Human cytomegalovirus-associated periodontitis in renal transplant patients

Prevalent latent human cytomegalovirus genotype b2 in biopsy samples of gastric cancer

Aim: Genotyping and prevalence of human cytomegalovirus (HCMV) in gastrointestinal tract remains unclear. Objective: Characterization of HCMV and its viral load in samples of patients with gastric cancer (GC) in northeast Iran. Methods: A total of 21 biopsies were collected from patients with GC. HCMV was detected and genotyped using multiplex nested PCR. Quantitative real-time PCR has been used to determine the viral load. Staining was performed to detect viral inclusions. Results: 76.19% of the samples had HCMV genotypic b2 with viral load <0.1 IU/μl. 66.67% of patients were positive for H. pylori. Conclusion: Multiplex nested-PCR method can detect CMV populations with low viral loads in GC biopsies. For the first time, it was determined that the genotype b2 of HCMV is prevalent in the gastrointestinal tract.

Orofacial diseases in solid organ and hematopoietic stem cell transplant recipients

OBJECTIVE

Solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients are at risk of several diseases, principally attributable to immunosuppression. This global overview of SOT/HSCT-associated orofacial diseases is aimed at providing a practical instrument for the oral healthcare management of SOT/HSCT recipients.

METHODS

Literature search was made through MEDLINE. The associations between orofacial diseases and SOT/HSCT were assessed using observational studies and case series and were classified into 'association', 'no association', and 'unclear association'.

RESULTS

Lip/oral cancers, drug-induced gingival overgrowth (DIGO), infections, including hairy leukoplakia and, less frequently, post-transplantation lymphoproliferative disorders (PTLDs) and oral lichenoid lesions of graft-versus-host disease (GVHD), were associated with SOT. Lip/oral cancers, GVHD, mucositis, DIGO, infections and, less frequently, PTLDs were associated with HSCT. Associations of orofacial granulomatosis-like lesions and oral mucosa-associated lymphoid tissue-type lymphoma with SOT, and of pyogenic granuloma and hairy leukoplakia with HSCT were unclear. Periodontal disease and dental caries were not associated with SOT/HSCT. For none of the local treatments was there a strong evidence of effectiveness.

CONCLUSIONS

Solid organ transplant/HSCT recipients are at risk of orofacial diseases. Adequate management of these patients alleviates local symptoms responsible for impaired eating, helps prevent systemic and lethal complications, and helps where dental healthcare has been neglected.

Periodontitis case definition affects the association with renal function in kidney transplant recipients

AIM

The aim of this analysis was to investigate the association between periodontal status and renal allograft function in a cohort of renal transplant patients using different periodontitis case definitions.

MATERIAL AND METHODS

Fifty-eight kidney transplant patients were included. The subjects were classified into two groups, deterioration or stable/improvement of renal allograft function as expressed by the difference in glomerular filtration rate (GFR) between two time points at least 6 months apart. Chronic periodontitis was defined as: (1) two or more interproximal sites with clinical attachment level (CAL) ≥4 mm or two or more interproximal sites with probing depth (PD) ≥5 mm (DEF1); (2) PD ≥ 5 or CAL ≥ 4 in at least six proximal sites (DEF2); and (3) PD ≥ 5 or CAL ≥ 4 in at least two proximal sites in each quadrant (DEF3).

RESULTS

In a multivariate linear regression model, none of the continuous periodontal variables were significantly associated with deterioration of allograft function. Of the three definitions of chronic periodontitis, only DEF2 emerged as significantly more prevalent in subjects with GFR deterioration and was a statistically significant predictor of GFR deterioration over time.

CONCLUSION

These findings underscore the importance of periodontitis ‘case definition’ in the observed statistical associations between periodontitis and systemic disease.

Human cytomegalovirus and human immunodeficiency virus type-1 co-infection in human cervical tissue

Human cytomegalovirus (HCMV) and human immunodeficiency virus type-1 (HIV-1) infect the female genital tract. A human cervical explant model was developed to study single and dual infection by these viruses in the genital compartment. An HCMV strain expressing green fluorescent protein, and two clinical HCMV strains produced peak viral DNA copies at 14 to 21 days post-infection. Peak levels of HIV-1(Ba-L) p24 antigen occurred at 7 days post-infection. HIV-1(Ba-L) appeared to enhance HCMV in co-infected tissues. Singly and dually infected explants produced increased levels of cytokines IL-6, IL-8, and GRO-alpha in culture supernatants. Immunohistochemical and flow cytometric analysis showed HCMV infection of leukocytes with the phenotype CD45+/CD1a+/CD14+/HLA-DR+ but not stromal or endothelial cells. Cells expressing both GFP and HIV-1 p24 antigen were detected in co-infected tissues. The cervical explants provide an ex vivo human model for examining mechanisms of virus-virus interaction and pathogenesis in clinically relevant tissue.

Cytomegalovirus-Associated Periodontitis and Guillain-Barré Syndrome

BACKGROUND

Guillain-Barré syndrome (GBS), an autoimmune disorder of the peripheral nervous system, is characterized by rapidly ascending neural paralysis, hyporeflexia, and areflexia. The polyneuropathy of the GBS affects one to four humans per 100,000 of the population annually throughout the world (adults and children). The pathogenesis of GBS remains unclear. However, there are increasing indications that the disease is triggered by a preceding well-established febrile infection by cytomegalovirus (CMV). The present report describes active CMV within the periodontium of a 37-year-old patient affected by GBS.

METHODS

Real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR) was performed to detect CMV, Epstein-Barr virus-1 (EBV-1), herpes simplex 1 (HSV-1) and 2 (HSV-2) virus, and enteroviruses (polio-, coxsackie-, echo-, and enteroviruses 68 and 71) from periodontal sites demonstrating advanced attachment loss. Healthy sites and sites with inflamed gingival tissue were not included in the study. Anaerobic bacterial culture determined the occurrence of potential major periodontal pathogens.

RESULTS

Real-time RT-PCR and microbiologic analysis revealed the presence of a dual infection of CMV and specific bacterial plaque. CMV, Porphyromonas gingivalis, Tannerella forsythensis, and Campylobacter species were associated with periodontitis active sites, loss of attachment, and gingival bleeding. Furthermore, periodontal sites infected by active CMV had no visible radiographic crestal lamina dura.

CONCLUSIONS

The periodontium may serve as a reservoir for CMV and a source of viral replication. However, further research is needed to test whether viral replication in the periodontium precedes the GBS symptoms.