Oral Systemic Infection – Endocardial Involvement

Isabela Ioana Loghin, Laura Ghibu, Codrina Bejan, Florin Rosu, Carmen Mihaela Dorobat

The aim of the present study is to investigate oral systemic infections and their complications, with a closer look to the endocardial involvement. Material and methods The present study was performed on 31 patients diagnosed with oral sepsis between 2004-2010, in “Sf. Cuv. Parascheva” Infectious Diseases Hospital from Iasi. The link between dental intervention and bacterial endocarditis was anamnestic documented. The organic damages or dysfunctions occurred in sepsis were followed, and the aetiology and clinical response to the applied antibiotherapy were analysed. Results Patients included in this study, most men coming from rural areas, and having most affected group aged between 40 and 60 years, had presented in association predisposing conditions for the basic damage (oral sepsis). Other patients were accused of an oral hygiene lack and incomplete dental treatment for initial conditions. After interdisciplinary clinical examination and intraoperative assessment in Surgery Clinics (Oro-maxillo-facial Surgery, Ophthalmology) the diagnose of patients oriented to specific damages and then they were transferred to the Infectious Diseases Hospital and diagnosed with oral sepsis, on prone land to this pathology (valvular, implanted cardiac devices, diabetes, liver diseases, cancer, tuberculosis, pancytopenia). At 4 patients, the transthoracic echocardiography detected vegetation on mitral valve (specific for endocarditis) and prosthetic valve dehiscence in mitral position to a patient from rural areas, with periapical abscess and multiple root debris. Echocardiographic diagnosis of infectious endocarditis subsequently confirmed by positive blood cultures (Enterococcus faecalis, anaerobic gram-negative bacilli) was found at patients with valvular heart diseases and a history of tooth extraction without prophylaxis. Regarding the therapy of these infections were used antibiotics as beta-lactams in association with quinolones and/or chloramphenicol in order to cover the specific polimicrobian spectrum, applying the de-escalation techniques, with an evolution and favourable prognosis in more than half cases. Conclusions Literature and guidelines for prevention and management of odontogenic bacteraemia were in constant review, regarding prophylactic antibiotics and invasive procedures with dental visa, expressing different opinions. Diagnosis of infective endocarditis (5 cases) on patients with valvular heart disease and a history of tooth extraction without prophylaxis, unfortunately indicate a low level of compliance of some practitioners to the specific recommendations, and non-recognition of the situations when the prophylaxis is absolutely necessary.

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