Objective: To elucidate the distribution of serotypes of Actinobacillus actinomycetemcomitans (Aa) in Indonesia and the Netherlands and changes of the Indonesian distribution over an eight-years period. Methods: In 1994 subgingival plaque samples were taken from 158 adult subjects from a rural village in Western-Java for microbiological analysis. From these subjects 115 were sampled in 2002. From these samples 1-4 isolates per patient were retrieved from TSBV-agar and used for serotyping. Serotypes a-f were determined by PCR reactions based on specific sequences from the distinct serotype-expression gene clusters. Subgingival plaque from 102 consequtively Aa-positive adult periodontitis patients from the Netherlands were analyzed for serotype distribution for comparison. Results: In 1994 the serotype distribution of Aa in Indonesia was 18.5%, 47.7%, 16.9% and 1.5% for serotype a,b,c and e respectively. These serotypes shift to a more equal distribution of 8.5%, 30.5%, 35.6% and 10.2% in 2002. Serotypes d and f were not observed in Indonesia. The serotype distribution of A. actinomycetemcomitans in the Netherlands were 60.8%, 19.6%, 13.7%, 4.9% and 1,0% for serotype a,b,c,e and f respectively. In Indonesia but not in the Netherlands we found patients harboring multiple clones. In 1994 the following combinations were found: a+b: 6.2%, a+c: 4.6% and a+e: 4.6%. This distribution equalized in 2002 to a+b: 1.7%, a+c: 1.7%, a+e: 1.7%, b+c: 3.4% and c+e: 6.8%. Conclusion: The distribution of serotypes of Aa in Indonesia differs strongly from that in the Netherlands. Serotype a is predominant in the Netherlands whereas the serotype distribution of Aa in Indonesia seems to shift from a predominant serotype b population towards a more equally serotype distributed population. The equality of distribution and the presence of multi-clonality suggest that in Indonesia Aa behaves like a opportunistic pathogen rather than a primary pathogen.

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