Abstract
BackgroundOral mucositis is a serious and debilitating side effect of conditioning regimens for hematopoietic stem cell transplant (HSCT). Through HSCT, the homeostasis in the oral cavity is disrupted. The contribution of the oral microflora to mucositis remains to be clarified. The aim of our study was to investigate the relationship between yeasts, bacteria associated with periodontitis, and oral ulcerations in HSCT recipients.MethodsThis prospective observational study included 49 adult HSCT recipients. Twice weekly, oral ulcerations were scored, and oral rinsing samples were obtained. Samples were evaluated for the total bacterial load; the Gram-negative bacteria: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Tannerella forsythia, and Treponema denticola; and the yeasts: Candida albicans, Candida glabrata, Candida kefyr, Candida krusei, Candida parapsilosis, and Candida tropicalis using real-time polymerase chain reaction with specific primers and probes. Explanatory variables for oral ulcerations were calculated using the multilevel generalized estimated equations (GEE) technique.ResultsNone of the samples was positive for A. actinomycetemcomitans, while F. nucleatum was found most often (66 % of samples). C. albicans was the most isolated yeast (88 % of samples), whereas C. parapsilosis was found in only 8 % of the samples. Multivariate GEE analyses identified P. gingivalis, P. micra, T. denticola, F. nucleatum, C. glabrata, and C. kefyr as significant explanatory variables of oral ulcerations.ConclusionsOur data indicate that P. gingivalis in particular, but also P. micra, T. denticola, F. nucleatum, C. glabrata, and C. kefyr may play a role in ulcerative oral mucositis in patients undergoing HSCT.
Highlights
Mucositis remains one of the most common, serious, and painful side effects of cytotoxic cancer therapy [1]
Most of the bacterial species present in the oral cavity are harmless commensal bacteria, and under normal healthy conditions, there is homeostasis in the oral cavity. This delicate balance can be disturbed by the cancer itself, the anti-cancer treatment, or by the supportive therapies that all may contribute to a shift in the oral microflora of the oral cavity from mainly Gram-positive to Gram-negative bacteria [7]
LPS activates macrophages to produce inflammatory mediators like interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), prostaglandin E2 (PGE2), and matrix metalloproteinases (MMPs) [9]. These bacteria are associated with periodontitis and gingivitis, and they may have the ability to aggravate the inflammatory process in mucositis
Summary
Mucositis remains one of the most common, serious, and painful side effects of cytotoxic cancer therapy [1]. This delicate balance can be disturbed by the cancer itself, the anti-cancer treatment, or by the supportive therapies that all may contribute to a shift in the oral microflora of the oral cavity from mainly Gram-positive to Gram-negative bacteria [7]. This disruption of the balance may be related to direct cytotoxic effect on the oral flora, granulocytopenia, altered salivary output, alteration in cytokine release, use of antibiotics, compromised oral hygiene, and the acquisition of hospital-associated pathogens [8]. The aim of our study was to investigate the relationship between yeasts, bacteria associated with periodontitis, and oral ulcerations in HSCT recipients
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