Infectious diseases e.g. gastric ulcer, caries and perodontitis, are caused by bacteria in a biofilm. Adhesion of bacteria to host ligands e.g. proteins, polypeptides and glycoproteins, is a key event in biofilm formation and colonization of surfaces such as mucosa and tooth tissues. Thus, host ligands could contribute to the susceptibility to infectious diseases. The general aim of this doctoral thesis was to study the effect of phosphorylated polypeptides and gp-340 in saliva and milk on oral bacterial adhesion and aggregation. Statherin is a non-glycosylated, phosphorylated polypeptide in saliva. The polypeptide inhibits precipitation and crystal growth of calcium phosphate and mediates adhesion of microorganisms. By using a hybrid peptide construct, the domain for adhesion of Actinomyces isolated from human infections and from rodents was found to reside in the C-terminal end, and the adhesion was inhibitable. With alanine substitution the peptide recognition epitope in the C-terminal end was delineated to Q and TF, where QAATF was an optimal inhibitory peptide. In contrast, human commensal Actinomyces bound to the middle region in a non-inhibitable fashion. Gp-340 is another protein in saliva, and it is a large, multifunctional glycoprotein. Four novel size variants (I-IV) of salivary gp-340 were distinguished within individuals, and their glycoforms were characterized. All four size variants were identical in the N-terminal amino acid sequence and shared core carbohydrates. Low-glyco lung gp-340, high-glyco saliva gp-340, and size variants I-III aggregated bacteria differently. Human milk, which shares many traits with saliva, could inhibit adhesion of Streptococcus mutans to saliva-coated hydroxyapatite (s-HA), a model for teeth, in an individually varying fashion. Human milk caseins, lactoferrin, secretory IgA, and IgG inhibited the binding avidly. By using synthetic peptides the inhibitory epitope in b-casein was mapped to a C-terminal stretch of 30 amino acids. Inhibition by human milk, secretory IgA and the b-casein-derived inhibitory peptide was universal among a panel of mutans streptococci. The main conclusions are: (i) statherin mediates differential binding of commensal versus infectious Actinomyces strains with small conformation-dependent binding epitopes, (ii) salivary gp-340 has individual polymorphisms that at least affect binding of bacteria, (iii) human milk inhibits S. mutans adhesion to s-HA in an individually varying fashion, and the C-terminal end of human milk β-casein is one inhibitory component. Together these results suggest that the studied host ligands can influence the composition of the oral biofilm. Statherin may protect the host from colonization of bacteria associated with infections. Gp-340 size variants may affect functions related to host innate immune defences such as interactions with a wide array of bacteria, and human milk may have a protective effect in infants from colonization of mutans streptococci.

Aktinomyzeten sind ein Teil der residenten Flora des menschlichen Verdauungstraktes, des Urogenitalsystems und der Haut. Die zeitraubende Isolation und Identifikation der Aktinomyzeten durch konventionelle Methoden stellt sich häufig als sehr schwierig dar. In den letzten Jahren hat sich jedoch die Matrix-unterstützte Laser-Desorption/Ionisation-Flugzeit-Massenspektrometrie (MALDI-TOF-MS) als Alternative zu etablierten Verfahren entwickelt und stellt heutzutage eine schnelle und simple Methode zur Bakterienidentifikation dar. Unsere Studie untersucht den Nutzen dieser Methode für eine schnelle und zuverlässige Identifizierung von oralen Aktinomyzeten, die aus dem subgingivalen Biofilm parodontal erkrankter Patienten isoliert wurden. In dieser Studie wurden elf verschiedene Referenzstämme aus den Stammsammlungen ATCC und DSMZ und 674 klinische Stämme untersucht. Alle Stämme wurden durch biochemische Methoden vorab identifiziert und anschließend ausgehend von den erhobenen MALDI-TOF-MS-Daten durch Ähnlichkeitsanalysen und Klassifikationsmethoden identifiziert und klassifiziert. Der Genotyp der Referenzstämme und von 232 klinischen Stämmen wurde durch Sequenzierung der 16S rDNA bestimmt. Die Sequenzierung bestätigte die Identifizierung der Referenzstämme. Diese und die zweifelsfrei durch 16S rDNA Sequenzierung identifizierten Aktinomyzeten wurden verwendet, um eine MALDI-TOF-MS-Datenbank zu erstellen. Methoden der Klassifikation wurden angewandt, um eine Differenzierung und Identifikation zu ermöglichen. Unsere Ergebnisse zeigen, dass eine Kombination aus Datenerhebung mittels MALDI-TOF-MS und deren Verarbeitung mittels SVM-Algorithmen eine gute Möglichkeit für die Identifikation und Differenzierung von oralen Aktinomyzeten darstellt.

O estudo trata de infecções fúngicas por Histoplasma, Cryptococcus gattii e Paracoccidioides e por Actinomyces e Nocardia que simularam neoplasia a partir de achados radiológicos. O objetivo deste trabalho é demonstrar, através de casos do banco de dados do Laboratório de Micologia da Irmandade Santa Casa de Misericórdia de Porto Alegre, a importância de um diagnóstico diferencial destas infecções com doenças neoplásicas. Identificamos os aspectos epidemiológicos e clínico-laboratoriais desses pacientes e revisamos criticamente a literatura. A casuística foi constituída por 83 casos, extraídos de uma população de 1.368 pacientes, de 1981 a 2012. As características clínicas e radiológicas de neoplasia foram observadas principalmente na histoplasmose, pela formação de histoplasmoma, na criptococose por C. gattii pela capacidade de formar criptococoma; na actinomicose e na nocardiose pela produção de massas. O que reforça o fato de que a síndrome clínica não é patognomônica da doença neoplásica e que as doenças infecciosas, especialmente granulomatosas devem ser consideradas no diagnóstico diferencial. / The study comes to infections by Histoplasma, Cryptococcus gattii, Paracoccidioides, and also Actinomyces and Nocardia simulating neoplasia from radiological findings. The objective of this study is to demonstrated, through case database of Mycology Laboratory of Irmandade Santa Casa de Misericordia de Porto Alegre, the importance of a differential diagnosis of these infections with neoplastic disease. We identified the epidemiological, clinical and laboratorial datas of these cases and review the literature critically. The casuistic consisted of 83 cases, drawn from a population of 1,368 patients, from 1981-2012. The clinical and radiological features of malignancy were observed mainly in histoplasmosis by manifestation as histoplasmoma, in cryptoccosis by C.gattii to the ability to form crytococcoma; actinomycosis and nocardiosis by the production of masses. This fact emphasizes that the clinical syndrome is not pathognomonic of neoplastic diseases and that infectious diseases, especially granulomatous, should be considered in the differential diagnosis.

Orientador: Fernanda Lourenção Brighenti / Banca: Aline Voltan / Banca: Fabíola Galbiati / Banca: Elisa Aparecida Giro / Banca: Marlise Inêz Klein Furlan / Resumo: A proximidade entre micro-organismos presentes no biofilme dentário determina a existência de interações entre eles, que podem beneficiar ou antagonizar as espécies envolvidas. Os objetivos deste estudo foram: 1) apresentar uma revisão de literatura sobre interações entre espécies bacterianas cariogênicas no biofilme oral; 2) validar o uso do reator 'drip-flow' (DFR) para desenvolver biofilmes dentários e testar agentes antimicrobianos; 3) avaliar o crescimento e a suscetibilidade à clorexidina de biofilmes compostos por Streptococccus mutans ATCC 25175 e Lactobacillus acidophilus ATCC 4356, usando o DFR; 4) avaliar o crescimento e a suscetibilidade à clorexidina de biofilmes compostos por Streptococccus mutans e Actinomyces naeslundii ATCC 12104, usando o DFR. Biofilmes cresceram sobre lâminas de vidro cobertas com hidroxiapatita e caldo BHI suplementado com sacarose 0.2% ou 0.5%, dependendo das espécies e um fluxo de 10 mL/h foi usado. O DFR foi incubado por 24 h a 37 °C / 5% CO2. Biofilmes foram tratados com clorexidina 0.2% (CHX) ou NaCl 0.9% por 2 min. Crescimento e efeito dos tratamentos foram determinados por contagem de unidades formadoras de colônias (UFC). Biofilmes foram marcados com o kit de Viabilidade Live/Dead e analisados por microscopia confocal de varredura a laser para diferenciar células com membranas íntegras das lesadas pela ação da CHX. A validação do DFR foi analisada por teste t (α=0.05). Avaliação da interação foi analisada por ANOVA dois fatores e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The proximity between microorganisms present in dental biofilm determines the existence of interaction between them, which can benefit or antagonize the involved species. The aims of this study were: 1) to present a review about interactions among cariogenic bacterial species within oral biofilm; 2) to show the applicability of the drip flow reactor (DFR) for developing oral biofilms and testing antimicrobial agents; 3) to evaluate the growth and chlorhexidine susceptibility of biofilms comprised by Streptococcus mutans ATCC 25175 and Lactobacillus acidophilus ATCC 4356, using DFR; 3) to assess the growth and chlorhexidine susceptibility of biofilms comprised by Streptococcus mutans ATCC 25175 and Actinomyces naeslundii ATCC 12104, using DFR. Biofilms grew on hydroxyapatite coated glass slides, with BHI broth at 10 mL/h flow rate supplemented with 0.2 or 0.5% sucrose depending on the species used. DFR was incubated for 24 h at 37 °C / 5% CO2. Biofilms were treated with 0.2% chlorhexidine (CHX) or 0.9% NaCl for 2 min. Growth and effect of treatments were determined by colony forming units (CFU) counts. Biofilms were stained using the Live/Dead Viability kit and analyzed by confocal laser scanning microscopy (CLSM) to differentiate bacterial cells without damage and damaged by the action of CHX. DFR validation was analyzed by unpaired t test (α=0.05). Interaction evaluation was analyzed by two-way ANOVA and Tukey test (α=0.05). Literature review showed the role of microbial int... (Complete abstract click electronic access below) / Doutor

O estudo trata de infecções fúngicas por Histoplasma, Cryptococcus gattii e Paracoccidioides e por Actinomyces e Nocardia que simularam neoplasia a partir de achados radiológicos. O objetivo deste trabalho é demonstrar, através de casos do banco de dados do Laboratório de Micologia da Irmandade Santa Casa de Misericórdia de Porto Alegre, a importância de um diagnóstico diferencial destas infecções com doenças neoplásicas. Identificamos os aspectos epidemiológicos e clínico-laboratoriais desses pacientes e revisamos criticamente a literatura. A casuística foi constituída por 83 casos, extraídos de uma população de 1.368 pacientes, de 1981 a 2012. As características clínicas e radiológicas de neoplasia foram observadas principalmente na histoplasmose, pela formação de histoplasmoma, na criptococose por C. gattii pela capacidade de formar criptococoma; na actinomicose e na nocardiose pela produção de massas. O que reforça o fato de que a síndrome clínica não é patognomônica da doença neoplásica e que as doenças infecciosas, especialmente granulomatosas devem ser consideradas no diagnóstico diferencial. / The study comes to infections by Histoplasma, Cryptococcus gattii, Paracoccidioides, and also Actinomyces and Nocardia simulating neoplasia from radiological findings. The objective of this study is to demonstrated, through case database of Mycology Laboratory of Irmandade Santa Casa de Misericordia de Porto Alegre, the importance of a differential diagnosis of these infections with neoplastic disease. We identified the epidemiological, clinical and laboratorial datas of these cases and review the literature critically. The casuistic consisted of 83 cases, drawn from a population of 1,368 patients, from 1981-2012. The clinical and radiological features of malignancy were observed mainly in histoplasmosis by manifestation as histoplasmoma, in cryptoccosis by C.gattii to the ability to form crytococcoma; actinomycosis and nocardiosis by the production of masses. This fact emphasizes that the clinical syndrome is not pathognomonic of neoplastic diseases and that infectious diseases, especially granulomatous, should be considered in the differential diagnosis.

O estudo trata de infecções fúngicas por Histoplasma, Cryptococcus gattii e Paracoccidioides e por Actinomyces e Nocardia que simularam neoplasia a partir de achados radiológicos. O objetivo deste trabalho é demonstrar, através de casos do banco de dados do Laboratório de Micologia da Irmandade Santa Casa de Misericórdia de Porto Alegre, a importância de um diagnóstico diferencial destas infecções com doenças neoplásicas. Identificamos os aspectos epidemiológicos e clínico-laboratoriais desses pacientes e revisamos criticamente a literatura. A casuística foi constituída por 83 casos, extraídos de uma população de 1.368 pacientes, de 1981 a 2012. As características clínicas e radiológicas de neoplasia foram observadas principalmente na histoplasmose, pela formação de histoplasmoma, na criptococose por C. gattii pela capacidade de formar criptococoma; na actinomicose e na nocardiose pela produção de massas. O que reforça o fato de que a síndrome clínica não é patognomônica da doença neoplásica e que as doenças infecciosas, especialmente granulomatosas devem ser consideradas no diagnóstico diferencial. / The study comes to infections by Histoplasma, Cryptococcus gattii, Paracoccidioides, and also Actinomyces and Nocardia simulating neoplasia from radiological findings. The objective of this study is to demonstrated, through case database of Mycology Laboratory of Irmandade Santa Casa de Misericordia de Porto Alegre, the importance of a differential diagnosis of these infections with neoplastic disease. We identified the epidemiological, clinical and laboratorial datas of these cases and review the literature critically. The casuistic consisted of 83 cases, drawn from a population of 1,368 patients, from 1981-2012. The clinical and radiological features of malignancy were observed mainly in histoplasmosis by manifestation as histoplasmoma, in cryptoccosis by C.gattii to the ability to form crytococcoma; actinomycosis and nocardiosis by the production of masses. This fact emphasizes that the clinical syndrome is not pathognomonic of neoplastic diseases and that infectious diseases, especially granulomatous, should be considered in the differential diagnosis.

Magister Scientiae Dentium - MSc(Dent) / The epidemiology of periodontal disease in the Republic of South Africa has received only scant attention in the past and consequently the available information is limited. The present study was therefore planned with the primary goal being to establish base-line information regarding periodontal disease in a portion of the population. The adolescent age group was selected as the target for the survey in that destructive periodontal disease (periodontitis) probably commences in many instances during the teenage years and therefore the group would be the one most likely to derive maximum benefit from preventive care and simple treatment measures which could be realistically provided by existing community dental health services. To translate the result into practicality a simple method of treatment needs estimation was also incorporated. In view of the diverse nature of the inhabitants of the Republic of South Africa and in keep with previously conducted studies, the presedt survey was confined to a single ethnic group. The population comprised all 3 .684 white pupils in Standard VIII attending the 34 schools in the Cape Peninsula during 1977. A random sample of 500 was selected for investigation. The average age of the sample was 15 years 9 months and the two sexes were equally represented. Only 7,2% were classified in the lower grade socio-economic class and thus were considered not to have a significant effect on the results. METHOD A team of three, consisting of the author and two assistants, visited each school. Portable equipment included a reclining chair, lighting, compressed air, and hand instruments. The investigation began with a questionnaire to establish the attitude to and experience of symptoms, prevention, and treatment of periodontal disease within the sample. Each subject was then examined and at each of 12 sites, on the 8 incisors and 4 first molars, recordings were made of plaque, gingivitis, supragingival calculus, subgingival calculus, and loss of attachment (periodontitis) according to defined criteria. A standard statistical package was used to analyse the recordings. RESULTS The questionnaire: This showed that almost all the subjects (98%) were interested in the prevention and treatment of periodontal disease in order to achieve and maintain oral health. Not with standing this.The overall prevalence of plaque was 97% and the mean Plaque Index (Pl.I) was 0,94 with 75% of the subjects having a mean Pl.I=0,5. The site prevalence data revealed that out of 12 sites, on average, 4 had Pl.I~O, 4 had Pl.I~l, and 4 had Pl.I~2. In the maxilla the molar sites had the higher plaque levels, whilst in the mandible the incisor sites had higher plaque levels. The sex-specific data showed the males to have higher mean plaque levels than the females, but in 50% of sample with a mean PI.I 0,5 to 1,45 there was ) had had any appurtenant treatment. The overall prevalence of plaque was 97% and the mean Plaque Index (Pl.I) was 0,94 with 75% of the subjects having a mean Pl.I=0,5. The site prevalence data revealed that out of 12 sites, on average, 4 had Pl.I~O, 4 had Pl.I~l, nd 4 had Pl.I~2. In the maxilla the molar sites had the higher plaque levels, whilst in the mandible the incisor sites had higher plaque levels. The sex-specific data showed the males to have higher mean plaque levels than the females, but in 50% of sample with a mean PI.I 0,5 to 1,45 there was no difference.

Magister Chirurgiae Dentium (MChD) / There is an absence of both dental services and systematic planning to meet the oral health needs of the Black* population ~f greater Cape Town. Little epidemiological data exists upon which such planning can be based. This study describes the prevalence and treatment need related to tooth decay and periodontal disease ofaXhosa-speaking* squatter community on the outskirts of Cape Town. An age and sex stratified sample of 290 adults attending the SACLA clinic in Crossroads were examined. Examiner variability was measured by a percentage intra-examiner agreement for the DMFT of 95% and for the CPITN 84%. Cohen's kappa statistic, for tooth-specific caries detection errors was k = 0.877. The mean DMFT was 11.8 and varied little with sex or age below 55 years. After this age, the DMFT climbs steeply due largely to the rapid increase in the M value (missing teeth). The results show that for every tooth needing to be extracted, two teeth per subject required a restoration. Only three subjects already had some restorations. Periodontal health was reflected by a high prevalence of calculus (TN2 = 99%; MNS = 5.2) for the whole sample. Deep pockets were detected in 13% of those aged between 15 and 29 years, but only at a relatively low intensity (MNS = 0.1). This prevalence reached a high 60% for those aged between 45 and 64 years (MNS = 1.7). All subjects require oral hygiene instruction and gross scaling in at least four sextants, according to CPITN criteria. In conclus~on it is noted that there is a shortage of relevant epidemiological information necessary to the planning of oral health services to improve the oral health of the Xhosa-speaking community in the Western Cape. Caries prevalence rates are already high in young adults and a high tooth mortality rate and an absence of fillings, suggests that extraction is the only form of treatment made available to this community. The absence of appropriate prevention strategies such as water fluoridation is reflected in these results. The existence of small amounts of severe periodontal disease in young adults is of concern. The high prevalence of mild (and preventable) periodontal disease, seems to reflect a low awareness of the condition and/or a lack of resources to control it. It is no coincidence that such poor oral health was observed in this, a poor, peri-urban squatter community. This study, serves as a sad reminder of the maldistribution of oral health and socia-economic resources in South Africa. The socia-economic and political character of this community is reflected by the epidemiological picture of oral health observed in the study. It is clear that further data must be collected, especially a clear assessment of community-expressed needs. Active planning must take place urgently to integrate oral health with Primary Health Care to rectify the serious misuse and maldistribution of oral health resources required to improve the oral health of this population.

Actinomyces species play an important role in the pathogenesis of oral diseases and infections. Susceptibility testing is not always routinely performed, and one may oversee a shift in resistance patterns. The aim of the study was to analyze the antimicrobial susceptibility of 100 well-identified clinical oral isolates of Actinomyces spp. against eight selected antimicrobial agents using the agar dilution (AD) and E-Test (ET) methods. We observed no to low resistance against penicillin, ampicillin-sulbactam, meropenem, clindamycin, linezolid and tigecycline (0–2% ET, 0% AD) but high levels of resistance to moxifloxacin (93% ET, 87% AD) and daptomycin (83% ET, 95% AD). The essential agreement of the two methods was very good for benzylpenicillin (EA 95%) and meropenem (EA 92%). The ET method was reliable for correctly categorizing susceptibility, in comparison with the reference method agar dilution, except for daptomycin (categorical agreement 87%). Penicillin is still the first-choice antibiotic for therapy of diseases caused by Actinomyces spp.

No description available.