Abstract
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% 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%) patients. Microbiological analysis revealed a reduced number of potentially pathogenic microorganisms, such as coagulase-negative staphylococci (47%), Candida albicans (35.3%), Klebsiella pneumoniae (5.9%), enteropathogenic Escherichia coli (5.9%), and Stenotrophomonas maltophilia (5.9%). Patients with oral mucositis showed a higher frequency of coagulase-negative staphylococci (80%) when compared with patients with normal oral mucosa (33.3%). In conclusion, the results of the present study suggest that the prophylactic use of 0.12% 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.
Highlights
Leukemia is a consequence of malignant transformation of a single hematopoietic progenitor cell
Studies have demonstrated an increase in the number and proportion of Gram-negative bacilli such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella and Enterobacter spp. in the oral cavity of oncological patients, which are detected in approximately twothirds of all bacterial isolates [7,8]
Chlorhexidine has recognized fungicidal and bactericidal properties [14], and it has been shown that preventive treatment with this drug and oral hygiene care reduce the occurrence of oral complications related to hematological cancer treatment [14]. In light of these findings and in view of the scarcity of data regarding the microbiota associated with the occurrence of oral mucositis in the pediatric cancer population, the aim of this study was to clinically evaluate oral mucosal alterations and to qualitatively analyze the oral microbiota in children with Acute lymphoblastic leukemia (ALL) undergoing antineoplastic chemotherapy and prophylactic treatment with 0.12% chlorhexidine gluconate
Summary
Leukemia is a consequence of malignant transformation of a single hematopoietic progenitor cell. A sequence of molecular events disrupts the process of differentiation and limited proliferation that characterizes normal hematopoiesis and generates a leukemic clone capable of expanding by indefinite selfrenewal [1]. Oral mucositis is the most frequent complication of hematological cancer treatment, representing the main cause of pain [3,4,5] and a site favorable to the colonization and proliferation of bacteria [5,6]. Studies have demonstrated an increase in the number and proportion of Gram-negative bacilli such as Escherichia coli, Pseudomonas aeruginosa, Klebsiella and Enterobacter spp. in the oral cavity of oncological patients, which are detected in approximately twothirds of all bacterial isolates [7,8]. Gram-positive bacteria including coagulase-negative staphylococci and Enterococcus have been identified in samples
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