title: Intracerebral hemorrhage and deep microbleeds associated with cnm-positive Streptococcus mutans; a hospital cohort study.
abstract: Oral infectious diseases are epidemiologically associated with stroke. We previously showed that oral Streptococcus mutans with the cnm gene encoding a collagen-binding Cnm protein induced intracerebral hemorrhage (ICH) experimentally and was also associated with cerebral microbleeds (CMBs) in our population-based cohort study. We therefore investigated the roles of cnm-positive Streptococcus mutans in this single hospital-based, observational study that enrolled 100 acute stroke subjects. The cnm gene in Streptococcus mutans isolated from saliva was screened using PCR techniques and its collagen-binding activities examined. CMBs were evaluated on T2* gradient-recalled echo MRI. One subject withdrew informed consent and 99 subjects (63 males) were analyzed, consisting of 67 subjects with ischemic stroke, 5 with transient ischemic attack, and 27 with ICH. Eleven cases showed Streptococcus mutans strains positive for cnm. The presence of cnm-positive Streptococcus mutans was significantly associated with ICH [OR vs. ischemic stroke, 4.5; 95% CI, 1.17-19.1] and increased number of deep CMBs [median (IQR), 3 (2-9) vs. 0 (0-1), p = 0.0002]. In subjects positive for Streptococcus mutans, collagen binding activity was positively correlated with the number of deep CMBs (R(2) = 0.405; p < 0.0001). These results provide further evidence for the key role of oral health in stroke.
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Shuichi
authors: S
authors: Tonomura
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Masafumi
authors: M
authors: Ihara
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Tomohiro
authors: T
authors: Kawano
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Tomotaka
authors: T
authors: Tanaka
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Yoshinori
authors: Y
authors: Okuno
authors: Departments of Regenerative Medicine and Tissue Engineering, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Satoshi
authors: S
authors: Saito
authors: Department of Neurology, University of Louisville, 401 E. Chestnut Street, Suite 510, Louisville, Kentucky, 40292, USA.
authors: Robert P
authors: RP
authors: Friedland
authors: Department of Preventive Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji Agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
authors: Nagato
authors: N
authors: Kuriyama
authors: Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka 565-0871, Japan.
authors: Ryota
authors: R
authors: Nomura
authors: Department of Preventive Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji Agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
authors: Yoshiyuki
authors: Y
authors: Watanabe
authors: Department of Pediatric Dentistry, Osaka University Graduate School of Dentistry, 1-8 Yamada-Oka, Suita, Osaka 565-0871, Japan.
authors: Kazuhiko
authors: K
authors: Nakano
authors: Division of Cerebrovascular Medicine, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Kazunori
authors: K
authors: Toyoda
authors: Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
authors: Kazuyuki
authors: K
authors: Nagatsuka
mesh_terms: D018829:Adhesins, Bacterial / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002097:C-Reactive Protein / Q000032:analysis; D002352:Carrier Proteins / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D015331:Cohort Studies; D003094:Collagen / Q000737:chemistry / Q000378:metabolism; D004269:DNA, Bacterial / Q000378:metabolism; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011485:Protein Binding; D012463:Saliva / Q000382:microbiology; D013295:Streptococcus mutans / Q000302:isolation & purification / Q000378:metabolism*; D020521:Stroke / Q000382:microbiology / Q000473:pathology
chemical_list: D018829:Adhesins, Bacterial; D002352:Carrier Proteins; C488758:Cnm protein, Streptococcus mutans; D004269:DNA, Bacterial; D003094:Collagen; D002097:C-Reactive Protein