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12FEATURES OF MICROBIAL CONTAMINATION OF PERIODONTAL POCKETS IN PATIENTS WITH GENERALIZED PERIODONTITIS WITH CONCOMITANT CHRONIC RHEUMATIC
HEART DISEASE
Myhal O.
Danylo Halytskyi Lviv National University, Department of Therapeutic Dentistry Ohonovskyi R. Danylo Halytskyi Lviv National University, Department of Oral and Maxillofacial Surgery
PohranychnaKh. Danylo Halytskyi Lviv National University, Department of Oral and Maxillofacial Surgery
ABSTRACT
The article presents the nature of the microflora of periodontal pockets in patients with generalized periodontitis with concomitant chronic rheumatic heart disease in comparison with the microbial biocenosis of periodontal pockets in patients with generalized periodontitis without somatic pathology. Studies have shown the presence of quantitative and qualitative changes in the microbiocenosis in patients with generalized periodontitis against the background of chronic rheumatic heart disease.
Keywords: microflora of periodontal pockets, generalized periodontitis, chronic rheumatic heart disease.
INTRODUCTION. Imbalance of the oral microflora is an important factor in the development of dental diseases. Microorganisms and their exotoxins, possessing pyrogenic, cytotoxic, immunoreactive properties, cause destruction of surrounding tissues, production of antitoxic antibodies, decrease in phagocytic activity of neutrophils and a number of autoimmune reactions, initiate tissue hypoxia, excessive uncontrolled activation of free radicals, decreased functions of the physiological antioxidant system [1-6].
Elucidating the microbial landscape of periodontal pockets is essential for studying the periodontal status and analyzing the remedies.
PURPOSE. To study the features of the microflora of periodontal pockets in patients with generalized per-iodontitis with chronic rheumatic heart disease.
MATERIALS AND METHODS. Microbiological studies of the contents of periodontal pockets were performed at the Research Institute of Epidemiology and Hygiene of Danylo Halytskyi Lviv National Medical University. The study groups included 104 people with generalized periodontitis of I-III degrees: 72 patients with chronic rheumatic heart disease (CRHD), who formed the main group, and 32 people without somatic pathology - the control group.
To study the quantitative and qualitative composition of the flora of periodontal tissues, the material from the periodontal pocket of the tooth was taken with a sterile bacteriological loop and immediately applied to the nutrient environment and to a glass slide to prepare a fixed preparation. Meat-peptone agar, blood agar, yolk-salt agar, Endo medium, lactobacagar, and bifi-dum agar were used for the sowing of aerobic, facultatively anaerobic microorganisms, and microaerophiles. For the isolation of anaerobic bacteria, semi-liquid thi-oglycol environment was used; for fungi - Saburo environment. Sowing were carried out by he method of dense nutrient environment sectors, which allowed identifying the maximum possible spectrum of aerobic and facultative-anaerobic microflora and determining the degree of microbial contamination. To record the
quantitative composition of microorganisms, the number of colonies was counted, and after counting colony-forming units (CFU), the data were converted to decimal logarithms of the CFU (lg CFU). The genus of cultures and species identification of bacteria were established according to the determinant of Bergey bacteria [7].
RESULTS AND DISCUSSION. Microbiological examination revealed high contamination of periodon-tal tissues in patients with generalized periodontitis with CRHD and persons without somatic pathology with aerobic and anaerobic bacteria.
A total of 757 strains of microorganisms were singled out - 560 in the main group and 197 in the control group. From the sown microflora, 16 bacterial cultures were identified in patients of the main group and 12 in the control group. The data on the frequency of sowing of microorganisms in the study groups are presented in table 1.
The representatives of the coccal group were dominant in the microbiocenosis of periodontal pockets of patients of both groups - 61.6% of the microbial community in the main group of patients and 70.56% in the control group. The bulk of sown cultures, among coccal bacteria, in patients of the main and control groups, made up gram-positive cocci, which belonged to the genera Staphylococcus, Streptococcus and accounted for 31.96% and 38.58%, respectively, of the total number of sown strains of microorganisms (Table 1).
The share of streptococcal grouping by the frequency of excretion was the highest among sown grampositive cocci (58.1% - in the main group of patients and 51.32% - in the control group) and in the microbial community of periodontal pocket in general (18.57% and 19.8 % respectively of all sown microorganisms).
In the second place among coccal bacteria in the main group were staphylococci groups, which accounted for 12.5% of the microbial community. Gramnegative cocci, in particular Neisseria spp. and anaerobic cocci were sown with the same frequency - in 11.9% of patients with CRHD as opposed to 14.21% in the control group.
Table 1
The range of microorganisms of periodontal pockets in patients with generalized periodontitis of the main and _ control groups__
Microorganisms Main group Control group
abs. number % abs. number %
Gram-positive cocci: 179 31,96±2,47 76 38,58±3,74
• Staphylococcus spp. 70 12,50±1,38 28 14,21±2,57
• Streptococcus spp. • Micrococcus spp. 104 5 18,57±1,89 0,89±0,18* 39 9 19,80±3,06 4,57±1,23
Gram-negative cocci: 99 17,68±1,65 36 18,27±2,83
• Neisseria spp. 68 12,14±1,54 27 13,71±2,52
• Veilonella spp. 31 5,54±1,16 9 4,57±1,69
Anaerobic cocci: 67 11,96±1,68 27 13,71±2,52
• Peptostreptococcus spp. • Peptococcus spp. 67 0,0 11,96±1,68 0,00* 16 11 8,12±2,16 5,58±1,63
Lactobacillus spp. 37 6,61±1,07 16 8,12±2,18
Bifidobacterium spp. 30 5,36±1,12* 0 0,00
Corynebacterium spp. 45 8,04±1,29 10 5,08±1,71
Gram-negative anaerobic bacilli: 76 13,57±1,62 32 16,24±2,89
• Prevotella spp. 21 3,75±0,88 3 1,52±0,98
• Bacteriodes spp. 47 8,39±1,33 26 13,20±2,51
• Fusobacterium spp. 8 1,43±0,61 3 1,52±0,98
Spirochetes spp. 12 2,14±0,71* 0 0
Actinomycetes spp. 7 1,25±0,41 0 0
Candida spp. 8 1,43±0,57 0 0
Total 560 100,0 % 197 100,0 %
Note: * (p <0,05) - the difference between the indicators of the main and control groups is authentic
The frequency of sowing in patients of the main group of representatives of the genera Prevotella, Bac-teriodes, and Fusobacterium was insignificant . However, in total gram-negative anaerobic bacilli accounted for 13.57% of the studied microbial biocenosis of periodontal pockets as opposed to 16.24% in the control group. The decrease in the number of lactobacilli by 6.61% in the main group versus 8.12% in the control group attracts attention. The range of microorganisms in the periodontal pocket of patients with GP with concomitant CRHD and a group of somatically healthy individuals.
The cultures of tortuous microorganisms, actino-mycetes and yeast-like fungi were sown with a low frequency in patients of the main group, but they were not detected in the microbiocenosis of periodontal pockets of patients in the control group.
Quantitative indicators of streptococci grouping in patients of the main group significantly exceeded those in the control group (p <0.05). Data on the distribution of the streptococcal population are presented in Figure 1.
a-Streptococcus spp.
6,25
ß-Streptococcus spp.
1,72
Y-Streptococcus spp.
1,51
Main group Control group
Figure 1: Distribution of streptococci in the microbiocenosis ofperiodontal pockets ofpatients of the main and control groups in terms of hemolytic properties, lg CFU / g
Most of them have been identified as a-hemolytic streptococci. In the main group, a - hemolytic streptococci accounted for 6.25 ± 0.15 lg CFU / g as opposed to 3.51 ± 0.57 lg CFU / g in the control group (p <0.05). Conditionally pathogenic and pathogenic populations that had p-hemolytic properties in patients of the main group accounted for 1/5 of all sown streptococci (1.72 ± 0.35 lg CFU / g vs. 0.58 ± 0.29 lg CFU / g in control group, p <0,05). In patients with chronic rheumatic heart disease, there was a significant increase in the colonization density of a- and p-hemolytic streptococci of
the periodontal pocket by almost 2 times due to a decrease in the concentration of streptococci with y-hemolytic properties.
The level of periodontal pocket population with staphylococci was low and averaged 0.95 ± 011 lg CFU / g in the main group of patients and 0.60 ± 0.11 lg CFU / g in the control group. It should be noted that in the control group, only strains of coagulase-negative staphylococci: S. epidermidis, S. haemolyticus, S. Sapro-phyticus were sown (table 2).
Table 2
Population level of microorganisms of periodontal pockets in patients with generalized periodontitis
Colonization density, lg KyO/r
Microorganisms Main group Control group
n=76 n=32
Staphylococcus epidermidis 1,36±0,25 1,22±0,28
Staphylococcus haemolyticus 0,27±0,10 0,68±0,21
Staphylococcus saprophyticus 0,19±0,09 0,51±0,19
Staphylococcus aureus 1,98±0,29* 0,00
a-Streptococcus spp. 6,25±0,15* 3,51±0,57
ß-Streptococcus spp. 1,72±0,35* 0,58±0,29
/-Streptococcus spp. 1,51±0,37 2,22±0,57
Micrococcus spp. 0,14±0,07* 0,94±0,32
Neisseria spp. 5,39±0,24* 4,28±0,44
Veilonella spp. 2,25±0,35 1,60±0,49
Peptococcus spp. 0,00 0,37±0,09*
Peptostreptococcus spp. 0,95±0,03* 0,53±0,11
Lactobacillus spp. 2,72±0,38 1,63±0,32
Bifidobacterium spp. 1,45±0,29* 0,00
Corynebacterium spp. 2,91±0,31* 0,92±0,26
Prevotella spp. 0,30±0,06* 0,10±0,06
Bacteriodes spp. 0,89±0,09 0,77±0,08
Fusobacterium spp. 0,33±0,12 0,30±0,17
Spirochetes spp. 0,17±0,05* 0,00
Actinomycetes spp. 0,09±0,04 0,00
Candida spp. 0,24±0,09* 0,00
CepegHi 3HaneHHa 1,55±0,07* 0,96±0,08
Note: * (p <0,05) - the difference between the indicators of the main and control groups is authentic
In patients with CRHD, 50.50% of the staphylococcal group was the population of S. aureus, which is characteristic of the rheumatic group of diseases [8]. Their pathogenic effect is the ability to synthesize hya-luronidase, which due to the breakdown of hyaluronic acid leads to the destruction of connective tissue epithelium, fibroblasts, sharp dilation of microvessels and increased permeability of their walls, increased leukocyte migration and leukocyte infiltration [9,10] The density of staphylococcal colonization of the studied biotope of patients of the main group ranged from (0.19 ± 0.09) to (1.98 ± 0.29) lg CFU / g.
Saprophytic Neisseria colonized the studied biotope with a density of 5.39 ± 0.24 lg CFU / g, which significantly exceeded the data for the control group.
Obligatory anaerobic cocci were found with a low population, but the concentration of Peptostreptococcus spp. significantly exceeded that in the control group. Representatives of the genus Peptococcus spp. colonized the biotope of periodontal pockets only in the control group with a density of 0.37 ± 0.09 lg CFU / g (p <0.05).
The frequency of detection and the number of lac-tobacilli in the periodontal pockets of the main and control groups were reduced relative to the physiological norm.
Bifidobacteria were found only in patients of the main group and colonized the studied biotope with a density of 1.45 ± 0.29 lg CFU / g (p <0.05).
Gram-positive non-spore bacilli that belong to the Corynebacterium spp. genus statistically significantly prevailed in the biotope of periodontal pockets of patients of the main group. The role of corynebacteria in the development of the pathological process in perio-dontal tissues is associated with their ability to reduce the redox potential, which promotes the development of anaerobes [11].
The population level of gram-negative bacilli Bac-teriodes spp. and Fusobacterium spp. in patients of the main group exceeded the studied biotope in the control group by 15.58% and 10%, respectively (p> 0.05). The periodontal effect of bacteroids is caused by the release of volatile sulfur-containing compounds that increase the permeability of the oral mucosa, as well as the production of a number of proteolytic enzymes that break
down collagen, destroying periodontal ligaments and periodontal tissues in general.
The populations of the Prevotella spp. genus colonized the microbiocenosis of periodontal pockets of patients with CRHD with a density of 0.30 ± 0.06 lg CFU / g, which was three times the value of the control group (p <0,05).
Yeast fungi of the Candida genus were found only in patients of the main group with a low concentration of 0.24 ± 0.09 lg CFU / g (p <0.05).
Actinomycetes, helical microorganisms and mi-crococci colonized the periodontal pockets of patients with CRHD with the lowest density.
Conclusions. Studies have shown the presence of quantitative and qualitative changes in the microbial bi-ocenosis in generalized periodontitis in individuals with concomitant chronic rheumatic heart disease.
In the main group of patients, a significant proportion of hemolytic staphylococci and streptococci with pronounced pathogenic properties was observed in the microbiocenosis of periodontal pockets, which is a potential risk of transient bacteremia due to invasive dental interventions and, as a consequence, recurrent cardiac recurrence.
The prevalence of Spirochetes spp., Actinomycetes spp., Candida spp. and reduced frequency of sowing of coccoid microorganisms (61.6% of all identifies microorganisms in the main group as opposed to 70.56% in the control group) and anaerobes (25.53% vs. 29.95% in the control).
Thus, the study presented the polymicrobial nature of periodontal pockets in patients with generalized per-iodontitis with concomitant chronic rheumatic heart disease, which is characterized by the prevalence of he-molytic staphylococcal, streptococcal flora, aggressive to periodontal structures hyaluronidase-active species, and the presence of fungal cultures.
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КЛИНИЧЕСКОЕ И ЭКОНОМИЧЕСКОЕ ОБОСНОВАНИЕ ЦЕЛЕСООБРАЗНОСТИ МАЛОИНВАЗИВНЫХ ГЕРНИОПЛАСТИК ПО МЕТОДИКАМ IPOM И ETEP У БОЛЬНЫХ
ВЕНТРАЛЬНЫМИ ГРЫЖАМИ
Ромащенко П.Н.
начальник кафедры и клиники факультетской хирургии ВМА имени С.М. Кирова,
член-корреспондент РАН Семенов В. В.
К.м.н., майор медицинской службы, преподаватель кафедры факультетской хирургии им. С.П. Федорова Военно-медицинской академии им. С.М. Кирова
Прудьева С.А.
Врач-хирург клиники факультетской хирургии Военно-медицинской академии им. С.М. Кирова
