ABSTRACT
The clinical course of an adult patient with acute lymphocytic leukemia and localized, rapidly progressive periodontal disease in a setting of marrow regeneration is described. Initial presentation of this condition was consistent with herpes simplex virus infection involving the gingiva; however, more extensive evaluation including radiographs, cultures and biopsy revealed necrotic tissue, nonspecific bacterial growth and acute gingival inflammation, with no evidence of viral infection. While most acute oral infections in chemotherapy patients occur during the development of marrow aplasia, this lesion initially developed late during the marrow recovery phase. The characteristics of this lesion are compared with those occurring in noncancer patients with rapidly progressive periodontitis and who have genetically governed neutrophil and/or lymphocyte defects.
Subject(s)
Periodontal Diseases/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Adult , Gingival Diseases/etiology , Gingival Diseases/pathology , Humans , Male , Necrosis/pathology , Periodontal Diseases/pathology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Ulcer/pathologyABSTRACT
This study characterized the subgingival microbial flora associated with 27 acute exacerbations of preexistent periodontal disease in 24 patients with chemotherapy-induced myelosuppression. All but two acute periodontal infections developed at low granulocyte levels (less than 1,000/microL). Suspected pathogens were detected in high concentrations in subgingival plaque specimens in 17 episodes of acute periodontal infection; a single pathogen was recovered in ten acute infections, and more than one pathogen was recovered in seven acute infections. Staphylococcus epidermidis, Candida albicans, S aureus, and Pseudomonas aeruginosa predominated, with combinations of these detected in some patients. Concomitant bacteremias developed in two of these patients. The subgingival microflora associated with ten acute periodontal infections was characterized by predominantly indigenous microorganisms, which in nine episodes were in abnormal proportions compared with microbial profiles in noncancer patients with similar degrees of periodontal disease. These data demonstrate that pathogens normally associated with infections in myelosuppressed cancer patients, as well as indigenous oral flora, are associated with acute periodontal infections during granulocytopenia. This finding is important, since this body site has not commonly been recognized as a source for acute infection in these patients.
Subject(s)
Antineoplastic Agents/adverse effects , Bone Marrow/drug effects , Infections/microbiology , Neoplasms/drug therapy , Periodontal Diseases/microbiology , Acute Disease , Adult , Antineoplastic Agents/therapeutic use , Female , Humans , Infections/etiology , Male , Middle Aged , Neoplasms/complications , Periodontal Diseases/etiologyABSTRACT
Common oral complications of chemotherapy include mucositis, infections secondary to profound bone marrow aplasia, and gingival bleeding. Mucositis and infections were treated with appropriate antibiotic therapy; a symptomatic tooth was extracted before chemotherapy was begun. Transfusions were performed to obtain adequate platelet levels. A regimen of ticarcillin disodium and gentamicin sulfate is recommended for antibiotic prophylaxis for selected dental procedures.
