Elsevier

Journal of Endodontics

Volume 39, Issue 8, August 2013, Pages 1084-1087
Journal of Endodontics

Case Report/Clinical Techniques
A Case of Coinfection in a Chronic Maxillary Sinusitis of Odontogenic Origin: Identification of Dialister pneumosintes

https://doi.org/10.1016/j.joen.2013.04.025Get rights and content

Abstract

Introduction

In this report, we discuss the case of a 39-year-old woman presenting with a case of chronic maxillary sinusitis.

Methods

Dialister pneumosintes, Staphylococcus epidermidis, and Peptostreptococcus spp. were isolated from endosinusal samples obtained during surgery. The patient showed extensive periodontopathy and had undergone prior endodontic treatment for endodontic infection of teeth #13, #14, and #15, which failed and presumably acted as a bridge for the sinusal infection. After nasosinusal surgery, consisting of opening and toilet of the maxillary sinus, combined with extraction of the 3 previously mentioned teeth and antibiotic treatment, the patient showed complete healing.

Results

S. epidermidis and Peptostreptococcus spp. were identified with a traditional biochemical test and confirmed by pyrosequencing. Conversely, D. pneumosintes could not be identified with the conventional method, but it was identified using DNA pyrosequencing. In addition, to better understand the role and the virulence of this bacterium in odontogenic sinusitis, we have evaluated the ability of D. pneumosintes to produce biofilms onto inert surfaces. D. pneumosintes is a known endodontic and periodontal pathogen found in necrotic pulp, subgingival plaque, and deep periodontal pockets.

Conclusions

To our knowledge, the pathogenic role of D. pneumosintes in odontogenic sinusitis has never been evidenced. Thus, its detection in endosinusal specimens may provide a significant insight into the pathogenesis of this relevant medical condition.

Section snippets

Case Report

A 39-year-old, nonsmoking woman was referred to the Otolaryngology Department of the San Paolo Hospital, University of Milan, Milan, Italy, with a history of 6 months of facial pain, purulent nose discharge, and a foul taste in her mouth that did not respond to nasal washes or long-term antibiotic treatment with amoxicillin 875 mg and clavulanate 125 mg 3 times a day for 15 days. The patient was otherwise healthy and did not report a fever although laboratory blood analysis suggested an

Discussion

Because of the close proximity of the roots of the maxillary posterior dentition to the floor of the sinus, endodontic infections of these teeth may frequently spread to the maxillary sinus, generating inflammatory changes in the mucosal lining that may lead to severe complications 8, 14. Although clinical documentation regarding primary endodontic treatment of #13, #14, and #15 was not available for the present case, a relationship between oral infection and the observed sinusitis may be

Conclusions

To the best of our knowledge, this is the first case reporting an isolation of D. pneumosintes in a mixed infection of a maxillary chronic sinusitis, and considering the type of microorganisms isolated, we can assume their odontogenic provenience, possibly from the teeth that experienced endodontic treatment failure. Concerning the higher virulence characteristics of microorganisms producing biofilm with respect to the planktonic state, it is worth noting that D. pneumosintes proved able to

Acknowledgments

The authors deny any conflicts of interest related to this study.

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      In a large collection of Dialister spp. systematically collected by Morio et al., D. pneumosintes was the most frequently identified species (46 samples out of 74) and was documented in a diverse set of clinical samples: cutaneous (52.2%), intra-abdominal (23.9%), respiratory (15.2%), blood (4.3%) and gynecological (2.2%) [3]. A common feature of several of these reports is the likely dental origin of the bacterial infection [7,9,10,12]. In some of these report [7], like in our case, it was the diagnosis of the dental pathogen that prompted the search for the oral cavity infection.

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