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Introduction: Septic arthritis by Aggregatibacter aphrophilus is an uncommon entity, so it's important to diagnose it early, to avoid serious consequences. In adults, the knee is the most affected site. Methods: We present a case of a 17-year-old boy, with pain in the left knee since one month ago. It shows an increase in local temperature, erythema and movement inability. A nuclear magnetic resonance (NMR) was performed and empirical treatment was given with cephalothin and clindamycin. A knee arthrotomy was realized, and intramedullary secretion and bone tissue was sent to study. Results: the NMR images were suggestive of an infectious process. In the culture gram-negative coccobacilli were isolated, later identified like as Aggregatibacter aphrophilus. According to this diagnostic, the treatment was changed to ceftriaxone The main conclusions: the rapidity and certainty in the choice of antimicrobial therapy is the most important step for a well evolution of this infection, therefore is very important to emphasize the importance of a correct identification of these rare microorganisms

Introducción: Aunque la artritis séptica es una entidad poco común, es importante debido a las graves consecuencias de un diagnóstico tardío o un incorrecto tratamiento. En adultos, la rodilla es el sitio más afectado. El objetivo de este trabajo es presentar un caso clínico de artritis séptica por Aggregatibacter aphrophilus en rodilla en un paciente joven, inmunocompetente, sin antecedentes patológicos. Materiales y métodos: Se estudia el caso de un joven de 17 años, tabaquista, con un cuadro de 1 mes de evolución caracterizado por gonalgia izquierda, aumento de la temperatura local, eritema e impotencia funcional. Se realizan análisis de sangre, una ecografía,y resonancia magnética (RMN).Se solicitan hemocultivos y cultivos de líquido intrarticular de rodilla. En la RMN se observa una lesión expansiva en la región femoral, sugestiva de un proceso infeccioso. Se comienza tratamiento empírico con cefalotina y clindamicina. Se realiza una artrotomia de rodilla enviándose para su estudio secreción endomedular, tejido óseo y endomedular. Resultados: Los hemocultivos y el cultivo del líquido intraarticular fueron negativos, pero los materiales obtenidos por técnica quirúrgica fueron positivos para el cultivo, aislándose cocobacilos gram negativos, posteriormente identificados como Aggregatibacter aphrophilus Se realizó el diagnóstico de artritis séptica por Aggregatibacter aphrophilus y se roto el tratamiento antimicrobiano a ceftriaxona. Conclusión: La rapidez y la certeza en la elección de la terapia antimicrobiana son un paso decisivo para la evolución de la enfermedad, por lo tanto se remarca la importancia de una correcta identificación de estos microorganismos poco frecuentes.

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AIM: The aim of the present study was to evaluate the influence of the baseline detection of Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) on the clinical outcomes of moxifloxacin (MOX) as an adjunct to full-mouth scaling and root planing (SRP) in generalized aggressive periodontitis (GAgP). METHODS: Forty patients were randomly distributed to two therapy protocols: SRP + placebo or SRP combined with MOX. A. actinomycetemcomitans was detected using culture methods. The significance of the treatment option (MOX or SRP + placebo) on the dependent variables (probing depth [PD] and clinical attachment level [CAL]), considering the interaction with the baseline detection of A. actinomycetemcomitans, was estimated. RESULTS: MOX therapy led to a higher significant PD reduction and CAL gain in A. actinomycetemcomitans-positive patients at baseline. In A. actinomycetemcomitans-positive patients, the reduction of sites ≥5 mm was higher in the MOX group. A. actinomycetemcomitans was not present in sites with PD ≥6 mm in the MOX group. The interactions of A. actinomycetemcomitans and MOX were significantly associated with CAL gain and PD reduction at 6 months. CONCLUSIONS: Adjunctive MOX trended toward better clinical responses in A. actinomycetemcomitans-positive patients at baseline. These results suggest that A. actinomycetemcomitans at baseline might modify the effect of adjunctive MOX in GAgP.

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BACKGROUND: Mannheimia haemolytica is an important etiological agent in bovine respiratory disease. OBJECTIVES: Explore risk factors for recovery of susceptible and resistant M. haemolytica in feedlot cattle and explore associations with health outcomes. ANIMALS: Cattle (n = 5,498) from 4 feedlots sampled at arrival and later in feeding period. METHODS: Susceptibility of M. haemolytica isolates tested for 21 antimicrobials. Records of antimicrobial use and health events analyzed using multivariable regression. RESULTS: M. haemolytica recovered from 29% of cattle (1,596/5,498), 13.1% at arrival (95% CI, 12.3-14.1%), and 19.8% at second sampling (95% CI, 18.7-20.9%). Nearly half of study cattle received antimicrobial drugs (AMDs) parenterally, mostly as metaphylactic treatment at arrival. Individual parenteral AMD exposures were associated with decreased recovery of M. haemolytica (OR, 0.2; 95% CI, 0.02-1.2), whereas exposure in penmates was associated with increased recovery (OR, 1.5; 95% CI, 1.05-2.2). Most isolates were pan-susceptible (87.8%; 95% CI, 87.0-89.4%). AMD exposures were not associated with resistance to any single drug. Multiply-resistant isolates were rare (5.9%; 95% CI, 5.1-6.9%), but AMD exposures in pen mates were associated with increased odds of recovering multiply-resistant M. haemolytica (OR, 23.9; 95% CI, 8.4-68.3). Cattle positive for M. haemolytica on arrival were more likely to become ill within 10 days (OR, 1.7; 95% CI, 1.1-2.4). CONCLUSIONS AND CLINICAL IMPORTANCE: Resistance generally was rare in M. haemolytica. Antimicrobial drug exposures in penmates increased the risk of isolating susceptible and multiply-resistant M. haemolytica, a finding that could be explained by contagious spread.

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BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the clinical and microbiological effect of photodynamic therapy (PDT) in the non-surgical treatment of periodontitis in HIV patients. METHODS: Twelve HIV patients from the CEAPE/UNIP, Brazil, with periodontitis were included in this 6-month, split-mouth, double-blind, controlled clinical trial. Patients were placed in the following groups: Group SRP-scaling and root planning with an ultrasonic device (SRP); and Group SRP + PDT-SRP associated with a course of PDT with a diode laser with a wavelength of 660 nm and 0.03 W power associated with methylene blue 0.01% lasting 133 seconds. All clinical measurements (periodontal probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), full-mouth plaque index (FMPI), bleeding score (FMBS)), and microbiological parameters (detection of Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), and Aggregatibacter actinomycetemcomitans (Aa)) were assessed at baseline and at 45 days, and 3 and 6 months after therapy. The ANOVA/Tukey was used for statistical analysis (α = 5%). RESULTS: There were no differences in any of the investigated parameters observed at baseline in the two groups (P > 0.05). Moreover, participants in the SRP + PDT group presented a higher PPD reduction and CAL gain than those in the SRP group at 45 days and 3 and 6 months. At 6 months, sites receiving SRP + PDT showed a significant PPD reduction of 1.4 ± 0.5 mm, while those in the SRP group showed a 0.3 ± 0.8 mm reduction (P < 0.05). The CAL gain at the sixth month was 1.3 ± 0.5 mm and 0.2 ± 0.7 mm for participants in the SRP + PDT and SRP groups, respectively (P < 0.05). Microbiologically, both therapies presented a reduction in the detection of Pg, Tf, and Aa, and there was no difference between them (P > 0.05). CONCLUSION: We concluded that PDT therapy used adjunctively to SRP could promote additional benefits in the treatment of HIV-associated periodontitis.

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Chemokines and chemokine receptors have been implicated in the selective migration of leukocyte subsets to periodontal tissues, which consequently influences the disease outcome. Among these chemoattractants, the chemokines CCL3, CCL4 and CCL5 and its receptors, CCR1 and CCR5, have been associated with increased disease severity in mice and humans. Therefore, in this study we investigated the modulation of experimental periodontitis outcome by the treatment with a specific antagonist of CCR1 and 5 receptors, called met-RANTES. C57Bl/6 mice was orally infected with Aggregatibacter actinomycetemcomitans and treated with 0.05, 0.1, 0.5, 1.5 and 5 mg doses of met-RANTES on alternate days, and evaluated by morphometric, cellular, enzymatic and molecular methods. At 0.5 mg up to 5 mg doses, a strong reduction in the alveolar bone loss and inflammatory cell migration were observed. Interestingly, 5 mg dose treatment resulted in the maximum inhibition of inflammatory cell migration, but resulted in a similar inhibition of bone loss when compared with the lower doses, and also resulted in increased bacterial load and CRP response. When 0.5 and 5 mg therapy regimens were compared it was observed that both therapeutic protocols were able to downregulate the levels of pro-inflammatory, Th1-type and osteoclastogenic cytokines, and CD3+ and F4/80+ cells migration to periodontal tissues, but the high dose modulates host response in a more pronounced and unspecific and excessive way, interfering also with the production of antimicrobial mediators such as MPO, iNOS and IgG, and with GR1+ and CD19+ cells migration. Our results demonstrate a thin line between beneficial immunoregulation and impaired host defense during experimental periodontitis, and the determination of the exact equilibrium point is mandatory for the improvement of immune-targeted therapy of periodontitis.

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