflammatory disease is associated with the risk of Parkinson's disease: a population-based retrospective matched-cohort study

Background

The cause−effect relation between periodontal inflammatory disease (PID) and Parkinson’s disease (PD) remains uncertain. The purpose of our study was to investigate the association between PID and PD.

Methods

We conducted a retrospective matched-cohort study by using Taiwan’s National Health Insurance Research Database. We identified 5,396 patients with newly diagnosed PID during 1997–2004 and 10,792 cases without PID by matching sex, age, index of year (occurrence of PID), and comorbidity. Cox proportional hazard regression was used to evaluate the risk of subsequent PD.

Results

At the final follow-up, a total of 176 (3.26%) and 275 (2.55%) individuals developed PD in the case and control groups, respectively. Patients with PID have a higher risk of developing PD (adjusted hazard ratio = 1.431, 95% CI [1.141–1.794], p = 0.002).

Discussion

Our results show that PID is associated with an increased risk of developing PD. Whilst these findings suggest that reducing PID may modify the risk of developing PD, further study will be needed.

Effectiveness of oral hygiene interventions against oral and oropharyngeal reservoirs of aerobic and facultatively anaerobic gram-negative bacilli

BACKGROUND

Aerobic and facultatively anaerobic gram-negative bacilli (AGNB) are opportunistic pathogens and continue to cause a large number of hospital-acquired infections. AGNB residing in the oral cavity and oropharynx have been linked to nosocomial pneumonia and septicemia. Although AGNB are not considered members of the normal oral and oropharyngeal flora, medically compromised patients have been demonstrated to be susceptible to AGNB colonization.

METHODS

A literature search was conducted to retrieve articles that evaluated the effectiveness of oral hygiene interventions in reducing the oral and oropharyngeal carriage of AGNB in medically compromised patients.

RESULTS

Few studies have documented the use of mechanical oral hygiene interventions alone against AGNB. Although a number of studies have employed oral hygiene interventions complemented by antiseptic agents such as chlorhexidine and povidone iodine, there appears to be a discrepancy between their in vitro and in vivo effectiveness.

CONCLUSION

With the recognition of the oral cavity and oropharynx as a reservoir of AGNB and the recent emergence of multidrug and pandrug resistance in hospital settings, there is a pressing need for additional high-quality randomized controlled trials to determine which oral hygiene interventions or combination of interventions are most effective in eliminating or reducing AGNB carriage.

Effect of inhaled budesonide on oropharyngeal, Gram-negative bacilli colonization in asthma patients

BACKGROUND AND OBJECTIVE

The effect of inhaled budesonide on oropharyngeal Gram-negative bacilli colonization (OGNBC) in asthmatic patients was investigated.

METHODS

Oropharyngeal cultures were obtained from asthmatic patients attending the hospital respiratory outpatient clinic, at baseline and 1 month after treatment with 800 microg/day of inhaled budesonide. Cultures were evaluated for OGNBC and compared with those of healthy controls.

RESULTS

A total of 148 cultures (74 from asthma patients, 74 from healthy controls) were evaluated. Six cultures (8.1%) from healthy controls, eight cultures (10.8%) from asthma patients obtained before treatment and 20 cultures (27.0%) obtained after treatment were positive for OGNBC (P < 0.05). Gender, age, presence of atopy and the degree of illness were not found to be related to the presence of OGNBC in and healthy control cultures. In the cultures obtained from the patients after treatment, OGNBC was higher in patients >50 years and in those with FEV1 < 70% (P < 0.05). Nine (18.8%) of 48 patients <50 years compare with 11 (42.3%) of the 26 patients >50 revealed OGNBC (P < 0.05). OGNBC were observed in 18.9% of the patients with FEV1 = 70% and in 47.6% of those with FEV1 < 70% (P < 0.05).

CONCLUSIONS

The increased rate of OGNBC in asthma patients treated with inhaled budesonide was found to be related to increased age and lower level of FEV1. Further studies with larger numbers of patients are required for the interpretation of this colonization in the course of lower respiratory infections in these patients.