Culture-Proven Candida Albicans Endogenous Endophthalmitis in a Patient with Onychomycosis

ABSTRACT

Purpose: To report a case of Candida albicans endogenous endophthalmitis in an immunocompetent patient with onychomycosis.

Methods: Retrospective case report.

Results: A 40-year-old man with onychomycosis presented with C. albicans subretinal abscess in the left eye. Systemic and intravitreal injections did not prevent further progression of the infection. The patient underwent pars plana vitrectomy. One month after surgery, the intraocular inflammation gradually subsided. However, his visual acuity stayed at counting fingers as a result of macular scarring.

Conclusion: The aim of this case presentation is to emphasize that endogenous fungal endophthalmitis can be seen in an immunocompetent patient. The use of systemic steroids in the past was the main reason for the progression of the disease in this case. In these situations, when the clinical findings suggest a fungal etiology, it should keep in mind that endogenous candida endophthalmitis can be a result of fungal infections from distant sites such as the toenails and systemic steroids should not be started before definite diagnosis.     

Periodontal status in two siblings with severe congenital neutropenia: diagnosis and mutational analysis of the cases

BACKGROUND: Severe congenital neutropenia (SCN), also known as Kostmann syndrome, was originally reported as an autosomal recessive disease of neutrophil production. The disease is characterized by a maturation arrest of neutrophil precursors at the promyelocytic stage of differentiation and by extremely low levels of mature neutrophils in peripheral blood. METHODS: A 6-year-old male presented with a complaint of gingival swelling and bleeding, and swelling at the left side of his face. Upon clinical examination, severe inflammation of all gingival tissues was apparent, and a periapical abscess with mobility was noted on the left mandibular second molar. Medical and dental histories revealed numerous recurrent bacterial infections associated with oral and non-oral tissues. His medical history with recurrent infections led us to evaluate his 3-year-old sister to determine the status of her oral health. Inflammation of her oral tissues and recurrent bacterial infections were apparent. Their consanguineous parents were in good health. To assist in identifying possible systemic diseases underlying the inflammatory situation in the siblings, consultations were requested from the Pediatric Hematology Department at Selcuk University and Pediatric Oncology Department at Gulhane Military Medical Academy. RESULTS: Based on absolute neutrophil count (< or =200/mm(3)) and bone marrow aspiration findings consistent with early maturation arrest in myelopoiesis, the cases were diagnosed as SCN. No chromosomal abnormality was detected upon cytogenetic examination. Sequencing analysis also revealed no mutation in the neutrophil elastase or growth factor independent-1 (GFI-1) genes in these patients. Severe periodontal disease, attachment loss, and mobility for over 50% of the deciduous teeth were noted. Within 6 months, the male sibling lost all of his deciduous teeth due to periapical and periodontal infections. His sister presented with tooth mobility for all mandibular incisors. Monthly visits, including scaling, polishing, and 0.2% chlorhexidine digluconate irrigation were performed to support their oral hygiene and to avoid recurrent oral infections. We have been able to stabilize these patients' periodontal conditions during a 2-year follow-up period. CONCLUSION: This case report emphasizes the role of periodontists and pediatric dentists in the diagnosis of diseases linked with neutrophil and other systemic disorders and highlights the need to optimize the health of oral tissues with regular appointments.     

The effects of water and acetone-based dentin adhesives on apical microleakage

In this study, the aim was to assess the in vitro apical microleakage of a resin-based sealer used with two different adhesives. Thirty nine freshly extracted maxillary incisors were used. The teeth were decoronated at the cemento-enamel junction with a water-cooled fissure bur. Chemo-mechanical debridement of the root canals was accomplished with the step-back technique. The smear layer was removed by 19% ethylenediamine tetra acetic acid (EDTA). The roots were then divided into three experimental groups of thirteen teeth in each. Specimens in group 1 were filled with gutta-percha, AH Plus sealer, and water-based adhesive system (Syntac Single Component). Group 2 specimens were filled with gutta-percha, AH Plus sealer, and acetone-based dentin adhesive (Prime & Bond NT ). Specimens of group 3 were filled with only gutta-percha and AH Plus sealer (no adhesive was applied). The teeth were immersed into 2% methylene blue solution. Apical sealing qualities were assessed by measuring the linear dye penetration with a stereomicroscope. Dentin tubule penetration was observed under scanning electron microscopy (SEM). Results showed no statistically significant difference between the materials used, however, the leakage in group 2 was less than group 1 and 3.     

Does periodontal disease reflect atherosclerosis in continuous ambulatory peritoneal dialysis patients?

BACKGROUND: Chronic infection and inflammation, including periodontitis, are linked to an increased risk for atherosclerosis. To investigate the possible adverse effects of periodontitis in continuous ambulatory peritoneal dialysis (CAPD) patients, we compared periodontal severity with inflammation and malnutrition, which are associated with poor atherosclerotic outcome in CAPD patients. METHODS: A total of 110 CAPD patients were included in this study to evaluate their clinical periodontal status by using the plaque index, gingival index, and periodontal disease index. Values for nutritional and inflammatory markers and atherosclerotic risk factors were included for analysis with the periodontal index. Analysis of variance, post hoc Tukey's honestly significant difference, univariate and multivariate linear regression analysis, Pearson correlation analysis, and chi2 analysis were used in the evaluation of the data. RESULTS: Poor oral health status was exhibited by 85.5% of our CAPD patients with periodontal disease. We found that age and longer dialysis duration were associated with the severity of periodontitis. Parameters of malnutrition and inflammation and atherosclerotic risk factors also were associated with poor periodontal status. We carried out multiple regression analysis and found that age, albumin level, and duration of dialysis were associated independently with the severity of periodontitis in CAPD patients. A higher percentage of patients in the severe periodontitis group had malnutrition (chi2 = 59.4; P < 0.001), inflammation (chi2 = 60; P < 0.001), and atherosclerosis (chi2 = 65.6; P < 0.001). CONCLUSIONS: Periodontal health is poor in CAPD patients and correlates with markers of malnutrition, inflammation, and atherosclerosis. The diagnosis and treatment of periodontal diseases require better awareness.     

The effect of smoking on epithelial proliferation in healthy and periodontally diseased marginal gingival epithelium

BACKGROUND: Smoking causes an increase in the thickness of gingival epithelium, which is the outcome of increased keratinocyte proliferation or loss. Smoking-related changes in the proliferative activity of the gingival epithelium are largely uncharacterized for periodontal diseases. The aim of the present study was to determine the effects of smoking on the proliferation of the epithelium in periodontally diseased marginal gingiva by comparing the expression patterns of two different proliferation markers. METHODS: Gingival biopsies (N=60) were obtained from smokers who had clinically healthy gingiva (n=10), smokers with gingivitis (n=10), smokers with periodontitis (n=10), non-smokers with clinically healthy gingiva (n=10), non-smokers with gingivitis (n=10), and non-smokers with periodontitis (n=10). The quantitative measurement of maximum epithelial thickness was performed on hematoxylin and eosin-stained sections. The expression patterns for proliferating cell nuclear antigen (PCNA) and Ki67 were evaluated immunohistochemically. RESULTS: The percentage of PCNA-positive cells was higher than the percentage of Ki67-positive cells in all groups (P<0.001). When the mean values of PCNA and Ki67 were compared in each group, a statistically significant difference was observed only in the healthy smoker group (P=0.003). Significant differences in PCNA proliferation indices were only found between the smoker group and the non-smoker healthy group (P=0.015). CONCLUSIONS: Smoking had an affect on the proliferation of cells in the oral gingival epithelium, regardless of periodontal status. The increase in thickness of the epithelium was not associated with smoking; periodontal status and inflammation seemed to be more important factors. Smoking induced the replication activity of gingival epithelium and induced DNA repair.     

Lateralization of Neurobiological Response in Adolescents with Post-Traumatic Stress Disorder Related to Severe Childhood Sexual Abuse: the Tri-Modal Reaction (T-MR) Model of Protection

This study inquires into neurobiological response to stress and its clinical correlates among adolescents with post-traumatic stress disorder (PTSD). Structural magnetic resonance imaging (MRI) measures of cerebral anatomy were carried out on 23 female adolescents with PTSD related to severe childhood sexual abuse and 21 matched healthy controls. Clinician Administered PTSD Scale for Children and Adolescents, Adolescent Dissociative Experiences Scale, Childhood Trauma Questionnaire, Schedule for Affective Disorders and Schizophrenia for School Age Children, Beck Depression Scale, and a set of neuro-cognitive tests were administered to all participants. Compared to controls, PTSD group bilaterally had smaller amygdala, hippocampus, anterior cingulate, and thinner prefrontal cortex but normal thalamus. Further analyses within the PTSD group suggested an association between symptoms of PTSD and sizes of right brain structures including smaller amygdala but larger hippocampus and anterior cingulate. Thinner right prefrontal cortex and larger right thalamus seemed to be related to denial and response prevention, respectively. Being related to both hemispheres, dissociative amnesia was negatively associated with proportion of the right amygdala to right thalamus and to both left and right prefrontal cortex. Suggesting a neuro-protective effect against traumatic stress at least through adolescence, depersonalization–derealization and identity alteration were correlated with thicker left prefrontal cortex. Unlike the lateralization within PTSD group, correlations between regions of interest were rather symmetrical in controls. The graded response to stress seemed to be aimed at mental protection by lateralization of brain functions and possibly diminished connection between two hemispheres. A Tri-Modal Reaction (T-MR) Model of protection is proposed.