Analysis of the Oral Microbiome in a Patient with Cardiofaciocutaneous Syndrome and Severe Periodontal Disease: Impact of Systemic Antibiotic Therapy

Abstract

An 8-year-old girl diagnosed with cardiofaciocutaneous syndrome presented to our department with gingival pain, inflammation, and bleeding. Her medical history included hypoplasia of the corpus callosum, intellectual disability, trichothiodystrophy, global developmental delay, myopia, laryngomalacia, hypothyroidism, and osteoporosis. A diagnosis was reached of "periodontitis as a direct manifestation of systemic diseases". During 9 years of follow-up, there were exacerbation episodes with spontaneous gum bleeding, ulcers in the interdental papilla, tooth mobility, and progressive tooth loss. Some of these exacerbation episodes resolved clinically with the administration of amoxicillin and metronidazole. We therefore proposed an oral microbiome study (subgingival and saliva samples) before and after antibiotic therapy. The most abundant genera at the subgingival level before administering antibiotics were Prevotella, Streptococcus, Fusobacterium, Leptotrichia, and Aggregatibacter. Of the 94 genera sequenced, 57 were less abundant in the post-treatment state than at baseline, particularly certain Gram-negative periodontal pathogens such as Porphyromonas, Treponema, Aggregatibacter, Fusobacterium, and Campylobacter. In contrast, other genera related to oral health, such as Haemophilus, Granulicatella, and Abiotrophia, showed an increase after administering the antibiotic. In conclusion, periodontitis exacerbations as a direct manifestation of systemic disease can occasionally be controlled exclusively with systemic antibiotics, without the need for performing mechanical periodontal therapy. This clinical recovery is correlated to substantial changes in the oral microbiome, which lead to the recovery of eubiosis of the microbiota.

Keywords: antibiotics; cardiofaciocutaneous syndrome; microbiome; periodontitis.

Figure 1

(A) Periodontal disease exacerbation; (B) Clinical outcome after one week of antibiotic therapy (without mechanical treatment).

Figure 2

(A) Periodontal disease involving anterior teeth; (B) Periodontal disease progression despite periodic mechanical treatment (3 years later).

Figure 3

General rarefaction graphs. Rarefaction analysis permits estimating the overall diversity covered by the obtained squences. The figures represent the number of sequences (x axis) versus the number of taxa (y axis). S1, baseline subgingival sample; S2, post-therapy subgingival sample; Saliva 1, baseline saliva sample; Saliva 2, post-therapy saliva sample.

Figure 4

Representation created using the Krona hierarchical browser of the phylotypes identified at the phylum, class, order, family, genus, and species level in an individual with periodontitis: (A) Baseline subgingival sample; (B) Subgingival sample compatible with gingival health after antibiotic therapy.

Figure 5

Representation created using the Krona hierarchical browser of the phylotypes identified at the phylum, class, order, family, genus, and species level in an individual with periodontitis: (A) Baseline saliva sample; (B) Saliva sample after antibiotic therapy.

Figure 6

Characteristics of the clusters of samples: (A) Identified clusters of the taxa of the saliva and subgingival plaque samples at baseline and post-therapy; (B) principal coordinates analysis (PCoA) with weighted UniFrac distances of the samples by cluster assignment. S1, baseline subgingival sample; S2, post-therapy subgingival sample; Saliva 1, baseline saliva sample; Saliva 2, post-therapy saliva sample.