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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
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ORIGINAL ARTICLE
Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 72-75
 

Actinomycotic bacteraemia after dental procedures


Dept. of Microbiology, BJ Medical College, Pune - 411 001, India

Correspondence Address:
Dept. of Microbiology, BJ Medical College, Pune - 411 001, India

 ~ Abstract 

PURPOSE: To assess role of oral flora in causing bacteraemia following dental manipulations. METHODS: Fifty patients undergoing dental manipulations were assessed to study the incidence and nature of bacteraemia following dental procedures with special emphasis on Actinomyces. RESULTS: Incidence of bacteraemia was seen to be 80% of which Actinomycotic bacteraemia was found to be 30 %. Common species of Actinomyces isolated were A.viscosus (58.33 %), A.odontolyticus (8.33 %) and A. naeslundi (8.33 %). Aerobic bacteraemia was seen in 48% patients. Common aerobes isolated from bacteraemia following dental procedures were alpha haemolytic streptococci (25.93 %) and diphtheroides (20.38 %). Anaerobic bacteraemia was seen in 6% patients. Common Anaerobes isolated were Peptostreptococcus spp (33.32 %), Prevotella spp. (16.66%) and Bacteroides spp (16.66%). Mixed aerobic and anaerobic bacteraemia was present in 26 % of the patients. CONCLUSIONS: Actinomycotic bacteraemia was more commonly seen in patients with periodontal infections. Thus, prophylactic measures need to be instituted in such patients to prevent cervicofacial, thoracic or abdominal Actinomycosis developing later on.

How to cite this article:
Bhatawadekar S, Bhardwaj R. Actinomycotic bacteraemia after dental procedures. Indian J Med Microbiol 2002;20:72-5


How to cite this URL:
Bhatawadekar S, Bhardwaj R. Actinomycotic bacteraemia after dental procedures. Indian J Med Microbiol [serial online] 2002 [cited 2014 Dec 18];20:72-5. Available from: http://www.ijmm.org/text.asp?2002/20/2/72/8350


Actinomyces species are an important component of normal flora of the Oropharynx. They have been reported to cause infection which presents as cervicofacial, thoracic or abdominal lesions.[1] In the oral cavity they have been commonly implicated as a cause of periodontitis.
Dental procedures on patients with periodontitis are likely to result in transient bacteraemia.[2] This bacteraemia when caused by Actinomyces may result in bacterial endocarditis in patients with cardiac valve defects.[3] A nidus of these organisms settle at various sites during the phase of bacteraemia and later multiply, resulting in cervicofacial, thoracic or abdominal actinomycosis. Patients having prosthetic joint replacement, may lose a prosthetic joint because of Actinomycotic infection.[4] In patients on haemodialysis or with kidney transplant, it may result in renal infection. Lastly, with the increasing incidence of HIV, Actinomycotic bacteraemia may lead to deep seated abscesses in an immunocompromised state.[5]
In the present study, an effort was made to assess role of oral flora especially Actinomyces in causing bacteremia following dental manipulations.

 ~ Materials and Methods Top

Fifty patients undergoing various dental procedures were studied. All the patients in this study were given co-trimoxazole for three days prior to the procedures. All the dental procedures were carried out under local anesthesia. Ten millilitre of blood was collected 10 minutes after the dental procedures and processed as follows:
1) Five millilitre of blood was added to 50 mL of freshly prepared thioglycollate broth containing resazurin as an indicator. This broth was used to cultivate the microaerophilic and the anaerobic organisms. After inoculating blood into the broth, air was evacuated from the bottle and the bottle was flushed with the carbon dioxide.
2) Five millilitre of blood was added to 50 mL of tryptose phosphate broth for aerobic blood culture.
The thioglycollate broth was plated on neomycin blood agar and kanamycin-vancomycin blood agar. Brain heart infusion agar was used for culturing Actinomyces. All strict anaerobes were subjected to biochemical tests and the isolates identified according to the Wadsworth anaerobic manual.[6]
The Actinomyces isolates were put up for slide culture and microcolonies were examined under the microscope as described in Bergey's manual. Microcolonies obtained were compared with photographs in Bergey's manual.[7] The identification tests performed were nitrate reduction, catalase test, esculin hydrolysis, urease production and fermentation of glucose, mannitol, raffinose, trehalose and maltose.[8]

 ~ Results Top

In the present study, the incidence of bacteraemia following various dental procedures was 80%. Incidence of Actinomycotic bacteraemia was 30%. Twelve species of Actinomyces were isolated [Table - 1]. A.viscosus [Figure:1] was the commonest species encountered and comprised of 58.33% of the isolates of Actinomyces. Other Actinomyces isolated were A.odontolyticus 8.33% [Figure:2] and A.naeslundi (8.33% each) and speciation could not be done for three isolates. Other microorganisms were also isolated from these blood samples. In 24 patients (48%) aerobic type of bacteria alone were isolated.
Obligatory anaerobic bacteria were detected in 3 patients (6%), where as mixed flora i.e. aerobes and anaerobes were obtained, in 13 patients (26%). Common aerobes isolated [Table - 2] were viridians streptococci (25.93%) and diphtheroides (20.38%). The common anaerobes isolated [Table - 3] from blood samples were Peptostreptococcus spp. (24.99%), Prevotella spp. (16.66%) and Bacteroides spp. (16.66%).

 ~ Discussion Top

Blood is usually sterile, but transient bacteraemia can occur after manipulation of an infective focus.[9],[10] Every dental procedure, even minor dental manipulation, may result in transient bacteremia. This has been demonstrated as early as 1935 by Okell and Elliott.[2] In the present study, over all incidence of bacteraemia after dental manipulations was 80%. Microbial isolates obtained in the present study may have originated from to normal oral flora which are known to cause disease at other sites such as infective endocarditis, prosthetic joint infection, intracranial abscesses and renal abscesses.[3],[4] Incidence of bacteraemia was maximum after dental manipulations, in those patients who had associated periodontal disease. In India periodontitis is more commonly seen vis-a-vis dental caries and was the indication for 66.66% of the extractions in the present study. The pathogenesis of periodontal inflammation appears to be multifactorial, dependent on bacterial products and, host response to these products. The bacteria reported from periodontal diseases are mainly Actinomyces species, particularly A.viscosus and A.odontolyticus.[11]
In the present study, incidence of Actinomycotic bacteraemia was 30%. Out of 12 patients in whom Actinomyces were isolated 6 had periodontitis. Actinomyces causing bacteraemia following dental procedures has been reported to range from 8.54%.[12] to 14.73%.[13] In a similar study by Crawford et al[14] Actinomycotic bacteraemia was caused by A. odontolyticus in 20% and A.viscosus in 40% of their patients.
Dental procedures leading to bacteraemia, especially caused by Actinomyces can act as a potential focus of endogenous infection. Transient bacteraemia may lead to a shower of Actinomyces going into circulation which may settle at different sites and form a nidus on which a chronic Actinomycotic infection develops. Porter[15] reported 121 cases of cervicofacial Actinomycosis, 27 had a history of dental extraction or facial injury and in 33 patients caries teeth had been noted. A case of late prosthetic joint infection[4] was reported in which infective bacteria  A.israelii  , originated from the oral cavity.
Actinomycotic infection linked to the oral cavity, at present reported in literature, may be representing only the tip of the iceberg. Increased awareness may generate evidence linking Actinimycotic disease at other sites, either cutaneous or deep seated to bacteraemia resulting from dental manipulation. Bacteraemia, especially with Actionomyces, after dental procedures, may have long term sequelae. Therefore, frequent follow up and prophylactic antibiotics for patients under going dental manipulations is required to prevent these sequelae. The best approach to control this bacteraemia would be preoperative preparation of the oral cavity with a view to decrease the bacterial load at the time of dental procedure. This could be done by antiseptic mouth washes and local application of antiseptic prior to onset of surgery. 

 ~ References Top

1.Schaal KP. Actinomycoses, Actinobacillosis and related diseases. In: Topley & Wilson's Microbiology & microbial infections. Vol. 3 Bacterial infections. 9th ed. William J, Hausler Jr MS (Great Britain - Arnold) 1998:777-787.  Back to cited text no. 1    
2.Okell CC, Elliott SD. Bacteremia and oral sepsis. Lancet 1935;2:869-872.  Back to cited text no. 2    
3.Kaplin EK, Anderson RC. Infective endocarditis after use of dental irrigation devise . Lancet 1977;2:610.  Back to cited text no. 3    
4.Thyne GM, Ferguson JW, Antibiotic prophylaxis during dental treatment in patients with prosthetic joints. J Bone Joint surg 1991;73B(2):191-194.  Back to cited text no. 4    
5.Leucartorto FM, Colin KF, Maza J. Post Scaling bacteraemia in HIV associated gingivitis and periodontitis. Oral Surg Oral Med Oral Pathol 1992;73:550-554.  Back to cited text no. 5    
6.Sutter VL, Citron DM, Edelstein MAC, Finegold SM. Wadsworth anaerobic bacteriology manual. 4th edn.(Baltimore California. Star publishing Company) 1986.  Back to cited text no. 6    
7.Klaus SP, Actinomyces. In: Sneath PHA, Mair NS, Sharpe ME, HOH JG (eds ) Bergey's manual of systematic bacteriology vol. 2, 9th edn. (Baltimore William and Wilkins) 1986:1383-1399.  Back to cited text no. 7    
8.Baron EJ, Finegold SM, Bailey and Scott's Diagnostic Microbiology, 8th edn. (Mosby Company) 1990:521-525.  Back to cited text no. 8    
9.Barrington FT, Wright HD. Bacteraemia following operations on the urethra. J Pathol Bacteriol 1930;33:871-889.  Back to cited text no. 9    
10.Southworth H, Flake CG. Blood Culture after tonsillectomy. Am Med Sci 1938;195: 667-670.   Back to cited text no. 10    
11.Jenzano JW, Crawford JJ. Oral Microbiology. In: Jolik W K, Wilett H P, Amos D B, Coifert C M . Zinsser's Microbiology, 19th edn. (International edition) USA 1988; 578-587.  Back to cited text no. 11    
12.Rogosa M, Hampp EG, Nevin TA, Wagner HN, Driscoll EJ, Baer PN. Blood sampling and cultural studies in the detection of postoperative bacteremias. J Am Dent Assoc 1960;60:171-180.  Back to cited text no. 12    
13.Sweet JB, Gill VJ, Chusid MJ, Elin RJ. Nitroblue tetrazolium and limulus assays for bacteremia after dental extraction: effect of topical antisepsis. J Am Dent Assoc 1978;96:276-281.   Back to cited text no. 13    
14.Crawford J, Sconyers JR, Moriarthy JD, King RC, West JE. Bacteraemia after tooth extractions studied with aid of prereduced anaerobically sterilised culture media. Applied Microbiology 1974;27:927-932.  Back to cited text no. 14    
15.Porter IA. Actinomycosis in Scotland. Brit Med J 1953;2:1084-1086.  Back to cited text no. 15    
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