Isolation of Pathogenic Microorganisms in Oral Cavity of Children with Cancer in Basrah Pediatric Oncology Center

Abstract

Background: Oral hygiene has been essential to improved oral and general health status of infant and children in the pediatric cancer and critical ill children, because of poor oral hygiene associated with dental plaque accumulation, bacterial colonization in oropharyngeal area and higher nosocomial infection.

Method: A case control study has been carried out on 62 children, their age ranged from 1 - 15 years, with newly diagnosed malignancy (33 males, and 29 females) admitted to Basrah pediatric oncology center from 1st of January till the end of October 2020, and 108 healthy children (56 males, and 52 females). This study has been done to look for the frequency and types of pathogenic microorganism in oral cavity of children with malignancy at time of diagnosis on day zero and during induction phase of chemotherapy on day 14 - 21.

Result: The study show Gram positive species (G+ve) were the most common microorganism in both control group and patient with cancer dominated by oral Viridians streptococci, and there is shifting and modification of oral microflora to more pathogenic and opportunistic Gram negative species (G-ve) in patients with cancer before induction (11), during induction (29) in comparison to control group, p value statistically significant 0.024, and most common G-ve isolated were Pseudomonas species, Klebsiella Pneumonia, Neisseria cataralis, Enterobacter cloaca, and Escherichia coli. Candida species especially Candid albicans was more common fungi isolated, and there is increased risk of oral colonization with fungal microorganism, before chemotherapy (53), and more increment during induction of chemotherapy (66%) compared to control groups (34%) p value statistically significant 0.023. Infection with G-ve has been increased during induction of chemotherapy in moderate to severe neutropenia (p = 0.049), in addition G-ve increased with severity of mucositis (60%), but Candida species were more with mild mucositis (82.8%). Regarding type of malignancy, G-ve and Candida species were more isolated from patients with solid tumor while G-ve were more with lymphohematopoietic malignancy.

Conclusion: From this study can be concluded, that there is great variation in proportion and types of oral microflora, modification and shifting of microorganism to more pathogenic and opportunistic negative species in patient with cancer, these will affect the health status of children especially those with neutropenia and mucositis.