Keywords
Entamoeba gingivalis Trichomonas tenax Enfermedades periodontales periodontitis Metanálisis, Entamoeba gingivalis Trichomonas tenax Periodontal diseases Periodontitis Meta-analysis
Parasites in Periodontal Health and Disease: A Systematic Review and Meta-analysis
Abstract
Antecedentes: La periodontitis es una enfermedad inflamatoria desencadenada por la infección del surco periodontal por microbios. Junto a la abundante microbiota eubacteriana, se han identificado al menos dos parásitos: la ameba Entamoeba gingivalis y el flagelado Trichomonas tenax. Queda por descifrar el papel de estos protistas en la fisiopatología de la enfermedad periodontal. Una gran diversidad en su prevalencia medida, principalmente debido a preocupaciones metodológicas, impide un mayor análisis del vínculo etiológico entre estos parásitos y la periodontitis.
Métodos: Para determinar la prevalencia de E. gingivalis y T. tenax en bolsas periodontales en comparación con surcos sanos, hemos realizado una revisión sistemática, buscando en 3 bases de datos remotas (Pubmed, LILACS y Google Scholar), restringiéndonos a trabajos en los que el diagnóstico de el parásito se hizo utilizando métodos moleculares. Se incluyeron para el metanálisis un total de 5 estudios para E. gingivalis y 2 estudios para T. tenax.
Resultados: En las bolsas periodontales, la prevalencia de parásitos es del 76,9% (95%-IC: 71,5-81,7%) para E. gingivalis y del 38,6% (95%-IC: 27,2-50,0%) para T. tenax. Ambos parásitos son más abundantes en las bolsas periodontales en comparación con los surcos sanos, con una razón de riesgo de 3,96 (IC 95 %: 1,57–9,98) para E. gingivalis y 21,82 (IC 95 %: 6,71–70,96) para T. tenax . Los dos subtipos de E. gingivalis exhibieron la misma razón de riesgo: 3,30 (IC 95 %: 1,27–8,55) para ST1 y 3,30 (IC 95 %: 0,42–26,03) para ST2, pero ST1 fue más prevalente (70,6 %, IC del 95 %: 65,0–76,2 %) que ST2 (43,9 %, IC del 95 %: 35,5–52,4 %) en las bolsas periodontales.
Conclusión: En conjunto, los datos muestran que los parásitos son más frecuentes en los enfermos que en los sanos. Sin embargo, las diferencias de prevalencia entre especies y subtipos requieren más estudios para poder concluir sobre sus contribuciones individuales en la fisiopatología de las enfermedades periodontales. La heterogeneidad en la estimación de la prevalencia debe investigarse más a fondo, en particular para distinguir la heterogeneidad biológica de la metodológica.
Background: Periodontitis is an inflammatory disease triggered by the infection of the periodontal sulcus by microbes. Together with the abundant eubacterial microbiota, at least two parasites have often been identified: the amoeba Entamoeba gingivalis and the flagellate Trichomonas tenax. The role of these protists in the pathophysiology of periodontal disease remains to be deciphered. A high diversity in their measured prevalence, mainly due to methodological concerns, prevents further analysis of the aetiological link between these parasites and periodontitis. Methods: To determine E. gingivalis and T. tenax prevalence in periodontal pockets as compared to healthy sulci, we have conducted a systematic review, searching 3 remote databases (Pubmed, LILACS, and Google Scholar), restricting to papers in which the diagnostic of the parasite was made using molecular methods. A total of 5 studies for E. gingivalis and 2 studies for T. tenax were included for the meta-analysis. Results: In the periodontal pockets, the prevalence of parasites is 76.9% (95%-CI: 71.5–81.7%) for E. gingivalis and 38.6% (95%-CI: 27.2–50.0%) for T. tenax . Both parasites are more abundant in periodontal pockets as compared to healthy sulci, with a risk ratio of 3.96 (95%-CI: 1.57–9.98) for E. gingivalis and 21.82 (95%-CI: 6.71–70.96) for T. tenax . The two subtypes of E. gingivalis exhibited the same risk ratio: 3.30 (95%-CI: 1.27–8.55) for ST1 and 3.30 (95%-CI: 0.42–26.03) for ST2, but ST1 was more prevalent (70.6%, 95%-CI: 65.0–76.2%) than ST2 (43.9%, 95%-CI: 35.5–52.4%) in periodontal pockets. Conclusion: Altogether, the data show that parasites are more prevalent in the diseased than in the healthy. However, the differences in prevalence between species and subtypes call for more studies to be able to conclude about their individual contributions in the pathophysiology of periodontal diseases. The heterogeneity in prevalence estimation should be investigated further, in particular to make out biological from methodological heterogeneity.
Background: Periodontitis is an inflammatory disease triggered by the infection of the periodontal sulcus by microbes. Together with the abundant eubacterial microbiota, at least two parasites have often been identified: the amoeba Entamoeba gingivalis and the flagellate Trichomonas tenax. The role of these protists in the pathophysiology of periodontal disease remains to be deciphered. A high diversity in their measured prevalence, mainly due to methodological concerns, prevents further analysis of the aetiological link between these parasites and periodontitis. Methods: To determine E. gingivalis and T. tenax prevalence in periodontal pockets as compared to healthy sulci, we have conducted a systematic review, searching 3 remote databases (Pubmed, LILACS, and Google Scholar), restricting to papers in which the diagnostic of the parasite was made using molecular methods. A total of 5 studies for E. gingivalis and 2 studies for T. tenax were included for the meta-analysis. Results: In the periodontal pockets, the prevalence of parasites is 76.9% (95%-CI: 71.5–81.7%) for E. gingivalis and 38.6% (95%-CI: 27.2–50.0%) for T. tenax . Both parasites are more abundant in periodontal pockets as compared to healthy sulci, with a risk ratio of 3.96 (95%-CI: 1.57–9.98) for E. gingivalis and 21.82 (95%-CI: 6.71–70.96) for T. tenax . The two subtypes of E. gingivalis exhibited the same risk ratio: 3.30 (95%-CI: 1.27–8.55) for ST1 and 3.30 (95%-CI: 0.42–26.03) for ST2, but ST1 was more prevalent (70.6%, 95%-CI: 65.0–76.2%) than ST2 (43.9%, 95%-CI: 35.5–52.4%) in periodontal pockets. Conclusion: Altogether, the data show that parasites are more prevalent in the diseased than in the healthy. However, the differences in prevalence between species and subtypes call for more studies to be able to conclude about their individual contributions in the pathophysiology of periodontal diseases. The heterogeneity in prevalence estimation should be investigated further, in particular to make out biological from methodological heterogeneity.
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