E. gingivalis and Periodontal Disease in AIDS
Abstract & Commentary
Synopsis: Metronidazole is a safe and effective therapy for HIV-infected patients with severe gingival disease.
Source: Lucht E, et al. Clin Infect Dis 1998;27:471-473.
Severe periodontal disease is a frequent occurrence in patients with HIV infection. While earlier studies suggest that many of these patients have significant alterations in their viral and fungal but not their bacterial oral microflora, the possible role of protozoal infection in gingival disease has not been previously explored. Lucht and associates examined the prevalence of various protozoa in salivary and dental plaque specimens in 45 patients with HIV and 15 HIV-negative controls. Periodontal disease was present in 13 of 45 (29%) HIV-positive patients compared with two of 15 (13%) HIV-negative controls.
Entamoeba gingivalis was the only protozoa found in the oral cavities of HIV-infected patients, where it was present in 10 (77%) of those with peridontal disease. Only one of the HIV-negative controls and none of the HIV-positive patients, without evidence of gingivitis, had E. gingivalis present in plaque specimens. No other protozoa were identified, including Cryptosporidium or Microsporidium species, or Pneumocystis carinii.
Comment by Carol A. Kemper, MD
While good dental cleaning combined with topical solutions of 10% povidone-iodine solution and chlorhexidine mouth rinses are effective for many of these cases, oral metronidazole has been useful in cases of severe acute necrotic gingival disease—which may be, in part, explained by the known susceptibility of E. gingivalis to metronidazole. Metronidazole is a safe and effective therapy for HIV-infected patients with severe gingival disease.
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