多通道分子信标聚合酶链反应在新生儿侵袭性念珠菌感染快速诊断中的应用

目的初步建立新生儿侵袭性真菌感染（IFI）常见念珠菌的多通道分子信标荧光聚合酶链反应（MQ-PCR）检测体系，实现新生儿IFI病原体的早期检出，并探讨患儿不同部位念珠菌检出率的差异。 方法收集2018年1月至2019年4月首都医科大学附属北京妇产医院收治的34例临床诊断为脓毒败血症并疑似IFI新生儿的血液、深部痰液和咽拭子标本；常规行血培养及微生物鉴定，并应用MQ-PCR体系对3类标本进行念珠菌检测，比较两种方法念珠菌阳性检出率和检测时长。 结果本研究MQ-PCR体系检测白色念珠菌、近平滑念珠菌、光滑念珠菌和热带念珠菌的检出下限均为50 FU/ml，线性检测范围为5 × 10¹～1 × 10⁵ CFU/ml，且MQ-PCR体系所检出细菌与其他14种常见致病性细菌或DNA序列同源性较高的真菌无交叉反应。9例（9/34、26.5%）患儿经血培养念珠菌阳性确定为IFI；此9例IFI患儿同一血液样本、自身不同部位（深部痰液、咽拭子）样本行MQ-PCR均检出念珠菌阳性，且检出菌种与血培养完全一致。比较血标本两种方法念珠菌阳性检出率：血培养法为26.5%（9/34），MQ-PCR为32.4%（11/34），差异无统计学意义（χ² = 0.5、P = 0.5）。血培养法念珠菌阳性检出率（26.5%）和相应的自身不同部位标本MQ-PCR法念珠菌阳性检出率差异均无统计学意义（P均> 0.05），其中咽拭子、深部痰液和血标本中念珠菌阳性检出率分别为41.2%（14/34）、32.4%（11/34）和32.4%（11/34）。MQ-PCR检测血液、深部痰液和咽拭子标本时长分别为3.5（3.2，3.9）h、3.1（2.9，3.2）h和2.7（2.5，2.9）h，较血培养时长[94.0（78，105.8）h]显著缩短，差异均有统计学意义（Z =－2.7、P = 0.008，Z =－2.5、P = 0.013，Z =－2.7、P = 0.008）。 结论对IFI新生儿多部位标本应用MQ-PCR检测念珠菌，较血培养具备高符合率及快速检出的优点，利于新生儿念珠菌定植及血流感染的早期诊断及动态监测。     

The clinical evaluation of 414 cases of male urethritis

PURPOSE: We reviewed the clinical data of male urethritis diagnosed as sexually transmitted disease with the aim of revealing its clinical features. PATIENTS AND METHODS: In a total number of 414 males diagnosed as having acute urethritis transmitted by sexual activities between January and December in 2000, clinical data were collected and analyzed. In addition, questionnaire concerning the awareness of pharyngeal infection was obtained. RESULTS: Their ages ranged from 16 to 60 years with a mean of 31 years. The source of infection was a commercial sexual worker (CSW) in 288 (69.6%) out of 414 cases. In 241 cases in whom an infection route was determined, 199 cases (82.6%) were considered to have an infection through oral sex. Microbiological examinations isolated Neisseria gonorrhea alone in 206 (49.8%), Chlamydia tracomatis alone in 47 (11.3%) and both in 46 (11.1%) cases. In our study, 57.5% and 20.8% of Neisseria gonorrhea strains were resistant to penicillin and new quinolones, respectively. Based on questionnaire, 174 (57.8%) out of 301 cases were not aware of possible infection from the pharynx through oral sex. CONCLUSION: The remarkable prevalence of gonococcal urethritis might be in part due to the lacking of awareness of infection through oral sex and sexual activities without a condom. Instruction on the prevention as well as the actual situation of urethritis is needed for general population with a broad age spectrum. The appropriate use of antimicrobial agents with sufficient susceptibility and less inductivity of drug-resistance is also of clinical importance.     

Incidence of Propionibacterium acnes in arthroscopic rotator cuff repair

BackgroundRecently, Propionibacterium acnes was reported to be involved in postsurgical outcomes. We investigated the detection rate of P. acnes and clinical features of P. acnes infection following arthroscopic rotator cuff repair.MethodsSamples were collected from skin swabs before preparation, swabs of the synovium, sutures, and swabs from the arthroscope tip. We evaluated age, sex, presence of diabetes mellitus, preoperative contracture, operation time, blood test, Japanese Orthopaedic Association (JOA) scores, cuff integrity, deep infection, and positive inoculation rate.ResultsWe studied 90 patients (59 men and 31 women). Mean age was 60.6 years. Cultures of P. acnes showed a 65.5% positive superficial colonization rate (78.0%, male; 41.9%, female). Among the synovium swabs, P. acnes was detected in 13.6% and 0% of patients positive and negative for skin colonization with P. acnes, respectively. Positive culture was not correlated with age, sex, presence of diabetes mellitus, preoperative contracture, blood test, JOA score, cuff integrity, deep infection, operation time, and blood test date.ConclusionsP. acnes was detected at a higher rate in the skin of male patients. Patients with P. acnes detected on the skin showed higher rates of detection in the synovium. These findings suggest that the route of infection is via contamination.Level of evidenceDiagnostic level III; Case-control study.     

Prevalence of Neisseria gonorrhoeae infection in patients attending an antenatal clinic

Neisseria gonorrhoeae infection was diagnosed by culture using a selective medium (Thayer-Martin) in 140 (11.7%) of 1 200 pregnant black women attending an antenatal clinic in 1981. The study confirmed the need for specimens from three sites (endocervix, urethra and rectum)--endocervical cultures were positive in only 75.9% of infected women, in the remainder only the urethral and/or rectal cultures were positive. Rectal cultures were positive in 41.6%. Cultures of throat swabs from 200 women were all negative for N. gonorrhoeae. In comparison with endocervical specimens directly plated, high vaginal swab specimens placed in Stuart's transport medium before plating gave a lower yield of positive cultures. No penicillinase-producing N. gonorrhoeae strains were detected.     

Hospital infection and our policy to control]

Since we organized the committee to control hospital infection in April 1980, we have adopted various investigations and strategies. When wide spread of infection caused by Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa was recognized in 1981 our strategies were set up of water faucets with footpedal, frequent to wash of hands and use of disposable paper towels. Investigation of HBV markers revealed that the positive rate of HBV antibody was 21% in scrub and ward nurse group. Vaccination was performed to our HVB antibody negative members to protect them from the infection of HBV antigen. After HBV antigen positive patients were operated, we sterilized the operating room using our ultraviolet ray irradiation apparatus. In 1990, 50 cases infected with MRSA were detected bacteriologically, which occupied 68.5% of all those infected with Staphylococcus aureus. Therefore, we cultured MRSA from nose swabs and investigated numbers of bacteria in the air which were gathered with air sampler in the operating rooms and wards.     

线索细胞在男性泌尿生殖道感染的意义

目的:探讨线索细胞在男性泌尿生殖道感染的检出意义。方法:对264例门诊就诊的男性取尿道拭子或前列腺液,直接涂片在超高倍显微镜下找线索细胞,并对线索细胞阳性患者的配偶进行细菌性阴道病(BV)的检查诊断。结果:215例尿道拭子检出线索细胞11例(5.1%),49例前列腺液检出线索细胞1例(2.0%),11例配偶检查结果9例诊断为BV(81.8%)。结论:BV的病原体同样可侵犯并粘附于男性泌尿生殖道上皮细胞形成线索细胞,线索细胞阳性结合临床特征可诊断男性泌尿生殖道细菌感染。     

男性不育患者解脲支原体及沙眼衣原体感染与抗精子抗体关系的研究

目的:探讨在男性不育症中解脲支原体(UU)、沙眼衣原体(CT)感染与抗精子抗体(AsAb)的关系.方法:应用荧光定量PCR技术检测105例不育男性精液中UU和CT,应用ELISA法测定血清中的AsAb.结果:不育男性血清AsAb阳性率 34.3%(36/105),UU阳性率 32.4%(34/105),CT阳性率 25.7%(27/105).AsAb阳性组中UU阳性率 47.2%(17/36),阴性组中UU阳性率 24.6%(17/69),两组差异有统计学意义(P＜ 0.05).AsAb阳性组中CT阳性率 27.8%(10/36),阴性组中CT阳性率 24.6%(17/69),两组差异无统计学意义(P＞ 0.05).结论:UU和CT感染是不育症患者的常见病因,而UU是AsAb产生的重要原因之一.     

Urine versus brushed samples in human papillomavirus screening： study in both genders

Aim： To investigate whether urine is a good medium for screening and whether there is a correlation between the amount of extracted DNA and human papillomavirus （HPV）-positivity. Methods： In the present study, 30 first-voided urine （FVU） specimens and 20 urethroglandular swabs using cervex-brushes from male partners of HPV-positive patients, and 31 FVU specimens and 100 liquid-based cervix cytology leftovers sampled with cervix-brushes from HPV-positive women were examined for the presence of β-globin. Oncogenic HPV were detected using type-specific PCR. Results： β-globin was found in all the brushed samples, whereas it was found in only 68.9% of the FVU specimens. HPV-PCR was positive in 60.0% of the male brushes, in 29% of the female brushes and in 0% of the male FVU specimens. DNA concentration was, respectively, 0.9998 ng/μL, 37.0598 ng/μL and 0.0207 ng/μL. Conclusion： Urine is not a good tool for HPV detection, probably because the low DNA concentration reflects a low amount of collected cells. β-globin is measurable in FVU by real time quantitative PCR, but the DNA concentration is lower compared to brush sampling for both genders. β-globin-positivity of urethral and cervical swabs is 100%, showing a higher mean concentration of DNA, leading to a higher detection rate of HPV. This is the first article linking DNA- concentration to the presence of HPV.     

Histological correlates of clinically occult human papillomavirus infection of the uterine cervix

Occult infection of the uterine cervix by human papillomavirus (HPV) is assumed when viral DNA sequences are detected from cervical swabs but no lesion is detectable and the Papanicolaou smear is negative. In an attempt to identify what histological changes correlate with occult infections, DNA was extracted from 200 cervical swabs taken from hysterectomy specimens. The DNA was analyzed by Southern blot hybridization for the presence of HPV sequences. Eleven cases (5.5%) were positive. The entire cervix from each case as well as from 28 negative cases was processed for histological analysis. One of the positive cases contained a CIN 2 lesion. The other 10 showed parakeratosis, papillomatosis, acanthosis, as well as focal nuclear pleomorphism and perinuclear halos (borderline koilocytotic atypia) in proportions equal to the negative controls. In situ hybridization analysis of the cases that showed borderline koilocytotic atypia were negative. These findings confirm that clinically and cytologically occult HPV infection of the uterine cervix is not associated with diagnostic histological changes. This underscores the need for caution when interpreting cervical biopsies that show changes suggestive, but not absolutely diagnostic, of HPV infection. Further, the precise epithelial location of the virus remains unclear.     

Clinical observation of non-gonococcal urethritis

Sixty-one male urethritis cases, 28 gonococcal urethritis and 33 nongonococcal urethritis (NGU), were out-patients at the Department of Urology, Asahi General Hospital, during the 4 months, Oct. 1, 1984-Jan. 31, 1985. Thirteen of the 33 NGU patients (39.4%) were infected with C. trachomatis (CT). The efficacy of Doxycycline and the route of infection was studied in the cases of CT-positive CT-negative-NGU. CT infection from prostitutes was not so frequent as in the other pathogen infection of NGU. The efficacy of Doxycycline (100 mg b.i.d. for 2 weeks) against CT infection was excellent in the disappearance of subjective complaints and that of white blood cells in the urethral discharge in the CT positive-NGU group (13/13), in comparison with CT negative-NGU group (7/18). The efficacy of Doxycycline against CT was also confirmed from the follow-up study by the isolation of CT and by detection of CT antigen from urethral swabs using FITC conjugated monoclonal antibody against CT antigen.     

Acceptability and satisfaction towards self‐collection for chlamydia and gonorrhoea testing among transgender women in Tangerine Clinic,Thailand: shifting towards the new normal

IntroductionProvider‐collected swabs are an unappealing procedure for many transgender women and may have led to suboptimal rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Self‐collection for CT/NG testing is recommended for men who have sex with men. However, the information on acceptability and clinical performance to support a recommendation for transgender women is lacking. We aimed to determine the acceptability and satisfaction towards self‐collection for CT/NG testing among Thai transgender women.MethodsThai transgender women who attended Tangerine Clinic (a transgender‐led, integrated, gender‐affirming care and sexual health services clinic in Bangkok, Thailand) between May and July 2020 and had condomless sexual intercourse within the past six months were offered to collect urine and perform self‐swabs of pharyngeal, rectal, and if applicable, neovaginal compartments for pooled nucleic acid amplification testing for CT/NG infections. Participants received a diagram, video and oral instructions about how to perform self‐collection procedure. Those who accepted self‐collection were also offered to receive provider collection to evaluate the performance between the two methods. Self‐administered questionnaires were used to assess satisfaction.ResultsAmong 216 transgender women enrolled, 142 (65.7%) accepted self‐collection. All who accepted had pharyngeal, rectal and urine samples collected. Of 31 transgender women who had undergone genital surgery, 28 (90.3%) accepted neovaginal self‐swab. The acceptance rate increased from 46.2% in May to 84.5% in July 2020. One participant had an invalid result. All transgender women who accepted self‐collection could perform it without assistance, and 82.8% were highly satisfied with the method. None reported dissatisfaction. Due to the COVID‐19 pandemic, provider collection services were discontinued early, and only eight transgender women were able to perform both methods for performance evaluation. The performance agreement was 100%.ConclusionsThai transgender women had high acceptability and satisfaction towards self‐collection for CT/NG testing. The performance was promising compared to provider collection. Our results support the implementation of self‐collection to the sexually transmitted infection services, particularly during the COVID‐19 pandemic where physical distancing is the new normal. A larger study is warranted to determine the performance of self‐collection for CT/NG testing in each anatomical compartment and confirm the performance between self‐collection and provider collection.     

生殖支原体感染与性传播疾病关系的探讨

目的：建立聚合酶链反应技术（ＰＣＲ）检测我国性病高危人群分泌物标本中的Ｍｇ－ＤＮＡ,以探讨Ｍｇ感染在性传播疾病中的作用及地位。方法：用ＰＣＲ技术检测来自昆明、广东、上海、南京等地性病门诊病人４２３例、性罪错者２６１例尿道分泌物或宫颈分泌物的Ｍｇ－ＤＮＡ,并与正常对照组进行了比较。结果：①性病门诊组４２３例标本的Ｍｇ－ＰＣＲ阳性率达１５．１％（６４／６２３）,性罪错组的Ｍｇ－ＰＣＲ阳性率为８．８１％（２３／２６１）,均与正常对照组（１．３７％,１／７３）差异极显著（Ｐ＜０．０１）;②来自广东、昆明地区的性病门诊标本的Ｍｇ－ＰＣＲ阳性率为２０．１％（２６／１２９）及１８．８％（２６／１３８）,均与南京、上海地区的性病Ｍｇ－ＰＣＲ阳性率有显著差异（Ｐ＜０．０５）;③３１例无ＮＧＨ,ＵＵ,ＣＴ感染标本的Ｍｇ－ＰＣＲ阳性率为１２．９％（４／３１）,与有三种不同病原体单独或混合感染组的Ｍｇ－ＰＣＲ阳性率差异不显著（Ｐ＞０．０５）。结论：①我国性病高危人群即性病门诊及性罪错人群有着较高的Ｍｇ感染率;②我国性病高发地区如广东、昆明等地有着较高的Ｍｇ感染率;③Ｍｇ可以不依赖于任何病原微生物而存在于人的泌尿生殖道中,而且可能是?     

Chlamydia trachomatis infection as a problem among male partners of infertile couples

Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease supposed to cause urethritis, epididymitis, prostatitis and infertility in men. The objective of this study was to assess the frequency of C. trachomatis infection in male partners of infertile couples at childbearing age. Sixty infertile couples and a control group of 40 healthy volunteers were included in the study. Urethral swabs were taken from all the male participants and cervical swabs from the female partners of the infertile couples. Culturing on McCoy cell line and PCR were the methods used for detection of the infection. C. trachomatis was found in five out of the 60 male urethral samples. Three of the female partners of these five positive males were diagnosed with C. trachomatis infection, too. We registered a woman with C. trachomatis infection whose partner's samples were negative for the bacterium. The control group showed one specimen positive for C. trachomatis . The frequency of C. trachomatis infection was 8.3% in the male partners of infertile couples at childbearing age when compared with 2.5% in the control group. It is most likely that infertility in the couples with chlamydial infection was due to the pathogen studied.     

沙眼衣原体、解脲支原体感染与不孕的关系探讨

目的与方法：通过对宫颈粘液标本沙眼衣原体（CT）、解脲支原体（UU）及血清抗精子抗体（AsAb）的检测，探讨生殖道感染与不孕的关系。结果：CT、UU、AsAb在不孕组的检出率分别为29．41％、35．29％和38．23％；性病组分别为50．51％、67．01％和11．34％；对照组分别为5．75％、9．20％和1．15％。不孕组与对照组比较差异均高度显著（P＜0．001）。不孕组中CT或UU同时伴AsAb阳性者达69．23％。结论：作者认为CT和UU的生殖道感染是引起不孕的重要因素之一，建议作为不孕检测中的常规项目。     

Single dose 1 g ceftriaxone for urogenital and pharyngeal infection caused by Neisseria gonorrhoeae

Objectives: To evaluate the efficacy of 1 g ceftriaxone in the treatment of urethritis, cervicitis and pharyngeal infection caused by Neisseria gonorrhoeae (N. gonorrhoeae) including the oral cephem‐resistant strain with chimera penicillin‐binding protein 2 (PBP‐2) (cefozopran‐resistant N. gonorrhoeae, CZRNG). Methods: From September 2004 to November 2006, 67 patients (27 male and 40 female) who had genital infection and/or pharyngeal infection caused by N. gonorrhoeae were enrolled in this study at five participating centers in Japan. To detect the chimera PBP‐2 gene, polymerase chain reaction (PCR) was performed using established primers against the altered penA of CZRNG isolates. All patients received a single 1 g dose of ceftriaxone. Efficacy was evaluated only in those who returned for examination and culture for N. gonorrhoeae between 3 and 14 days after the treatment. Results: CZRNG isolates detected by PCR accounted for 41.7% (20/48) of urogenital infections and 60.0% (15/25) of pharyngeal infections in the treatment efficacy evaluable cases. 37 of 39 CZRNG isolates (94.9%) were multi‐drug resistant isolates that had simultaneous resistance to penicillin, tetracycline, and ciprofloxacin. Nineteen patients had N. gonorrhoeae isolates in the urogenital area and pharynx simultaneously. Ceftriaxone treatment eradicated all N. gonorrhoeae isolates from 48 patients with genitourinary infection and 25 patients with pharyngeal infection. Conclusions: We report for the first time that ceftriaxone is effective in patients with gonococcal urethritis, cervicitis, and pharyngeal infection caused by CZRNG that has chimera PBP‐2.     

武汉市第三医院烧伤重症监护病房三年间鲍氏不动杆菌分布及耐药性变化

目的 了解烧伤ICU鲍氏不动杆菌临床分布特征及耐药性变化,寻找与其感染相关的危险因素,为制定防治该菌株感染的策略提供参考. 方法 2006年1月-2008年12月,收集笔者单位烧伤ICU 156例患者的血液、静脉导管、痰液、创面分泌物及咽拭标本,行细菌培养.分析3年间细菌分布情况,检测细菌耐药性,行鲍氏不动杆菌感染相关危险因素分析.用WHONET 5.3软件处理细菌耐药率数据,对其他数据行x2检验与Logistic回归分析. 结果 3年间共检出鲍氏不动杆菌92株,在2006、2007、2008年各年度检出总菌株数中比例分别为23.1%(30/130)、27.5%(25/91)、28.2%(37/131).菌株来源:来自创面分泌物41株占44.6%,咽拭、痰液标本均检出14株各占15.2%,血液标本检出13株占14.1%,静脉导管10株占10.9%.除头孢哌酮/舒巴坦和亚胺培南外,所获鲍氏不动杆菌菌株对临床常用的10种抗生素平均耐药率均达50.0%以上.烧伤总面积(x2=24.374,P=0.000)、机械通气(x2=8.968,P=0.003)、抗生素使用时间(x2=3.981,P=0.046)、深静脉置管(x2=9.170,P=0.002)是引起烧伤ICU鲍氏不动杆菌感染的危险因素,前二者为独立危险因素. 结论 笔者单位烧伤ICU鲍氏不动杆菌广泛耐药且检出率呈逐年增加趋势.严格执行无菌操作及隔离措施,规范性使用抗生素,避免气管切开及深静脉置管等侵入性操作或缩短其时间,对预防和控制鲍氏不动杆菌感染有重要意义.     

Is repetitive intraoperative splash basin use a source of bacterial contamination in total joint replacement?

Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature.     

Prevalence of anal HPV infection in solid-organ transplant patients prior to immunosuppression

Patients that undergo organ transplantation have a high risk of developing various malignancies, depending on the duration and magnitude of immunosuppressive therapy. Among others, a 10-fold increased relative risk has been reported for the development of anal cancer. There is a strong association between persistent infection with high-risk mucosal types of human papillomavirus (HPV) and anogenital neoplasia. In this study we analysed the prevalence of anal HPV infection in organ transplant patients before starting immunosuppressive therapy. In a university transplant unit, patients (n=60, 40 male, 20 female) that were undergoing solid-organ transplantation (kidney, liver) for the first time were routinely screened for anal HPV infection. Anal swabs were obtained within 24 h after transplantation and analysed for the presence of mucosal-type HPV DNA by liquid DNA/RNA hybridization [hybrid capture (HC) 2 test]. Overall, some type of HPV DNA was detected in 14/60 (23.3%) patients; 9/60 (15%) were positive for high-risk HPV and 8/60 (13.4%) were positive for low-risk HPV, and 3/60 (5%) were positive for both types. Prevalence of HPV infection tended to be higher in patients that were receiving liver transplants than in those receiving kidney transplants (29.4% vs. 20.9%), but the difference did not reach statistical significance. In our series of organ transplant patients the prevalence of previous HPV infection (23.3%) before immunosuppressive therapy was started was higher than that found in previous epidemiological studies or in a control group. In particular, there was a high rate (15%) of infection with oncogenic HPV types. These findings have important implications on screening and surveillance policies in this patient group at risk of developing neoplasias, including anal cancer.     

淋菌性尿道炎合并砂眼衣原体感染的诊断和治疗

１９９３年８月－１９９４年６月，用微量酶联免疫分析方法自３２６例淋病患者检出１０２例砂眼衣原体感染者，阳性率３０．７％，其中男性５４例，阳性率２７．５％；女性４８例，阳性率３６．２％。对淋病合并ＣＴ感染较高的原因，症状，诊断和治疗进行了讨论。     

Oral bacteria in the occluded arteries of patients with Buerger disease

OBJECTIVE: Recent studies have suggested that infectious organisms play a role in vascular diseases. In this study, to explore a possible link between oral infection and Buerger disease, we investigated whether oral (periodontal) bacteria were present in occluded arteries removed from patients with characteristic Buerger disease. METHODS: Fourteen male patients with a smoking history who had developed characteristics of Buerger disease before the age of 50 years were included in this study. Occluded arteries, including superficial femoral (n = 4), popliteal (n = 2), anterior tibial (n = 4), and posterior tibial (n = 4) arteries, were removed and studied. A periodontist performed a periodontal examination on each patient and collected dental plaque and saliva samples from them at the same time. The polymerase chain reaction method was applied to detect whether seven species of periodontal bacteria--Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Campylobacter rectus, Actinobacillus actinomycetemcomitans, Prevotella intermedia , and Prevotella nigrescens--were present in the occluded arteries and oral samples. In addition, arterial specimens from seven control patients were examined by polymerase chain reaction analysis. RESULTS: DNA of oral bacteria was detected in 13 of 14 arterial samples and all oral samples of patients with Buerger disease. Treponema denticola was found in 12 arterial and all oral samples. Campylobacter rectus, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Prevotella nigrescens were found in 14% to 43% of the arterial samples and 71% to 100% of the oral samples. A pathologic examination revealed that arterial specimens showed the characteristics of an intermediate-chronic-stage or chronic-stage lesion of Buerger disease. All 14 patients with Buerger disease had moderate to severe periodontitis. None of the control arterial samples was positive for periodontal bacteria. CONCLUSIONS: This is the first study to identify oral microorganisms in the lesions of Buerger disease. Our findings suggest a possible etiologic link between Buerger disease and chronic infections such as oral bacterial infections.