Frequency of oral mucositis and microbiological analysis in children with acute lymphoblastic leukemia treated with 0.12 percent chlorhexidine gluconate

In view of the morbidity potential of oral complications in patients with leukemia, this study evaluated the clinical and microbiological alterations that occur in the oral mucosa of children with acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic administration of 0.12 percent chlorhexidine gluconate. The sample consisted of 17 children aged 2 to 12 years that underwent clinical examination of the oral mucosa for the detection of oral lesions. In addition, biological material was collected from labial and buccal mucosa for microbiological analysis. Oral mucositis was observed in only 5 (29.4 percent) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47 percent), Candida albicans (35.3 percent), Klebsiella pneumoniae (5.9 percent), enteropathogenic Escherichia coli (5.9 percent), and Stenotrophomonas maltophilia (5.9 percent). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80 percent) when compared with patients with normal oral mucosa (33.3 percent). In conclusion, the results of the present study suggest that the prophylactic use of 0.12 percent chlorhexidine gluconate reduces the frequency of oral mucositis and oral pathogens in children with ALL. In addition, the present findings suggest a possible relationship between coagulase-negative staphylococci and the development of oral mucositis.

Tendo em vista o potencial de morbidade das complicações orais em pacientes com leucemia, este estudo avaliou as alterações clínicas e microbiológicas que ocorrem na mucosa bucal de crianças com leucemia linfoblástica aguda (LLA), submetidas à quimioterapia antineoplásica e administração profilática do gluconato de clorexidina 0,12 por cento. A amostra foi constituída de 17 crianças de 2 a 12 anos, as quais foram submetidas a exame clínico da mucosa oral para a detecção de lesões bucais. Além disso, foi coletado material biológico das mucosas labial e jugal para análises microbiológicas. A mucosite oral foi observada em apenas 5 (29,4 por cento) pacientes. A análise microbiológica revelou a presença de um número reduzido de microorganismos potencialmente patogênicos, como estafilococos coagulase-negativos (47 por cento), Candida albicans (35,3 por cento), Klebsiella pneumoniae (5,9 por cento), Escherichia coli enteropatogênica (5,9 por cento) e Stenotrophomonas maltophilia (5,9 por cento). Pacientes com mucosite oral apresentaram uma maior freqüência de estafilococos coagulase-negativos (80 por cento) quando comparados aos pacientes que exibiam mucosa oral normal (33,3 por cento). Em conclusão, os resultados do presente estudo sugerem que o uso profilático do gluconato de clorexidina 0,12 por cento reduz a freqüência de mucosite oral e de patógenos orais em crianças com LLA. Além disso, os presentes achados sugerem uma possível relação entre estafilococos coagulase-negativos e o desenvolvimento de mucosite oral.

Helicobacter pylori coinfection is a confounder, modulating mucosal inflammation in oral submucous fibrosis.

The oral cavity has been considered a potential reservoir for Helicobacter pylori (H pylori) , from where the organism causes recurrent gastric infections. Aim: With this case-control study we tried to evaluate the role of H pylori in the etiology of mucosal inflammation, a condition that compounds the morbid state associated with oral submucous fibrosis (OSF). Materials and Methods : Subjects ( n = 150) were selected following institutional regulations on sample collection and grouped into test cases and positive and negative controls based on the presence of mucosal fibrosis and inflammation. The negative controls had none of the clinical signs. All patients underwent an oral examination as well as tests to assess oral hygiene/periodontal disease status; a rapid urease test (RUT) of plaque samples was also done to estimate the H pylori bacterial load. We used univariate and mutivariate logistic regression for statistical analysis of the data and calculated the odds ratios to assess the risk posed by the different variables. Results : The RUT results differed significantly between the groups, reflecting the variations in the bacterial loads in each category. The test was positive in 52% in the positive controls (where nonspecific inflammation of oral mucosa was seen unassociated with fibrosis), in 46% of the test cases, and in 18% of the negative controls (healthy volunteers) (χ2 = 13.887; P < 0.01). A positive correlation was seen between the oral hygiene/periodontal disease indices and RUT reactivity in all the three groups. Conclusions: The contribution of the H pylori in dental plaque to mucosal inflammation and periodontal disease was significant. Logistic regression analysis showed gastrointestinal disease and poor oral hygiene as being the greatest risk factors for bacterial colonization, irrespective of the subject groups. A positive correlation exists between RUT reactivity and the frequency of mucosal inflammation.

Etiology and outcome of oral mucosal lesions in children on chemotherapy for acute lymphoblastic leukemia.

Microbiological cultures were taken from oral cavity and blood in 100 mucositis episodes in 70 children with acute lymphoblastic leukemia (ALL). Oral mucositis was commonest in neutropenic children during induction chemotherapy. Fungal organisms (n=39) were commonest isolate from mucosa followed by bacteria (n=28). Isolation of organism from oral cavity had no association with those isolated from blood. Herpes serology was positive in 16% episodes compared to 2% of controls. Obtaining cultures from oral lesions is useful in appropriate management of lesions and thereby possibly preventing systemic spread.

Estomatite por prótese total: presença de bactérias e fungos / Denture stomatitis: presence of bacteria and yeasts

A presença de fungos e bactérias foi estudada em 26 pacientes portadores de estomatite e os resultados comparados com os obtidos de mucosa normal de pacientes desdentados, usuários ou näo de prótese total. O uso de prótese provocou aumento na quantidade de fungos, havendo correlaçäo com a severidade da estomatite. Em todos os grupos estudados, predominaram cocos e bacilos Gram positivos, sendo que na presença de estomatite houve aumento de filamentosos Gram positivos e de cocos e bacilos Gram negativos. Estes resultados sugerem que, além dos fungos, a modificaçäo da microbiota bacteriana pode ser relevante no desenvolvimento da estomatite provocada por prótese total superior