Targeted histological evaluation shows high incidence of actinomyces infection in medication-related osteonecrosis of the jaws

Abstract

Medication-Related Osteonecrosis of the Jaws (MRONJ) is a difficult-to-treat complication of the therapy of osteoporosis and some malignancies cured with bisphosphonates and antiresorptive drugs. The pathomechanism is unclear, but there is increasing observation that Actinomyces infection may play a role in its development and progression. The aim of our study was to demonstrate that histological examination using a validated triple staining procedure for Actinomyces bacteria strains can detect a high rate of Actinomyces infection in patient's samples with MRONJ. 112 previously hematoxylin-eosin (HE) stained samples submitted with the clinical diagnosis of MRONJ were re-evaluated histologically using an appropriate triple special staining validated for the identification of Actinomyces infection. During the first evaluation, when pathologists did not specifically look for Actinomyces, only 8.93% of the samples were reported as positive. In contrast, re-evaluation with triple staining provided a yield of 93.7% positive samples, therefore, we suggest the triple special staining to be standard in MRONJ histology evaluation. These results show that if the clinician suspects Actinomyces infection and brings this to the attention of the pathologist, it could significantly increase the number of correct diagnoses. It serves as an aid for clinicians in therapeutic success of MRONJ by selecting a long-term adequate antibiotic medication which is suitable for the elimination of actinomyces infection.

Analysis of oral microbiota diversity in Medication-Related Osteonecrosis of the Jaws based on 16S rDNA sequencing: A preliminary research

“…In addition to these six mentioned phyla, Campylobacterota was also detected in all four groups in this study, consistent with previous research [10,38]. In previous studies, Actinomyces has been frequently detected in the oral microbiota of MRONJ patients [4,1,42]. Ceulaer et al [6] based on the modi ed Köhler hypothesis, comprehensively analyzed relevant literature and proposed that BRONJ is a type of actinomycotic osteomyelitis of the jaw.…”

“…Researches had indicated that the predominant phyla in MRONJ patients were Bacteroidetes, Firmicutes, Actinomycetes and Fusobacteria [10,24,8]. Additionally, Actinomyces could be found in almost all MRONJ patients [29,39,4]. In a study conducted by X Wei et al [38], 38 bacterial genera were detected in patients with BRONJ and other oral infections.…”

Correlations between Immune Response and Etiopathogenic Factors of Medication-Related Osteonecrosis of the Jaw in Cancer Patients Treated with Zoledronic Acid

“…They can produce temporary bacteremia capable of causing microbial immune subversion that triggers systemic inflammation. The directed histological evaluation shows the high incidence of Actinomyces infection in drug-related osteonecrosis of the jaw [ 100 ], which was also observed in our study [ 35 ]. The critical role of bacterial infection in the pathogenesis of MRONJ can be justified by the decreased incidence in patients, after improved dental hygiene [ 100 , 101 , 102 , 103 ].…”

“…The directed histological evaluation shows the high incidence of Actinomyces infection in drug-related osteonecrosis of the jaw [100], which was also observed in our study [35]. The critical role of bacterial infection in the pathogenesis of MRONJ can be justified by the decreased incidence in patients, after improved dental hygiene [100][101][102][103]. Bisphosphonate-loaded bone is more susceptible to infections, not only because of the suppression of defense mechanisms, especially osteoclast activity and bone remodeling but also because the bisphosphonate-loaded bone is more prone to bacterial colonization [31].…”

The epidemiology, clinical presentation and treatment outcomes in CNS actinomycosis: a systematic review of reported cases

“…CNS cases usually have delayed presentation; by that time, the lesion may have extensive fibrosis, which can impair the identification of sulfur granules. Recent reports highlight the role of targeted histological evaluation in increasing the detection of actinomycosis [ 34 ]. The advent of molecular techniques (PCR, 16S rRNA gene sequencing) allows the rapid identification of actinomycosis species.…”