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Biomedical subjects

T T Lillich

Publications and source records attributed to T T Lillich.

At least 19 recordsLinked to original sources
PubMed1994

Emergence of gram-negative bacilli in the mouths of bone marrow transplant recipients using chlorhexidine mouthrinse.

PURPOSE/OBJECTIVES: To examine whether use of chlorhexidine (CHX) in stomatitis-prevention regimens following bone marrow transplantation (BMT) enhances the emergence of gram-negative bacilli (GNB) to a degree that exceeds its benefits. DATA SOURCES: Articles, book chapters, and case studies. DATA SYNTHESIS: Despite rigorous topical and systemic antimicrobial therapy, oral opportunistic GNB infections occur following BMT. This is most likely because of low susceptibility of GNB to CHX and not that CHX predisposes patients to these infections or the development of CHX resistant strains. CONCLUSIONS: The benefits of CHX use (e.g. preservation of oral mucosa and broad-spectrum antibacterial and antifungal effects) outweight the risks of GNB infection. IMPLICATIONS FOR NURSING PRACTICE: Routine clinical and microbiologic monitoring of the oral cavity are essential with use of CHX. Stomatitis care standards and patient instructions following discharge are included.

Adult↗
PubMed1991

Oral Candida albicans in bone marrow transplant patients given chlorhexidine rinses: occurrence and susceptibilities to the agent.

The tongue and buccal mucosa of 26 bone marrow transplant recipients given three 0.12% chlorhexidine digluconate (CHX) oral rinses daily for 8 weeks were sampled weekly for oral Candida albicans. Putative C. albicans colony-forming units on selective bismuth sulfite glucose glycine yeast agar plates were identified with the API 20C system. The CHX minimum inhibitory concentrations (MICs) of oral C. albicans isolates obtained at all 8 sample weeks was determined with a microbroth dilution sensitivity assay. The CHX MIC range for yeast isolates selected randomly at all sample weeks was up to 2.5 to up to 20 micrograms/ml (mean MIC less than or equal to 8.5 micrograms/ml). The CHX MIC range for isolates at week 1 was less than or equal to 5 to less than or equal to 10 micrograms/ml (mean MIC less than or equal to 7.9 micrograms/ml) compared with less than or equal to 2.5 to less than or equal to 20 micrograms/ml at week 8 (mean MIC less than or equal to 8.8 micrograms/ml). Therefore the persistence of oral C. albicans in bone marrow transplant recipients using CHX rinses was due neither to low CHX susceptibilities nor to the development of resistance to the agent.

Bone Marrow Transplantation↗
PubMed1990

In vitro effect of chlorhexidine and amikacin on oral gram-negative bacilli from bone marrow transplant recipients.

Prophylactic use of chlorhexidine (CHX) mouthrinses has been shown to benefit the oral health status of bone marrow transplant recipients and other immunosuppressed persons and to reduce systemic complications of oral origin. However, a problem that often emerges with these patients is oropharyngeal and lower respiratory tract colonization by opportunistic aerobic or facultative gram-negative bacilli (GNB). Trends in four studies indicated that CHX rinses may predispose these persons to oral colonization by GNB such as the enterobacteria, Klebsiella pneumoniae and Enterobacter cloacae. Since GNB are generally susceptible to broad-spectrum aminoglycoside antibiotics such as amikacin, the in vitro sensitivities of K. pneumoniae, E. cloacae, Pseudomonas aeruginosa, and Escherichia coli ATCC reference strains and K. pneumoniae and E. cloacae oral clinical isolates to combinations of CHX and amikacin were determined by means of a disk diffusion sensitivity assay on Mueller-Hinton agar. The amikacin minimum inhibitory concentrations for all GNB tested were much lower (less than or equal to 4.69 to less than or equal to 9.37 micrograms/ml) than those for CHX (less than or equal to 18.75 to less than or equal to 300 micrograms/ml), and combinations of CHX and amikacin gave larger growth inhibition zones than CHX alone. No antibacterial antagonism between CHX and amikacin was found, and their solubilities were compatible. Therefore use of topical amikacin in conjunction with CHX rinses may reduce oral colonization by GNB in severely immunocompromised patient populations.

Amikacin↗
PubMed1990

Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double-blind trial.

Patients receiving cytotoxic antineoplastic therapy often have treatment-associated stomatitis. A 0.12% chlorhexidine digluconate mouthrinse was evaluated (15 ml, three times a day) in a prospective, double-blind randomized trial as prophylaxis against cytotoxic therapy-induced damage to oral soft tissues. Seventy subjects, forty inpatients receiving high-dose chemotherapy and thirty outpatients receiving high-dose head and neck radiation therapy, were evaluated. Chlorhexidine mouthrinse significantly reduced the incidence of oral mucositis in the chemotherapy group on day 14 (p less than 0.02) and at 1 week follow-up on day 28 (p less than 0.002). Mucositis in the patients undergoing chemotherapy who received chlorhexidine also resolved more rapidly. Mucositis severity was significantly less compared to the control chemotherapy group on day 14 (p less than 0.03), day 21 (p less than 0.04), and on 1 week follow-up (p less than 0.02). Concomitant trends in the reduction in oral streptococci and yeast were noted in the chemotherapy group receiving chlorhexidine mouthrinse. Although no differences were observed in oral mucositis between the control and chlorhexidine groups of patients undergoing high-dose radiotherapy, similar reductions of oral microflora to those seen in the chemotherapy population were also noted for patients undergoing radiation therapy who received chlorhexidine. Although generally not significant, some increase in gram-negative bacilli was noted in the chlorhexidine-treated patients in both the chemotherapy and radiotherapy groups, but there was no correlation with increased systemic infection. Prophylactic chlorhexidine mouthrinse reduces oral mucositis and microbial burden in patients with cancer undergoing intensive chemotherapy.

Adult↗
PubMed1990

Oral antimicrobial agents--chlorhexidine.

Chlorhexidine's structural characteristics give it potent antimicrobial activity, effectiveness at low concentrations, substantivity that prolongs its therapeutic effect in the oral environment, minimal resorption from the gastrointestinal tract, and the ability to reduce plaque. The use of this agent for oral stomatitis in neoplasia patients has recently been studied. Treatment-associated oral soft tissue inflammation and ulceration were significantly reduced by chlorhexidine in patients undergoing intensive chemotherapy. Reductions in total streptococci and yeast counts were also observed. When used in conjunction with systemic antifungal agents, such as nystatin or clotrimazole, a significantly decreased incidence of clinical oral candidiasis and Candida septicemia was observed. In contrast, in two studies in which high-dose head and neck radiation therapy was applied, there was no reduction in stomatitis. Oral gram-negative bacilli have been shown to increase in high-dose chemotherapy patients who are taking chlorhexidine during the treatment period (3 wk to 2 mo). However, no increase in systemic gram-negative infections or other adverse negative medical consequences were observed. This agent appears to be of therapeutic benefit in reduction of dental plaque, gingivitis, and stomatitis in the high-risk chemotherapy population when used in conjunction with other topical and systemic antimicrobial agents as prophylaxis. Although no toxic or serious adverse effects of chlorhexidine rinse have been observed in the short-term studies to date, the effects of longer-term chlorhexidine administration should be evaluated.

Bone Marrow Transplantation↗
PubMed1989

Oral gram-negative bacilli in bone marrow transplant patients given chlorhexidine rinses.

Fifteen bone marrow transplant (BMT) patients who received three 0.12% chlorhexidine digluconate (CHX) mouthrinses daily for eight weeks were monitored weekly for the occurrence of oral opportunistic Gram-negative bacilli (GNB). Tongue and buccal mucosa were sampled with use of Culturette swabs that were streaked on plates containing selective MacConkey agar. After incubation, colony-forming units were scored and putative GNB classified with use of the API 20E rapid identification system and supplemental biochemical tests. After identification, the susceptibilities of all GNB to CHX were determined by means of a disk diffusion sensitivity assay. Sixty-seven percent (10) of the BMT subjects had at least one GNB-positive tongue culture, and 53% (8) had GNB in samples taken from the buccal mucosa. Of 218 samples taken, 26% and 24% from the tongue and buccal mucosa, respectively, were GNB-positive. The predominant clinical GNB isolates were Enterobacter cloacae (46%) and Klebsiella pneumoniac (30%). Their respective CHX minimum inhibitory concentrations (MICs) were similar to those of ATCC reference strains. Although the CHX MIC values of the clinical GNB isolates were high (less than or equal to 37.5 to less than or equal to 300 micrograms/mL), they were not dependent upon length of exposure to the agent. Therefore, changes in sensitivity or resistance to CHX did not appear to occur. The results suggest that the mouths of BMT patients--and perhaps of other immunosuppressed individuals--should be routinely monitored for GNB, as are other clinically important sites, such as the throat and the urinary and gastro-intestinal tracts.

Adolescent↗
PubMed1988

Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse.

Conditioning chemoradiotherapy damages the mucosal barrier of the mouth and throat and often produces severe oral inflammation and infection. In a prospective, double-blind, randomized study, we examined the use of a chlorhexidine digluconate mouthrinse for prophylaxis against oral mucosal complications in 51 bone marrow transplant patients. Use of chlorhexidine mouthrinse produced significant reductions in the incidence and severity of oral mucositis. Mucositis also resolved more quickly in patients receiving chlorhexidine. Concomitant reductions in total oral streptococci (p less than 0.02-p less than 0.001) and oral candida (p less than 0.004) were seen in patients using chlorhexidine. Persistent clinical oral candidiasis (thrush) was observed in 15 to 27 control group patients (56%), but only transiently in two (8%) of 24 patients who used chlorhexidine rinse (p less than 0.001). Five of 27 control group patients (19%) had candidemia, while no candidemia was observed in the chlorhexidine group (p less than 0.03). Three deaths from disseminated candidiasis occurred in the placebo group; none occurred in patients who received chlorhexidine. Prophylactic use of chlorhexidine mouthrinse produces reductions in oral soft tissue disease and oral microbial burden in patients undergoing bone marrow transplantation. The reductions in mucositis and in oral candida infections observed with prophylactic chlorhexidine mouthrinse represent a significant advantage for patients undergoing marrow transplantation.

Adolescent↗
PubMed1987

Therapeutic use of chlorhexidine in bone marrow transplant patients: case studies.

Patients undergoing cytotoxic chemotherapy and radiation therapy often experience severe oral complications during and after treatment despite supervised oral hygiene and conventional antimicrobial regimens. The antimicrobial compound chlorhexidine is an effective topical prophylactic agent against oral mucositis and candidiasis. Oral mucositis developed in four patients who underwent bone marrow transplantation; the condition was severe enough to prompt use of chlorhexidine. In each case, there was clinical resolution of mucositis and a concomitant decrease in the oral microbial burden 1 week after chlorhexidine use began. This strongly suggests that, in addition to its value in protecting these severely immunocompromised patients from oral infection, chlorhexidine also offers a therapeutic benefit in the resolution of existing oral infections and of mucositis.

Adult↗
PubMed1987

Chlorhexidine for prophylaxis against oral infections and associated complications in patients receiving bone marrow transplants.

Intensive chemoradiotherapy damages the mucosal barrier of the mouth and throat and is often associated with severe oral inflammation and infection. This study examined the use of a 0.12% chlorhexidine gluconate mouthrinse for prophylaxis against oral complications in patients receiving bone marrow transplants. Use of chlorhexidine mouthrinse produced reductions in oral soft tissue disease and oral microbial burden, including a significant decrease in oral mucositis and Candida infections. The advantage for patients undergoing intensive antineoplastic therapy, and potentially for other immunocompromised patients susceptible to oral infections, was studied.

Adolescent↗
PubMed1982

A case study of a nontraditional basic science curriculum.

This article presents a critical analysis of the ten-year experience of the Department of Oral Biology of the University of Kentucky College of Dentistry with a nontraditional basic science curriculum. The factors that led to the adoption of this curriculum are outlined, and its effects on students, faculty, and the college's administration are described. The pitfalls inherent in this approach and in the individualized self-instructional format for teaching the basic sciences to dental students are discussed. This critical evaluation is aimed at providing information for those contemplating similar sweeping curricular changes in the future to enable them to make rational decisions and to help them predict the effects of such changes on the educational program.

Curriculum↗
PubMed1980

Carbon dioxide metabolism by Capnocytophaga ochracea: identification, characterization, and regulation of a phosphoenolpyruvate carboxykinase.

Cell suspensions of Capnocytophaga ochracea incorporated [14C]NaHCO3 into a major four-carbon fermentation product, succinate, and cell-free extracts from this organism contained high levels of phosphoenolpyruvate carboxykinase (PEPCK). PEPCK is the major, if not the only, CO2(HCO-3)-fixing enzyme in C. ochracea since cell-free extracts were devoid of pyruvate-dependent and other phosphoenolpyruvate (PEP)-dependent CO2(HCO-3)-fixing enzymes. The reaction products of the enzyme, which was partially purified by diethylaminoethylcellulose column chromatography, were identified as adenosine 5'-triphosphate (ATP) and oxalacetate. The enzyme showed maximum activity when manganese (Mn2+) was the divalent cation in the incubation mixture, and it had an absolute requirement for the nucleoside 5-'diphosphate adenosine 5'-diphosphate (ADP). PEPCK showed a sigmoidal kinetic response to the Mn2+ concentration and homotropic interactions in its kinetic responses to each of its three substrates PEP, ADP, and CO2(HCO-3). The (S)0.5v values for Mn2+, PEP, ADP, and CO2(CHO-3) were approximately 0.08, 0.3, 0.1, and 10 mM, respectively, and Hill coefficients for these same ligands were 2.60, 1.7, 1.9, and 3.0, respectively. In addition, C. ochracea PEPCK is under metabolic control by the nucleoside -5'-triphosphate ATP, and it also showed a sigmoidal kinetic response to this allosteric effector. The Hill coefficient for ATP was 2.70.

Adenosine Diphosphate↗
PubMed1980

Energy metabolism in Capnocytophaga ochracea.

Among the microflora of the gingival sulcus are members of the genus Capnocytophaga which have been implicated as possible etiological agents of juvenile periodontitis and systemic infectious diseases. In this study, the pathway used by C. ochracea strain 25 for generating energy from glucose was investigated. When grown in a complex medium supplemented with glucose and NaHCO(3), the major end products formed were acetate (4.6 mmol), succinate (11.0 mmol), pyruvate (4.3 mmol), and oxalacetate (3.6 mmol), and the molar growth yield was 58. Addition of yeast extract to the growth medium caused (i) an increase in acetate (9.2 mmol) and succinate (14.3 mmol), (ii) a decrease in pyruvate (0 mmol) and oxalacetate (1.1 mmol), and (iii) the molar growth yield increased to 75. Glucose was transported by a phosphoenolpyruvate:phosphotransferase system and then catabolized to phosphoenolpyruvate by enzymes of the Embden-Meyerhof-Parnas pathway. No activities were detected for the key enzymes of the Warburg-Dickens, Entner-Douderoff, or hexose phosphoketolase pathways. During growth in the yeast extract-supplemented medium, approximately 37% of the phosphoenolpyruvate carbon was converted to acetate by pyruvate kinase, a pyruvate-decarboxylating enzyme activity, and acetate kinase; the remaining 63% was converted to succinate via phosphoenolpyruvate carboxykinase, malate dehydrogenase, fumarate hydratase, and fumarate reductase.

Adenosine Triphosphate↗
PubMed1972

Consequences of glycerol deprivation on the synthesis of membrane components in a glycerol auxotroph of Staphylococcus aureus.

In a glycerol auxotroph of Staphylococcus aureus, the deprivation of glycerol affected the formation of certain membrane components. (i) There was synthesis of fatty acids at the predeprivation rate even though the fatty acids synthesized accumulated as free fatty acids rather than as esterified fatty acids; (ii) there was a complete cessation of phospholipid and vitamin K isoprenologue biosynthesis; (iii) there was conservation of the glycerol esters of the complex phospholipids and glucolipids; (iv) there was an immediate decrease in the rate of synthesis of monoglucoslydiglyceride (30%) and diglucosyldiglyceride (60%); (v) there was a 50% decrease in the rate of synthesis of the polar and nonpolar carotenoids; (vi) there was synthesis of protoheme, heme a, and nonspecific membrane protein at the predeprivation rate; and (vii) there was an abrupt cessation in the formation of new, functional glycine transport activity.

Acetates↗