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Gingivitis and toothbrushes: potential roles in viridans streptococcal bacteraemia
H F Kennedy1, D Morrison, D Tomlinson
1Department of Microbiology, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, UK.
The Journal of Infection
|December 31, 2002
Summary
Severe gingivitis in a child with leukemia led to Streptococcus oralis bloodstream infection. Toothbrushes used by immunocompromised patients can harbor bacteria, necessitating regular replacement to prevent sepsis.
Area of Science:
- Oral Medicine
- Infectious Diseases
- Hematology Oncology
Background:
- Neutropenic patients with acute myeloid leukemia are susceptible to infections.
- Oral complications, including gingivitis and mucositis, are common in these patients.
- Viridans streptococci are a common cause of bloodstream infections in immunocompromised individuals.
Observation:
- A pediatric patient with acute myeloid leukemia and severe gingivitis developed Streptococcus oralis bacteremia.
- The S. oralis strain from blood culture was identical to an oral isolate, suggesting gingivitis as a potential entry point.
- A soft toothbrush used for oral care became colonized with S. oralis within two weeks.
Findings:
- Phenotypic and genotypic analyses confirmed the S. oralis strain from the toothbrush was indistinguishable from the blood and oral isolates.
- This indicates that the toothbrush itself can become a reservoir for pathogens causing bacteremia.
- Regular replacement of toothbrushes is crucial for immunocompromised patients.
Implications:
- Gingivitis, not just mucositis, can serve as a portal of entry for bacteremia in neutropenic patients.
- Soft toothbrushes may aid oral hygiene but require frequent replacement to prevent microbial colonization.
- This case highlights the importance of stringent oral care protocols and timely toothbrush replacement in immunocompromised populations.