Coagulase-Negative Staphylococcal Membrane-Damaging Toxins, Pain Intensity, and Metabolic Changes in Temporomandibular Disorder Patients with Chronic Muscle Pain

Aims: To investigate the association between toxin-producing staphylococci, symptom expression, and changes in urinary excre-tion of metabolites in temporomandibular disorder (TMD) patients and age- and sex-matched control subjects. Methods: Twenty-nine patients defined by the research diagnostic criteria/TMD as having Type 1a muscle pain (TMD1A), and 34 age- and sex-matched control subjects were assessed for the car-riage of staphylococcal species, staphylococcal toxin production, expression of symptoms, and changes in urinary excretion of amino and organic acids. Results: TMD1A patients had an increased incidence of carriage of toxin-producing coagulase-nega-tive staphylococcus (MDT-CoNS, P ＜ .004), which produced increased levels of δ-like membrane-damaging toxins. The TMD1A patients also had a reduction in the incidence of carriage of Staphylococcus aureus (P ＜ .02). Increased incidence of MDT-CoNS was positively associated with increased pain intensity as assessed by a visual analog scale (P ＜ .001). Odds ratio analysis revealed a 9.2-fold increase in MDT-CoNS recovery from the nose of TMD1A patients compared with the control subjects (odds ratio = 9.2, ＞ 95% confidence limits: 2.3 to 37.5, P ＜ .001). Increases in the carriage incidence of MDT-CoNS were also asso-ciated with increases in the urinary tyrosine:leucine ratio (P ＜ .004), which represents a change in the balance of proteolysis and protein synthesis. The toxin production by these CoNS species was also associated with an increased urinary excretion of glu-tamic acid (P ＜ .03). Conclusion: These data suggest that an increased colonization of MDT-CoNS on skin and mucosal mem-branes was associated with changed proteolysis, increased pain intensity, and an increase in excitatory amino acids consistent with events associated with the development of chronic orofacial mus-cle pain in TMD patients.

facial pain; metabolism; microbiology; temporomandibular disorders; staphylococcus pathogenicity; staphylococcal haemolysins; staphylococcal toxicity

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