Tongue Swabs Research Articles

Staphylococcal infection in the mouth

Objective A retrospective analysis of laboratory data to investigate the isolation of Staphylococcus aureus from the oral cavity and facial area in specimens submitted to a regional diagnostic oral microbiology laboratory. Methods A hand search of laboratory records for a three-year period (1998–2000) was performed for specimens submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital and School. Data were collected from forms where S. aureus was isolated. These data included demographics, referral source, specimen type, methicillin susceptibility and clinical details. Results For the period 1998–2000, there were 5,005 specimens submitted to the laboratory. S. aureus was isolated from 1,017 specimens, of which 967 (95%) were sensitive to methicillin (MSSA) and 50 (5%) were resistant to methicillin (MRSA). The 1,017 specimens were provided from 615 patients. MRSA was isolated from 37 (6%) of patients. There was an increasing incidence of S. aureus with age, particularly in the >70 years age group. The most common specimen from which MSSA was isolated was an oral rinse (38%) whilst for MRSA isolates this was a tongue swab (28%). The clinical condition most commonly reported for MSSA isolates was angular cheilitis (22%). Erythema, swelling, pain or burning of the oral mucosa was the clinical condition most commonly reported for MRSA isolates (16%). Patients from whom the MSSA isolates were recovered were most commonly (55%) seen in the oral medicine clinic at the dental hospital, whilst patients with MRSA were more commonly seen in primary care settings such as nursing homes, hospices and general dental practice (51%). Conclusion In line with more recent surveys, this retrospective study suggests that S. aureus may be a more frequent isolate from the oral cavity than hitherto suspected. A small proportion of the S. aureus isolates were MRSA. There were insufficient data available to determine whether the S. aureus isolates were colonising or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.

Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data.

A retrospective analysis of laboratory data to investigate the isolation of Staphylococcus aureus from the oral cavity and facial area in specimens submitted to a regional diagnostic oral microbiology laboratory. A hand search of laboratory records for a three-year period (1998-2000) was performed for specimens submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital and School. Data were collected from forms where S. aureus was isolated. These data included demographics, referral source, specimen type, methicillin susceptibility and clinical details. For the period 1998-2000, there were 5,005 specimens submitted to the laboratory. S. aureus was isolated from 1,017 specimens, of which 967 (95%) were sensitive to methicillin (MSSA) and 50 (5%) were resistant to methicillin (MRSA). The 1,017 specimens were provided from 615 patients. MRSA was isolated from 37 (6%) of patients. There was an increasing incidence of S. aureus with age, particularly in the >70 years age group. The most common specimen from which MSSA was isolated was an oral rinse (38%) whilst for MRSA isolates this was a tongue swab (28%). The clinical condition most commonly reported for MSSA isolates was angular cheilitis (22%). Erythema, swelling, pain or burning of the oral mucosa was the clinical condition most commonly reported for MRSA isolates (16%). Patients from whom the MSSA isolates were recovered were most commonly (55%) seen in the oral medicine clinic at the dental hospital, whilst patients with MRSA were more commonly seen in primary care settings such as nursing homes, hospices and general dental practice (51%). In line with more recent surveys, this retrospective study suggests that S. aureus may be a more frequent isolate from the oral cavity than hitherto suspected. A small proportion of the S. aureus isolates were MRSA. There were insufficient data available to determine whether the S. aureus isolates were colonising or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.

High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer.

Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non-C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.

Association of HIV viral load with oral diseases.

The measurement of HIV viral load as a predictor of disease progression has revolutionized the medical management of HIV patients. In this study, oral diseases as measured by DMFT (decayed, missing and filled teeth), periodontal assessment and oral Candidacolonization, were related to HIV viral load. Also correlated was HIV status assessments, including CD4+ count, a history of intravenous drug abuse (IVDA) and the use of protease inhibitor drugs. Oral and periodontal examination, dental radiographs, and tongue swab for fungal culture was accomplished over a 2-month period on 39 HIV positive patients attending the University of Maryland Dental School. Twenty-eight (71. 8%) of these patients had a history of IVDA. Viral load was measured by a quantitative RT-PCR. Among the patients with high viral load (>10 000 copies ml-1), 92.3% were found to have a history of IVDA. Also, patients with high viral load demonstrated average CD4+ counts of 136 mm-3 while moderate viral load (400-10 000 copies ml-1) corresponded to average counts of 271 mm-3. Periodontal pocket depths (PPD) of >5 mm at a minimum of two oral sites were found in 76.9% of the patients with high viral load. Among the high viral load patients, 69.2% had DMFT >20, 69.2% were culture positive for Candida and 81.5% of patients on protease inhibitors demonstrated moderate or low viral loads. These data demonstrated that elevated viral load levels correlate well with oral disease prevalence in this predominantly IVDA population of HIV-infected dental patients.

Occurrence of Yersinia enterocolitica O:3, Listeria monocytogenes O:4 and thermophilic Campylobacter spp. in slaughter pigs and carcasses in Trinidad

Pigs slaughtered at an abattoir in Trinidad were sampled for the occurrence of Yersinia, Listeria and Campylobacter at different sites. The antibiograms of Yersinia isolates were also determined. Of 141 samples each of rectal and tongue swabs taken, 23(16·1%) and 9(6·4%) were positive for Y. enterocolitica compared to 11(7·3%) of 150 tonsillar samples yielding the organism. Rectal swabs had a statistically significantly ( P ≤ 0·05, x 2 ) higher frequency of isolation than tongue or tonsillar swabs. All 43 isolates of Y. enterocolitica were serotype O:3 biotype 4. From a total of 139 rectal swabs cultured for thermophilic Campylobacter , 75(51·8%) were C. coli and 3(2·2%) were positive for C. jejuni . The difference was statistically significant ( P ≤ 0·001; x 2 ). Carcass swabs also yielded significantly more C. coli , 27(17·4%) than C. jejuni , 4(2·6%) of 155 samples cultured. Seven (5·0%) of 139 rectal swabs tested were positive for Listeria monocytogenes while only 3(1·9%) of 155 carcass samples yielded the organism but the difference was not statistically significant ( P ≥ 0·05; x 2 ). Nine of 10 isolates of L. monocytogenes were serotype 4 while one was serotype 1. Resistance of the 43 isolates of Y. enterocolitica was highest to penicillin (100·0%), neomycin (100·0%) but least to gentamycin (2·3%) and sulfamethoxazole/trimethoprim (0·0%). It was concluded that Y. enterocolitica serotype O:3, biotype 4 is predominant in pigs in Trinidad and the isolation of L. monocytogenes , particularly serotype 4, and C. coli and C. jejuni from pork carcasses may pose a health risk to consumers.

Studies on the Yeast Flora in Patients Suffering from Psoriasis Capillitii or Seborrhoic Dermatitis of the Scalp

In 65 patients with scalp psoriasis or seborrhoic dermatitis of the scalp, stool specimens, tongue swabs and scalp scales were examined for yeasts. The stool specimens showed in 70.8% of the patient group massive and in 7.7% moderate yeast colonization. Yeasts were found in 47.7% of the tongue cultures and in 12.5% of the scalp scales. Candida albicans was the predominant pathogen in the faeces and on the tongue. In comparison with a control group, frequency of yeasts in faeces and on the tongue in patients with psoriasis capillitii and seborrhoic dermatitis of the scalp could be shown to be significantly higher.

Comparison of Sampling and Isolation Procedures for Recovery of Yersinia Enterocolitica Serotype 0:3 from the Oral Cavity of Slaughter Pigs

Yersinia enterocolitica serotype 0:3/biotype 4 was isolated from the oral cavity of altogether 32 (68.1 %) of 47 freshly eviscerated slaughter pigs. Most efficient recovery was achieved by cultivation of tissue samples from both tongue and tonsils of the same individual. The isolation rate so obtained was significantly higher than that obtained by separate examination of either tonsil swabs or tongue swabs. However, the isolation frequency achieved by combined swabbing of the 2 sites was not significantly different. In general, tonsils were more productive for the recovery of 0:3 strains than were tongues, and tissue samples yielded higher isolation rates than did swabs. Three-week cold enrichment in a low selective medium proved essential for optimal recovery. However, the highest number of isolates was obtained using a combination of methods, including direct plating and selective enrichment in a modified Rappaport broth in addition to cold enrichment.