Aggregatibacter actinomycetemcomitans
Aggregatibacter actinomycetemcomitans
Nomenclature |
Aggregatibacter actinomycetemcomitans (Aa) |
Characteristics |
Gram-negative, facultative anaerobes, 7 serotypes with different leukotoxin expression (serotype b with a high incidence of localised aggressive periodontitis) |
Pathogenicity |
Highly pathogenic |
Virulence factors |
Leukotoxin A |
Occurrence |
In localised aggressive and chronic periodontitis. The virulence factors promote the colonisation and establishment of the germ in oro-pharyngeal space.
|
Treatment |
Antibiotic of choice is amoxicillin |
Literature |
Aberg, C.H., Kelk, P. and Johannsson, A., 2015. Aggregatibacter actinomycetemcomitans: virulence of its leukotoxin and association with aggressive periodontitis. Virulence, 6 (3), 188-195. Maeda, H., Fujimoto, C., Haruki, Y., Maeda, T., Kokeguchi, S., Petelin, M., Arai, H., Tanimoto, I., Nishimura, F. and Takashiba, S., 2003. Quantitative real-time PCR using TaqMan and SYBR Green for Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, tetQ gene and total bacteria. FEMMS Immunol Med Microbiol., 39 (1), 81-86. Malik, R., Changela, R., Krishan, P., Gugnani, S. and Bali, D., 2015. Virulence factors of Aggregatibacter actinomycetemcomitans – A status update. Journal of ICDRO, 7 (2), 137-145. |
Filifactor alocis
Filifactor alocis
Nomenclature |
Filifactor alocis (Fa) |
Characteristics |
Gram-positive, extremely difficult to cultivate anaerobes |
Pathogenicity |
Highly pathogenic |
Virulence factors |
15 different proteases, Microbial Surface Components Recognizing Adhesive Matrix (MSCRAMMs), F. alocis Complement Inhibitor (FACIN) |
Occurrence |
Occurs in subgingival specimens in chronic periodontitis (CP) and generalised aggressive periodontitis (GAP) and is associated with supportive tissue loss. Fa is the cause of chronic inflammation and induces the production of proinflammatory cytokines that lead to the apoptosis of gingival epithelial cells. Compared with Pg, Td, Tf, described in the literature as "red complex" and which are most commonly associated with periodontal disease in the literature, Fa was the third largest in a group of GAP patients and the second largest in CP patients. Fa is found predominantly in the biofilm region, originating from the middle or the apical part of the pocket (Schlafer, 2014). Fa is always closely intertwined with other periodontal germs, and has a symbiotic relationship with Pg, for example, which may result in a structural increase in biofilm. |
Treatment |
Antibiotic of choice: Metronidazol |
Literature |
Aruni, A.W., Roy, F. and Fletcher, H.M., 2011. Filifactor alocis Has Virulence Attributes That can Enhance Ist Persistence under Oxidative Stress Conditions and Mediate Invasion of Epithelial Cells by Porphyromonas gingivalis. Infection and Immunity, 79 (10), 3872-3886. Aruni, W., Chioma, O. and Fletcher, H.M., 2014. Filifactor alocis: The Newly Discovered Kid on the Block with Special Talents. Journal of Dental Research, 93 (8), 725-732. Aruni, W., Mishra, A., Dou, Y., Chioma, O., Hamilton, B.N. and Fletcher, H.M., 2015. Filifactor alocis- a new emerging periodontal pathogen. Microbes and Infection, 17 (7), 517-530. Jusko, M., Miedzak, B., Ermert,D., Magda, M., King, B.C., Bielecka, E., Riesbeck, K., Eick, S., Potempa, J. and Blom, A.M., 2016. FACIN, a Double-Edged Sword oft he Emerging Periodontal Pathogen Filifactor alocis: A Metabolic Enzyme Moonlighting as a Complement Inhibitor. Journal of Immunology, 197, 3245-3259. Schlafer, S., 2014. Filifactor alocis-der noch unterschätze Parodontitis-Keim in der Zahnfleisch-tasche. Zahnmedizin Report, 9:3. |
Porphyromonas gingivalis
Porphyromonas gingivalis
Nomenclature |
Porphyromonas gingivalis (Pg) |
Characteristics |
Gram-negative strict anaerobe |
Pathogenicity |
Highly pathogenic |
Virulence factors |
Membrane-associated proteases, which, for example, split fibrinogen, which leads to bleeding on probing (BOP), releases haemin and iron and at the same time leads to further propagation of the germ as a food source. Lipopolysaccharides, exopolysaccharides, OMP (outer membrane proteins), collagenase, trypsin-like protease, gelatinase, aminopeptidase. |
Occurrence |
The germ does not belong to the "normal" oral flora; the immune system is unable to completely control an infection. It occupies the periodontal area more uniformly than A. actinomycemtemcomitans, which is more likely to occur in isolated areas. |
Treatment |
Can usually be removed with root planing. If it is nevertheless detected after this treatment, reintervention with curettage or surgery is indicated. If Pg and Aa are present in larger quantities, antibiotics must be prescribed in addition to scaling/root planing. Antibiotics of choice are metronidazole or ornidazole + amoxicillin. |
Literature |
How, K.Y., Song, K.P.and Chan, K.G., 2016. Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line. Frontiers in Microbiology, 7 (53). Lyons, S.R., Griffen, A.L. and Leys, E.J., 2000. Quantitative Real-Time PCR for Porphyromonas gingivalis and Total Bacteria. Journal of Clinical Microbiology, 38 (6), 2362-2365. Mysak, J., Podzimek, S., Sommerova, P., Lyuya-Mi, Y., Bartova, J., Janatova, T., Prochazkova, J. and Duskova, Jana, 2014. Porphyromonas gingivalis: Major Periodontopathic Pathogen Overview. Journal of Immunology Research, ID 476068, 8. |
Prevotella intermedia
Prevotella intermedia
Nomenclature |
Prevotella intermedia (Pi) |
Characteristics |
Gram-negative obligate anaerobes |
Pathogenicity |
Strongly pathogenic |
Virulence factors |
Exopolysaccharides (EPS) |
Occurrence |
It has been documented as a (co-) pathogen of mostly mixed-infection dentoalveolar infections. It is also referred to as an early marker germ, which creates the anaerobic environment necessary for the settlement of the main periodontal germs via the metabolism of residual sugar in the sulcus or in the forming periodontal pocket. Pi uses steroid hormones as growth factors, and therefore occurs more often in pregnant women. |
Treatment |
Pi with increased germ counts can not be treated by means of scaling/root planing. Nitromidazole preparations (e.g. metronidazole) are the antibiotics of choice. Isolated penicillinase-related penicillin resistance is known; Other than anaerobic beta-lactam antibiotics (e.g, penicillin G, ampicillin, amoxicillin). The efficacy of clindamycin (resistance) and tetracycline varies; Aminoglycosides are always ineffective. |
Literature |
Potempa, M., Potempa, J., Kantyka, T., Nguyen, KA., Wawrzonek, K., Manadhar, S.P., Popadiak, K., Riesbeck, K., Eick, S. and Blom, A.M., 2009. Interpain A, a Cysteine Protease from Prevotella intermedia Inhibits Complement by Degrading Complement Factor 3. PLoS Pathogens, 5 (2), e1000316. Riggio, M.P., Lennon, A. and Roy, K.M., 1998. Detection of Prevotella intermedia in subgingival plaque of adult periodontitis patients by polymerase chain reaction. Journal Periodontal Research, 33 (6), 369-376. Yamanaka, T., Yamane, K., Furukawa, T., Matsumoto-Mashimo, C., Sigimori, C., Obata, N., Walker, C.B., Leung, K.P. and Fukushima, H., 2011. Comparision oft he virulence of exopolysaccharide- producing Prevotella intermedia to exopolysaccharide non- producing perodontoipathic organism. BMC Infection Disease, 11, 228-237 |
Tannerella forsythia
Tannerella forsythia
Nomenclature |
Tannerella forsythia (Tf) |
Characteristics |
Gram-negative strict anaerobe |
Pathogenicity |
Highly pathogenic |
Virulence factors |
3 proteolytic enzymes: Cysteine protease (PrtH), karilysin (structurally similar to human matrix metalloproteases), mirolase (calcium dependent serine protease) |
Occurrence |
Characteristically occurs with strong bone defects. In significantly higher numbers in "active" pockets than in "inactive" pockets. Also known in cases of recurrent periodontal disease. Often associated with refractory periodontids. There is a close relationship of coexistence with Treponema denticola and Porphyromonas gingivalis. |
Treatment |
Can usually be removed with root planing. Metronidazole or ornidazole are considered the antibiotics of choice, especially in cases of severe inflammatory symptoms. |
Literature |
Ksiazek, M., Mizgalska, D., Eick, S., Thorgersen, I.B., Enghild, J.J. and Potempa, J. 2015. KLIKK proteases of Tannerella forsythia: putative virulence factors with a unique domain structure. Frontiers in Microbiology, 6, 312. Saito, D., Coutinho, L.L., Borges Saito, C.P., Tsai, S.M., Höfling, J.F. and Goncalves, R.B., 2009. Real-time polymerase chain reactionquantification of Porphyromonas gingivalis and Tannerella forsythia in primary endodontic infections. Journal of Endodontics, 35 (11), 1518-1524. Sharma, A., 2000. Virulence mechansims of Tannerella forsythia. Periodontology, 54 (1), 106-116. |
Treponema denticola
Treponema denticola
Nomenclature |
Treponema denticola (Td) |
Characteristics |
Short, strictly anaerobic gram-negative spirochaete |
Pathogenicity |
Strongly pathogenic |
Virulence factors |
Tissue-destroying proteases, hyaluronidases, phosphatases and phospholipases. Stimulates formation of IL-1 alpha and TNF-alpha. |
Occurrence |
Is associated with periodontal destruction (advanced periodontitis), necrotising ulcerative gingivitis/periodontitis. |
Treatment |
It is useful as a marker in the evaluation of treatment success (scaling/root planing) in therapy refractory pockets. Antibiotics of choice, if necessary, are metronidazole or ornidazole. |
Literature |
Asai, Y., Jinno, T., Igarashi, H., Ohyama, Y. and Ogawa, T., 2002. Detection and Quantification of Oral Treponemes in Subgingival Plaque by Real-Time PCR. Journal of Clinical Microbiology, 40 (9), 3334-3340. Dashper, S.G., Seers, C.A., Tan, K.H. and Reynolds, E.C., 2011. Virulence Factors oft he Oral Spirochete Treponema denticola. Journal Dent. Research, 90 (6), 691-703. Pandit, N., Gugnani, S., Sushil, D. and Bali, D., 2016. Treponema denticola: A teammate in periodontal progression. Journal of ICDRO, 8 (1), 58-62. Sela, M.N., 2001. Role of Treponema denticola in periodontal diseases. Crit Rev Oral Biol Med, 12 (5), 399-413. |