title: A case of coinfection in a chronic maxillary sinusitis of odontogenic origin: identification of Dialister pneumosintes.
abstract: BACKGROUND
  In this report, we discuss the case of a 39-year-old woman presenting with a case of chronic maxillary sinusitis.
  
  
  METHODS
  Dialister pneumosintes, Staphylococcus epidermidis, and Peptostreptococcus spp. were isolated from endosinusal samples obtained during surgery. The patient showed extensive periodontopathy and had undergone prior endodontic treatment for endodontic infection of teeth #13, #14, and #15, which failed and presumably acted as a bridge for the sinusal infection. After nasosinusal surgery, consisting of opening and toilet of the maxillary sinus, combined with extraction of the 3 previously mentioned teeth and antibiotic treatment, the patient showed complete healing.
  
  
  RESULTS
  S. epidermidis and Peptostreptococcus spp. were identified with a traditional biochemical test and confirmed by pyrosequencing. Conversely, D. pneumosintes could not be identified with the conventional method, but it was identified using DNA pyrosequencing. In addition, to better understand the role and the virulence of this bacterium in odontogenic sinusitis, we have evaluated the ability of D. pneumosintes to produce biofilms onto inert surfaces. D. pneumosintes is a known endodontic and periodontal pathogen found in necrotic pulp, subgingival plaque, and deep periodontal pockets.
  
  
  CONCLUSIONS
  To our knowledge, the pathogenic role of D. pneumosintes in odontogenic sinusitis has never been evidenced. Thus, its detection in endosinusal specimens may provide a significant insight into the pathogenesis of this relevant medical condition.
authors.affiliation: Laboratory of Clinical-Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Department of Biomedical Sciences for Health, University of Milan, Italy. lorenzo.drago@unimi.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Drago
authors.forename: Christian
authors.initials: C
authors.lastname: Vassena
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Saibene
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Felisati
mesh_terms: D000328:Adult; D002908:Chronic Disease; D060085:Coinfection / Q000175:diagnosis*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005491:Focal Infection, Dental / Q000382:microbiology*; D005500:Follow-Up Studies; D016965:Gram-Negative Anaerobic Straight, Curved, and Helical Rods / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D015523:Maxillary Sinusitis / Q000382:microbiology*; D009957:Oroantral Fistula / Q000382:microbiology; D010462:Peptostreptococcus / Q000302:isolation & purification; D010483:Periapical Diseases / Q000382:microbiology; D017422:Sequence Analysis, DNA / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
chemical_list: D004269:DNA, Bacterial
keywords: Biofilm; Dialister pneumosintes; odontogenic infection; pyrosequencing