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Changes in the oral microflora during cytotoxic chemotherapy in children being treated for acute leukemia
E A O'Sullivan1, M S Duggal, C C Bailey
1Division of Child Dental Health, Leeds Dental Institute, United Kingdom.
Insights
Cytotoxic chemotherapy significantly impacts oral microflora in children with acute leukemia, particularly reducing Streptococcus mutans counts. Daunorubicin likely caused this reduction, while other bacteria mirrored those found in blood samples.
Area of Science:
- Oral microbiology
- Pediatric oncology
- Hematology
Background:
- Children with acute leukemias undergo cytotoxic chemotherapy, altering their oral microflora.
- Oral health is critical during cancer treatment due to increased infection risk.
Purpose of the Study:
- To investigate changes in oral microflora composition and Streptococcus mutans levels in pediatric acute leukemia patients undergoing chemotherapy.
- To assess the in vitro sensitivity of oral bacteria to cytotoxic agents.
Main Methods:
- Longitudinal study of 34 children with acute leukemia over 6-12 months.
- Monthly oral examinations, bacterial swabs, and saliva samples for Streptococcus mutans.
- In vitro sensitivity testing of oral flora to cytotoxic drugs and prophylactic antimicrobial mouthrinses.
Main Results:
- Significant reduction in Streptococcus mutans counts (p < 0.0001) during chemotherapy, linked to daunorubicin sensitivity.
- No significant changes in the overall composition of oral bacterial flora during treatment.
- Isolated bacteria mirrored those found in routine blood cultures of leukemia patients.
Conclusions:
- Cytotoxic chemotherapy, specifically daunorubicin, effectively reduces Streptococcus mutans in children with acute leukemia.
- The oral bacterial flora composition remains relatively stable despite chemotherapy, but mirrors systemic infection indicators.
Abstract:
Thirty-four children with diagnosed cases of acute leukemias and being treated with cytotoxic chemotherapy at St James' Hospital, Leeds, were followed for between 6 months and 1 year to determine the changes in their oral microflora. They were examined before treatment commenced and then at monthly intervals. Swabs were taken from the oral cavity to test for the presence or absence of bacteria and Candida. Saliva samples were also used to assess the levels of Streptococcus mutans in the mouth. Sensitivity tests were carried out to assess the effect of the cytotoxic agents on the oral flora. All children received prophylactic nystatin and chlorhexidine gluconate mouthrinses four times daily for the whole period of the study. There was significant difference (p < 0.0001) for counts of S. mutans at different treatment stages. Sensitivity tests showed that S. mutans was sensitive to the cytotoxic drug daunorubicin, and this drug was probably responsible for the fall in S. mutans counts. A significant difference was also found in the types of bacteria isolated between the study and reference groups, but there was no change in the composition of the flora in the study group during treatment. These bacteria were also found to mirror those cultured from routine blood samples in children with acute leukemia.