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High incidence of Aggregatibacter actinomycetemcomitans infection in patients with cerebral infarction and diabetic renal failure: a cross-sectional study

Minoru Murakami1, Jun-ichi Suzuki2*, Satoshi Yamazaki1, Masaya Ikezoe1, Rintaro Matsushima3, Norihiko Ashigaki4, Norio Aoyama4, Naho Kobayashi4, Kouji Wakayama2, Hiroshi Akazawa2, Issei Komuro5, Yuichi Izumi4 and Mitsuaki Isobe6

Author Affiliations

1 Department of Nephrology, Saku Central Hospital, Nagano, Japan

2 Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Tokyo, Japan

3 Department of Dentistry and Oral Surgery, Saku Central Hospital, Nagano, Japan

4 Department of Periodontology, Tokyo Medical and Dental University, Tokyo, Japan

5 Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan

6 Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan

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BMC Infectious Diseases 2013, 13:557  doi:10.1186/1471-2334-13-557

Published: 24 November 2013



Recent epidemiological studies suggest that periodontitis is a major risk factor for renal failure and cerebral infarction. The aim of this study was to evaluate the association among periodontitis, renal failure, and cerebral infarction, focusing on microbiological and immunological features.


Twenty-one patients treated with hemodialysis (HD) were enrolled in this study. They were 8 with diabetic nephropathy and 13 with non-diabetic nephropathy. Blood examination, periodontal examination, brain magnetic resonance image (MRI), and dental radiography were performed on all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontal pathogens, Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans), Porphyromonas gingivalis (P. gingivalis), and Prevotella intermedia (P. intermedia) using quantitative real-time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA).


We found that the patients with diabetic nephropathy had more A. actinomycetemcomitans compared with non-diabetic nephropathy (Pā€‰=ā€‰0.038) in dental plaque. Furthermore, the patients with diabetic nephropathy showed a significantly higher incidence of cerebral infarction compared with those with non-diabetic nephropathy (Pā€‰=ā€‰0.029). Clinical oral and radiographic scores tended to be higher among patients in the diabetic nephropathy group than in the non-diabetic nephropathy group.


Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role, at least a part, in the development of cerebral infarction in Japanese HD patients with diabetic nephropathy.

Periodontitis; Aggregatibacter actinomycetemcomitans; Diabetic nephropathy; Cerebral infarction