Oral bacteria in infective endocarditis requiring surgery: a retrospective analysis of 134 patients.

OBJECTIVES It has been reported that bacteria associated with infective endocarditis originate from the oral cavity in 26-45% of cases. However, little is known on the counts and species of periodontal microbiota in infected heart valves. The aim of this study was to identify these aspects of periodontal microbiota in infective endocarditis and to potentially initiate a dental extraction concept for periodontally compromised teeth concerning patients requiring heart valve surgery. MATERIALS AND METHODS The retrospective study group consisted of tissue samples from infected heart valves of 683 patients who had undergone heart valve surgery. Before patients had undergone cardiac surgery, the following laboratory tests confirmed the occurrence of endocarditis in all patients: blood cultures, echocardiography, electrocardiography, chest X-ray, and electrophoresis of the serum proteins. The specimens were aseptically obtained and deep frozen immediately following surgery. Microbiological diagnosis included proof of germs (dichotomous), species of germs, and source of germs (oral versus other). RESULTS Microbiota was detected in 134 (31.2%) out of 430 enrolled patients. Oral cavity was supposed to be the source in 10.4% of cases, whereas microbiota of the skin (57.5%) and gastrointestinal tract (GIT, 24.6%) were detected considerably more frequently. Moreover, periodontal bacteria belonged mostly to the Streptococci species and the yellow complex. None of the detected bacteria belonged to the red complex. CONCLUSION Most frequently, the skin and GIT represented the site of origin of the microbiota. Nevertheless, the oral cavity represented the source of IE in up to 10%. Consequently, it needs to be emphasized that a good level of oral hygiene is strongly recommended in all patients undergoing heart valve surgery in order to reduce the bacterial load in the oral cavity, thereby minimizing the hematogenous spread of oral microbiota. The prerequisites for conservative dental treatment versus radical tooth extraction must always be based on the patient's cooperation, and the clinical intraoral status on a sense of proportion in view of the overall clinical situation due to the underlying cardiac disease. CLINICAL RELEVANCE The oral cavity is a source of oral microbiota on infected heart valves. Patients requiring heart valve surgery should always undergo a critical evaluation of dental treatment affecting periodontally compromised teeth, favoring a systematic, conservative-leaning recall

Toll-Like Receptors 2 and 4 Regulate the Frequency of IFNγ-Producing CD4+ T-Cells during Pulmonary Infection with Chlamydia pneumoniae

TLR2 and TLR4 are crucial for recognition of Chlamydia pneumoniae in vivo, since infected TLR2/4 double-deficient mice are unable to control the infection as evidenced by severe loss of body weight and progressive lethal pneumonia. Unexpectedly, these mice display higher pulmonary levels of the protective cytokine IFNγ than wild type mice. We show here, that antigen-specific CD4+ T-cells are responsible for the observed IFNγ-secretion in vivo and their frequency is higher in TLR2/4 double-deficient than in wild type mice. The capacity of TLR2/4 double-deficient dendritic cells to re-stimulate CD4+ T-cells did not differ from wild type dendritic cells. However, the frequency of CD4+CD25+Foxp3+ T-cells was considerably higher in wild type compared to TLR2/4 double-deficient mice and was inversely related to the number of IFNγ-secreting CD4+ effector T-cells. Despite increased IFNγ-levels, at least one IFNγ-mediated response, protective NO-secretion, could not be induced in the absence of TLR2 and 4. In summary, CD4+CD25+Foxp3+ regulatory T-cells fail to expand in the absence of TLR2 and TLR4 during pulmonary infection with C. pneumoniae, which in turn enhances the frequency of CD4+IFNγ+ effector T-cells. Failure of IFNγ to induce NO in TLR2/4 double-deficient cells represents one possible mechanism why TLR2/4 double-deficient mice are unable to control pneumonia caused by C. pneumoniae and succumb to the infection

Großer Lebensmittel-assoziierter Ausbruch durch rekombinante Noroviren GII.g/GII.1 in einem süddeutschen Krankenhaus

a) Einleitung Noroviren sind derzeit die häufigsten Gastroenteritiserreger. Durch ihre niedriger infektiöse Dosis und Umweltstabilität verursachen sie häufig Ausbrüche in Krankenhäusern und anderen Gemeinschaftseinrichtungen. Wir berichten über den größten Norovirusausbruch in einem Münchner Krankenhaus der vergangenen Jahre mit über hundert infizierten Patienten und insgesamt 28 betroffenen Mitarbeitern aus verschiedenen Bereichen. b) Material/Methoden Wir wiesen Noroviren GII durch real time Amplifikation eines 94 bp am 3´Ende des Nichtstruktur Polyprotein nach. Sieben positive Proben, aus verschiedenen Bereichen des Klinikums einschließlich zweier Außenstellen, sowie Proben von 2 Küchenmitarbeitern wurden sequenziert. Dabei untersuchten wir 1110 bp, bestehend aus Polymerase- und Capsidsequenzen. Das Ausbruchsmanagement bestand aus einer task force, die neben dem ärztlichen Direktor aus Ärzten, Pflegekräften, Hygieniker und Virologen Apotheke, Einkauf, und Küchenbereich bestand. Zu den Maßnahmen gehörten unter anderem Abfrage aller betroffenen Stationen mit mindestens täglicher Aktualisierung der line-list, Umstellen desinfizierender Maßnahmen, sehr eng kontrolliertes Patientenmanagement (Verlegungen nur nach Rücksprache mit der Hygiene), Begehung aller betroffenen Stationen und der Küche, Abfrage der Nahrungsmittelaufnahme durch Fragebögen, Fortbildung des Personals und enge Kooperation mit den zuständigen Behörden. c) Ergebnisse Am 15.06. traten bei Patienten erstmalig Übelkeit und Erbrechen auf, am Folgetag wurde bei den ersten Patienten Noroviren in Stuhlproben nachgewiesen. Die letzte Neuinfektion wurde am 23.06. registriert, so dass der Ausbruch bereits am 04.07. in Absprache mit dem RGU München für beendet erklärt wurde. Insgesamt wurde Norovirus RNA bei 116 Patienten auf 34 Stationen sowie 28 Mitarbeitern nachgewiesen. Zweiundzwanzig Mitarbeiter waren in der direkten Patientenversorgung tätig, eine Mitarbeiterin arbeitete im Laborbereich. Fünf der Mitarbeiter waren im Küchenbereich beschäftigt und sind damit die wahrscheinlichste Infektionsquelle. Sie gaben keine bzw. nur wenig ausgeprägte Symptome an, mit denen sie weiterarbeiteten. In den bisher untersuchten Lebensmittelrückstellproben konnten keine Noroviren detektiert werden. Alle untersuchten Sequenzen entsprachen einem rekombinanten GII.g/GII.I Stamm. Die ähnlichsten publizierten Sequenzen unterscheiden sich nur durch 17 Nukleinsäure-, und 3 Aminosäureaustausche d) Schlussfolgerungen Wir beschreiben hier den größten Norovirenausbruch in Münchener Kliniken der letzten Jahre. Er breitete sich rasch aus und trat außerhalb der üblichen Norovirussaison auf. Durch schnelle Einleitung strikter Hygienemaßnahmen und einer engen Überwachung der betroffenen Stationen fanden wir nach 10 Tagen keine Neuinfektionen und konnten den Ausbruch zeitnah für beendet erkären. Erstmalig wiesen wir den rekombinanten Stamm GII.g/II.1 in unserem Universitätsklinikum nach. Fehlende oder niedrige Immunität der exponierten Personen könnte die initial rasche Ausbreitung begünstig haben. Zusammenfassend zeigen unsere Daten, dass bei Gastroenteritisfällen auch in den Sommermonaten mit Noroviren gerechnet werden muss. Diese können auch von oligo- oder asymptomatischem Personal ausgehen. Schnelle Erregerdiagnose und entsprechende Hygienemaßnahmen sind wesentlich in der Bekämpfung der Infektion

Fungal brain infection—no longer a death sentence

The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients' and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically

Periodontopathogenic bacteria in prosthetic joint infection: a retrospective analysis of 1,673 patients.

OBJECTIVES Prosthetic joint infection (PJI) is a severe complication for patients and represents an increasing health problem. At present, very limited data are available on the potential role of periodontopathogenic bacteria in PJI. The aim of this analysis was to compare the presence of periodontopathogenic bacteria in surgically treated patients diagnosed with PJI (study) to that of surgically treated infected orthopedic patients without PJI (controls). METHOD AND MATERIALS Patient records of all orthopedic surgical treatments performed between January 2009 and March 2014 were retrospectively screened. The study group consisted of 996 PJI patients, and the control group of 677 individuals, following surgical treatment of orthopedic infections. During surgery, microbiologic smears were taken and processed by standard procedures for microbiologic diagnosis. RESULTS Periodontopathogenic bacteria were detected in both groups (4.3% study and 5.6% control group). Nine periodontal pathogenic species from the yellow, violet, and orange complex were identified, without any statistically significant difference between the two groups. CONCLUSIONS Within their limits, the presented results indicate that periodontal bacteria may contribute similarly to PJI and other surgically treated orthopedic infections. The finding that periodontal pathogenic bacteria were identified in both groups highlights the importance of oral infection control prior to orthopedic surgery

Subversion of Toll-like receptor signaling by a unique family of bacterial Toll/interleukin-1 receptor domain-containing proteins

Pathogenic microbes have evolved sophisticated molecular strategies to subvert host defenses. Here we show that virulent bacteria interfere directly with Toll-like receptor (TLR) function by secreting inhibitory homologs of the Toll/interleukin-1 receptor (TIR) domain. Genes encoding TIR domain containing–proteins (Tcps) were identified in Escherichia coli CFT073 (TcpC) and Brucella melitensis (TcpB). We found that TcpC is common in the most virulent uropathogenic E. coli strains and promotes bacterial survival and kidney pathology in vivo. In silico analysis predicted significant tertiary structure homology to the TIR domain of human TLR1, and we show that the Tcps impede TLR signaling through the myeloid differentiation factor 88 (MyD88) adaptor protein, owing to direct binding of Tcps to MyD88. Tcps represent a new class of virulence factors that act by inhibiting TLR- and MyD88-specific signaling, thus suppressing innate immunity and increasing virulence