Comparison of oral microflora in selective IgA deficiency and x linked agammaglobulinemia cases with control group

Yıl 2013, Cilt: 48 Sayı: 3, 204 - 209, 01.10.2013

Ayça Aslan Kıykım Nursen Topçuoğlu Güven Külekçi Haluk Çokuğraş Necla Akçakaya Yıldız Camcıoğlu

Öz

Aim: X linked agammaglobulinemia and selective IgA deficiency are predominantly antibody deficiency syndromes Recurrent sinopulmonary infections are common problems observed in both diseases IgG IgM and salivary IgA which are present especially in gingival crevice are involved in the defense of the oral cavity The aim of our study was to investigate oral mucosa dental health and variation in the microflora in selective IgA deficiency and XLA patients by comparison with the healthy group Material and Method: We reviewed 18 selective IgA deficient subjects 12 66 7 boys and 6 33 3 girls 12 patients with Bruton rsquo;s disease and 31 age matched healthy children aged 2 18 years with normal leucocyte and immunoglobuline levels Oral mucosal investigation dental caries plaque and gingival indices were assessed and all patients were evaluated for S mutans Lactobacillus and yeast colonization in İstanbul University Faculty of Dentistry Results: No significant differences were detected between the groups in terms of high MS level and other parameters Significantly higher lactobacillus and yeast levels were found in XLA patients compared to the selective IgA deficient subjects and healthy group respectively High lactobacillus and yeast levels were correlated with frequent consumption of starch rich food Presence of dental caries was correlated with high plaque and gingival indices Conclusions: The higher frequency of Lactobacillus and yeast colonization in XLA patients indicates that antibodies have a major influence on oral microbiota and antibacterial defense The similar frequency of dental caries and oral mucosal lesions among the groups suggests the importance of neutrophils and antibacterial substances taking part in innate immunity Turk Arch Ped 2013; 48: 204 209

Anahtar Kelimeler

Dental caries, selective IgA deficiency, oral microbiota, X linked agammaglobulinemia

Selektif IgA eksikliği ve X’e bağlı agammaglobülinemi olgularında ağız mikroflorasının sağlam grupla karşılaştırılması

Öz

Amaç: X rsquo;e bağlı agammaglobülinemi ve selektif IgA eksikliği antikor eksikliklerine örnek iki hastalıktır ve yineleyen sinopulmoner enfeksiyonlar hastalığın tanımlayıcı bulgularıdır Ağız boşluğunda özellikle diş eti ceplerinde bulunan salgısal IgA immünglobülin G ve M diş sağlığının korunmasında önemli etmenlerdir Biz bu çalışmada selektif IgA eksikliği ve X rsquo;e bağlı agammaglobülinemi tanılı hastaların ağız diş sağlığını ve ağız mikroflorasındaki değişimi araştırmayı amaçladık.

Gereç ve Yöntem: Çalışmamıza Selektif IgA eksikliği tanısıyla izlenen 12 rsquo;si 66 7 erkek altısı 33 3 kız toplam 18 hasta ve X rsquo;e bağlı agammaglobülinemi Bruton Hastalığı tanısıyla izlenen 12 erkek hasta alındı Kontrol grubu olarak 2 18 yaş arası lökosit ve yaşa göre immünglobülin değerleri normal sınırlarda olan hasta grubuna benzer yaşta 31 hasta alındı Hastalar İstanbul Üniversitesi Diş Hekimliği Fakültesi rsquo;nde diş çürükleri plak ve diş eti indeksleri mutant streptokok laktobasil ve maya düzeyleri açısından değerlendirildi.

Bulgular: Gruplar arasında ağız içi lezyon ve diş çürükleri karşılaştırıldığında istatistiksel anlamlı fark saptanmadı X rsquo;e bağlı agammaglobülinemide selektif IgA eksikliğine göre laktobasil düzeyi kontrol grubuna göre maya varlığı anlamlı olarak yüksek bulundu Yüksek maya ve laktobasil düzeyleri sık nişastalı gıda tüketimiyle diş çürükleri yüksek plak ve diş eti indeksleriyle ilişkili bulundu.

Çıkarımlar: X rsquo;e bağlı agammaglobülinemi hastalarında saptanan yüksek maya ve laktobasil düzeyleri antikorların ağız mikroflorasının oluşumu ve antibakteriyel savunmada önemli yer aldığının göstergesidir Selektif IgA eksikliği ve X rsquo;e bağlı agammaglobülinemi hastalarının ağız içi lezyon ve diş çürüğü sıklığında sağlam gruba göre fark saptanmaması antikorlar dışında nötrofiller ve doğal immün sistemde yer alan diğer antibakteriyel etmenlerin etkili olduğunu düşündürmüştür.

Anahtar Kelimeler

Ağız içi mikroflora, diş çürüğü, selektif IgA eksikliği, X’e bağlı agammaglobülinemi

Kaynakça

• Bonilla FA, Geha RS. 12. Primary immunodeficiency diseases. J Allergy Clin Immunol 2003; 111(Suppl 2): 571-81.
• Cunningham-Rundles C. Physiology of IgA and IgA deficiency. J Clin Immunol 2001; 21(5): 303-9
• Wang Z, Yunis D, Irigoyen M, et al. Discordance between IgA switching at the DNA level and IgA expression at the mRNA level in IgA-deficient patients. Clin Immunol 1999; 91: 263-70.
• Lawton AR, Royal SA, Self KS, Cooper MD. IgA determinants on B-lymphocytes in patients with deficiency of circulating IgA. J Lab Clin Med 1972; 80: 26-33.
• Conley ME, Cooper MD. Immature IgA B cells in IgA-deficient patients. N Engl J Med 1981; 305(9): 495-7.
• Yel L. Selective IgA deficiency. J Clin Immunol 2010; 30: 10-6.
• Yalçın I. X’e bağlı agammaglobülinemi (Bruton Hastalığı). Türkiye Klinikleri Pediatrik Bilimler 2005; 1: 7-9.
• Ebersole JL. Humoral immune responses in gingival crevice fluid: local and systemic implications. Periodontol 2000 2003; 31: 135
• Ebersole JL, Taubman MA, Smith DJ. Gingival crevicular fluid antibody to oral microorganisms. II. Distribution and specificity of local antibody responses. J Periodontal Res 1985; 20(4): 349-56.
• Smith DJ, van Houte J, Kent R, Taubman MA. Effect of antibody in gingival crevicular fluid on early colonization of exposed root surfaces by mutans streptococci. Oral Microbiol Immunol 1994; 9(2): 65-9.
• Mouton C, Hammond PG, Slots J, Genco RJ. Serum antibodies to oral Bacteroides asaccharolyticus (Bacteroides gingivalis): relationship to age and periondontal disease. Infect Immun 1981; 31(1): 182-92.
• Luo Z, Smith DJ, Taubman MA, King WF. Cross-sectional analysis of serum antibody to oral streptococcal antigens in children. J Dent Res 1988; 67(3): 554-60.
• Kent R, Smith DJ, Joshipura K, Soparkar P, Taubman MA. Humoral IgG antibodies to oral microbiota in a population at risk for rootsurface caries. J Dent Res 1992; 71(7): 1399-407.
• Atkinson JC, O’Connell A, Aframian D. Oral manifestations of primary immunological diseases. J Am Dent Assoc 2000; 131(3): 345Tar I, Kiss C, Maródi L, Márton IJ. Oral and dental conditions of children with selective IgA deficiency. Pediatr Allergy Immunol 2008; 19(1): 33-6.
• Nikfarjam J, Pourpak Z, Shahrabi M, et al. Oral manifestations in selective IgA deficiency. Int J Dent Hyg 2004; 2(1): 19-25.
• Coykendall AL. Proposal to elevate the subspecies of Streptococcus mutans to species status based on their molecular composition. Int J Syst Bacteriol 1977; 27(1): 26-30.
• Külekçi G. Bir infeksiyon hastalığı: Diş çürüğü. İçinde: Agacfidan A, Erturan AZ, (yazarlar). XXXIII. Türk Mikrobiyoloji Kongresi Kongre Kitabı. İstanbul, 2008:148-56.
• Robertson PB, Wright TE 3rd, Mackler BF, Lenertz DM, Levy BM. Periodontal status of patients with abnormalities of the immune system. J Periodontal Res 1978; 13(1): 37-45.
• Robertson PB, Mackler BF, Wright TE, Levy BM. Periodontal status of patients with abnormalities of the immune system. II. observations over a 2-year period. J Periodontol 1980; 51(2): 70-3.
• Cole MF, Arnold RR, Rhodes MJ, McGhee JR. Immune dysfunction and dental caries: a preliminary report. J Dent Res 1977; 56(3): 198-20
• Legler DW, McGhee JR, Lynch DP, et al. Immunodeficiency disease and dental caries in man. Arch Oral Biol 1981; 26(11): 905Brown LR, Mackler BF, Levy BM, et al. Comparison of the plaque microflora in immunodeficient and immunocompetent dental patients. J Dent Res 1979; 58(12): 2344-52.
• Dahlén G, Björkander J, Gahnberg L, Slots J, Hanson LA. Periodontal disease and dental caries in relation to primary IgG subclass and other humoral immunodeficiencies. J Clin Periodontol 1993; 20(1): 7-13.
• Norhagen GE, Engström PE, Hammarström L, Smith CI, Nord CE. Oral and intestinal microflora in individuals with different immunoglobulin deficiencies. Eur J Clin Microbiol Infect Dis 1990; 9(8): 631-3.
• Aksu G, Genel F, Koturoğlu G, Kurugöl Z, Kütükçüler N. Serum immunoglobulin (IgG, IgM, IgA) and IgG subclass concentrations in healthy children: a study using nephelometric technique. Turk J Pediatr 2006; 48(1): 19-24.
• Külekçi G. Diş çürüğü aktivite testleri nedir? Neden, ne zaman ve nasıl uygulanmalı? IDO Dergi 2001; 81: 10.
• Gold OG, Jordan HV, Van Houte J. A selective medium for Streptococcus mutans. Arch Oral Biol 1973; 18(11): 1357-64.
• Rogosa M, Mitchell JA, Wiseman RF. A selective medium for the isolation and enumeration of oral and fecal lactobacilli. J Bacteriol 1951; 62(1): 132-3.
• Brathall D, Björkander J. Bacteria and oral fluid component: report of the oral condition in hypogammaglobulinaemic patients. In: Lehner T, Cimasoni G, (eds). The borderland between caries and periodontal disease. London: Academic press, 1980: 159-73.
• Arnold RR, Pruitt KM, Cole MF, Adamson JM, McGhee JR. Salivary antibacterial mechanisms in immunodeficiency. In: I. Kleinberg, S. A. Ellison and I. D. Mandel, (eds). Saliva and dental caries. New York: N.Y. Information Retrieval Inc, 1979: 449-62.
• Fernandes FR, Nagao AT, Mayer MP, Zelante F, Carneiro-Sampaio MM. Compensatory levels of salivary IgM anti-Streptococcus mutans antibodies in IgA-deficient patients. J J Investig Allergol Clin Immunol 1995; 5(3): 151-5.
• Engström GN, Engström PE, Hammarström L, Smith CI. Oral conditions in individuals with selective immunoglobulin A deficiency and common variable immunodeficiency. J Periodontol 1992; 63(12): 984-9.
• Aslan Kıykım ve ark. Birincil immün yetersizlikte ağız mikroflorası / Oral microflora in primary immune deficiencies Norhagen G, Engström PE, Hammarström L, Söder PO, Smith CI. Immunoglobulin levels in saliva in individuals with selective IgA deficiency: compensatory IgM secretion and its correlation with HLA and susceptibility to infections. J Clin Immunol 1989; 9(4): 279Kirstilä V, Tenovuo J, Ruuskanen O, Nikoskelainen J, Irjala K, Vilja P. Salivary defense factors and oral health in patients with common variable immunodeficiency. J Clin Immunol 1994; 14(4): 229Arnold RR, Cole MF, Prince S, McGhee JR. Secretory IgM antibodies to Streptococcus mutans in subjects with selective IgA deficiency. Clin Immunol Immunopathol 1977; 8(3): 475-86.
• Malamud D. Influence of saliv ary proteins on the fate of oral bacteria. In: Mergenhagen SE, Rosan B, (eds). Molecular basis of oral microbial adhesion. Washington, D.C: American Society for Microbiology, 1985: 117-24.
• Marcotte H, Lavoie MC. No apparent influence of immunoglobulins on indigenous oral and intestinal microbiota of mice. Infect Immun 1997; 64(11): 4694-9.
• Aguirre A, Testa-Weintraub LA, Banderas JA, Haraszthy GG, Reddy MS, Levine MJ. Sialochemistry: a diagnostic tool. Crit Rev Oral Biol Med 1993; 4(3-4): 343-50.
• Rudney JD. Does variability in salivary protein concentrations influence oral microbial ecology and oral health. Crit Rev Oral Biol Med 1995; 6(4): 343-67.
• McCourtie J, Douglas LJ. Relationship between cell surface composition of Candida albicans and adherence to acrylic after growth on different carbon sources. Infect Immun 1981; 32(3): 1234Knight L, Fletcher J. Growth of Candida albicans in saliva: stimulation by glucose associated with antibiotics, corticosteroids, and diabetes mellitus. J Infect Dis 1971; 123(4): 371-7