-
Frontiers in Cellular and Infection... 2018is a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome divides strains into opportunistic,... (Review)
Review
is a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome divides strains into opportunistic, hypervirulent, and multidrug-resistant groups and separates from two closely related species, and . Some strains of act as opportunistic pathogens, infecting critically ill and immunocompromised patients. These are a common cause of health-care associated infections including pneumonia, urinary tract infections (UTIs), and bloodstream infections. and are often clinically indistinguishable from opportunistic . Other strains of are hypervirulent, infecting healthy people in community settings and causing severe infections including pyogenic liver abscess, endophthalmitis, and meningitis. A third group of encode carbapenemases, making them highly antibiotic-resistant. These strains act as opportunists but are exceedingly difficult to treat. All of these groups of and related species can colonize the gastrointestinal tract, and the accessory genome may determine if a colonizing strain remains asymptomatic or progresses to cause disease. This review will explore the associations between colonization and infection with opportunistic, antibiotic-resistant, and hypervirulent strains and the role of the accessory genome in distinguishing these groups and related species. As infections become progressively more difficult to treat in the face of antibiotic resistance and hypervirulent strains, an increased understanding of the epidemiology and pathogenesis of these bacteria is vital.
Topics: Anti-Bacterial Agents; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Genes, Bacterial; Genome, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Mucous Membrane; Opportunistic Infections; Virulence
PubMed: 29404282
DOI: 10.3389/fcimb.2018.00004 -
International Journal of Implant... Nov 2021To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis. (Meta-Analysis)
Meta-Analysis Review
Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis.
PURPOSE
To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.
MATERIAL AND METHODS
Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched.
RESULTS
Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = - 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = - 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = - 28.09%; p = 0.01 and WMD = - 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to - 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = - 1.47 mm; p = 0.01), PD (- 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = - 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = - 11.11%; p = 0.11).
CONCLUSIONS
Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.
Topics: Anti-Infective Agents, Local; Dental Implants; Humans; Mucositis; Peri-Implantitis; Prospective Studies
PubMed: 34779939
DOI: 10.1186/s40729-021-00388-x -
Wounds : a Compendium of Clinical... May 2021Patients with oral mucositis (OM) have inflamed epithelial lesions of the mouth that progress to form painful ulcerations with submucosal hemorrhaging and infection....
Patients with oral mucositis (OM) have inflamed epithelial lesions of the mouth that progress to form painful ulcerations with submucosal hemorrhaging and infection. Oral mucositis makes it painful to eat, drink, and speak, resulting in distress, weight loss, and declining health.1 These symptoms occur in up to 40% of patients within 5 to 10 days after beginning chemotherapy (CT), and in nearly all patients within 1 to 2 weeks of starting radiotherapy (RT) for head and neck cancer. Oral mucositis can be severe enough to interrupt treatment and reduce survival rates. In 2014, the Mucositis Guidelines Leadership Group of the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology released OM treatment guidelines aiming to provide nutritional support, while reducing pain, inflammation, hemorrhaging, and oral microbial contamination. This installment of Evidence Corner explores 2 recent systematic reviews of randomized controlled trial (RCT) evidence informing clinical decisions in ways that may change thoughts about effective topical OM treatment.
Topics: Head and Neck Neoplasms; Humans; Mucositis; Pain; Stomatitis; Systematic Reviews as Topic
PubMed: 34370681
DOI: No ID Found -
MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.Cancer May 2014Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational... (Review)
Review
BACKGROUND
Mucositis is a highly significant, and sometimes dose-limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis.
METHODS
A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were rated according to the presence of major and minor flaws as per previously published criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible.
RESULTS
The literature search identified 8279 papers, 1032 of which were retrieved for detailed evaluation based on titles and abstracts. Of these, 570 qualified for final inclusion in the systematic reviews. Sixteen new guidelines were developed for or against the use of various interventions in specific treatment settings. In total, the MASCC/ISOO Mucositis Guidelines now include 32 guidelines: 22 for oral mucositis and 10 for gastrointestinal mucositis. This article describes these updated guidelines.
CONCLUSIONS
The updated MASCC/ISOO Clinical Practice Guidelines for mucositis will help clinicians provide evidence-based management of mucositis secondary to cancer therapy.
Topics: Amifostine; Analgesics; Anti-Infective Agents; Anti-Inflammatory Agents; Anti-Ulcer Agents; Antineoplastic Agents; Cryotherapy; Cytokines; Esophagitis; Evidence-Based Medicine; Humans; Hyperbaric Oxygenation; Intercellular Signaling Peptides and Proteins; Low-Level Light Therapy; Mucositis; Neoplasms; Oral Hygiene; Phototherapy; Proctitis; Protective Agents; Radiation-Protective Agents; Radiotherapy; Stomatitis; Sucralfate
PubMed: 24615748
DOI: 10.1002/cncr.28592 -
Nature Apr 2016Cytolytic proteins and peptide toxins are classical virulence factors of several bacterial pathogens which disrupt epithelial barrier function, damage cells and activate...
Cytolytic proteins and peptide toxins are classical virulence factors of several bacterial pathogens which disrupt epithelial barrier function, damage cells and activate or modulate host immune responses. Such toxins have not been identified previously in human pathogenic fungi. Here we identify the first, to our knowledge, fungal cytolytic peptide toxin in the opportunistic pathogen Candida albicans. This secreted toxin directly damages epithelial membranes, triggers a danger response signalling pathway and activates epithelial immunity. Membrane permeabilization is enhanced by a positive charge at the carboxy terminus of the peptide, which triggers an inward current concomitant with calcium influx. C. albicans strains lacking this toxin do not activate or damage epithelial cells and are avirulent in animal models of mucosal infection. We propose the name 'Candidalysin' for this cytolytic peptide toxin; a newly identified, critical molecular determinant of epithelial damage and host recognition of the clinically important fungus, C. albicans.
Topics: Calcium; Candida albicans; Candidiasis; Cell Membrane Permeability; Cytotoxins; Epithelial Cells; Fungal Proteins; Host-Pathogen Interactions; Humans; Mucous Membrane; Mycotoxins; Signal Transduction; Virulence; Virulence Factors
PubMed: 27027296
DOI: 10.1038/nature17625 -
Integrative Cancer Therapies Dec 2018Chemoradiotherapy-associated mucositis can manifest as pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and infection. Mucositis is a major...
BACKGROUND
Chemoradiotherapy-associated mucositis can manifest as pain, inflammation, dysphagia, diarrhea, weight loss, rectal bleeding, and infection. Mucositis is a major dose-limiting side effect of chemotherapy, affecting nutritional intake and oral and intestinal function. Despite several interventions being available, there is a need for safe and effective preventative and treatment options for treatment-induced mucositis. The goals of this review are to discuss interventions based on foods and natural products and present the research to date.
METHODS
A narrative literature review identified 60 clinical studies examining various nutritional compounds and 20 examining probiotics. 9 studies on probiotics for the prevention of diarrhea were also assessed on methodological quality and limitations identified.
RESULTS
Several compounds have been posited as useful adjuvants for cancer treatment-related mucositis. Probiotics demonstrate efficacy for the prevention and treatment of chemoradiotherapy-induced gastrointestinal toxicity without significant side effects. Glutamine and activated charcoal were reported to reduce chemotherapy-induced diarrhea but not radiation-induced intestinal mucositis. Honey has been reported to decrease treatment interruptions, weight loss, and delays the onset of oral mucositis. Zinc, glutamine, and topical vitamin E were demonstrated efficacy for oral mucositis.
CONCLUSION
There is plausible clinical evidence for the administration of several adjunctive treatments for the prevention and treatment of mucositis. Probiotics were reported to reduce the burden of intestinal mucositis and treatment-induced diarrhea. Activated charcoal and glutamine are beneficial for chemotherapy-induced diarrhea, whereas the administration of honey, zinc, and glutamine reduce the risk of developing oral mucositis during chemotherapy or radiotherapy.
Topics: Chemotherapy, Adjuvant; Diarrhea; Drug-Related Side Effects and Adverse Reactions; Humans; Mucositis; Neoplasms; Probiotics; Radiation Injuries; Radiotherapy
PubMed: 30136590
DOI: 10.1177/1534735418794885 -
Cell Jan 2016Proper adaptation to environmental perturbations is essential for tissue homeostasis. In the intestine, diverse environmental cues can be sensed by immune cells, which...
Proper adaptation to environmental perturbations is essential for tissue homeostasis. In the intestine, diverse environmental cues can be sensed by immune cells, which must balance resistance to microorganisms with tolerance, avoiding excess tissue damage. By applying imaging and transcriptional profiling tools, we interrogated how distinct microenvironments in the gut regulate resident macrophages. We discovered that macrophages exhibit a high degree of gene-expression specialization dependent on their proximity to the gut lumen. Lamina propria macrophages (LpMs) preferentially expressed a pro-inflammatory phenotype when compared to muscularis macrophages (MMs), which displayed a tissue-protective phenotype. Upon luminal bacterial infection, MMs further enhanced tissue-protective programs, and this was attributed to swift activation of extrinsic sympathetic neurons innervating the gut muscularis and norepinephrine signaling to β2 adrenergic receptors on MMs. Our results reveal unique intra-tissue macrophage specialization and identify neuro-immune communication between enteric neurons and macrophages that induces rapid tissue-protective responses to distal perturbations.
Topics: Animals; Cell Line; Intestinal Mucosa; Intestine, Small; Macrophages; Mice; Mucous Membrane; Neuroimmunomodulation; Neurons; Receptors, Adrenergic, beta-2; Salmonella Infections; Salmonella typhimurium; Specific Pathogen-Free Organisms
PubMed: 26777404
DOI: 10.1016/j.cell.2015.12.023 -
British Journal of Hospital Medicine... Sep 2022Almost all cancer therapies lead to a wide array of side effects, owing to the disruption of normal physiological processes and alteration of immunological responses. Of... (Review)
Review
Almost all cancer therapies lead to a wide array of side effects, owing to the disruption of normal physiological processes and alteration of immunological responses. Of these, mucositis is one of the most commonly encountered side effects, presenting in about 20-40% of all patients receiving chemotherapy and 80% of those being treated with radiotherapy for head and neck malignancies. This article provides a brief introduction and comprehensive overview of the various treatment modalities used in managing this complication. The key to management is a multidisciplinary approach, revolving around pain control, oral hygiene, nutritional support and management of superimposed infection. The scarcity of therapeutic options for prevention or treatment of mucositis has resulted in clinical difficulty in controlling it, which, in turn, seriously affects the patient's quality of life and cancer management, contributing to patient morbidity and mortality.
Topics: Antineoplastic Agents; Drug-Related Side Effects and Adverse Reactions; Head and Neck Neoplasms; Humans; Mucositis; Quality of Life; Stomatitis
PubMed: 36193926
DOI: 10.12968/hmed.2022.0324 -
Viruses Feb 2022HIV mainly targets CD4 T cells, from which Th cells represent a major cell type, permissive, and are capable of supporting intracellular replication at mucosal sites. Th... (Review)
Review
HIV mainly targets CD4 T cells, from which Th cells represent a major cell type, permissive, and are capable of supporting intracellular replication at mucosal sites. Th cells possess well-described dual roles, while being central to maintaining gut integrity, these may induce inflammation and contribute to autoimmune disorders; however, Th cells' antiviral function in HIV infection is not completely understood. Th cells are star players to HIV-1 pathogenesis and a potential target to prevent or decrease HIV transmission. HIV-1 can be spread among permissive cells via direct cell-to-cell and/or cell-free infection. The debate on which mode of transmission is more efficient is still ongoing without a concrete conclusion yet. Most assessments of virus transmission analyzing either cell-to-cell or cell-free modes use in vitro systems; however, the actual interactions and conditions in vivo are not fully understood. The fact that infected breast milk, semen, and vaginal secretions contain a mix of both cell-free viral particles and infected cells presents an argument for the probability of HIV taking advantage of both modes of transmission to spread. Here, we review important insights and recent findings about the role of Th cells during HIV pathogenesis in mucosal surfaces, and the mechanisms of HIV-1 infection spread among T cells in tissues.
Topics: Animals; Disease Models, Animal; HIV Infections; HIV-1; Humans; Mucous Membrane; Th17 Cells; Virus Replication
PubMed: 35215997
DOI: 10.3390/v14020404 -
Journal of Molecular Medicine (Berlin,... Sep 2017Of the total human body's surface, the majority is internal surface, belonging to the lungs (100 m) and intestinal tract (400 m). In comparison, the external surface... (Review)
Review
Of the total human body's surface, the majority is internal surface, belonging to the lungs (100 m) and intestinal tract (400 m). In comparison, the external surface area, belonging to the skin, comprises less than 1% (2 m). Continuous exposure of the mucosal surface to external factors (e.g., pathogens, food particles) requires tight regulation to maintain homeostasis. MicroRNAs (miRNAs) have gained noticeable attention as playing important roles in maintaining the steady-state of tissues by modulating immune functions and inflammatory responses. Accordingly, associations have been found between miRNA expression levels and human health conditions and diseases. These findings have important implications in inflammatory diseases involving pulmonary and intestinal mucosa, such as acute lung injury or inflammatory bowel disease. In this review, we highlight the known biology of miRNAs and discuss the role of miRNAs in modulating mucosal defense and homeostasis. Additionally, we discuss miRNAs serving as potential therapeutic targets to treat immunological conditions, particularly mucosal inflammation.
Topics: Animals; Gene Expression Regulation; Humans; Immunity, Mucosal; Inflammation; Inflammatory Bowel Diseases; MicroRNAs; Mucous Membrane; Pneumonia; RNA Interference
PubMed: 28726085
DOI: 10.1007/s00109-017-1568-7