Abstract
Entamoeba gingivalis is considered an oral commensal but demonstrates a pathogenic potential associated with periodontal disease in immunocompromised individuals. Therefore, this study evaluated the occurrence, opportunistic conditions, and intraspecific genetic variability of E. gingivalis in HIV(+)/AIDS patients. Entamoeba gingivalis was studied using fresh examination (FE), culture, and PCR from bacterial plaque samples collected from 82 HIV(+)/AIDS patients. Genetic characterization of the lower ribosomal subunit of region 18S (18S-SSU rRNA) was conducted in 9 positive samples using low-stringency single specific primer PCR (LSSP-PCR) and sequencing analysis. Entamoeba gingivalis was detected in 63.4% (52/82) of the samples. No association was detected between the presence of E. gingivalis and the CD4+ lymphocyte count (≤200 cells/mm3 (p = 0.912) or viral load (p = 0.429). The LSSP-PCR results helped group E. gingivalis populations into 2 polymorphic groups (68.3% similarity): group I, associated with 63.6% (7/11) of the samples, and group II, associated with 36.4% (4/11) of the samples, which shared 74% and 83.7% similarity and association with C and E isolates from HIV(−) individuals, respectively. Sequencing of 4 samples demonstrated 99% identity with the reference strain ATCC 30927 and also showed 2 divergent clusters, similar to those detected by LSSP-PCR. Opportunistic behavior of E. gingivalis was not detected, which may be related to the use of highly active antiretroviral therapy by all HIV(+)/AIDS patients. The high occurrence of E. gingivalis in these patients can be influenced by multifactorial components not directly related to the CD4+ lymphocyte counts, such as cholesterol and the oral microbiota host, which could mask the potential opportunistic ability of E. gingivalis. The identification of the 18S SSU-rRNA polymorphism by LSSP-PCR and sequencing analysis provides the first evidence of genetic variability in E. gingivalis isolated from HIV patients.
Highlights
Oral manifestations are frequent in human immunodeficiency virus (HIV) patients and are primarily and diagnosed during the course of HIV infection
Occurrence of E. gingivalis in HIV(+)/AIDS Patients The occurrence rate of E. gingivalis determined by direct FE
E. gingivalis is not included as a cause of oral lesions in HIV/AIDS by the guidelines of the EC-Clearinghouse on Oral Problems Related to HIV Infection and the World Health Organization Collaborating Center on Oral Manifestations of the Immunodeficiency Virus (1993) [1]
Summary
Oral manifestations are frequent in human immunodeficiency virus (HIV) patients and are primarily and diagnosed during the course of HIV infection. Oral manifestations are diagnosed and classified according to guidelines developed by the ECClearinghouse on Oral Problems Related to HIV Infection and the World Health Organization Collaborating Center on Oral Manifestations of the Immunodeficiency Virus. The oral parasite Entamoeba gingivalis is not included as an HIV-associated periodontal infection in the current guidelines [1]. Entamoeba gingivalis was originally isolated and described by Gros [2], but subsequent studies on this parasite are scarce, outdated, and controversial, mainly due to the difficulty in maintaining E. gingivalis in vitro. Entamoeba gingivalis exists as a trophozoite and is transmitted through oral contact. Its occurrence can vary according to age, presence of periodontal disease, and immunosuppression conditions [3,4,5]
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