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Aggregatibacter Actinomycetemcomitans, an Aggressive Oral Bacteria - a Review

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Aggregatibacter Actinomycetemcomitans, an Aggressive Oral Bacteria - a Review International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Review Article Aggregatibacter Actinomycetemcomitans, an Aggressive Oral Bacteria - A Review D Mythireyi1, MG Krishnababa2 1Dept of Periodontics, SRM Dental College, SRM University, Chennai, India 2Dept of Periodontics, Sathyabama Dental College, Chennai, India Correspondence Email: [email protected] Received: 10/07//2012 Revised: 31/07/2012 Accepted: 10/08/2012 ABSTRACT Aggregatibacter actinomycetemcomitans, an oral commensal which is also an opportunist pathogen has a distinct racial bias and a surprising range of potential virulence factors and virulence mechanisms. It is a pathogen not only in the periodontium but also in some non oral infections, possesses several virulence determinants which contribute to its ability to colonize the oral cavity, persist in the periodontal pocket, resist and evade host defenses, cause destruction to soft and hard tooth-supporting tissues, and interfere with host tissue repair after infection. The purpose of this review is to elaborate the microbiological aspects of this bacteria which makes it clinically significant. Keywords: Aggregatibacter actinomycetemcomitans, aggressive periodontitis, leukotoxin I INTRODUCTION increases. [3] In periodontitis , only 10 to 30 species, mainly gram negative More than 500 cultivable bacterial anaerobic bacteria, are putative pathogens. species have been isolated from the [4] Three species Actinobacillus gingival crevices of human beings, [1] but actinomycetemcomitans , Porphyromonas the actual species count may be gingivalis and Bacteroides forsythus are thousands, since a wide proportion of presently considered as periodontal bacteria remains uncultivable or pathogens and primary etiological agents unidentified. [2] The sub gingival in periodontitis (World Workshop in bacterial flora consists of facultatively Periodontics 1996 ). Additional putative anaerobic gram positive species in the periodontal pathogens include Prevotella healthy oral cavity, but in gingivitis the intermedia, Prevotella nigrescens, proportion of gram negative bacteria Campylobacter rectus , Fusobacterium International Journal of Health Sciences & Research (www.ijhsr.org) 105 Vol.2; Issue: 5; August 2012 nucleatum , Peptostreptococcus micros and was first isolated from human spirochetes ( American Academy of cervicofacial actinomycosis together with Periodontology 1992 , Haffajee & Actinomyces and was thus described as Socransky 1994 , World Workshop in Bacterium actinomycetemcomitans by Periodontics 1996 ) Klinger in 1912. [9] Later Lieske in 1921 reclassified as Bacterium comitans. II HISTORICAL PERSPECTIVE During the past 95 years , the taxonomic A. actinomycetemcomitans was first position has met several changes . In isolated and identified in 1912 by Klinger. [5] 1929 , Topley and Wilson changed the It was so named because of its consistent genus name to Actinobacillus although association with Actinomyces israelii in Bacterium actinomycetemcomitans had a actinomycotic infections. In 1934 Klaber weak resemblance to Actinobacillus reported that this organism occurred only in lignirersiii , the type species of the genus association A. israelli. Heinrich and Pulverer Actinobacillus . In the name (1959) reported that 30% of actinomycotic Actinobacillus actinomycetemcomitans , lesions contained this organism. However the new genus name refers to the star King and Tatum in 1962 reported instances shaped structure ( Greek actis “ray “ ) in of infection with A.actinomycetemcomitans the centre of the colonies of rod shaped unconnected with diagnosed actinomycosis. cells. They considered this organism to be an King & Tatum (1962) [10] described important etiologic agent of endocarditis. [6] the close phenotypic similarity of Since that time more cases of Actinobacillus actinomycetemcomitans with A.actinomycetemcomitans endocarditis have H. aphrophilus, and Actinobacillus been reported (Mitchell & Gillespie 1964, actinomycetemcomitans was subsequently Goss et al 1967 , Affias et al 1978). It has reassigned to the genus Haemophilus as also been reported in brain abscess (Martin Haemophilus actinomycetemcomitans by et al 1967), urinary tract et al infection Potts et al 1985. [11] The genus change (Townsend & Glenwatter 1969), infection of was however, not favoured , as thyroid gland (Burgher et al 1973) Actinobacillus actinomycetemcomitans osteomyletis (Muhle et al 1979). A. was not closely related to Haemophilus actinomycetemcomitans was first influenza , the type species of the genus recognized as a possible periodontal Haemophilus. [12] The difference between pathogen by its increased frequency of Actinobacillus actinomycetemcomitans and detection and higher numbers in lesions of Haemophilus influenzae is based on a localized juvenile periodontitis (Newman et number of chemotaxonomic characteristics al 1976, Slots 1976, Newman & Socransky as well as on 16S rRNA gene sequence 1977, Slots et al 1980, Mandell & Socransky phylogeny . Therefore the previous genus 1981, Zambon et al 1983, Chung et al 1989 ) Actinobacillus was reinstated. [13] [7] Phylogenetic analysis of the three Pasteurellaceae genera , Actinobacillus - III TAXONOMIC CLASSIFICATION Haemophilus – Pasteurella , based on Aggregatibacter (previously 16SrRNA gene sequences , revealed that Actinobacillus actinomycetemcomitans), a Actinobacillus actinomycetemcomitans is member of family Pasteurellaceae, [8] has closely related Haemophilus aphrophilus been recognized as one of the key and Haemophilus paraaphrophilus and pathogens in periodontitis. This bacterium that these three species together with International Journal of Health Sciences & Research (www.ijhsr.org) 106 Vol.2; Issue: 5; August 2012 Haemophilus segnis formed a single into well developed colonies takes phylogenetic cluster . Due to their 24-48hrs. On solid growth media, fresh phylogeny and their typical phenotypic A. actinomycetemcomitans isolates adhere charecteristics - the autoaggregation, the to agar and form circular colonies 0.5 to species Actinobacillus 1mm in diameter with slightly irregular actinomycetemcomitans, Haemophilus edges. aphrophilus , Haemophilus paraaphrophilus Fresh oral isolates of A. and Haemophilus segnis were recently actinomycetemcomitans are invariably reclassified to a novel genus fimbriated and form small ( ~1mm ), Aggregatibacter by Norskov – Lauritsen rough surface, translucent colonies, with an and Kilan; 2006. [14] internal star shaped morphology. Repeated subculturing of the clinical isolates Taxonomic classification: Full lineage: results in a spontaneous change from Domain Bacteria rough to smooth colony morphology as Phylum Proteobacteria represented by A. actinomycetemcomitans Class Gammaproteobacteria strains from American Type Culture Order Parteurellales [15] Family Pasteurellaceae Collection. Genus Aggregatibacter The rough colony morphology and Species actinomycetemcomitans the tight adherence (autoaggregation Taxonomic I D 714 phenotype ) have been attributed to the Type strain ATCC33384 presence of long and bundled fimbriae NCTC 9710 on the cell surface . Colonies of the smooth variants lack the star like inner IV CULTURAL CHARECTERISTICS structure and the cells do not express A actinomycetemcomitans is a fimbriae. [16] The non fimbriated smooth small non motile Gram negative colony variants grow as large , round coccobacillus. It is capnophilic and opaque colonies on agar. facultatively anaerobic, it grows well in 5% CO2 in air or anaerobically and growth Figure 1 : Photograph of a primary isolation plate of a sub gingival plaque sample from a diseased site from a subject with LJP. The majority of small round convex colonies on this plate are isolates of A. actinomycetemcomitans Occasionally the rough to smooth transition goes through an intermediate phase in which the colonies are translucent but smooth surfaced. Genes for the fimbriae biogenesis of A. International Journal of Health Sciences & Research (www.ijhsr.org) 107 Vol.2; Issue: 5; August 2012 actinomycetemcomitans reside in the 12-kb flp operon that contains 14 genes flp-1-flp-2- tadV- rcpCAB-tadZABCDEFG. The transcription - initiation points of the operon were located at 101 and 102 nucleotides upstream of flp – 1 A B Figure-2. Colony morphology of an A. actinomycetemcomitans strain on A. specific medium, and B , a nonspecific medium The internal star is easily seen V BIOCHEMICAL Fresh clinical isolates are adherent to CHARECTERISTICS the agar , difficult to emulsify Lack of growth on Mac Conkey and Prolonged incubation (5 to 7) days – other enteric agars colonies may develop a central Catalase production : + ve density that appears as four or six Nitrate reduction : + ve pointed star. This characteristic is Oxidase negative : + ve ( occasional lost on repeated subcultures and the strains may be weakly positive ) colonies become less adherent Urease : - ve Growth in broth: Indole production : - ve Growth is scant and adherent to sides X V factor requirement : - ve of the tube Glucose , Fructose , Mannose : VI FACTORS INFLUENCING THE strong fermentation GROWTH AND VIABILITY OF A. Acid production from maltose , ACTINOMYCETEMCOMITANS mannitol and xylose varies The addition of increasing concentrations of yeast extract to Non – haemolytic bacteriological medium increased the Based on the variability in fermenting growth rate of several A. maltose, mannitol, xylose and dextrin A. actinomycetemcomitans strains.The actinomycetemcomitans strains have been
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