title: The connection between ruptured cerebral aneurysms and odontogenic bacteria.
abstract: BACKGROUND
  Patients with ruptured saccular intracranial aneurysms have excess long-term mortality due to cerebrovascular and cardiovascular diseases compared with general population. Chronic inflammation is detected in ruptured intracranial aneurysms, abdominal aortic aneurysms and coronary artery plaques. Bacterial infections have been suggested to have a role in the aetiology of atherosclerosis. Bacteria have been detected both in abdominal and coronary arteries but their presence in intracranial aneurysms has not yet been properly studied.
  
  
  OBJECTIVE
  The aim of this preliminary study was to assess the presence of oral and pharyngeal bacterial genome in ruptured intracranial aneurysms and to ascertain if dental infection is a previously unknown risk factor for subarachnoid haemorrhage.
  
  
  METHODS
  A total of 36 ruptured aneurysm specimens were obtained perioperatively in aneurysm clipping operations (n=29) and by autopsy (n=7). Aneurysmal sac tissue was analysed by real time quantitative PCR with specific primers and probes to detect bacterial DNA from several oral species. Immunohistochemical staining for bacterial receptors (CD14 and toll-like receptor-2 (TLR-2)) was performed from four autopsy cases.
  
  
  RESULTS
  Bacterial DNA was detected in 21/36 (58%) of specimens. A third of the positive samples contained DNA from both endodontic and periodontal bacteria. DNA from endodontic bacteria were detected in 20/36 (56%) and from periodontal bacteria in 17/36 (47%) of samples. Bacterial DNA of the Streptococcus mitis group was found to be most common. Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Treponema denticola were the three most common periodontal pathogens. The highly intensive staining of CD14 and TLR-2 in ruptured aneurysms was observed.
  
  
  CONCLUSIONS
  This is the first report showing evidence that dental infection could be a part of pathophysiology in intracranial aneurysm disease.
authors.affiliation: Department of Oral and Maxillofacial Diseases, Tampere University Hospital, , Tampere, Finland.
authors.forename: Mikko J
authors.initials: MJ
authors.lastname: Pyysalo
authors.forename: Liisa M
authors.initials: LM
authors.lastname: Pyysalo
authors.forename: Tanja
authors.initials: T
authors.lastname: Pessi
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: Juha E
authors.initials: JE
authors.lastname: Öhman
mesh_terms: D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification; D017542:Aneurysm, Ruptured / Q000382:microbiology* / Q000473:pathology; D001424:Bacterial Infections / Q000382:microbiology* / Q000473:pathology; D004269:DNA, Bacterial / Q000032:analysis*; D005260:Female; D016967:Fusobacterium nucleatum / Q000302:isolation & purification; D006801:Humans; D002532:Intracranial Aneurysm / Q000382:microbiology* / Q000473:pathology; D018950:Lipopolysaccharide Receptors / Q000032:analysis; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology*; D010519:Periodontium / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D013345:Subarachnoid Hemorrhage / Q000382:microbiology* / Q000473:pathology; D051195:Toll-Like Receptor 2 / Q000032:analysis; D048373:Treponema denticola / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial; D018950:Lipopolysaccharide Receptors; C495342:TLR2 protein, human; D051195:Toll-Like Receptor 2
keywords: BACTERIOLOGY; INFECTIOUS DISEASES; SUBARACHNOID HAEMORRHAGE