Oral flora in acute stroke patients: A prospective exploratory observational study

Boaden, Elizabeth; Lyons, Mary; Singhrao, Simarjit Kaur; Dickinson, Hazel; Leathley, Michael J; Lightbody, Catherine Elizabeth; McLoughlin, Alison; Khan, Zarine; Crean, St John; Smith, Craig J.; Higham, Susan; Watkins, Caroline

doi:10.1111/ger.12271

Cited by 34 publications

(27 citation statements)

References 56 publications

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“…While there is limited knowledge on the prolonged effects of astrocyte activation poststroke in humans, GFAP blood concentrations have been associated with stroke severity and long-term functional outcome [48]. The combination of sustained neuroinflammation and systemic immunosuppression leaves stroke patients vulnerable to infection [49]. Therefore, we speculate that it was these prolonged neuro-inflammatory effects that contribute to the functional deficits we observed in our mice post-stroke.…”

Section: Cells and Significant Increases In Cd4+ T Cells And Cd8+ T mentioning

confidence: 83%

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Brichacek¹,

Nwafor²,

Benkovic³

et al. 2020

Preprint

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Recent literature implicates gut epithelia mucosa and intestinal microbiota as important players in post-stroke morbidity and mortality. As most studies have focused on the acute effects of stroke on gut dysbiosis, our study objective was to measure chronic, longitudinal changes in the gut microbiota and intestinal pathology following ischemic stroke. We hypothesized that mice with experimental ischemic stroke would exhibit chronic gut dysbiosis and intestinal pathology up to 36 days post-stroke compared to sham controls. Male C57BL/6J mice were subjected to 60 minutes of transient middle cerebral artery occlusion (tMCAO) or sham surgery. To determine the long-term effects of tMCAO on gut dysbiosis, fecal boli were collected pre- and post-tMCAO on days 0, 3, 14, and 28. Bioinformatics analysis demonstrate significant differences in abundance among Firmicutes and Bacteroidetes taxa at the phylum, family, and species levels in tMCAO compared to sham mice that persisted up to one month post-stroke. The most persistent changes in post-stroke microbial abundance were a decrease in bacteria family S24-7 and significant increases in Ruminococcaceae. Overall, these changes resulted in a persistently increased Firmicutes:Bacteroidetes ratio in stroke animals. Intestinal histopathology showed evidence of chronic intestinal inflammation that included marked increases in immune cell infiltration with mild-moderate epithelial hyperplasia and villous blunting. Increased astrocyte and microglial activity were also detected one-month post-stroke. These results demonstrate that acute, post-stroke disruption of the gut-brain-microbiota axis progresses to chronic gut dysbiosis, intestinal inflammation, and chronic neuroinflammation.Clinical PerspectivesThe microbiota-gut-brain axis, recently implicated in several neurological disorders, remains largely unexplored at chronic time points post-tMCAO.Our results demonstrate chronic gut dysbiosis, prolonged behavioral deficits, and persistent cerebral and intestinal inflammation post-tMCAO in male C57BL/6J mice.These results suggest that manipulation of microbiota may help reduce poor outcomes after stroke and lead to improved post-stroke functional recovery.

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Section: Cells and Significant Increases In Cd4+ T Cells And Cd8+ T mentioning

confidence: 83%

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Brichacek¹,

Nwafor²,

Benkovic³

et al. 2020

Preprint

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“…Boaden et al . recently described the bacterial profiles of the oral cavities of 50 patients during the first 2 weeks following stroke but found no associations between particular phylotypes and infections, concluding that their study may support larger observational studies ( 19 ).…”

Section: Introductionmentioning

confidence: 93%

“…In contrast, some studies have shown that improvement of oral care regimens in stroke patients can reduce incidence of stroke-associated pneumonia (18)(19)(20)(21). Boaden et al recently described the bacterial profiles of the oral cavities of 50 patients during the first 2 weeks following stroke but found no associations between particular phylotypes and infections, concluding that their study may support larger observational studies (19).…”

Section: Introductionmentioning

confidence: 97%

“…Ample evidence exists supporting a potential link between oral diseases or insufficient oral hygiene and development of aspiration pneumonia, although not specifically considering stroke patients (12,(15)(16)(17) and not from prospective investigations (18). In contrast, some studies have shown that improvement of oral care regimens in stroke patients can reduce incidence of stroke-associated pneumonia (18)(19)(20)(21). Boaden et al recently described the bacterial profiles of the oral cavities of 50 patients during the first 2 weeks following stroke but found no associations between particular phylotypes and infections, concluding that their study may support larger observational studies (19).…”

Section: Introductionmentioning

confidence: 99%

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Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

et al. 2020

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Stroke-associated pneumonia is a major cause for poor outcomes in the post-acute phase after stroke. Several studies have suggested potential links between neglected oral health and pneumonia. Therefore, the aim of this prospective observational study was to investigate oral health and microbiota and incidence of pneumonia in patients consecutively admitted to a stroke unit with stroke-like symptoms. This study involved three investigation timepoints. The baseline investigation (within 24 h of admission) involved collection of demographic, neurological, and immunological data; dental examinations; and microbiological sampling (saliva and subgingival plaque). Further investigation timepoints at 48 or 120 h after baseline included collection of immunological data and microbiological sampling. Microbiological samples were analyzed by culture technique and by 16S rRNA amplicon sequencing. From the 99 patients included in this study, 57 were diagnosed with stroke and 42 were so-called stroke mimics. From 57 stroke patients, 8 (14%) developed pneumonia. Stroke-associated pneumonia was significantly associated with higher age, dysphagia, greater stroke severity, embolectomy, nasogastric tubes, and higher baseline C-reactive protein (CRP). There were trends toward higher incidence of pneumonia in patients with more missing teeth and worse oral hygiene. Microbiological analyses showed no relevant differences regarding microbial composition between the groups. However, there was a significant ecological shift over time in the pneumonia patients, probably due to antibiotic treatment. This prospective observational study investigating associations between neglected oral health and incidence of SAP encourages investigations in larger patient cohorts and implementation of oral hygiene programs in stroke units that may help reducing the incidence of stroke-associated pneumonia.

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“…The health risk to individuals with swallowing difficulties is often compounded by impaired physical and cognitive function, which may impact further on the eating process. Decreased levels of alertness, fatigue, inability to maintain trunk and head alignment, reduced postural stability and tone, limb and body apraxia, visual perceptual difficulties, communication problems, a lack of insight, depression and poor oral hygiene (Boaden et al 2017), can all affect eating, drinking and swallowing of food, fluids and medication.…”

Section: Full Textmentioning

confidence: 99%

Are you IDDSI ready?

Boaden

Lightbody

Watkins

2019

British Journal of Neuroscience Nursing

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The International Dysphagia Diet Standardisation Initiative (IDDSI) global framework was launched in November 2015. It was subsequently adopted by the Royal College of Speech and Language Therapists and the British Dietetic Association following expert review and professional membership consultation. In the UK, NHS England established an External IDDSI Reference Group comprising of stakeholders including professional, catering, industry and manufacturing representatives. The IDDSI External reference Group have endorsed a UK Aware, Prepare, Adopt model of implementation and all manufacturers and all healthcare settings are anticipated to be fully IDDSI compliant by April 2019. This requires whole system change with a comprehensive training programme. Those providing and delivering food and drink to individuals with swallowing difficulties need to familiarise themselves with food and drink consistencies and their testing methods. Resources are available to assist local healthcare institutions with implementation of the framework at www.rcslt.org / www.bda.org / www.iddsi.org.

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Oral flora in acute stroke patients: A prospective exploratory observational study

Abstract: Objective: To describe the bacterial profile of the oral flora during the first 2 weeks following a stroke, examining changes in the condition of the oral cavity and infections.Background: Dysphagia is common after a stroke and can lead to aspiration pneumo-

Cited by 34 publications

References 56 publications

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Experimental Stroke Induces Chronic Gut Dysbiosis and Neuroinflammation in Male Mice

Oral Health, Oral Microbiota, and Incidence of Stroke-Associated Pneumonia—A Prospective Observational Study

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