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Biomedical subjects

J Bagg

Publications and source records attributed to J Bagg.

At least 55 records · Page 3Linked to original sources
PubMed2000

Origins of Staphylococcus epidermidis and Streptococcus oralis causing bacteraemia in a bone marrow transplant patient.

Coagulase-negative staphylococcal bacteraemia in immunocompromised patients is often associated with the use of central venous catheters, while the proposed origin of viridans streptococci causing bacteraemia in this patient group is the oral cavity. This report describes an episode of polymicrobial bacteraemia caused by Staphylococcus epidermidis and Streptococcus oralis followed by several further episodes of S. epidermidis bacteraemia in a 15-year-old boy after bone marrow transplantation. Pulsed-field gel electrophoresis (PFGE) of SmaI chromosomal DNA digests was used to compare blood culture and oral isolates of S. epidermidis and Str. oralis. The results indicated that the mouth was the source of both S. epidermidis and Str. oralis causing the first episode of bacteraemia. PFGE further demonstrated that the central venous catheter was the origin of a second strain of S. epidermidis responsible for subsequent episodes of staphylococcal bacteraemia. Both the oral mucosa and central venous lines should be considered as potential sources of organisms, including coagulase-negative staphylococci, associated with bacteraemia in immunocompromised patients.

Adolescent↗
PubMed2000

Efficacy of the cyclodextrin liquid preparation of itraconazole in treatment of denture stomatitis: comparison with itraconazole capsules.

This study investigated the efficacy of a cyclodextrin solution of itraconazole in the treatment of Candida-associated denture stomatitis. It was found that the liquid and capsule preparations of itraconazole were equally effective adjuncts in the treatment of this condition. However, the side effect profile indicates that capsules are the preferred formulation.

Adult↗
PubMed2000

Hepatitis C virus and oral lichen planus/lichenoid reactions: lack of evidence for an association.

Some studies have suggested an association between the mucocutaneous disorder lichen planus and chronic infection with hepatitis C virus. Most of these studies have been based purely on serological markers. The present study sought to detect hepatitis C virus RNA in both peripheral blood and in biopsy material collected from oral mucosal lesions. Twenty-seven patients were studied, six with classical lichen planus and 21 with oral lichenoid reactions. The diagnoses were confirmed by histopathological examination. Reverse transcription PCR was employed to detect hepatitis C virus RNA in the blood specimens. The same method was used to detect hepatitis C virus RNA in lesional tissue, following RNA extraction from sections of the biopsies. The virus was not detected in any of the paired blood and tissue specimens examined. It is concluded that hepatitis C virus is not commonly associated with oral lichen planus or lichenoid reactions in Scotland.

Biopsy↗
PubMed2000

The microflora associated with extra-oral endosseous craniofacial implants: a cross-sectional study.

Infection of soft tissues surrounding extra-oral craniofacial endosseous implants is a common clinical problem. The aim of this study was to analyse the microflora associated with such implants, in both health and disease. Eighteen patients with a total of 49 implants were studied. Each patient was seen on two occasions for both a clinical examination and for collection of microbiological samples, using swabs and paper points, from the peri-abutment soft tissues. Specimens were cultured on blood agar and on agars selective for staphylococci and yeasts. Isolates were identified and selective antibiotic susceptibility testing undertaken. No single organism emerged as a predominant cause of peri-abutment skin infection but Staphylococcus aureus, Gram-negative bacilli and yeasts were all present as potential pathogens in this context. Culture and sensitivity results should therefore guide the treatment of these infections.

Adolescent↗
PubMed1999

Barriers to the use of a diagnostic oral microbiology laboratory by general dental practitioners.

OBJECTIVE: To identify barriers on the use of diagnostic microbiology facilities in general dental practice. DESIGN: A cross-sectional survey using a postal questionnaire. SETTING: Primary/secondary care interface between the diagnostic oral microbiology laboratory, University of Glasgow Dental Hospital and School, Glasgow and dental practitioners within the surrounding health boards, 1998. SUBJECTS: All GDPs (797) within Argyll and Clyde, Ayrshire and Arran, Lanarkshire and Greater Glasgow Health Boards. MAIN OUTCOME MEASURES: The responses were expressed as both absolute and relative frequencies. RESULTS: Responses were received from 430 (55%). The most frequent reason for failure to use the service was lack of information, with more than half of the respondents claiming to be unaware of the facility. Lack of request forms and sampling equipment were also viewed as barriers to using the service. CONCLUSIONS: The laboratory is failing to successfully communicate its role in addressing the growing burden of antibiotic resistance in the community and must be more proactive in encouraging appropriate use and increasing accessibility of the service to GDPs.

Attitude of Health Personnel↗
PubMed1999

Water, water everywhere but not a drop to drink?

Biofilms are emerging as an increasing problem as medical technology advances. Dental practice is no exception and interest in the role of biofilms within dental units as a possible source of cross-infection is intensifying. It is difficult to quantitate the risks associated with aerosolised bacteria for the majority of patients seen in general practice. However, it seems prudent to eliminate this source of infection during treatment of compromised patients. This article attempts to provide a brief overview of current concepts and problems in this area of infection control.

Biofilms↗
PubMed1999

Fluoride release, microbial inhibition and microleakage pattern of two orthodontic band cements.

OBJECTIVES: To compare, in vitro, the fluoride release, microbial inhibition and microleakage pattern of a conventional glass ionomer cement (Ketac-Cem) and an acid-modified composite (Ultra Band-Lok) for band cementation. METHODS: Fluoride release was measured from cement discs (3.0 mm diameter and 1.5 mm thick) at regular intervals over 40 days using a potentiometric method. Microbial inhibition was determined for each cement using an agar diffusion test against one of four different strains of Streptococcus mutans. Thirty pairs of banded third molars (15 banded pairs for each cement) were thermocycled and microleakage determined by a dye penetration method. The depth of microleakage was assessed by an index applied by two examiners independently to photographic records taken of the mid-buccal aspect of each tooth. RESULTS: The cumulative and daily fluoride release for days 5, 15 and 40 were significantly greater for Ketac-Cem than for Ultra Band-Lok (all p < 0.05). After the initial set, the anti-microbial activity was significantly greater for Ketac-Cem than for Ultra Band-Lok over the following 24 h period for all four strains of S. mutans (all p < 0.05). There was no significant difference between the two cement groups for microleakage at the cement/enamel interface (p = 0.66) but a borderline significance was detected for microleakage at the cement/band interface (p = 0.051). CONCLUSIONS: The fluoride release and anti-microbial activity of Ketac-Cem were greater than that of Ultra Band-Lok. There was no significant difference in microleakage between the cements at the cement/enamel interface but a borderline difference existed between the cements at the cement/band interface.

Composite Resins↗
PubMed1999

Oral carriage of staphylococci in patients with rheumatoid arthritis.

OBJECTIVE: To determine the prevalence of oral staphylococcal carriage in patients with rheumatoid arthritis compared with healthy controls. METHODS: Fifty healthy adults, 25 healthy elderly volunteers and 25 patients with rheumatoid arthritis were studied. An oral rinse, tongue swab and nasal swab were collected for culture on blood agar and a range of selective agars. Isolates of staphylococci were identified and antibiotic sensitivity profiles determined by standard methods. RESULTS: Staphylococci were isolated from the mouths of 94% of the healthy adults, 24% of whom carried Staphylococcus aureus. All the healthy elderly carried oral staphylococci and 36% were colonized with S. aureus. Staphylococci were isolated from 96% of the rheumatoid arthritis patients and this group had the highest carriage rate of S. aureus (56%), significantly higher than the healthy adults (P < 0.05). In all three groups, Staphylococcus epidermidis was isolated from the mouths of > 80%. No methicillin-resistant strains of S. aureus were isolated. CONCLUSION: Oral carriage of S. aureus appears to be common in patients with rheumatoid arthritis and studies of the mouth as a source of infection in septic arthritis would be merited.

Adolescent↗
PubMed1999

Detection of serum antibodies against cytomegalovirus, varicella zoster virus and human herpesvirus 6 in patients with recurrent aphthous stomatitis.

There has recently been renewed interest in the possible role of viruses in recurrent aphthous stomatitis (RAS). In this study, sera from 22 patients with RAS, 24 patients with oral lichen planus (OLP) and 15 healthy controls were screened for IgG and IgM class antibodies to human cytomegalovirus (HCMV), varicella zoster virus (VZV) and human herpesvirus 6 (HHV-6). Commercially available ELISA and immunofluorescence kits were employed. There were no significant differences in the prevalence of IgG antibodies to HCMV, VZV or HHV-6 among the three patient groups. Similarly, there were no significant differences between the prevalence of HCMV and VZV IgM antibodies among RAS patients and controls. However, specific HHV-6 IgM was detected in 21 (95%) of the RAS patients and 17 (71%) of the lichen planus patients compared with 8 (53%) of the healthy controls. This difference between RAS patients and controls was statistically significant (P<0.01). These results do not support an aetiological role for HCMV or VZV in RAS but suggest possible involvement of HHV-6.

Adult↗
PubMed1999

The effect of saliva specimen collection, handling and storage protocols on hepatitis C virus (HCV) RNA detection by PCR.

OBJECTIVES: Commercial assays can now be adapted to detect salivary anti-hepatitis C virus (HCV) antibodies, increasing the potential of saliva as a non-invasive diagnostic specimen suited to surveillance and epidemiological studies. However, current diagnostic algorithms involve confirmation of HCV infection by RT-PCR. Manipulation and storage conditions of serum can influence the stability of viral RNA. This study examined whether varying specimen collection, handling and storage protocols also affected subsequent HCV RNA detection by RT-PCR applied to saliva specimens. METHODS: Whole unstimulated saliva, together with saliva samples collected in two commercially available devices (Salivette and Omnisal) were obtained from 50 HCV seropositive intravenous drug users. The specimens were subjected to a number of handling and storage conditions, including heat treatment and prolonged storage, then examined for HCV RNA by RT-PCR using primers derived from the 5' non-coding region (5'NCR). RESULTS: HCV RNA was detected in saliva samples from 25 (50%) of the patients. No single collection device or handling procedure identified all the subjects with HCV RNA positive saliva though whole saliva yielded the greatest number of positive results. CONCLUSIONS: Collection and processing of saliva specimens for RT-PCR analysis is complex. At present, detection of salivary HCV RNA by PCR is not sufficiently sensitive for use as a diagnostic tool in epidemiological studies.

Adult↗
PubMed1999

Hepatitis C virus and oral disease: a critical review.

Hepatitis C virus (HCV) infection is widespread with an estimated 3% of the world population being infected. Acute infection is usually mild but chronicity develops in as many as 70% of patients, of whom at least 20% will eventually develop cirrhosis. A further 1-4% of cirrhotic individuals will develop hepatocellular carcinoma. Infection with HCV may have effects on various organs other than the liver. HCV has been causally associated with a remarkable array of extrahepatic manifestations, some of which remain unproven. This review discusses the evidence implicating HCV in the aetiology of two important oral conditions, namely Sjögren's syndrome and lichen planus.

Hepacivirus↗
PubMed1998

Predominance of HCV type 2a in saliva from intravenous drug users.

Paired serum and saliva samples were collected simultaneously from 50 intravenous drug users with serologically proven hepatitis C virus infection. The oral health of the volunteers was also assessed. Hepatitis C virus RNA was detected by nested PCR, employing primers from the 5' noncoding region. Positive PCR products were sequenced using the Sequenase PCR Product Sequencing Kit (Amersham Life Sciences). HCV RNA was detected in 33 (66%) of the 50 serum samples. HCV RNA was detected in 19 (57.6%) of the corresponding 33 saliva samples. There was no correlation between oral health status or HIV seropositivity and the detection of HCV in saliva. However, subjects with HCV in their saliva were significantly more likely to complain of xerostomia (P < 0.05). Isolate genotypes were identified in paired serum and saliva of 15 intravenous drug users. HCV genotypes 1, 2, 3 and 6 were detected in both specimens. In seven cases, a differing HCV genotype was found in serum compared to the paired saliva specimen. The distributions of genotypes in serum and saliva were very different, with genotype 2a more common in saliva than serum (P < 0.005). These data suggest that in some cases the source of salivary HCV may not be serum transudation along the periodontal membrane or across damaged mucosa, and that an alternative local source, possibly the salivary glands themselves, should be considered.

Adult↗
PubMed1998

A comparison of fluconazole and itraconazole in the management of denture stomatitis: a pilot study.

OBJECTIVES: To compare fluconazole capsules (50 mg daily for 14 days) and itraconazole capsules (100 mg daily for 15 days) in the treatment of denture stomatitis, using objective clinical and mycological outcome measures. METHODS: Twenty complete denture wearers with denture stomatitis were enrolled. At baseline, palatal erythema was measured with an electro-optical instrument, a denture disc specimen was collected from the fitting surface of the denture for culture and an oral rinse and imprint cultures were collected for mycological culture. Ten patients received fluconazole capsules (50 mg daily for 14 days) and 10 received itraconazole capsules (100 mg daily for 15 days). Palatal erythema was reassessed and the microbiological specimens re-collected on day 14. RESULTS: The most common form of denture stomatitis seen in this group of patients was Newton's Type II. All patients responded to advice to leave their dentures out at night but there was a poor overall improvement in denture hygiene. There was an objective reduction in palatal erythema following treatment with both fluconazole and itraconazole. A wide range of yeasts were isolated from the mouths of all the denture stomatitis patients before treatment. C. albicans was the most common isolate. A mycological cure was achieved in only five of the 20 patients, one in the fluconazole group and four in the itraconazole group. A further eight patients in the fluconazole group and three in the itraconazole group had reduced yeast counts by the second visit. CONCLUSION: Fluconazole and itraconazole were of comparable efficacy in the treatment of denture stomatitis, on the basis of reduction in palatal erythema and mycological culture.

Adult↗
PubMed1998

Fluconazole-resistant Candida species in the oral flora of fluconazole-exposed HIV-positive patients.

The purpose of this study was to examine the effect of preceding fluconazole treatment on the oral mycologic flora and on the sensitivity of oral Candida albicans isolates to fluconazole. Saline oral rinses were collected from 89 HIV-positive patients, of whom 48 had been exposed to fluconazole and 41 were fluconazole-naive. The rinses were cultured on Sabouraud's and Pagano Levin agars, and yeasts were identified by standard methods. Fluconazole sensitivity of C. albicans isolates was measured by disk diffusion assay. C. albicans was isolated from 69% of patients who had received fluconazole and from 93% of the patients who were fluconazole-naive (p < 0.05). Nine other species of yeasts were also isolated, most commonly C. glabrata. Five patients previously exposed to fluconazole harbored fluconazole-resistant C. albicans, whereas no resistance was detected among the patients who were fluconazole-naive (p < 0.01). Sixteen of the patients who were fluconazole-exposed carried yeasts other than C. albicans, compared with only five patients in the fluconazole-naive group (p < 0.01). All of the fluconazole-resistant strains were isolated from patients with low CD4 counts (less than 100 cells/ml) and after lengthy fluconazole exposures. Nevertheless, patients in Charlotte, N.C., who had a greater mean fluconazole exposure time (10.25 +/- 1.41 months) than patients in Glasgow, UK, (0.65 +/- 0.18 months; p < 0.005), did not develop significantly more in vitro resistance or species diversity. This study indicates that long-term fluconazole treatment can have significant effects on the yeast flora of the mouth, particularly in a patient with a CD4 count of less than 100 cells/ml.

Adult↗
PubMed1998

Oral disease in terminally ill cancer patients with xerostomia.

Xerostomia is common among patients with advanced cancer and is likely to contribute to oral disease. This study determined the prevalence of oral signs and symptoms among a group of 70 terminally ill cancer patients [25 male, 45 female; age range 42-88 (mean 66) years] complaining of oral dryness, and examined the associated oral microflora. Imprint cultures for yeasts, coliforms and staphylococci were collected from the tongue and, in denture wearers, from the plate and denture fitting surface. A swab was collected for culture of herpes simplex virus. 68 patients (97%) complained of oral dryness during the day and 59 patients (84%) complained of oral dryness at night. Oral soreness was reported by 22 patients (31%). 46 patients (66%) had difficulty talking and 36 (51%) reported difficulty eating. Of the 56 denture wearers, 40% complained of denture problems. On examination, 63 (90%) of the patients had clinically dry mouths. Oral mucosal abnormalities were detected in 45 patients (65%), most commonly erythema (20%), coated tongue (20%), atrophic glossitis (17%), angular cheilitis (11%) and pseudomembraneous candidosis (9%). 47 (67%) of the patients carried yeasts, 18 (26%) were carriers of Staphylococcus aureus and 13 (19%) carried coliforms. Herpes simplex virus was isolated from 5 patients, of whom 2 had herpetic stomatitis. Oral complications and abnormalities of the oral microflora can be detected among significant numbers of terminally ill cancer patients with xerostomia.

Adult↗
PubMed1998

Evaluation of an optical instrument for objective assessment of oral mucosal erythema.

This study evaluated the sensitivity and reproducibility of an optical instrument, the Erythema Meter, for quantifying erythema of palatal mucosa. The instrument is based on the principle that haemoglobin in the vasculature selectively absorbs green light but has little effect on red light and allows derivation of an 'erythema index'. Non-clinical investigations were carried out by taking a series of Erythema Meter readings from each colour block on a red check-standard used by graphic artists for colour reproduction. For clinical assessment, 20 dentate patients with healthy palatal mucosa and 40 complete denture wearers (20 with denture stomatitis and 20 with healthy palatal mucosa) were enrolled, and palatal erythema determined both visually and using the Erythema Meter. Two weeks later the Erythema Meter readings for the 40 patients with healthy palatal mucosa were repeated, to allow assessment of the reproducibility of the Erythema Meter scores. The median erythema index was 12 (range 2-38) for dentate patients with healthy palatal mucosa and 5 (range 0-29) for denture wearers with healthy palatal mucosa. For denture stomatitis patients the median erythema index was 95 (range 36-117). The overall reproducibility coefficient was 88%. Visual scoring correlated poorly with the Erythema Meter scores for those with moderate degrees of erythema. The Erythema Meter provides an objective and reproducible means of measuring the degree of erythema of the palatal mucosa.

Adolescent↗