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Detection of Staphylococcus aureus in the Pulp of an Endocarditis Patient

Elodie Terrer, Oumarou Hama H, Gouriet F, Habib G, Catherine Jh, Raskin A, Lan R, Hadj Said M, Aboudharam G, Terrer E, Drancourt M
Published: 20 July 2020
Modern Research in Dentistry , Volume 5, pp 486-489; doi:10.31031/mrd.2020.05.000610

Abstract: Oumarou Hama H1,2, Gouriet F1,5, Catherine JH3,4,5, Habib G1,5, Raskin A3,4,5, Hadj Said M3,5, Lan R3,4,5, Aboudharam G2,3,5, Drancourt M1,2,5 and Terrer E2,3,5* 1IHU Méditerranée Infection, Marseille, France 2Aix-Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France 3Aix-Marseille Université, UFR Odontologie, Marseille, France 4Aix-Marseille Université, Anthropologie bioculturelle Droit Ethique Santé, Marseille, France 5APHM, Hôpital Timone, Marseille, France *Corresponding author: Elodie Terrer, Aix-Marseille University, MEPHI, IHU Méditerranée-Infection 19-21 Boulevard Jean Moulin, 13005 Marseille, France Submission: July 08, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000610 ISSN:2637-7764Volume5 Issue2 Objective: Dental pulp is acknowledged to be an organic tissue sample on which the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis, can be based. Method: Molecular detection of aureus was performed in the dental pulp extracted from one tooth collected in a patient firmly diagnosed with S. aureus infectious endocarditis. Result: We report on one patient diagnosed with Staphylococcus aureus endocarditis in whom aureus DNA was further detected by PCR in the dental pulp. We advocate not throwing away extracted teeth, appropriate microbial investigations of which may reveal bacteraemic pathogens not otherwise detectable. Keywords: Bacteremia; Tooth; MALDI TOF MS; Microbiology; Diagnosis; Cardiology Dental pulp is acknowledged to be a suitable organic tissue upon which to base the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis [1,2]. Non-exposed dental pulp can be invaded by bacteria with predominance of aero-intolerant bacteria of the genera Eubacterium, Propionibacterium and Actinomyces [3]. Furthermore, molecular approaches have made it possible to detect the DNA of Coxiella burnetii, a pathogen responsible for endocarditis [4] in the dental pulp of experimentally-infected guinea pigs [5], as well as HIV DNA in a seropositive patient [6]. In addition, one case of Bartonella quintana bacteraemia has been detected by PCR in the dental pulp sample collected from a patient who had been diagnosed with B. quintana bacteraemia six months previously but who was not longer bacteraemic when the tooth was extracted [1]. Infectious endocarditis (IE) is mainly caused by streptococci, staphylococci and enterococci and, rarely, by fungi [7,8]. Staphylococcus aureus (S. aureus) is one of the pathogens most frequently involved in blood-borne infections, including IE [9,10]. In this paper, we report on one patient diagnosed with S. aureus endocarditis in whom S. aureus DNA was further detected by PCR in the dental pulp. In April 2019, a 54-year-old patient was admitted to the emergency department of the Timone hospital (Marseille, France) with fever, confusion and tetraparesia. A cerebral scan found multiple left hypodense fronto-parietal and left occipital lesions. Blood and the cerebrospinal fluid cultured methicillin-susceptible S. aureus. Empiric antibiotic therapy combining amoxicillin, gentamycin and acyclovir was then changed for cefazolin, 12g/day and clindamycin 600mg four times/day. A transthoracic echocardiography found vegetation on the native bicuspid aortic valve and a moderate aortic insufficiency. The patient was then diagnosed with S. aureus infectious endocarditis. A total body scan found bilateral renal, splenic and hepatic embolisms. Brain magnetic resonance imaging found several right frontal, left occipital, temporal, thalamic and bilateral cerebellar hyper signals with haemorrhagic organisation in the right frontal and occipital lesion. Five days later, the patient presented with septic shock and was admitted to the cardiologic intensive care unit. Antibiotic therapy was changed for intravenous sulfamethoxazole 4,800mg/day, clindamycin 1,800mg/day, gentamycin 160mg/day and rifampicin 1,800mg/day. Laboratory tests showed leucocytosis at 19G/L, haemoglobin at 10.4g/dL, platelets at 180G/L, and protein C-reactive at 95.5mg/L. 18fluorodeoxyglucose-positron emission tomography/computed tomography showed multiple hypermetabolic foci in the lymph nodes, liver, muscles and bones. Spinal magnetic resonance imaging showed a lumbar L4-L5 and cervical C5-C6 spondylodiscitis. Initial clinical and biological evolution was favourable, however, three weeks later the cardiac lesion worsened with severe aortic valve insufficiency. Cardiac surgery was performed and the patient underwent an aortic bio prosthesis. Culture of the explanted cardiac valve remained sterile and PCR-based tests for the pan bacterial 16S RNA gene, Enterococcus faecalis, Enterococcus faecium, S. aureus, Coxiella burnetii and Bartonella spp. were negative. Histological examination of the explanted valve showed a valvular tissue largely destroyed by a dense, non-specific and polymorphic inflammatory reaction, with many neutrophils. As part of the routine management of patients with IE, 13 teeth with infectious foci of endodontic or periodontal origin were extracted using amoxicillin antibiotic prophylaxis according to the recommendations of the Haute Autorité de Santé (HAS) and the Agence Nationale de Sécurité du Médicament (ANSM). After obtaining the patient’s informed consent, the teeth were microbiologically investigated in line with advice from the IHU Mediterranean Infection Ethics Committee (Advice, 05/29/2018). The evolution of the patient was favourable at the six-month follow-up consultation. Six of the 13 extracted teeth (n°13, n°24, n°25, n°35, n°36, n°37) were used for bacteriology investigation. Teeth were decontaminated with 1% chlorhexidine (MP Biomedicals, Illkirch, France), washed with UltraPure™...
Keywords: Staphylococcus aureus / Coxiella Burnetii / Tissue / Infectious Endocarditis / blood borne / Patient Diagnosed / Six Months / Aureus Infectious / Santé

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