Periodontal pathogens ( Porphyromonas gingivalis and Fusobacterium nucleatum) may promoting oral cancer ( Kaposi's sarcoma)

Kaposi's sarcoma  (KS) is a tumor caused by human herpesvirus 8 (HHV8, also known as Kaposi's sarcoma-associated herpesvirus, KSHV).  About 20% of HIV patients develop Kaposi's sarcoma (KS) lesions in the oral cavity while other patients never develop oral KS. It is not known if the oral micro environment plays a role in oral KS tumor development.

Xiaolan and colleagues from Case Western Reserve University, Cleveland, Ohio demonstrated that a group of metabolic by-products (short chain fatty acids), from bacteria that cause periodontal disease (Porphyromonas gingivalis and Fusobacterium nucleatum) promote lytic replication of KSHV. These new findings provide mechanistic support that periodontal pathogens create a unique micro environment in the oral cavity that contributes to KSHV replication and development of oral KS. However, more research is needed to find out if patients with KS suffer more often from periodontal disease and exhibit higher levels short chain fatty acids produced by the periodontal pathogens.

oral cavity Kaposi's sarcoma

Fecal transplants for the treatment of recurrent Clostridium difficile infection

Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high. Fecal microbiota transplantation has been shown to be a superior therapeutic modality for the treatment of recurrent C. difficile infection (RCDI) and disease is fecal transplantation. A recent review of 317 patients from 27 case-report series concluded that fecal transplantation was highly effective and resulted in disease resolution in 92% of patients involved in the study.

Van Nood and colleagues provided the first controlled study of treating RCDI with fecal transplantation. In an open-label, non-blinded manner, 43 adult patients were randomly assigned to oral vancomycin, oral vancomycin plus bowel lavage or vancomycin plus bowel lavage followed by fecal transplantation by nasoduodenal tube. Of the patients in the randomized group to receive fecal transplantation from a donor, clinical disease resolved in 81% (13/16) after the first infusion. An additional infusion from a different donor resulted in resolution in two additional patients. Of the control groups, clinical resolution occurred in 31% (4/13) of patients who received vancomycin alone, and in 23% (3/13) of those who received vancomycin plus bowel lavage.

Fecal transplantation appears to be a promising therapy for RCDI, but important unkowns exist. These include the most effective dose, method of preparation, route of administration, and the safety of using donor samples. With the publication of one controlled trial, more data are needed to address these concerns.