Microbiota present in combined endodontic-periodontal diseases and its risks for endocarditis

Abstract

Abstract Introduction: Infective endocarditis (IE) is an inflammatory disease usually caused by bacteria that enter the bloodstream and settle in the inner linings or valves of the heart, as well as in blood vessels. Despite modern antimicrobial and surgical treatments, IE continues to cause substantial morbidity and mortality. The oral microbiota has been considered one of the most significant risk factors for IE. The objective of this study was to analyze the microbiota present in clinical samples of root canals (RCs) and periodontal pockets (PPs), in cases with combined endo-periodontal lesions (EPL) in order to detect the species related to IE using the NGS sequencing technique. Methods Microbial samples were collected from the 15 RCs and their associated PPs. Genomic studies associated with bioinformatics combined with the structuring of a database (genetic sequences of bacteria reported for infective endocarditis) allowed to assess the microbial community of both sites. Results The main genera detected in the RC and PPs were Parvimonas, Streptococcus and Enterococcus, both directly linked with IE. A total of 98 species in the RCs and 133 in PPs were identified. Among them 28 species from the RCs and 45 from the PPs were related to IE. Functional inference showed that the microbiological profile of RCs and PPs may not be the only risk factors for IE, but also for other diseases considered systemic such as: Myocarditis, Human Cytomegalovirus infection, Bacterial invasion of epithelial cells, Huntington's disease, Amyotrophic lateral sclerosis and Hypertrophic cardiomyopathy. In addition, it was possible to predict antimicrobial resistance variants for broad-spectrum drugs such as ampicillin, tetracycline, macrolide, among others. Conclusion Microorganisms present in the combined EPL can be a risk factor not only for IE, but also for diseases that are considered systemic. Antimicrobial resistance variants for broad-spectrum drugs were also inferred based on picrust. State-of-the-art sequencing combined with bioinformatics proved to be a powerful tool for conducting studies of microbial communities, which could considerably assist in the diagnosis of serious infections. Clinical Relevance: Few studies have investigated the microbiota in teeth compromised by combined endo-periodontal lesions (EPL) but did not correlate the microbiological findings to any systemic condition, particularly with Infective Endocarditis, using the Next Generation Sequencing technique. In these cases, the presence of apical periodontitis and periodontal diseases could increase the risk for the development of IE, in susceptible patients.