title: Influence of TNF-α blockers on the oral prevalence of opportunistic microorganisms in ankylosing spondylitis patients.
abstract: OBJECTIVE
  To compare the oral prevalence and antimicrobial susceptibility of candida spp., staphylococci, enterobacteriaceae, and pseudomonas spp. from ankylosing spondylitis (AS) patients receiving conventional and anti-TNF-α therapy.
  
  
  METHODS
  The study included 70 AS patients, diagnosed according to the modified New York criteria (1984). The volunteers were divided into 2 groups: a biological group (AS BioG) (n=35) (on anti-TNF-α therapy) and a conventional group (AS ConvG) (n=35). The control group (ContG) (n=70) was made up of healthy individuals matched for age, gender, and oral conditions. After clinical examination, oral rinse samples were collected and plated in specific culture media. The number of colony-forming units per milliliter (cfu/ml) was obtained, and isolates were identified using the API system. Antimicrobial susceptibility tests were performed according to the NCCLS guidelines. Prevalence and counts of microorganisms were statistically compared between the 3 groups, using the Mann-Whitney and Chi-square tests. Significance level was set at 5%.
  
  
  RESULTS
  In both the AS BioG and the AS ConvG, staphylococci counts were higher than that in the ContG (p<0.0001). Candida albicans and staphylococcus epidermidis were the most commonly found species in all the groups. Serratia marcescens and klebsiella oxytoca were more prevalent in the AS BioG and the AS ConvG, respectively. Two candida isolates (2.8%) from the AS BioG and 5 (10.8%) from the AS ConvG were resistant to amphotericin B and 5-fluorocytosine. A low percentage of staphylococci isolates was resistant to amoxicillin, ciprofloxacin, and doxycycline.
  
  
  CONCLUSIONS
  Higher counts of staphylococci were observed in both AS groups, regardless of the current therapy, age, sex, and oral conditions. Anti-TNF-α therapy could not be correlated with increased counts of microorganisms.
authors.affiliation: São José dos Campos Dental School, Universidade Estadual Paulista, Sao José dos Campos, Brazil. dentistadanielfreitas@hotmail.com
authors.forename: Daniel F A
authors.initials: DF
authors.lastname: Pereira
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Pinheiro
authors.forename: Pollyanna F N
authors.initials: PF
authors.lastname: Silva
authors.forename: Guilherme R
authors.initials: GR
authors.lastname: Teodoro
authors.forename: Fernanda L
authors.initials: FL
authors.lastname: Brighenti
authors.forename: Cristiane Y
authors.initials: CY
authors.lastname: Koga-Ito
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology*; D009059:Mouth Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011237:Predictive Value of Tests; D015995:Prevalence; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D000890:Anti-Infective Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha