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ORIGINAL RESEARCH Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 89-91
Prevalence of oral Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease and healthy population in Shiraz, southern Iran


1 Department of Oral Medicine, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Parasitology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Prosthodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran

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Date of Submission03-Feb-2008
Date of Decision23-Apr-2009
Date of Acceptance20-Oct-2009
Date of Web Publication27-Apr-2010
 

   Abstract 

Background: It was shown that two parasites of Entamoeba gingivalis (E. gingivalis) and Trichomonas tenax (T. tenax) may be responsible for oral parasitic infection. This study was designed to evaluate the prevalence of these parasites in oral cavity of patients with periodontal disease and in healthy population in Shiraz, Southern Iran.
Materials and Methods: A total of 50 patients with periodontal disease (case group) and 50 subjects with healthy gingiva (control group) entered in the present study. A questionnaire recorded general health, smoking habits, and any history of antibiotic consumption during the last six months for each patient. In the case group, saliva was collected by sterile swab and the gingival crevicular fluid by the paper point. The plaque and calculi were collected by sterile curette and scaler. In the control group, saliva and gingival crevicular fluid were collected and sent to laboratory for further studies.
Results: In the case group, nine patients were infected, six with E. gingivalis and three with T. tenax. Seven patients had mobility of the teeth, one patient was smoker and five had previous history of antibiotic consumption. In the control group, only one subject was infected with E. gingivalis without any history of smoking and antibiotic consumption.
Conclusion: Parasitic infections are relatively common in patients with periodontal disease. It seems that follow-up of instructions are essential in control of parasitic infection in Southern Iran.

Keywords: Entamoeba gingivalis , periodontal disease, southern Iran, Trichomonas tenax

How to cite this article:
Ghabanchi J, Zibaei M, Afkar M D, Sarbazie A H. Prevalence of oral Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease and healthy population in Shiraz, southern Iran. Indian J Dent Res 2010;21:89-91

How to cite this URL:
Ghabanchi J, Zibaei M, Afkar M D, Sarbazie A H. Prevalence of oral Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease and healthy population in Shiraz, southern Iran. Indian J Dent Res [serial online] 2010 [cited 2018 Aug 15];21:89-91. Available from: http://www.ijdr.in/text.asp?2010/21/1/89/62821
Trichomonas tenax (T. tenax) is an anaerobic commensal of the human oral cavity. Several studies were undertaken in relation to prevalence of T. tenax in patients with chronic periodontitis. [1],[2],[3] Transmission can be through saliva, droplet spray, and kissing or use of contaminated dishes and drinking water. [4],[5] Worldwide, its prevalence in the mouth ranges from 4 to 53%. [6],[7],[8] Since the organism is believed to enter the respiratory tract by aspiration from the oropharynx and cause bronchopulmonary trichomoniasis, the importance of oral infections has been increased recently. [9],[10],[11] T. tenax has also been found in submaxillary glands. [12] Entamoeba gingivalis (E. gingivalis) belongs to the Entamoeba species. This organism has a small round nucleus with a central karyosome and fine granular cytoplasm. [13] The oral cavity of human is colonized by specific bacteria, fungi and protozoa. E. gingivalis and T. tenax are protozoa found in human oral cavity and could be seen in swabs taken from dental pockets on the surface of periodontium. The occurrence of E. gingivalis and T. tenax is correlated with the age of host. [6] E. gingivalis was the only protozoa found in the oral cavities of HIV/1 infected patients with periodontal disease.[14] It seems that metabolic disabilities favor pathological changes in periodontal tissues and may influence the species composition of mixed protozoan, bacterial and/or fungal infections in patients with different systemic diseases. [15] As there are controversies on infection to these parasites and their correlation to periodontal diseases and due to their public health importance, this study was carried out to determine the prevalence of E. gingivalis and T. tenax in oral cavity of patients with periodontal disease and in healthy population in Shiraz, Southern Iran.


   Materials and Methods Top


The study included 100 individuals who referred to Shiraz Dental School in Shiraz, Southern Iran. A total of 50 aged-matched 10-60 years old patients (29 females and 21 males) with periodontal disease confirmed radiographically and clinically (periodontal pocket, calculus, swelling and change in consistency and color of the gingiva) were considered as case group. A total of 50 patients aged between 11-54 years (26 females and 24 males) without any periodontal disease and healthy gingiva (pink in color, normal shape, and consistency) were also selected as control group. In both groups, saliva was collected by sterile swab and the gingival crevicular fluid by paper point and all specimens were put in the containers. The container was labeled and sent to the Department of Parasitology and Mycology of Shiraz Medical School. In the case group, the plaque and calculi were collected by sterile curette and scaler. A homogeneous suspension of the sample diluted in normal saline was prepared and then some drops of albumin were added to the solution to increase its adhesion property. A smear was provided and then dried by Schuadinn and methanol, was stained by Giemsa method and studied under microscope for presence of E. gingivalis and T. tenax. The intensity of infestation was not determined in each sample.

A written consent was provided from each patient and the study was approved in the university Ethics Committee. A questionnaire recorded the history of patients' general health, smoking habits, and any antibiotic consumption. Trichrome and Giemsa staining methods were used for parasitological studies. Microscopic observations were made three times under dry magnification. The statistical analysis was performed using SPSS software (Version 11.0, Chicago, IL, USA) by the Chi-square test to study the correlation between the kind of oral disease, age and sex with the presence of parasites.


   Results Top


In the case group, nine patients were infected to the parasites, six (66.7%) with E. gingivalis, and three (33.3%) with T. tenax [Table 1]. Of those infected, six were detected under calculus plaques, two in saliva, and one in gingival fluid. The mean SD age of patients was 35.4 3.7 years. Out of nine patients, seven (77.8%) suffered from progressive periodontal disease including tooth mobility. One patient had previous history of smoking and five (55.6%) had history of antibiotic consumption.

In the control group, the mean SD of patients' age was 28.6 2.1 years. One patient in the control group was infected with E. gingivalis. Males showed a higher infection rate than females with an age range of 30-39 years [Table 2] (P<0.005).


   Discussion Top


This study showed that patients with periodontal disease were more prone to parasitic infections. The prevalence of oral trichomonasis in our study (33.3%) was compatible with many other published reports, which mostly ranged from 12 - 32%. [1],[2],[3],[6],[7],[8] Results of the present study are similar to finding of El Hayawan study, [1] who isolated E. gingivalis from oral cavity of patients with periodontal disease but he could not isolate T. tenax from the oral cavity of those patients. E. gingivalis and T. tenax are commensal protozoa of human oral cavity. Their role in marginal chronic periodontitis was previously reported, and revealed that when a decrease in the immunity level happens or when immunosuppressive drugs are used, the infection may occur in the oral cavity. [1]

Wantland examined 700 patients with periodontitis and found a prevalence of 26.5%. [7] Feki et al. in France reported a prevalence of 28% of T. tenax and 50.7% of E. gingivalis among 300 patients. The mean age was 30 - 32 years old for carriers of E. gingivalis and 45-54 old for those of T. tenax. Mahdi in Iraq examined the saliva of 143 patients with poor oral hygiene and reported a prevalence of 8.4% for T. tenax, [16] but another investigation showed that saliva was not a suitable media for detection of parasite. [17]

In Iran, 50 patients with periodontitis were examined and 46% were found to be infected by T. tenax and E. gingivalis, but the prevalence of each parasite was not determined. [18] Cambon et al. showed that neither the sex, maxillofacial anomalies nor smoking had any influence on parasite incidence and E. gingivalis was encountered in 85% of subjects free from paradonthopathy. Age, social status, alcohol consumption, dental condition, and gingival pathology influenced the presence of T. tenax. [19]

Vrablic et al. [2] showed that oral protozoa of T. tenax and E. gingivalis do not occur in small children and rarely were found in older ones. Their highest occurrence rates were recorded in adults with periodontitis which is similar to the result of the present study.

As parasitic infections are relatively common in our patients with periodontal disease and increase in periodontal disease would result into an increase in parasitic infestations, it seems that following oral and general hygiene instructions are essential in control of parasitic infestations, especially for E. gingivalis and T. tenax in Southern Iran.


   Acknowledgments Top


The authors would like to thank the Office of Vice Chancellor for Research of Shiraz University of Medical Sciences for financial support of this study and Dr. D. Mehrabani at Center for development of Clinical Studies of Nemazee Hospital for editorial assistance.

 
   References Top

1.Hayawan IA, Bayoumi MM. The prevalence of Entamoeba gingivalis and Trichomonas tenax in periodontal disease. J Egypt Soc Parasitol 1992;22:101-5.  Back to cited text no. 1      
2.Vrablic J, Tomova S, Catar G. Occurrence of the protozoa, Entamoeba gingivalis and Trichomonas tenax in the mouth of children and adolescent with hyperplastic gingivitis caused by phenytoin. Bratisl Lek Listy 1992;93:136-40.  Back to cited text no. 2      
3.Feki A, Molet B. Importance of Trichomonas tenax and Entamoeba gingivalis protozoa in the human oral cavity. Rev Odontostomatol 1990;19:37-45.  Back to cited text no. 3      
4.Hersh SM. Pulmonary trichomoniasis and Trichomonas tenax. J Med Microbiol 1985;20:1-10.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Memlik F. Trichomonads in pleural effusion. JAMA 1968;204:1145-6.  Back to cited text no. 5      
6.Sarowaska J, Wojnicz D, Kaczkowski H, Jankowski S. The occurrence of Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease, Immunosupression and genetic diseases. Adv Clin Exp Med 2004;13:291-7.  Back to cited text no. 6      
7.Wantland WW, Luer D. Correlation of some oral hygiene variable with age, sex and incidence of oral protozoa. J Dental Res 1970;49:293-7.  Back to cited text no. 7      
8.Vrablic J, Tomova S, Catar G, Randova L. Morphology and diagnosis of Entamoeba gingivalis and Trichomonas tenax and their occurrence in children and adolescent. Bratisl Lek Listy 1991;92:241-6.  Back to cited text no. 8      
9.Chiche L, Donati S, Corno G, Benoit S, Granier I, Chouraki M, et al. Trichomonas tenax in pulmonary and pleural diseases. Presse Med 2005;34:1371-2.  Back to cited text no. 9      
10.Mallat H, Podglajen I, Lavarde V, Mainardi JL, Frappier J, Cornet M. Molecular characterization of Trichomonas tenax causing pulmonary infection. J Clin Microbiol 2004;42:3886-7.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Mahmoud MS, Rahman GA. Pulmonary trichomoniasis improved diagnosis by using polymerase chain reaction targeting Trichomonas tenax 18S r RNA gene in sputum specimens. J Egypt Soc Parasitol 2004;34:197-211.  Back to cited text no. 11  [PUBMED]    
12.Duboucher C, Mogenet M, Perie G. Salivary trichomoniasis; A case report of infestation of a submaxillary gland by Trichomonas tenax. Arch Pathol Lab Med 1995;119:277-9.  Back to cited text no. 12      
13.Okada H, Matsumato T, Miyuki K, Nakahira T, Omura M, Yamamoto H. Clinico pathological and cytolological study of Entamoeba gingivalis. J Japanese soc Clin Cytol 2002;41:321-6.  Back to cited text no. 13      
14.Lucht E, Evengard B, Skott J, pehrson P, Nord CE. Entamoeba gingivalis in human immunodeficiency virus type 1-infected patients with periodontal disease. Clin infect Dis 1998;27:471-3.  Back to cited text no. 14      
15.Chomicz L, Piekarczyk J, Starosciak B, Fiedor P, Piekarczyk B, Szubinska D, et al. Comparative studies on the occurrence of protozoans, bacteria and fungi in the oral cavity of patients with systemic disorders. Acta Parasitologica 2002;47:147-53.  Back to cited text no. 15      
16.Mahdi NK, Al Saeed AT. Trichomonas tenax in Basrah, Iraq. J Pak Med Assoc 1993;43:261-2.  Back to cited text no. 16      
17.Kikuta N, Yamammato A, Fukura K, Goto N. Specific and sensitive detection of Trichomonas tenax by the polymerase chain reaction. Lett Appl Microbiol 1997;24:193-7.  Back to cited text no. 17      
18.Pestechyan N. Frequency of Entamoeba gingivalis and Trichomonas tenax in patients with periodontal disease and healthy controls in Isfahan province, Iran. Proceeding of 4 th Iranian Congress of Parasitology. Mashad, 2002. p. 117.  Back to cited text no. 18      
19.Cambon M, Petavy AF, Guitot J, Glandier I, Deguillaume J, Coulet M. A study of the frequency of protozoa and yeasts isolated from the paradontium of 509 subjects. Pathol Biol 1979;27:603-6.  Back to cited text no. 19      

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Correspondence Address:
J Ghabanchi
Department of Oral Medicine, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: The Offi ce of Vice Chancellor for Research of Shiraz University of Medical Sciences, Conflict of Interest: None


DOI: 10.4103/0970-9290.62821

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    Tables

  [Table 1], [Table 2]

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