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Background: Candida infections are responsible for increased morbidity and mortality in immunocompromised patients, with Candida having the ability to form highly structured biofilms that protect them from the external environment and the action of antifungals. Few studies have reported on real-time interactions between Candida species. Objective: This study aimed to investigate the interspecies biofilm changes of oral Candida species using the xCELLigence system and the CV staining technique. Methods: This study demonstrated the mixed biofilm interactions of Candida species using an impedance-based biofilm monitoring system and crystal violet staining. Results: When using the xCELLigence system, the maximum cell index increased in most mixed biofilms, except for the C. glabrata/C. parapsilosis and C. albicans combinations. Bulk biofilm formation measured by CV staining was the highest in C. albicans and C. tropicalis combinations and the lowest in the C. glabrata/C. parapsilosis combination. Pseudohyphae were observed in C. albicans and C. glabrata in combination with C. tropicalis or C. parapsilosis. Conclusion: This study is the first to report on the real-time interactions of Candida species using the xCELLigence system and suggests that the presence of specific species influences the biofilm formation of commonly isolated Candida species.

The objective of this study was to elucidate the proteomic mechanisms of drug resistance in HIV-infected African patients. Cell membrane fractions from forty oral Candida isolates isolated from African HIV-positive patients were analysed using HPLC-MS with the aim of identifying proteins associated with their pathogenicity and drug resistance. Heat shock proteins that mediate the fungicidal activity of salivary peptides were found in all tested Candida fractions, with pH-responsive proteins associated with increased pathogenicity only being present in the three most commonly isolated species. ABC multidrug transporter efflux pumps and estrogen binding proteins were only found in C. albicans fractions, while ergosterol biosynthesis proteins were identified in four species. The combination of various adherence, invasion, upregulation and efflux pump mechanisms appear to be instrumental for the Candida host colonization and drug resistance emergence in HIV-infected individuals.

The South African medicinal plant Oncosiphon suffruticosum (L.) Källersjö is an important remedy used to treat chronic, respiratory, and skin ailments. From the essential oil (EO) extracted by the hydrodistillation, sixteen constituent components were identified with oxygenated monoterpenes: camphor (31.21%), filifolone (13.98%), chrysanthenone (8.72%), 1,8-cineole (7.85%), and terpinen-4-ol (7.39%) as predominant constituents. In the antibacterial activity study, the EO was found most susceptible against Pseudomonas aeruginosa with an MIC of 6.4 mg/mL, however, it showed the same activity against Staphylococcus aureus and Escherichia coli with an MIC value of 12.8 mg/mL. The sun protecting factor (SPF) of the EO was found to be 2.299 and thus establishing it as a potentially important cosmeceutical for sunscreen applications. This is the first report investigating the essential oil of O. suffruticosum for its chemical composition and skin-related in vitro biological activities viz antibacterial, antioxidant capacity, antityrosinase, and sun protection factor.

In this study, procyanidin dimers and Leucosidea sericea total extract (LSTE) were employed in the synthesis of silver nanoparticles (AgNPs) and characterized by ultraviolet-visible (UV-Visible) spectroscopy, high-resolution transmission electron microscopy (HRTEM), selected area electron diffraction (SAED), X-ray diffraction (XRD), and dynamic light scattering (DLS) techniques. AgNPs of about 2&ndash, 7 nm were obtained. DLS and stability evaluations confirmed that the AgNPs/procyanidins conjugates were stable. The formed nanoparticles exhibited good inhibitory activities against the two enzymes studied. The IC50 values against the amylase enzyme were 14.92 &plusmn, 1.0, 13.24 &plusmn, 0.2, and 19.13 &plusmn, 0.8 &micro, g/mL for AgNPs coordinated with LSTE, F1, and F2, respectively. The corresponding values for the glucosidase enzyme were 21.48 &plusmn, 0.9, 18.76 &plusmn, 1.0, and 8.75 &plusmn, 0.7 &micro, g/mL. The antioxidant activities were comparable to those of the intact fractions. The AgNPs also demonstrated bacterial inhibitory activities against six bacterial species. While the minimum inhibitory concentrations (MIC) of F1-AgNPs against Pseudomonas aeruginosa and Staphylococcus aureus were 31.25 and 15.63 &micro, g/mL respectively, those of LSTE-AgNPs and F2-AgNPs against these organisms were both 62.50 &micro, g/mL. The F1-AgNPs demonstrated a better bactericidal effect and may be useful in food packaging. This research also showed the involvement of the procyanidins as reducing and capping agents in the formation of stable AgNPs with potential biological applications.

During pregnancy, the oral cavity is characterised by an acidic environment and an inflammatory response brought about by vomiting and changes in hormonal levels, respectively, thereby increasing the mother’s risk of developing caries. Although evidence exists to support an association between pregnancy-associated periodontal disease and adverse pregnancy outcomes, there is a paucity of studies which focus on the caries prevalence and other oral manifestations of pregnant women. The aim of this study was to assess the oral health status and treatment needs of pregnant women attending antenatal clinics in KwaZulu-Natal, South Africa. Randomly selected mothers (n=443) attending a maternal obstetrics unit participated in the study. A questionnaire elicited demographic information about the participants, while the measurement of decayed, missing, and filled indices (DMFT) determined their caries status. Oral lesions were noted if present. Descriptive statistics for independent variables described frequencies in the various categories of race, location, pregnancy stage, etc., with the association between 2 independent variables tested by chi-square. Dependent variables such as DMFT were expressed as means and standard deviations, and ANOVA was used to examine whether independent variables significantly influenced the DMFT. The mean DMFT was 7.18 (±4.22) with significant correlations observed between DMFT, D, M, and age. F scores differed significantly between races, location, and educational levels and showed a significant correlation with pregnancy stage. Pregnancy epulis was diagnosed in 38 (8.5%), oral lesions in 65 (14.7%), and tooth mobility in 26 (5.9%) mothers. Early oral health screening during pregnancy can ensure the overall well-being of both the mother and the foetus.

Background Dermatophyte infections are becoming increasingly prevalent in humans. Limited availability of antifungal agents and the increasing number of treatment failures have motivated research for therapeutic alternatives, which can be developed as potential antifungal agents. Medicinal plant extracts have been proposed as alternative treatments and scientists are seeking medicinal plant species that could be developed into medicines for various skin diseases including fungal skin infections. South Africa has a rich diversity of indigenous medicinal plants with dermatological therapeutic relevance. Aim This study aimed to review research that have documented the use of medicinal plants indigenous to South Africa in the treatment of fungal skin infections with a view to identify plants with the potential for further therapeutic development. Methods Computerized literature searches were performed on databases MEDLINE, SCOPUS, GOOGLE SCHOLAR, MEDLINE EBSCOHOST, SCIENCE DIRECT, Global Electronic Thesis and Dissertations (ETD) and South African National ETD. Results Fifteen medicinal extracts were identified as having significant antifungal activity. This is of significant importance as most fungal pathogens are developing resistance to conventional synthetic antifungal agents. Conclusion This review identified a diversity of South African medicinal plant species which have the potential to be developed for the treatment of fungal skin infections. These medicinal plants offer a safe alternative to synthetic antifungals currently used, particularly since they are less toxic, readily available, and are supported by indigenous and traditional knowledge systems.

Aerobic vaginitis (AV) is an endogenous opportunistic infection brought about by the disruption of the normal vaginal microbiota. Its early diagnosis and treatment during pregnancy may reduce the risk of negative pregnancy outcomes. The aim of this review was to report on the aerobic bacteria most prevalent in AV and to provide evidence of the threat of untreated AV on pregnancy outcomes. More than 300 papers on preterm delivery were extracted from several research domains and filtered to include only AV-associated bacteria such as Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Group B streptococci and their association with adverse pregnancy outcomes. Due to the diverse sample groups, study techniques and outcomes, a meta-analysis was not conducted. The review revealed that the association of AV with adverse pregnancy outcomes has not been as widely researched as bacterial vaginosis (BV) and needs further investigation. Furthermore, the frequent misdiagnosis of AV coupled with the emerging antimicrobial resistance associated with bacteria implicated in AV and neonatal nosocomial infections pose a problem for prophylaxis and treatment to reduce the risk of maternal and neonatal morbidity and mortality. Keywords: Aerobic vaginitis; pregnancy risks; antimicrobial resistance La vaginite aérobie (VA) est une infection opportuniste endogène provoquée par la perturbation du microbiota vaginal normal. Son diagnostic précoce et son traitement pendant la grossesse peuvent réduire le risque de résultats négatifs de grossesse. L'objectif de cette revue était de faire un rapport sur les bactéries aérobies les plus répandues en VA et de prouver la menace de la VA non traitée sur les résultats de la grossesse. Plus de 300 articles sur l'accouchement prématuré ont été tirés de plusieurs domaines de recherche et filtrés pour inclure uniquement des bactéries associées à la VA telles que Staphylococcus aureus, Enterococcus faecalis, Escherichia coli et streptocoques du groupe B et leur association avec des résultats de grossesse indésirables. En raison des divers groupes d'échantillons, des techniques d'étude et des résultats, une méta-analyse n'a pas été menée. L'examen a révélé que l'association de la VA avec les résultats de grossesse défavorisés n'a pas été aussi largement étudiée que la vaginose bactérienne (VB) et doit faire l'objet d'une enquête plus approfondie. En outre, le diagnostic erroné de la VA y compris la résistance antimicrobienne émergente associée à une bactérie impliquée dans les infections à vent et nonnéomatologiques constitue un problème pour la prophylaxie et le traitement afin de réduire le risque de morbidité et de mortalité maternelle et néonatale. Mots clés: vaginite aérobie, risques de grossesse, résistance antimicrobienne

Background Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. Study objective This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. Materials and methods The study sample comprised 443 pregnant women with a mean (± standard deviation) age of 24.13 (±5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. Results While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. Conclusion This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes.

We introduce a compartmental model of ordinary differential equations for the population dynamics of listeriosis, and we derive a model for analysing a listeriosis outbreak. The model explicitly accommodates neonatal infections. Similarly as is common in cholera modeling, we include a compartment to represent the reservoir of bacteria. We also include a compartment to represent the incubation phase. For the 2017/18 listeriosis outbreak that happened in South Africa, we calculate the time pattern and intensity of the force of infection, and we determine numerical values for some of the parameters in the model. The model is calibrated using South African data, together with existing data in the open literature not necessarily from South Africa. We make projections on the future outlook of the epidemiology of the disease and the possibility of eradication.

Background/Objectives: With mucocutaneous candidiasis being highly prevalent in HIV patients, the emergence of fluconazole-resistant Candida species forms a major challenge in treating and eradicating these infections. The objective of this study was to establish the antifungal activity of K21, a membrane-rupturing antimicrobial compound derived from a silica quaternary ammonium compound (SiQAC) with tetraethoxysilane (TEOS). Methods: The study sample included 81 Candida species of which 9 were type strains and 72 were clinical isolates. Minimum inhibitory concentrations, synergy, fractional inhibitory concentration index (FICI), and time kill assays were determined by broth microdilution. Electron microscopy (EM) was used to determine the qualitative changes brought about after treatment with K21. Results: K21 inhibited the growth of all fluconazole-resistant and susceptible Candida strains with only 2 h of exposure required to effectively kill 99.9% of the inoculum, and a definite synergistic effect was observed with a combination of K21 and fluconazole. EM demonstrated the presence of two forms of extracellular vesicles indicative of biofilm formation and cell lysis. Conclusion: The study established the efficacy of K21 as an antifungal agent and with fluconazole-resistant candidiasis on the increase, the development of K21 can provide a promising alternative to combat acquired drug resistance.

Background: Maternal colonization of Group B streptococci (GBS) during pregnancy is an important risk factor for neonatal morbidity and mortality. The aim of this study was to determine the prevalence and serotype distribution of GBS isolated from a cohort of pregnant women in the Western Cape, South Africa. Methods: Two ano-vaginal swabs were collected from 301 women at 28–37 weeks of gestation. Participants were recruited from four different antenatal clinics in the Western Cape, South Africa. GBS were detected by culture and PCR and serotypes confirmed by latex agglutination tests. Antibiotic sensitivity was performed using disc diffusion. Results: The GBS colonization rate was 16.6%. Serotype distribution revealed serotype V as the predominant serotype (66.67%) followed by serotype III (21.05%). Serotypes Ia, II, IV, and IX constituted 1.75% each and 3 GBS isolates were non-typeable. Serotype V demonstrated resistance to most of the antibiotics tested, while serotype III demonstrated better susceptibility, except for tetracycline. No significant differences were observed for GBS colonization or serotype distribution according to HIV status. Conclusion: Predominating serotypes differed from those previously reported from other regions in South Africa. Global surveillance of serotype distribution plays an important role in informing vaccine development and antibiotic prophylaxis.

INTRODUCTION: Although the association between periodontal disease (PD) and adverse pregnancy outcomes has gained recognition amongst antenatal healthcare workers, not much has changed in practice to address it. This prospective study tested the hypothesis that BANA (N-benzoyl-DL-arginine-2-naphthylamide), a diagnostic test for PD, may inform obstetricians and other antenatal healthcare practitioners, of the risk of adverse pregnancy outcomes in mothers attending antenatal clinics. METHODS: At first visit, the presence of suspected periodontopathogens was assessed by BANA testing of dental plaque from 443 mothers attending antenatal clinics in KwaZulu-Natal, South Africa and an association later sought with pregnancy outcomes. The accuracy of BANA to predict adverse pregnancy outcomes was evaluated by the calculation of likelihood ratios. The study complied with the Declaration of Helsinki. RESULTS: Significant differences were found between pregnancy outcomes of BANA-negative and BANA-positive mothers (p

Candida albicans and streptococci are amongst the most common fungal and bacterial organisms present in the oral cavity, with a growing body of evidence implicating C. albicans in increased caries severity and in the formation of the cariogenic biofilm. However, the interactive mechanisms between cariogenic streptococci and Candida are yet to be elucidated. In this study, the real-time biofilm formation of C. albicans, S. mutans and S. sanguinis was assessed individually and in combination using the xCELLigence system, an impedance-based microbial biofilm monitoring system. The impedance signal was the highest for C. albicans, followed by S. mutans and S. sanguinis. Although the streptococcal mixed adhesion was found to follow a similar trend to that of S. sanguinis, the introduction of C. albicans resulted in higher adhesion patterns, with the combined growth of S. sanguinis and C. albicans and the combination of all three species resulting in higher biofilm formation than any of the individual organisms over time. This study, the first to use impedance for real-time monitoring of interkingdom biofilms, adds to the body of evidence that C. albicans and oral streptococcal adhesion are interlinked and suggests that interkingdom interactions induce changes in the oral biofilm dynamics over time.

The aetiology and pathogenesis of bacterial vaginosis (BV) is unclear but it appears to be associated with factors that disrupt the normal acidity of the vagina thus altering the equilibrium between the normal vaginal microbiota. BV has serious implications for female morbidity, including reports of pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. This paper reviewed new available information regarding possible factors contributing to the establishment of the BV vaginal biofilm, examined the proposed role of anaerobic microbial species recently detected by new culture-independent methods and discusses developments related to the effects of BV on human pregnancy. The literature search included Pubmed (NLM), LISTA (EBSCO), and Web of Science. Because of the complexity and diversity of population groups, diagnosis and methodology used, no meta-analysis was performed. Several anaerobic microbial species previously missed in the laboratory diagnosis of BV have been revealed while taking cognisance of newly proposed theories of infection, thereby improving our understanding and knowledge of the complex aetiology and pathogenesis of BV and its perceived role in adverse pregnancy outcomes.

Background: Listgarten and Hellden (1978) used darkfield microscopy of wet mounts to differentiate between healthy and periodontally diseased sites in the mouth by expressing the different bacterial morphotypes observed as a percentage of the total number of bacteria counted. This method of periodontal disease assessment gained favour as a diagnostic tool but presented with the limitation of immediate examination to determine the number of motile rods present and an inability to distinguish between gingivitis and periodontitis. Grading of bacterial morphotypes into several distinct categories of health or disease (Ison and Hay, 2002), simplified the scoring system of Gram-stained smears for the diagnosis of bacterial vaginosis (Nugent et al. 1991). The application of a similar grading system using stained smears rather than wet mounts could be advantageous to the diagnosis of periodontal disease. Objectives/aims: This study tested the hypothesis that stained smears of dental plaque collected from the gingival crevice of individuals with varying probing pocket depths (PD) may provide a grading system for periodontal disease assessment. Materials and methods: Subgingival plaque samples were collected from 49 patients, stained with a silver stain and the proportions of each bacterial morphotype graded relative to their respective PD measurements. Results: This technique allowed for a grading system of I–IV, with grade I indicating health and grade IV indicating severe periodontal disease. Discussion: Stained smear examination eliminates the time restriction for motile rod enumeration and allows for storage of smears for future reference. Conclusion: Standardization of the microscopic areas to be evaluated or examined will facilitate the agreement of cut-off values for the diagnosis of periodontal disease.

Background:Candidainfections are responsible for increased morbidity and mortality rates in at-risk patients, especially in developing countries where there is limited access to antifungal drugs and a high burden of HIV co-infection. Objectives:This study aimed to identify antifungal drug resistance patterns within the subcontinent of Africa. Methods: A literature search was conducted on published studies that employed antifungal susceptibility testing on clinicalCandidaisolates from sub-Saharan African countries using Pubmed and Google Scholar. Results: A total of 21 studies from 8 countries constituted this review. Only studies conducted in sub-Saharan Africa and employing antifungal drug susceptibility testing were included. Regional differences inCandidaspecies prevalence and resistance patterns were identified. Discussion: The outcomes of this review highlight the need for a revision of antifungal therapy guidelines in regions most affected byCandidadrug resistance. Better controls in antimicrobial drug distribution and the implementation of regional antimicrobial susceptibility surveillance programmes are required in order to reduce the highCandidadrug resistance levels seen to be emerging in sub-Saharan Africa.

Bacterial vaginosis (BV) has been associated with pelvic inflammatory disease, adverse pregnancy outcomes, increased susceptibility to sexually transmitted infections and infertility. Diagnosis of BV should be rapid, reliable and safe. This is especially vital in pregnant women where intervention may be necessary for the well-being of both the mother and the foetus.This paper consulted PUBMED, LISTA and Web of Science for point-of-care and laboratory-based tests commonly used for the diagnosis and management of BV in pregnant women. An overview of strengths and weaknesses of the methods used may partially explain why treatment plans have failed. Differences in sampling and detection methods, time of gestation, inter-examiner variability and interpretation of data, and the use of different reference tests, amongst many other factors, complicated a meta-analysis of the data.Inconsistencies found in clinical and laboratory detection methods used for the monitoring of treatment have a direct impact on success rates. With current advances in technology, the diagnosis of BV is taking on a new perspective. New information implicating specific vaginal biofilms in adverse pregnancy outcomes through the application of advanced technology promises to change the way we view the aetiology, diagnosis and management of BV.

The treat ment of invasive candidiasis and other Candida infections with the appropriate antifungal agent is assisted by the identification of Candida isolates to the species level. Rapid and accurate methods of differentiation are therefore imperat ive if t reat ment is to be effective, particularly in HIV-positive patients and in pregnant mothers where intervention may be necessary to reduce the risk for preterm delivery. The time used for isolation, identificat ion and detection of mixed cultures may be reduced with the help of available chro mogenic med ia. In this study, five commercial chro mogenic med ia were evaluated for the differentiation of Candida species. Six type-strains of Candida species were streaked onto each of five different chro mogenic media and incubated for up to 4 days at the different temperatures recommended by the manufacturers. This co mparative evaluation demonstrated the strengths and weaknesses of each mediu m employed and found CHROMagar™ Candida and Chro mogenic Candida Agar to be the most effective for distinguishing between different Candida species.

Background: Salivary gland disease (SGD) in HIV/AIDS is clinically and histopathologically very similar to Sjogren's Syndrome (SS), although the mechanism of tissue damage is unknown. The aim of this study is to determine the prevalence of SGD in primary SS and in HIV/AIDS in USA and in West African patients, and to seek distinguishing histopathologic features that may help to elucidate underlying mechanisms. Methods: Histologic sections of minor salivary glands from 164 HIV-positive and -negative patients from Cameroon and the US, and from 17 US patients with primary SS, were evaluated following salivary gland biopsy for inflammatory changes. To confirm the presence of fibrosis, collagen I, which is the most abundant collagen type, was assessed immunohistochemically in H&E-stained sections. Results: Forty-eight per cent of patients with HIV from Cameroon had severe SGD, while it was only in 6% of patients from the US. Patients with HIV in the US had less fibrosis and collagen I deposits than Cameroonians. Seventy-six per cent of US HIV-positive patients had received anti-retroviral therapy, while none of the African patients had. SS and AIDS patients had a tendency for lymphocytes to locate in a perivascular rather than in a periductal distribution. Conclusions: The prevalence of SGD and the presence of fibrosis and collagen I in Cameroonians with HIV is significantly higher than in HIV-positive American patients, and is similar to US patients with primary SS. The impact of patient selection, anti-retroviral therapy, and pathogenic mechanisms on salivary gland pathology is discussed.

Candida species are a common cause of infection in immune-compromised HIV-positive individuals, who are usually treated with the antifungal drug, fluconazole, in public hospitals in Africa. However, information about the prevalence of drug resistance to fluconazole and other antifungal agents on Candida species is very limited. This study examined 128 Candida isolates from South Africa and 126 Cameroonian Candida isolates for determination of species prevalence and antifungal drug susceptibility. The isolates were characterized by growth on chromogenic and selective media and by their susceptibility to 9 antifungal drugs tested using the TREK™ YeastOne9 drug panel (Thermo Scientific, USA). Eighty-three percent (82.8%) of South African isolates were Candida albicans (106 isolates), 9.4% were Candida glabrata (12 isolates), and 7.8% were Candida dubliniensis (10 isolates). Of the Cameroonian isolates, 73.02% were C. albicans (92 isolates); 19.05% C. glabrata (24 isolates); 3.2% Candida tropicalis (4 isolates); 2.4% Candida krusei (3 isolates); 1.59% either Candida kefyr, Candida parapsilopsis, or Candida lusitaneae (2 isolates); and 0.79% C. dubliniensis (1 isolate). Widespread C. albicans resistance to azoles was detected phenotypically in both populations. Differences in drug resistance were seen within C. glabrata found in both populations. Echinocandin drugs were more effective on isolates obtained from the Cameroon than in South Africa. A multiple-drug resistant C. dubliniensis strain isolated from the South African samples was inhibited only by 5-flucytosine in vitro on the YO9 panel. Drug resistance among oral Candida species is common among African HIV patients in these 2 countries. Regional surveillance of Candida species drug susceptibility should be undertaken to ensure effective treatment for HIV-positive patients.

The study of the aetiology of periodontal diseases has continued for decades with much progress shown in the last two decades. Having moved through periods of “whole” plaque (with emphasis on mass) being attributed to the disease process, to “specific” species being implicated, we have finally returned to examining the oral microbiota as an ecological niche involving not only a selected few species but looking at plaque as a whole where all the players are invited to participate with their roles no longer individually defined but viewed as a team effort with recognition of their individual strengths and contributions. Recent findings using advanced technology, are confirming findings viewed by electron microscopy nearly half a century ago, but we now have the knowledge and expertise to interpret those findings with deeper understanding. This chapter will attempt to examine the microbial succession within the plaque biofilm from health to disease, bearing in mind the susceptibility of the host, the microbial heterogeneity and the expression of virulence by the putative pathogens.

Background. The “red complex” microorganisms, namely,Porphyromonas gingivalis,Treponema denticola, andTannerella forsythiaare considered as potential pathogens causing HIV-associated periodontal diseases. Moreover, it has been recognized that an association exists between CD4+ T cell counts and periodontal disease progression.Objective. To establish whether CD4+ T cell counts or oral hygiene plays a greater role in producing BANA-positive results in HIV-associated periodontal disease.Materials and Methods. One hundred and twenty HIV-positive patients participated in the study, and their CD4+ T cell counts were obtained from their medical records. The six Ramfjord teeth were used for evaluating periodontal clinical indices and subgingival plaque sampling. BANA test was used for the detection and prevalence of the “red complex” bacteria in plaque samples.Results. A majority of 69.17% HIV-positive patients were BANA-positive. No significant associations were found between BANA and CD4+ T cell counts. A highly significant association was found between BANA with probing depth and clinical attachment level (P≤0.0001) and between BANA and the use of interdental aids (P=0.0168).Conclusion. HIV-associated periodontal diseases are strongly related to oral hygiene practices rather than the effect of CD4+ T cell counts, and the use of interdental aids was marked as a significant predictor of BANA-negative plaque samples.

Background: Preterm birth significantly impacts on neonatal morbidity and mortality and is apparently increasing world-wide. Several studies have attempted to define a causative role for periodontal disease in adverse pregnancy outcomes but few have focused on the microbiology of periodontal disease in relation to these outcomes.Results: The evidence for a positive correlation is strong, supported by microbiological and immunological findings. Conflicting results are often associated with uncontrolled confounding factors.Materials and Methods: A literature search was conducted in order to establish whether or not a role exists for oral Gram-negative bacteria in adverse pregnancy outcomes. Association and intervention studies are summarized along with pathogenic potential of the Gram-negative bacteria most frequently implicated in periodontal disease.

Reports show that more than 20 million infants world-wide are born prematurely with 95% of all pre-term births occurring in developing countries. Oral colonization of gram-negative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight infants.This study comprised 200 women admitted to the department of obstetrics and gynecology of the teaching hospital of Butare in Rwanda. Gingival crevicular fluid was collected from each quadrant of the mother's mouth (using paper points) within 24 hours of delivery. A dichotomous score of presence or absence of gingival inflammation was recorded for each patient along with demographic data such as age, marital status etc. Samples were examined by PCR for the presence of Aggregatibacter actinomycetemcomitans and selected members of the red and orange complexes described by Socransky et al., (1998), and their presence associated with age, gingival inflammation and pregnancy outcomes.Association of bacterial species with the risk of periodontal disease and thus the risk of preterm delivery was only observed when they occurred in pairs or groups of three or more. Aa appeared to be a necessary co-factor for significant associations of bacterial groups with the variables recorded.

Studies suggest that apoptosis plays a major role in destruction of salivary glands in Sjogren's Syndrome. We hypothesise that apoptosis results in the exposure of cryptic T cell epitopes and an autoimmune response which is pathway-specific. Objective To activate the extrinsic or intrinsic apoptotic pathway to examine morphology, adhesion molecules, markers of antigen processing, and autoantigens on apoptotic bodies in vitro . Methods Tumor necrosis factor-α (TNF-α) or staurosporine, a protein kinase inhibitor, was used to trigger the extrinsic or intrinsic apoptotic pathway in a Human Salivary Gland cell line (HSG), in vitro . Activated genes were profiled by cDNA array. Apoptotic bodies were visualised using light and SEM. Proteins were evaluated by immunofluorescence and confirmed by functional binding assays with Jurkat lymphocytes. Results TNF-α-triggered extrinsic apoptosis resulted in “sticky” aggregated, apoptotic bodies which displayed cleaved α-fodrin autoantigen. In contrast, intrinsic apoptosis induced by staurosporine, resulted in dispersed cell blebs which were α-fodrin-negative. cDNA arrays revealed that TNF-α, but not staurosporine, upregulated transcriptional expression of Intercellular Adhesion Molecule-1 (ICAM-1) and Macrophage Inflammatory Protein-3 (CCL20). Conclusion The apoptotic pathway controls morphological, structural and functional properties of apoptotic bodies. Collectively, TNF-α-dependent activation of the extrinsic apoptotic pathway leads to upregulation of ICAM-1 and CCL20 in HSG in vitro . This suggests that pathogenesis in Sjogren's Syndrome may involve a TNF-controlled cross-talk between apoptotic ductal and CCL20-attracted dendritic cells via the CD137/CD137L signalling pathway.

Background The immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices). Methods One hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients’ medical records and patients’ HIV stage determined and grouped according to their CD4+ T cell counts into A (3), B (200–500 cells /mm3) and C (>500 cells /mm3). Results The mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170). Conclusion The findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.

Periodontal disease, which attacks the gums and supporting structures of the tooth, is one of the major causes of tooth loss in adults. Few studies on general well-being have compared the differences in oral health between men and women with studies from Europe and USA reporting that there are more edentulous women than men.Among the many factors contributing to tooth loss are poverty, availability and accessibility to dental and other health care as well as cultural traditions. This study examined a population living in a high fluoride area near Cape Town. This isolated community has until recently been unexposed to the diets and habits of the western world and have inter-married for decades. The results of this study indicated that although women had better oral hygiene habits than men, tooth loss was associated with age rather than gender.

The prevalence of periodontal disease is widespread throughout the world. Its severity varies considerably and the factors responsible for this variation are not known. Although the effect of fluoride on the reduction of dental caries is well established, its effect on chronic inflammatory periodontal disease is obscure. In this investigation, the prevalence and severity of periodontitis in 71 adults residing in a high fluoride area (2-3 ppm) was studied. In spite of large amounts of plaque and the prevalence of severe gingivitis in these individuals, there was little evidence of periodontal destruction (mean probing depth = 2.5 mm; mean loss of attachment = 1.02 mm). The possible reasons for the resistance of this population to = 1.02 mm). The possible reasons for the resistance of this population to periodontitis are discussed.

A low socio-economic community residing in Crossroads, Cape Town, consists of people who originated from the Eastern Cape areas of the Ciskei and Transkei. These individuals have had virtually no dental care, with the exception of emergency treatment for pain. A darkfield microscopic study of a random sample of 52 individuals was undertaken to determine the predominant morphological forms in the subgingival plaque of this population. Spirochetes were found to constitute 42.1% and motile rods, 7.7%, of the total darkfield microscopic count. Clinical assessment of the periodontal status of 100 individuals revealed the following mean values; plaque index (PI) = 1.44, gingival index (GI) = 1.31, probing depth (PD) = 2.35 mm and loss of attachment = 0.64 mm. Subgingival calculus deposits were present in 42% of the group and little or no mobility of the teeth was evident. Poor oral hygiene resulted in 90% of the tooth surfaces of the sampled population in Crossroads being covered with plaque, yet these individuals appear to be resistant to periodontitis. The high proportions of spirochetes and motile rods found in the subgingival plaque of this group were not indicative of periodontitis and therefore, fail to confirm the findings of other investigators.

Differential darkfield microscopic examination of subgingival plaque samples from a community, which on clinical evidence had a contained gingivitis (mean probing depth 3.1 mm), revealed 35.7% spirochaetes and 7.4% motile rods. In spite of persistent plaque deposits and a high proportion of spirochaetes, this isolated population in Namaqualand, South Africa, appears to be resistant to periodontitis.

The influence of prophylactic tinidazole therapy on vaginal carriage rates of anaerobes and the development of post-operative anaerobic infection was studied in 100 women undergoing abdominal hysterectomy. Tinidazole prophylaxis (50 patients) led to a decrease of anaerobe vaginal carriage rate from 56% pre-operatively to 10 and 30% on the third and seventh post-operative days, respectively. In the control group (50 patients), no significant decrease in anaerobe yield was noted, corresponding percentages being 72, 64 and 74. Post-operative infection occurred in 34 cases (28 controls, 6 tinidazole prophylaxis). Wound swabs from patients in the latter group did not yield anaerobes on culture, and infections either resolved spontaneously (2 cases) or responded to tinidazole therapy, with or without addition of ampicillin and kanamycin (4 cases). In the control group, 21 cases of post-operative wound infection and 4 of vault infection were seen. Wound swabs from 6 of the former group yielded aerobes only and 10 mixed growth of aerobes/anaerobes. Post-operative wound/vault infections in control patients cleared spontaneously (18 cases) or responded to imidazole therapy, with or without ampicillin and kanamycin (7 cases). These data suggest that tinidazole may be a useful adjunct in imidazole prophylaxis and treatment of anaerobic infection.