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Entamoeba Gingivalis Ve Periodontal Hastalıklardaki Etkinliğinin Değerlendirilmesi Entamoeba Gingivalis and Evaluation Of

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Entamoeba Gingivalis Ve Periodontal Hastalıklardaki Etkinliğinin Değerlendirilmesi Entamoeba Gingivalis and Evaluation Of Turk Mikrobiyol Cemiy Derg 2020;50(4):204-10 Derleme / Review doi:10.5222/TMCD.2020.204 Entamoeba gingivalis ve Periodontal Hastalıklardaki Etkinliğinin Değerlendirilmesi Entamoeba gingivalis and Evaluation of its Effectiveness in Periodontal Diseases Fatma Esenkaya Taşbent* ID , Ceren Ceran Boran** ID *Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, Konya, Türkiye **Konya Ağız ve Diş Sağlığı Hastanesi, Konya, Türkiye ÖZ Periodontitis, dünya çapında en yaygın hastalıklardan ve halk sağlığı sorunlarından biridir. Çeşitli etiyolojik etkenler, konak yanıtları ve çevresel faktörler arasındaki karmaşık etkileşimi içeren çok faktörlü bir kronik enflamatuvar hastalıktır. Risk faktörleri hâlen araştırılmaktadır. Çoğu çalışma Alındığı tarih / Received: özellikle olası bakteriyel etiyoloji ve konak yanıtları üzerine vurgu yapar. Bir protozoa olan 18.04.2020 / 18.April.2020 Entamoeba gingivalis ağız boşluğunda yaşayan paraziter bir etkendir. Birçok çalışma, bu protozo- anın enfeksiyon oranlarını periodontitisli hastalarda, sağlıklı kontrol gruplarına göre daha yüksek Kabul tarihi / Accepted: oranda bildirmiştir. Ancak, bu protozoanın periodontal hastalığın gelişimindeki rolü halen tartış- 04.07.2020 / 04.July.2020 malıdır. Bu nedenle bu derlemede, esas olarak patojenliği henüz belirlenemeyen E. gingivalis ile Yayın tarihi / Publication date: ilgili literatür verilerinin derlenmesi amaçlanmıştır. 31.12.2020 / 31.December.2020 Anahtar kelimeler: Periodontal hastalık, periodontitis, Entamoeba gingivalis ABSTRACT ORCİD Kayıtları Periodontitis is one of the most common and public health problems worldwide. It is a F. E. Taşbent 0000-0003-4190-5095 multifactorial chronic inflammatory disease involving a complex interaction between various C. C. Boran 0000-0003-3341-4827 etiological factors, host responses, and environmental factors. Risk factors have still been under investigation. Many studies emphasize the possible bacterial etiology and host responses. ✉ [email protected] Entamoeba gingivalis, is a protozoon that resides in the oral cavity of individuals. Many studies have reported that infection rates of this protozoa was higher in patients with periodontitis compared to healthy controls. However, the role of this protozoon in the development of periodontal disease remains controversial. Therefore, in this review, it is aimed to compile the Atıf: Esenkaya Taşbent F, Ceran Boran C. Entamoeba literature data on E. gingivalis whose pathogenicity is yet to be determined. gingivalis ve periodontal hastalıklardaki etkinliğinin değerlendirilmesi. Turk Mikrobiyol Cemiy Derg. 2020;50(4):204-10. Keywords: Periodontal disease, periodontitis, Entamoeba gingivalis GİRİŞ Yükü 2017 raporunda tüm dünyada 796 milyon ciddi periodontitis olgusu olduğu bildirilmek- Periodontitis, periodontal ligament, sement ve tedir(1). alveol kemiğinde yıkıma neden olan kronik bir ilti- haptır. En sık peridontal hastalıklardan biri olan Periodontal hastalıklarda süreç; duyarlı kişilerde periodontitis, 35-44 yaş aralığında yaklaşık %50 genetik-çevresel faktörlerin de katkısıyla, konak yanı- sıklıkla görülen bir durumdur. Şiddetli periodonti- tı ve biyofilm yapısındaki spesifik olmayan mikrobi- tis denilen hastalığın ilerlemiş formunun, son epi- yota arasında geçen yineleyen karmaşık etkileşimler- demiyolojik verilere göre 2017 yılında yaşa göre le başlamaktadır. Bu etkileşimlerle oluşan enflamas- standardize edilmiş prevalansı %9.8 iken, insidansı yonun öncülüğünde patolojik değişimlerin başladığı her 100.000 kişide 900 olgudur. Küresel Hastalık düşünülmektedir(2). Bu akut enflamasyon (gingivitis) © Telif hakkı Türk Mikrobiyoloji Cemiyeti’ne aittir. Logos Tıp Yayıncılık tarafından yayınlanmaktadır. Bu dergide yayınlanan bütün makaleler Creative Commons Atıf-Gayri Ticari 4.0 Uluslararası Lisansı ile lisanslanmıştır. © Copyright Turkish Society of Microbiology. This journal published by Logos Medical Publishing. Licenced by Creative Commons Attribution-NonCommercial 4.0 International (CC BY) 204 F. Esenkaya Taşbent ve C. Ceran Boran, Entamoeba gingivalis ve Periodontal Hastalıklar kontrol altına alınmadığında hastalık ilerleyerek peri- mikroorganizma ilişkisi, yavaş yavaş patojenik olanla odontitis gelişir(3). yer değiştirmektedir. Birçok çalışmada periodontitis disbiyotik bir hastalık olarak bildirilmektedir. Çeşitli sistemik hastalıklar ve koşullar periodontitis Periodontitis geliştikçe oral mikrobiyata Gram pozitif seyrini olumsuz etkileyebilir. HIV enfeksiyonu, Down aeroblardan, Gram negatif anaeroblara kaymak- sendromu, çeşitli tümörler, obezite, diabet, artrit, tadır(3,6,7). osteoporoz, stres ve depresyon gibi çeşitli hastalık durumlarında periodonsiyumun etkilendiği bildiril- Disbiyotik mikrobiyataya geçiş aynı zamanda, doku miştir(4). yıkımı ve alveolar kemik kaybına neden olan güçlü konakçı inflamatuvar yanıtı da tetiklemektedir. Araştırmalar yıkıcı konak inflamatuvar yanıtın etkile- Disbiyosizde bakteriyel etiyolojiye ek olarak, çoğun- rinin yanı sıra, periodontitisin temelde biyofilm ile lukla izole edilmeyen viral, protozoal etiyolojilerin, ilişkili bir hastalık olduğunu ortaya koymaktadır. genetik ve immünolojik faktörlerin de katkı sağladığı Biyofilm tabakası, konak ve mikroorganizma tarafın- ileri sürülmektedir(2,3,6). Yakın zamanda yapılan bir dan salgılanan yapışkan hücredışı polimerler tarafın- çalışmada, enfekte peridontal ceplerde Entamoeba dan oluşturulmuş ekstraselüler yapıdaki matriksin, gingivalis sıklığının önemli ölçüde arttığı ve hatta bu diş yüzeyine tutunması ile meydana gelmiş polimik- bölgede insan rRNA’sından sonra ikinci sıklıkta robial bir yapıdır. Biyofilm oluşumunda salgılanan E. gingivalis rRNA’sına rastlandığı belirtilmektedir(8). polimerik madde; polisakkaritler, proteinler, lipitler, Bu derlemede, E. gingivalis’in tartışılagelen patojeni- nükleik asitler ve diğer polimerlerden oluşur. Bu tesi ile ilgili son güncel bilgilerin ortaya konması madde bakterilerin yüzeye ve birbirlerine yapışma- amaçlanmıştır. sına yardımcı olur. Biyofilmde bulunan bakterilerin minimum inhibitör konsantrasyonlarının normal Periodontal hastalıkta Entamoeba gingivalis kültür ortamındaki bakterilere göre 20-100 kat Periodontitis antik çağlardan beri tanımlanmış daha yüksek olduğu bildirilmektedir. Bunun nedeni olmasına rağmen, parazitler ile ilişkisi yalnızca bir antibiyotiklerin biyofilm içine nüfus edememeleri yüzyıl önce kanıtlanmıştır(9). Periodontal hastalığa ve ayrıca biyofilm popülasyonundaki bakterilerin sahip kişilerin biyofilm ve tükrük örneklerinden, antibiyotiklere daha az duyarlı olmasıdır. Biyofilm E. gingivalis’in sık izole edilmiş olması, bu amibin ayrıca konakçı bağışıklıktan kaçmak için de iyi bir periodontal hastalıkların etiyolojisinde önemli rol korunaktır. Biyofilm polimikrobial yapıdadır. Oral oynadığını düşündürmüştür. Diğer taraftan sağlıklı biyofilm içerisinde yüzlerce farklı bakterinin yanı ağızlarda da bulunabilmesi kommensal bir parazit sıra spiroketler, protozoalar, mantar ve virüsler de olarak kabul görmesine neden olmuştur(10-13). bulunur(3,5). Entamoeba gingivalis’in patojenitesi 1893’te sor- Birçok kronik hastalık durumunda belirli bir etiyolojik gulanmış ve bunu periodontitis ile ilişkilendiren ajan yerine, mikrobiyatadaki faydalı mikroorganiz- ilk sistematik çalışma 1914’te yayınlanmıştır. Bu maların azalması, patojen olanların artmasıyla olu- çalışmada, 46 piyore olgusunun (periodontitis) şan yeni mikrobiyal ortam sorumlu tutulmaktadır. toplamında amip saptanmıştır(9,14). Günümüzde Mikrobiyatada oluşan bu değişime disbiyozis denil- patojenik etkisi üzerine tam olarak net bilgiler mektedir. Periodontitis, otitis media, inflamatuvar elde edilememiştir. Parazitin eliminasyonu ile bağırsak hastalığı, gastro-ösafagial reflü, bakteriyel çeşitli periodontitis tiplerinde iyileşme sağlandığı vaginozis gibi hastalıkların etyopatogenezinde mik- klinik ve mikroskobik bir incelemede rofloradaki disbiyozis olduğu düşünülmektedir(3,6). gösterilmiştir(15). Oral disbiyozis ile simbiyotik olan konak- 205 Turk Mikrobiyol Cemiy Derg 2020;50(4):204-10 Entamoeba gingivalis protozoaları, ökaryotik tek kaydedilmiştir(24). Enflamatuvar sürecin, parazitin hücreli mikroskobik organizmalardır. E. gingivalis çoğalması için uygun bir anaerobik ortam oluştura- Rhizopoda şubesi amip takımı, Entamoebidae ailesi bileceği bildirilmektedir(10,25). ve Entamoeba cinsi bir protozoondur. Uzunluğu 10-30 mm’dir, hızlı hareket etmelerine izin veren Entamoeba gingivalis, insanda tanımlanmış ilk amip psödopodlara sahiptir. Sferoid çekirdeği 2-4 mm’dir. olasına rağmen yakından ilişkili türlerin aksine, hare- Çevresel kromatin materyali küçük ve hemen hemen ket kabiliyetinin özellikleri çalışılmamıştır. Fizyolojisi eşit büyüklükte düzensiz tanecikler şeklindedir. hakkında bilgi yetersizdir(9,25). Nükleolus küçük ve çoğunlukla merkezi konumludur. Ektoplazma ve endoplazma ayırımı çok barizdir. Entamoeba gingivalis ve Periodontal Hastalıkların Endoplazmada çok sayıda besin vakuolü bulunur. Patogenezi Besinlerini çoğu kez bakteriler, bazen de konağın Entamoeba gingivalis ile ilgili çalışmalar ilk yıllarda epitel hücreleri, lökositler ve oldukça ender olarak da mikroskobik tanıya dayalı olup, daha sonra molekü- eritrositler oluşturur. Dişlerin ve dişeti dokularının ler çalışmalar ile gen amplifikasyonunun gelişmesi ve yüzeyinde yaşar(15-17). Tonsil ve tonsil kriptalarında da amibin gen sekansının yapılmasıyla, çalışmaların gözlenmiştir. Baş ve boyun lezyonlarında veya osteom- daha doğru bir şekilde ilerlemesi sağlanmıştır(14).
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