Oropharyngeal colonisation with fungi and gram-negative rods in patients treated with radiotherapy of the head and neck

Makkonen, Tanja; Borthen, L.; Heimdahl, Anders; Joensuu, Heikki; Lehtonen, O.-P.; Nord, Carl Erik

doi:10.1016/0266-4356(89)90048-x

Cited by 28 publications

(13 citation statements)

References 13 publications

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“…The presence of yeasts in the oral cavity is usually a minor embarrassment, but the possible role of yeasts in the development oforal cancer (Krogh, 1990;O'Grady and Reade, 1992) and infections of other organs requires attention. Patients undergoing cytostatic drug treatment (Dreizen et al, 1983) and radiotherapy are particularly vulnerable to yeast infections (Makkonen et al, 1989;Saral, 1991). Bergendal et al (1979) have reported a higher rate of colonization by yeasts in the mouth and feces in denture-wearers with stomatitis than in denturewearers wvithout stomatitis (100% vs. 40% and 71% vs. t35' , respectively).…”

Section: Discussionmentioning

confidence: 98%

Salivary Yeasts, Saliva, and Oral Mucosa in the Elderly

Närhi¹,

Ainamo²,

Meurman

1993

J Dent Res

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Yeasts are commensals in the oral cavity and may not cause disease unless there are predisposing host factors, such as other disease, or when medication is being taken. The elderly are at increased risk of yeast infection. In this paper, prevalence of salivary yeasts in a group of 368 inhabitants of Helsinki aged 76, 81, and 86 years is reported. Salivary yeasts were counted by the Oricult-N dip-slide method, salivary secretion rate and buffering capacity were measured, type of dentition was noted, and signs of yeast infection and the occurrence of subjective symptoms were determined. There was no growth of yeasts in 25% of the subjects. From one to 20 colonies/slide were observed in 21%, 21-50 colonies in 21%, and over 50 colonies (a high count) in 33%. Subjects with low salivary flow rates and low buffering capacities had significantly higher yeast counts than did subjects with normal salivary flow rates and buffering capacities. High yeast counts were found in 19% of subjects with natural teeth. The corresponding percentages in those wearing partial or complete dentures were 32 and 41, respectively. High salivary yeast counts were associated with oral mucosal lesions but not with subjective complaints of oral symptoms.

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Section: Discussionmentioning

confidence: 98%

Salivary Yeasts, Saliva, and Oral Mucosa in the Elderly

Närhi¹,

Ainamo²,

Meurman

1993

J Dent Res

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“…A marked increase in oropharyngeal gram-negative colonization is seen in patients with well-documented decreased salivary flow such as those with Sjögren syndrome or radiation-induced sialadenitis (12)(13)(14). Colonization with yeast is associated with medications that induce xerostomia (13,15).…”

Section: Discussionmentioning

confidence: 99%

Oral Clearance and Pathogenic Oropharyngeal Colonization in the Elderly

Palmer

Albulak

Fields

et al. 2001

Am J Respir Crit Care Med

117

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The elderly have an increased incidence of oropharyngeal colonization with respiratory pathogens, a well-known risk factor for the development of pneumonia. Changes in the oral milieu may occur secondary to decreased salivary production and abnormalities in swallowing. These abnormalities, common in the elderly, may result in impaired clearance of organisms, allowing pathogenic colonization. To test this hypothesis, we performed a prospective cross-sectional analysis of 75 elderly institutionalized patients and measured oral clearance using (99m)Tc-human serum albumin (HSA) administered to the oropharynx. Oropharyngeal cultures, salivary cell populations, elastase activity, and clinical parameters were measured simultaneously. Retention of radiolabel ranged from 100% to 2.3% over 120 min of observation. Clearance in the oropharynx was significantly decreased in those patients who had oropharyngeal colonization with gram-negative bacilli (GNB), Staphylococcus aureus (SA), or yeast compared with those demonstrating normal flora by 95% confidence intervals. Decreased clearance was also seen in patients on antidepressants by 95% confidence levels. The absolute number of salivary lymphocytes/ml and buccal cells/ml was increased in colonized patients versus noncolonized persons (mean +/- SEM, 128 x 10(3) +/- 49 x 10(3), 25.4 +/- 11.6 x 10(3)). Elastase activity was elevated in patients who had GNB compared with patients without GNB (mean +/- SEM, 10.6 nM +/- 5.7, versus 2.2 nM +/- 1.2, p = 0.036). We conclude that a decrease in salivary clearance of potentially pathogenic organisms may be a major risk factor for the development of colonization in the elderly.

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“…Moreover, C andida , which is not often isolated from healthy individuals, increased in number and frequency after head and neck RT [Almstahl and Wikstrom, 1999;Brown et al, 1975;Ramirez-Amador et al, 1997]. Makkonen et al [1989] found that 11 of 19 surviving patients treated with RT were still colonized with persisting or new species of fungi and Gram-negative rods 6 months after RT. They postulated that there was impaired metabolic activity of the anaerobic microfl ora facilitating new colonization with exogenous microorganisms.…”

Section: Discussionmentioning

confidence: 99%

The Persistence of <i>Streptococcus mutans</i> in Nasopharyngeal Carcinoma Patients after Radiotherapy

et al. 2005

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The aim of the study was to examine the persistence of oral Streptococcus mutans in nasopharyngeal carcinoma patients after radiotherapy. Ten subjects, ranging in age from 20 to 67 years, participated. DMFT/DMFS, salivary level of mutans streptococci and oral health status were recorded. Pooled plaque samples were obtained from the cervical margins and the interproximal regions of all the teeth and the occlusal surfaces of the molars prior to, immediately after, 3 and 6 months after the completion of radiotherapy. At least 10 colonies of S. mutans were isolated from each subject and totally 645 isolates were genotyped by restriction endonuclease analysis. The results showed that the salivary level of S. mutans increased significantly with the reduction of salivary flow rate after radiotherapy. Each subject had at least 1 genotype of S. mutans isolated throughout the follow-up period. In 3 subjects who initially carried 2 or more genotypes, 1 or 2 genotypes of S. mutans could not be detected 3 months after treatment. Moreover, the genotypes that became undetectable were predominant bacteria in the first sampling. The result indicated that most S. mutans genotypes were persistent after radiotherapy but some genotypes that might not adapt to the alteration of oral environment became undetectable.

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Oropharyngeal colonisation with fungi and gram-negative rods in patients treated with radiotherapy of the head and neck

Cited by 28 publications

References 13 publications

Salivary Yeasts, Saliva, and Oral Mucosa in the Elderly

Salivary Yeasts, Saliva, and Oral Mucosa in the Elderly

Oral Clearance and Pathogenic Oropharyngeal Colonization in the Elderly

The Persistence of <i>Streptococcus mutans</i> in Nasopharyngeal Carcinoma Patients after Radiotherapy

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