Oral manifestations of aplastic anemia in children.

BACKGROUND: Few studies concerning oral manifestations of aplastic anemia (AA) in children have been reported. The purpose of the authors' study was to describe oral lesions in children with AA. METHODS: The authors conducted a retrospective review using medical records of children diagnosed with AA who were treated at the Pediatric Service of the Regional Hospital of Concepción, Chile, between March 1996 and May 2001. They recorded episodes of oral mucosal lesions and assessed platelet and neutrophil counts at the time the oral lesions appeared. RESULTS: Twelve children (nine boys and three girls) were diagnosed with AA. Their age range was 3 to 12 years (median age, 7 years). Nine subjects were receiving immunosuppressive therapy, and three received only supportive care. The most common oral manifestation of the disease was hemorrhage, which developed most often in patients with platelet counts less than 25 x 10(9) cells/liter. The second and third most common oral manifestations were candidiasis and viral infection, respectively. CONCLUSIONS: Children with AA frequently exhibit oral manifestations of the condition. Prevention, early diagnosis and proper treatment of oral complications are essential to diminish morbidity and avoid a possible fatal outcome. CLINICAL IMPLICATIONS: Oral lesions can be the first manifestation of AA; consequently, dentists should be aware of these manifestations so that an early diagnosis of the disease can be made.

Oral ulcers in children under chemotherapy: clinical characteristics and their relation with Herpes Simplex Virus type 1 and Candida albicans.

OBJECTIVE: The objective of this study was to determine the clinical characteristics of oral ulcers in pediatric oncology patients undergoing chemotherapy and their relation with the presence of Herpes Simplex Virus (HSV) type 1 and Candida albicans. STUDY DESIGN: The sample consisted of 20 ulcerative lesions from 15 children treated with chemotherapy in the Pediatric Service of the Regional Hospital of Concepción, Chile. Two calibrated clinicians performed clinical diagnosis of the ulcers and registered general data from the patients (age, general diagnosis, absolute neutrophil count, and number of days after chemotherapy) and clinical characteristic of the ulcers: number, size, location, presence or absence of pain and inflammatory halo, edge characteristics, and exudate type. Additional to clinical diagnosis, culture for Candida albicans (C) and polymerase chain reaction (PCR) for Herpes Simplex Virus type 1 was performed. RESULTS: Ten ulcers occurred in patients with acute lymphoblastic leukemia, five in patients with acute myeloblastic leukemia and five in patients with other neoplastic diseases. Eight ulcers were HSV (+) / C (-), 6 HSV (-) / C (-), 4 HSV (+) / C (+) and 2 HSV (-) / C (+). Preferential location was the hard palate. Most lesions were multiple, painful, with inflammatory halo, irregular edges and fibrinous exudate. The average size was 6,5 millimeters, and the mean number of days after chemotherapy was 7.5 days. CONCLUSIONS: Oral ulcers in children with oncological diseases did not present a specific clinical pattern. They were strongly associated with HSV.

Effect of white cell counts on the presence of human herpes simplex virus type-1 in saliva of pediatric oncology patients.

OBJECTIVE: The objective of this study was to assess if there is increased herpes simplex virus type 1 (HSV-1) salivary shedding in oncology pediatric patients with severe cytopenia (SC). STUDY DESIGN: HSV-1 was detected by real time PCR in saliva samples from oncology pediatric patients (n = 30) during SC and relative cytopenia (RC), and from healthy children (n = 27). RESULTS: The frequency of HSV-1 positive saliva samples was higher in patients with SC as compared to controls (P < .05), and this frequency presented a significant reduction during RC periods (P < .02). The SC group positive for HSV-1 presented both a twofold increase in the neutrophil-to-lymphocyte ratio as compared with SC patients negative for HSV-1 (P < .05), and a positive correlation between neutrophil and lymphocyte counts (P < .05, R = 0.82, R(2) = 0.67). This correlation was not found in oncology patients negative for HSV-1 during SC and RC. CONCLUSION: Severe cytopenia in oncology pediatric patients could be an important susceptibility factor for increased HSV-1 salivary shedding.