Análise da microbiota bucal de pacientes com leucemia linfoblástica aguda

Abstract

Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. The application of chemotherapy protocols can achieve an event-free survival rate of approximately 90% of patients in long term, however administration of antineoplastic drugs may be associated with significant alterations in the oral cavity of patients with ALL due to its toxic effects. The reactivation of human herpesvirus simple (HSV) is extremely common in cancer patients, both with or without mucositis, and these infections tends to be more likely, lasting and severe, posing a threat in cases of imunosupression. This study evaluated the clinical and microbiological changes that occurred in the oral mucosa of pediatrics with ALL undergoing treatment in the Fundação de Hematologia e Hemoterapia do Amazonas, according to the Grupo Brasileiro de Tratamento da Leucemia na Infância (GBTLI- 2009). Nine patients, aged 2 to 14 years old, were evaluated, and included in the study from September to November 2014. These patients underwent clinical examination of the oral mucosa to identify oral lesions, as well as the analysis of buccal mucosa cells during different times according to stages of induction and consolidation. Three healthy patients were also evaluated in a just one moment. Conventional PCR was performed to detect presence of HSV-1, HSV-2, CMV and EBV. There was a higher prevalence of children of 2 years old, distributed uniformly by gender. The diagnosis of ALL B- derivative was the most frequent. Oral diseases appeared around the 2nd, 3rd and 4th week of inductions’ stage, including erythema, dry mouth and dry lips. None of the patients presented oral mucositis. None of the samples tested showed positivity for HSV-1, HSV-2 and CMV. Only three samples of ALL patients and a healthy patient showed DNA amplification for EBV. On the bacterial subject, it was deteced the presence of S. mitis, S. oralis, S salivarius and S. sanguinis. Results showed that there were few oral abnormalities found in patients receiving therapeutic protocols according to stratification in subgroups recommended by GBTLI-ALL-2009. Negative results suggested that the virus may be in a state of latency since the assessed mucosa was healthy. Probably, periodic evaluation by dentists and follow-up of oral alterations, associated with better understanding of the oral microbiota may contribute to improve the quality of life in these patients.