Oral bacteria and yeasts in relationship to oral ulcerations in hematopoietic stem cell transplant recipients

• Published in: Supportive care in cancer Vol. 20; no. 12; pp. 3231 - 3240
• Main Authors: Laheij, Alexa M. G. A., de Soet, Johannes J., von dem Borne, Peter A., Kuijper, Ed J., Kraneveld, Eefje A., van Loveren, Cor, Raber-Durlacher, Judith E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-12-2012; Springer; Springer Nature B.V
• Subjects: Adult; Analysis; Bacteria; Bacterial Load; Candida - isolation & purification; Female; Gram-Negative Bacteria - isolation & purification; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Mouth; Mouth - microbiology; Nursing; Nursing Research; Oncology; Oral Ulcer - etiology; Oral Ulcer - microbiology; Original; Original Article; Pain Medicine; Prospective Studies; Real-Time Polymerase Chain Reaction; Rehabilitation Medicine; Side effects; Stem cells; Stomatitis - etiology; Stomatitis - microbiology; Transplantation; Transplantation Conditioning - adverse effects; Transplants & implants; Ulcers; Yeast; Oral ulceration; Yeasts; Stomatitis; Oral mucositis; Periodontal pathogens; HSCT
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-012-1463-2

Background
Oral 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.
Methods
This 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.
Results
None 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.
Conclusions
Our 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.