Bacterial endocarditis and dental infections in the post-COVID-19 era: a review of current concepts
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260332Keywords:
Infective endocarditis, Dental infection, Oral health, SARS-CoV-2, Post-COVID syndrome, Antibiotic prophylaxis, Bacteremia, Healthcare disruptionAbstract
The COVID-19 pandemic has profoundly impacted global healthcare, leading to shifts in the epidemiology, diagnosis, and management of various infectious diseases. Infective endocarditis (IE), a severe and life-threatening infection of the endocardial surface of the heart, has seen a resurgence in recent years, with oral streptococci remaining a predominant causative agent. This review explores the evolving relationship between dental infections, oral health, and the risk of IE in the post-COVID-19 landscape. We examine the pathophysiological mechanisms linking dental bacteremia to endocardial colonization, emphasizing the role of endothelial damage induced by SARS-CoV-2 as a potential novel risk factor. The pandemic led to significant disruptions in routine dental care, resulting in an accumulation of untreated dental disease and a cohort of patients with advanced oral infections. Concurrently, altered immune responses and the pro-thrombotic, pro-inflammatory state associated with COVID-19 may create a more susceptible environment for bacterial adhesion and vegetation formation. This article synthesizes current evidence on these interactions, discusses updates in antibiotic prophylaxis guidelines, and highlights the critical importance of restoring access to dental care and reinforcing collaborative efforts between cardiologists, infectious disease specialists, and dentists in the post-pandemic period.
Metrics
References
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36(44):3075-128.
Durack DT. Prevention of infective endocarditis. N Engl J Med. 1995;332(1):38-44. DOI: https://doi.org/10.1056/NEJM199501053320107
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. American Dental Association. COVID-19: Implications for Dental Care. J Am Dent Assoc. 2020;151(9):799-801.
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. DOI: https://doi.org/10.1016/S0140-6736(20)30937-5
Rodbard S. Blood velocity and endocarditis. Circulation. 1963;27:18-28. DOI: https://doi.org/10.1161/01.CIR.27.1.18
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008;117(24):3118-25. DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.758524
Moreillon P, Que YA. Infective endocarditis. Lancet. 2004;363(9403):139-49. DOI: https://doi.org/10.1016/S0140-6736(03)15266-X
Siqueira JF, Rôças IN. Microbiology of apical periodontitis. Essential Endodontology. Wiley-Blackwell. 2008.
Cope AL, Francis N, Wood F, Mann MK, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev. 2014;26(6):CD010136. DOI: https://doi.org/10.1002/14651858.CD010136.pub2
Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30-44. DOI: https://doi.org/10.1038/nri3785
Offenbacher S. Periodontal diseases: pathogenesis. Ann Periodontol. 1996;1(1):821-78. DOI: https://doi.org/10.1902/annals.1996.1.1.821
Parahitiyawa NB, Jin LJ, Leung WK, Yam WC, Samaranayake LP. Microbiology of odontogenic bacteremia: beyond endocarditis. Clin Microbiol Rev. 2009;22(1):46-64. DOI: https://doi.org/10.1128/CMR.00028-08
Roberts GJ, Gardner P, Simmons NA, Longhurst P, Holzel HS, Sury MR. Dental bacteremia in children. Pediatr Cardiol. 1997;18(1):24-7. DOI: https://doi.org/10.1007/s002469900103
Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008;35(4):277-90. DOI: https://doi.org/10.1111/j.1600-051X.2007.01173.x
Kebschull M, Demmer RT, Papapanou PN. "Gum bug, leave my heart alone!"—epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010;89(9):879-902. DOI: https://doi.org/10.1177/0022034510375281
Figuero E, Han YW, Furuichi Y. Periodontal diseases and adverse health conditions: The role of the oral microbiota. Periodontol 2000. 2020;83(1):90-105. DOI: https://doi.org/10.1111/prd.12295
Amraei R, Rahimi N. COVID-19, renin-angiotensin system and endothelial dysfunction. Cells. 2020;9(7):1652. DOI: https://doi.org/10.3390/cells9071652
Al-Obaidi MM, El Ouarradi A, Kantri A, Agrad K, Bensahi I, Merzouk F, et al. A case of infective endocarditis following COVID-19. IDCases. 2021;25:e01227.
Proal AD, VanElzakker MB. Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Front Microbiol. 2021;12:698169. DOI: https://doi.org/10.3389/fmicb.2021.698169
Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, et al. Prevention of viridans group streptococcal infective endocarditis:
A scientific statement from the American Heart Association. Circulation. 2021;143(20):e963-78.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J. 2015;36(44):3075-128. DOI: https://doi.org/10.1093/eurheartj/ehv319
Downloads
Published
How to Cite
Issue
Section
