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Gingival colonization with selective HACEK microbes in children with congenital heart disease
Robert Steelman1, David A Rosen, E R Nelson
1Department of Pediatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon 97201, USA. steelmar@ohsu.edu
Insights
Children with congenital heart disease (CHD) show higher levels of HACEK microbes, specifically Eikenella corrodens. This increased microbial presence is independent of gingival inflammation severity or cyanosis in pediatric patients.
Area of Science:
- Oral microbiology
- Pediatric cardiology
Background:
- Congenital heart disease (CHD) is associated with increased HACEK (Hemophilus, Actinobacillus, Cardiobacter, Eikenella, Kingella) microbial colonization and gingival inflammation in children.
- Previous studies suggest a link between CHD and specific oral bacteria, but the role of gingival inflammation as a confounding factor requires further investigation.
Purpose of the Study:
- To investigate the prevalence of HACEK microbes in children with CHD compared to healthy children, specifically when gingival inflammation levels are matched.
- To determine if specific HACEK bacteria, such as Eikenella corrodens and Actinobacillus actinomycetemcomitans, are more common in children with CHD, irrespective of gingival inflammation.
Main Methods:
- A case-control study involving 12 children with CHD and 12 healthy controls, matched for gingival inflammation using the Massler gingival index.
- Subgingival plaque samples were collected and cultured for HACEK microbes.
- Statistical analysis using Fischer's exact test (P<0.05 significance level).
Main Results:
- No significant difference in gingival inflammation was observed between the CHD (mean index 6.5) and control (mean index 6.4) groups.
- Eikenella corrodens was significantly more prevalent in children with CHD (9/12) compared to controls (3/12) (P<0.05).
- Actinobacillus actinomycetemcomitans was found in 3/12 CHD patients but not in controls (P>0.05). No significant differences were found between cyanotic and acyanotic CHD patients for these bacteria.
Conclusions:
- Children with CHD harbor specific HACEK microbes, notably Eikenella corrodens, at a higher rate than healthy children, even when gingival inflammation is comparable.
- The increased prevalence of these oral microbes in CHD is not directly linked to the degree of gingival inflammation or cyanosis.
- Further research is necessary to fully understand the clinical implications of these microbial findings in pediatric CHD patients.
Abstract:
It was previously shown that children with congenital heart disease (CHD) harbored Hemophilus, Actinobacillus, Cardiobacter, Eikenella, and Kingella (HACEK) microbes to a greater extent and had more severe gingival inflammation than a normal group of children. The purpose of this study was to determine if HACEK microbes are more prevalent in children with CHD than in normal children when there is no difference in gingival inflammation. Two groups of 12 children were matched with respect to gingival inflammation. Each child had a gingival index recorded as described by Massler. The experimental group consisted of 12 children with CHD 2.5-10 years old (average 5.5) and the control group consisted of 12 healthy children 2-13 years old (average 5.6). Subgingival samples were obtained and cultured for HACEK microbes. Fischer's exact test was performed with the significance level defined at P<0.05. The average gingival indices for the experimental and control groups were 6.5 and 6.4, respectively (N.S.). Nine of 12 children with CHD had Eikenella corrodens (E.c.) compared to 3/12 control patients ( P<0.05). Three of 12 CHD patients but no control patient had Actinobacillus actinomycetemcomitans (A.a.) (N.S.). There were no significant differences in E.c. or A.a. presence between cyanotic and acyanotic CHD patients. This study found that the greater extent of specific HACEK microbes harbored by children with CHD is not associated with cyanosis or the degree of gingival inflammation. Further study is needed to delineate fully the medical significance of this observation.