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Birungi N, Fadnes LT, Engebretsen IMS, Tumwine JK, Lie SA, Åstrøm AN. Caries experience by socio-behavioural characteristics in HIV-1-infected and uninfected Ugandan mothers - a multilevel analysis. Acta Odontol Scand 2022; 80:91-98. [PMID: 34176405 DOI: 10.1080/00016357.2021.1942544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To assess caries experience in Ugandan mothers according to HIV status, socio-behavioural-characteristics, gingival bleeding status and to examine whether HIV status impacts the association of socio-behavioural characteristics with caries experience. Third, using multilevel analysis, this study assessed to what extent surface-specific caries experience varied between and within individuals. MATERIALS AND METHODS Caries experience was recorded using the World Health Organization's Decayed, Missed and Filled Teeth/Surfaces indices from a cohort of 164 HIV-1-infected Ugandan mothers and a cross sectional comparison group of 181 negative controls. Mixed-effects logistic regression was conducted with surface-specific caries experience as the outcome variable. RESULTS The prevalence of caries in HIV-1-infected and uninfected mothers was 81% and 71%, respectively. Significant associations occurred between caries experience at surface level and women's increasing age (odds ratio [OR] = 1.8, 95% confidence interval [CI]: 1.1-2.8) and presence of gingival bleeding (OR = 2.0, 95% CI: 1.2-3.2). Intra-class correlation (ICC) coefficient amounted to 0.54 (95% CI 0.48‒0.59). CONCLUSIONS Caries prevalence was higher in HIV-1 infected than in uninfected mothers and increased with age and gingival bleeding. ICC indicated that 54% of the variance was attributable to variation between individuals. Socio-demographic differences in dental caries did not vary by HIV-1 status.
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Affiliation(s)
- Nancy Birungi
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - James Kashugyera Tumwine
- Department of Paediatrics’ and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Lee KH, Coull BA, Moscicki AB, Paster BJ, Starr JR. Bayesian variable selection for multivariate zero-inflated models: Application to microbiome count data. Biostatistics 2021; 21:499-517. [PMID: 30590511 DOI: 10.1093/biostatistics/kxy067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 09/06/2018] [Accepted: 09/09/2018] [Indexed: 01/22/2023] Open
Abstract
Microorganisms play critical roles in human health and disease. They live in diverse communities in which they interact synergistically or antagonistically. Thus for estimating microbial associations with clinical covariates, such as treatment effects, joint (multivariate) statistical models are preferred. Multivariate models allow one to estimate and exploit complex interdependencies among multiple taxa, yielding more powerful tests of exposure or treatment effects than application of taxon-specific univariate analyses. Analysis of microbial count data also requires special attention because data commonly exhibit zero inflation, i.e., more zeros than expected from a standard count distribution. To meet these needs, we developed a Bayesian variable selection model for multivariate count data with excess zeros that incorporates information on the covariance structure of the outcomes (counts for multiple taxa), while estimating associations with the mean levels of these outcomes. Though there has been much work on zero-inflated models for longitudinal data, little attention has been given to high-dimensional multivariate zero-inflated data modeled via a general correlation structure. Through simulation, we compared performance of the proposed method to that of existing univariate approaches, for both the binary ("excess zero") and count parts of the model. When outcomes were correlated the proposed variable selection method maintained type I error while boosting the ability to identify true associations in the binary component of the model. For the count part of the model, in some scenarios the univariate method had higher power than the multivariate approach. This higher power was at a cost of a highly inflated false discovery rate not observed with the proposed multivariate method. We applied the approach to oral microbiome data from the Pediatric HIV/AIDS Cohort Oral Health Study and identified five (of 44) species associated with HIV infection.
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Affiliation(s)
- Kyu Ha Lee
- The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA and Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 10833, USA
| | - Bruce J Paster
- The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA and Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Jacqueline R Starr
- The Forsyth Institute, 245 First Street, Cambridge, MA 02142, USA and Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA 02115, USA
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Schulte F, King OD, Paster BJ, Moscicki AB, Yao TJ, Van Dyke RB, Shiboski C, Ryder M, Seage G, Hardt M. Salivary metabolite levels in perinatally HIV-infected youth with periodontal disease. Metabolomics 2020; 16:98. [PMID: 32915320 PMCID: PMC7784422 DOI: 10.1007/s11306-020-01719-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/28/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Salivary metabolite profiles are altered in adults with HIV compared to their uninfected counterparts. Less is known about youth with HIV and how oral disorders that commonly accompany HIV infection impact salivary metabolite levels. OBJECTIVE As part of the Adolescent Master Protocol multi-site cohort study of the Pediatric HIV/AIDS Cohort Study (PHACS) network we compared the salivary metabolome of youth with perinatally-acquired HIV (PHIV) and youth HIV-exposed, but uninfected (PHEU) and determined whether metabolites differ in PHIV versus PHEU. METHODS We used three complementary targeted and discovery-based liquid chromatography-tandem mass spectrometry (LC-MS/MS) workflows to characterize salivary metabolite levels in 20 PHIV and 20 PHEU youth with and without moderate periodontitis. We examined main effects associated with PHIV and periodontal disease, and the interaction between them. RESULTS We did not identify differences in salivary metabolite profiles that remained significant under stringent control for both multiple between-group comparisons and multiple metabolites. Levels of cadaverine, a known periodontitis-associated metabolite, were more abundant in individuals with periodontal disease with the difference being more pronounced in PHEU than PHIV. In the discovery-based dataset, we identified a total of 564 endogenous peptides in the metabolite extracts, showing that proteolytic processing and amino acid metabolism are important to consider in the context of HIV infection. CONCLUSION The salivary metabolite profiles of PHIV and PHEU youth were overall very similar. Individuals with periodontitis particularly among the PHEU youth had higher levels of cadaverine, suggesting that HIV infection, or its treatment, may influence the metabolism of oral bacteria.
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Affiliation(s)
- Fabian Schulte
- Forsyth Center for Salivary Diagnostics, Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Oliver D King
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bruce J Paster
- Forsyth Center for Salivary Diagnostics, Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, CA, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Mark Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - George Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Markus Hardt
- Forsyth Center for Salivary Diagnostics, Department of Applied Oral Sciences, The Forsyth Institute, 245 First Street, Cambridge, MA, USA.
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, USA.
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Ryder MI, Shiboski C, Yao TJ, Moscicki AB. Current trends and new developments in HIV research and periodontal diseases. Periodontol 2000 2020; 82:65-77. [PMID: 31850628 DOI: 10.1111/prd.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the advent of combined antiretroviral therapies, the face of HIV infection has changed dramatically from a disease with almost certain mortality from serious comorbidities, to a manageable chronic condition with an extended lifespan. In this paper we present the more recent investigations into the epidemiology, microbiology, and pathogenesis of periodontal diseases in patients with HIV, and the effects of combined antiretroviral therapies on the incidence and progression of these diseases both in adults and perinatally infected children. In addition, comparisons and potential interactions between the HIV-associated microbiome, host responses, and pathogenesis in the oral cavity with the gastrointestinal tract and other areas of the body are presented. Also, the effects of HIV and combined antiretroviral therapies on comorbidities such as hyposalivation, dementia, and osteoporosis on periodontal disease progression are discussed.
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Affiliation(s)
- Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Caroline Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna-Barbara Moscicki
- Division of Adolescent Medicine, Department of Pediatrics, University of California, Los Angeles, California, USA
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Moscicki AB, Yao TJ, Russell JS, Farhat S, Scott M, Magpantay L, Halec G, Shiboski CH, Ryder MI. Biomarkers of oral inflammation in perinatally HIV-infected and perinatally HIV-exposed, uninfected youth. J Clin Periodontol 2019; 46:1072-1082. [PMID: 31385616 DOI: 10.1111/jcpe.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 06/25/2019] [Accepted: 07/22/2019] [Indexed: 12/24/2022]
Abstract
AIM To examine oral biomarkers that have been associated with periodontal disease progression in HIV-infected adults in perinatally HIV-infected and HIV-exposed but uninfected youth. MATERIAL AND METHODS This was a cross-sectional, multicentre substudy of youth participating in the Oral Health Pediatric HIV/AIDS Cohort study. Gingival crevicular fluid repository samples from participants with and without periodontal disease (using Gingival Index [GI] and Bleeding on Probing [BOP] parameters on dental examination) were tested for concentration levels of inflammatory biomarkers. Associations were assessed using Wilcoxon test and Spearman correlation. RESULTS For perinatal HIV youth (n = 129), the markers consistently elevated (p < .05) in sites with GI ≥2 and in sites with BOP were interleukin-1β, 6 and 13, macrophage inflammatory protein-1α and metalloproteinase-9. Serum tumour necrosis factor-α and soluble CD14 were positively correlated with a summary count of elevated cytokines. No associations were seen among HIV-uninfected subjects (n = 71). CONCLUSIONS The association of oral biomarkers of inflammation with clinical indicators of periodontal inflammation and systemic immune activation suggests that perinatal HIV-infected youth may be at higher risk for developing significant periodontal disease, associated with tooth loss and HIV progression. More frequent dental care of this group is needed to prevent potential periodontal progression.
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Affiliation(s)
- Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, CA, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jonathan S Russell
- Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sepideh Farhat
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA, USA
| | - Mark Scott
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, CA, USA
| | - Larry Magpantay
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gordana Halec
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Caroline H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
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Gingival Recession and Localized Aggressive Periodontitis Among HIV-infected Children and Adolescents Receiving Antiretroviral Therapy. Pediatr Infect Dis J 2019; 38:e112-e115. [PMID: 30096098 DOI: 10.1097/inf.0000000000002166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Limited information is available on gingival recession or localized aggressive periodontitis among HIV-infected children and adolescents. This study reports on the prevalence of these conditions among children and adolescents receiving antiretroviral therapy (ART). METHODS A cross-sectional study on HIV-infected children and adolescents attending a Pediatric HIV clinic in Gauteng, South Africa, between January 2013 and June 2016. Patients received an oral examination and oral hygiene instructions, irrespective of oral- or dental-related complaints. Hard and soft tissue pathology was managed and recorded, together with relevant demographic and clinical data. Statistical analysis was performed in Stata 14 with P < 0.05 as significant. RESULTS A total of 554 children and adolescents 5-19 years of age (median age: 12.2 years; interquartile range: 10.3-14.9) were included, of whom 78 (14.1%) presented with gingival recession on permanent mandibular incisors and/or localized aggressive periodontitis of molar teeth. Multivariable logistic regression revealed that patients with gingival recession and aggressive periodontitis had a significantly shorter duration of ART and were more likely to have suboptimal HIV control (CD4 count ≤500 cells/µL and/or HIV viral load ≥50 copies/mL) and be on advanced ART regimens after virologic failure on first- and second-line treatment. CONCLUSIONS The results emphasize the importance of oral health care among HIV-infected children and adolescents from the onset, to prevent and manage conditions that could result in tooth loss and permanent disfigurement. This is of particular importance in the presence of virologic failure and immunosuppression.
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The association between oral disease and type of antiretroviral therapy among perinatally HIV-infected youth. AIDS 2018; 32:2497-2505. [PMID: 30096069 DOI: 10.1097/qad.0000000000001965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study explores the association between combination antiretroviral therapy (cART) and oral health outcomes (dental and periodontal) among perinatally HIV-infected (PHIV) youth. METHODS We conducted a cross-sectional study of oral health among PHIV youth participating in the Oral Health substudy of the Pediatric HIV/AIDS Cohort Study (PHACS). Dentists at research sites were trained/calibrated on how to perform a standardized oral mucosal, dental and periodontal examination. They assessed the decayed-missing-filled-surfaces and teeth index (DMFS/T). The number of decayed surfaces and teeth and the number of teeth with gingival bleeding on probing for each participant were derived from the examination. Data for analysis included lifetime measurements of CD4 cell count and viral load, sociodemographic information and current/past history of ART. RESULTS Among 209 PHIV youth, 95% were on ART at the time of enrolment. Among 143 PHIV youth on the same cART for at least 1 year, we found that the mean decayed teeth score of those receiving cART containing an integrase inhibitor was 86% higher than that of those on cART without an integrase inhibitor after adjusting for age, lifetime proportion of unsuppressed viral load and CD4 cell count nadir. Initiating protease inhibitors before age 6 years was associated with a significantly lower DMFT score than participants who initiated at age 6 years and older. CONCLUSION Our study revealed that PHIV youth who received cART containing an integrase inhibitor had a significantly higher number of untreated active caries than those on cART without an integrase inhibitor. This may warrant closer dental surveillance of those receiving an integrase inhibitor.
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Starr JR, Huang Y, Lee KH, Murphy CM, Moscicki AB, Shiboski CH, Ryder MI, Yao TJ, Faller LL, Van Dyke RB, Paster BJ. Oral microbiota in youth with perinatally acquired HIV infection. MICROBIOME 2018; 6:100. [PMID: 29855347 PMCID: PMC5984365 DOI: 10.1186/s40168-018-0484-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/15/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Microbially mediated oral diseases can signal underlying HIV/AIDS progression in HIV-infected adults. The role of the oral microbiota in HIV-infected youth is not known. The Adolescent Master Protocol of the Pediatric HIV/AIDS Cohort Study is a longitudinal study of perinatally HIV-infected (PHIV) and HIV-exposed, uninfected (PHEU) youth. We compared oral microbiome levels and associations with caries or periodontitis in 154 PHIV and 100 PHEU youth. RESULTS Species richness and alpha diversity differed little between PHIV and PHEU youth. Group differences in average counts met the significance threshold for six taxa; two Corynebacterium species were lower in PHIV and met thresholds for noteworthiness. Several known periodontitis-associated organisms (Prevotella nigrescens, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Filifactor alocis) exhibited expected associations with periodontitis in PHEU youth, associations not observed in PHIV youth. In both groups, odds of caries increased with counts of taxa in four genera, Streptococcus, Scardovia, Bifidobacterium, and Lactobacillus. CONCLUSIONS The microbiomes of PHIV and PHEU youth were similar, although PHIV youth seemed to have fewer "health"-associated taxa such as Corynebacterium species. These results are consistent with the hypothesis that HIV infection, or its treatment, may contribute to oral dysbiosis.
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Affiliation(s)
- Jacqueline R Starr
- Forsyth Institute, 245 First St, Cambridge, MA, 02142, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Yanmei Huang
- Forsyth Institute, 245 First St, Cambridge, MA, 02142, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Kyu Ha Lee
- Forsyth Institute, 245 First St, Cambridge, MA, 02142, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - C M Murphy
- Forsyth Institute, 245 First St, Cambridge, MA, 02142, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Caroline H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Mark I Ryder
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, CA, USA
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Bruce J Paster
- Forsyth Institute, 245 First St, Cambridge, MA, 02142, USA.
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
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Ferreira MVM, Cavalcanti ÉFF, PM Rubini ND, Ferreira DC, Gonçalves LS, V Colombo AP. Oral status and periodontal microbiota of HIV-infected youth infected by vertical transmission. Future Virol 2018. [DOI: 10.2217/fvl-2018-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: This study evaluated the oral status and microbiota of HIV+ youth infected by vertical transmission. Materials & methods: 34 HIV+ and 36 HIV- individuals (14–24 years of age) were examined for oral infections/lesions. Subgingival biofilm was collected and the microbiota determined by checkerboard DNA–DNA hybridization. Results: Over 90% of the HIV+ youth were under highly active antiretroviral therapy, but 64.6% had AIDS and 47% presented oral manifestations. HIV+ youth showed more periodontal attachment loss and inflammation than HIV- (p < 0.05), and also high prevalence of caries. Most species were detected in higher prevalence in the microbiota of HIV+ than controls. Conclusion: HIV+ youth infected by vertical transmission presented more periodontal destruction and inflammation, and greater prevalence of microbial pathogens compared with HIV- individuals.
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Affiliation(s)
- Mariana VM Ferreira
- School of Dentistry, Department of Clinics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Medical Microbiology, Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Édila FF Cavalcanti
- School of Dentistry, Department of Clinics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Norma de PM Rubini
- Department of Allergy & Immunology, Gafrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Dennis C Ferreira
- School of Dentistry, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Lucio S Gonçalves
- School of Dentistry, Estácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Ana Paula V Colombo
- Department of Medical Microbiology, Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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