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Nakagawa Y, Shimada Y, Kawasaki Y, Honda H, Aoki T, Takanabe Y, Takagi R, Maruoka Y, Oka S. Risk factors for post-tooth extraction complications in HIV-infected patients: A retrospective study. Jpn J Infect Dis 2021; 74:392-398. [PMID: 33518617 DOI: 10.7883/yoken.jjid.2019.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study subjects were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Results of blood test, underlying diseases, surgical site, extraction method, and postoperative complications were obtained from the medical records. The risk factors potentially involved in postoperative complications were analyzed by multivariate logistic regression. Patients were divided into two groups, 61 (26%) patients with CD4 count of <200 /μL, and 170 (74%) patients with ≥200 /μL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n=10; surgical site infection, n=2). The rate of complications was not different between the CD4<200 /μL group (1.6%), and the CD4≥200 /μL group (6.5%) (adjusted odds ratio (aOR): 9.328, 95% confidence interval (CI): (0.470, 185.229), p=0.1431). Surgical extraction method with bone excavation, but not CD4 count, were identified as risk factors for post-extraction complications (aOR: 22.037, 95%CI: (1.519, 319.617), p=0.0234). A low CD4 count is not a risk factor for post-extraction complications in HIV-infected patients. We advise that tooth extraction should be performed based on dental/oral condition, rather than delayed until improvement of CD4 count.
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Affiliation(s)
- Yumiko Nakagawa
- Department of Oral health Sciences, Otemae Junior College, Japan.,AIDS Clinical Center, National Center for Global Health and Medicine, Japan
| | - Yasuyuki Shimada
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Japan
| | - Haruhito Honda
- AIDS Clinical Center, National Center for Global Health and Medicine, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Japan
| | - Yusuke Takanabe
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Japan
| | - Ritsuo Takagi
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Japan
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Yamamoto K, Mawatari M, Fujiya Y, Kutsuna S, Takeshita N, Hayakawa K, Nakamura M, Takanabe Y, Maruoka Y, Inoue M, Hara T, Nagasaka S, Tayama N, Miyazaki Y, Umeyama T, Ohmagari N. Survival case of rhinocerebral and pulmonary mucormycosis due to Cunninghamella bertholletiae during chemotherapy for acute myeloid leukemia: a case report. Infection 2020; 49:165-170. [PMID: 32720129 DOI: 10.1007/s15010-020-01491-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/22/2020] [Indexed: 11/24/2022]
Abstract
A 42-year-old man diagnosed with acute myeloid leukemia complained of progressive swelling of the right side of his face with pain 11 days after the third cycle of consolidation therapy with high-dose arabinosylcytosine-cytarabine. Head and neck magnetic resonance imaging showed a mass lesion in his right maxillary sinus with parapharyngeal involvement, which included the right masseter muscle, intraorbital involvement, and an abscess in his brain. Chest computed tomography revealed peribronchial small nodules in his right upper lobe and a necrotic tumor in his right lower lobe. Molds identified as Cunninghamella bertholletiae were isolated from the necrotic ulcer. According to these results, chemotherapy for leukemia was discontinued. High-dose liposomal amphotericin (10 mg/kg/day) was initiated. Because renal dysfunction occurred, the dosage was decreased to 6 mg/kg and combined with 150 mg/day micafungin. Debridement of necrotic tissue in the right maxillary sinus and establishment of the fenestration between the sinus and oral cavity were performed. Subsequently, brain and lung lesions were surgically removed. Rhinocerebral mucormycosis was successfully treated without relapse over 3 years by a 112-day course of intravenous anti-fungal therapy and 223-day course of terbinafine and partial surgical removal, respectively, to maintain masticatory and ocular functions. To our knowledge, there has been no other report of a long-term survival case of rhinocerebral mucormycosis due to C. bertholletiae.
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Affiliation(s)
- Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan.
| | - Momoko Mawatari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiro Fujiya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Miki Nakamura
- Department of Hematology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Takanabe
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Tetsuo Hara
- Department of Neurosurgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Takashi Umeyama
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, Japan
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