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Aribi Al-Zoobaee FW, Yee Shen L, Veettil SK, Gopinath D, Maharajan MK, Kunnath Menon R. Antiviral Agents for the Prevention and Treatment of Herpes Simplex Virus Type-1 Infection in Clinical Oncology: A Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8891. [PMID: 33265920 PMCID: PMC7730702 DOI: 10.3390/ijerph17238891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022]
Abstract
Cancer therapy may be complicated and compromised by viral infections, including oral herpes simplex virus (HSV) infection. This network meta-analysis aimed to identify the best antiviral agent to prevent or treat oral HSV infection in patients being treated for cancer. A search was conducted for trials published since inception until the 10th of May 2020 in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. A network meta-analysis was performed on the data from randomized controlled trials that assessed antiviral agents for preventive or therapeutic activity vs. placebo, no treatment or any other active intervention in patients being treated for cancer. The agents were ranked according to their effectiveness in the prevention of oral HSV using surface under the cumulative ranking (SUCRA). Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the evidence. In total, 16 articles were included. The pooled relative risk (RR) to develop oral HSV infection in the acyclovir group was 0.17 (95% CI: 0.10, 0.30), compared to 0.22 (95% CI: 0.06, 0.77) in the valacyclovir group. Acyclovir ranked highest for the prevention of oral HSV followed by valacyclovir. Subgroup analysis with different acyclovir regimens revealed that the best regimens in terms of HSV-1 prevention were 750 mg/m2 acyclovir administered intravenously followed by 1600 mg per day orally. Acyclovir (250 mg/m2 per day) administered intravenously was the least effective against the prevention of oral HSV.
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Affiliation(s)
| | - Loo Yee Shen
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia;
| | - Sajesh K. Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT 84132, USA;
| | - Divya Gopinath
- Oral Diagnostics and Surgical Sciences, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia;
| | - Mari Kannan Maharajan
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, 57000, Malaysia;
| | - Rohit Kunnath Menon
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur 57000, Malaysia
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Watson EE, Metcalfe JE, Kreher MR, Maxymiw WG, Glogauer M, Schimmer AD. Screening for Dental Infections Achieves 6-Fold Reduction in Dental Emergencies During Induction Chemotherapy for Acute Myeloid Leukemia. JCO Oncol Pract 2020; 16:e1397-e1405. [PMID: 32609586 DOI: 10.1200/op.20.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with newly diagnosed acute myeloid leukemia (AML) are at risk of infection, including odontogenic infections, during induction chemotherapy. It is unknown whether clinical dental screening to diagnose and treat odontogenic disease in these patients can reduce the incidence of dental emergencies. METHODS Between November 1, 2014, and December 31, 2016, we screened 147 patients with newly diagnosed AML before their admission for induction chemotherapy (n1 = 147, "screened" group). The patients not screened acted as controls (n2 = 190, "unscreened" group), as did patients diagnosed with AML in the 26 months before the initiation of the screening program (n3 = 304, "prescreening" group). The number of patients in each group who presented for emergency dental assessment during admission for induction chemotherapy was determined by 2 independent reviewers. RESULTS Among the 147 patients in the screened group, only 1 patient presented with an infectious odontogenic emergency (0.68% [95% CI, -0.64% to 1.98%]). In the unscreened group, 8 developed an infectious odontogenic emergency during induction chemotherapy (4.21% [95% CI, 1.37% to 7.15%]), a statistically significant difference (P = .046, a = 0.05). A similar rate of infectious dental emergencies was observed in the prescreening group (4.28% [95% CI, 2.0% to 7.2%]). CONCLUSION Clinical dental screening before induction chemotherapy in patients with AML resulted in a 6-fold reduction in infectious dental emergencies during the induction period.
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Affiliation(s)
- Erin E Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Jessica E Metcalfe
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Matthew R Kreher
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Walter G Maxymiw
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Aaron D Schimmer
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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De Conno F, Ripamonti C, Sbanotto A, Ventafridda V. Oral Complications in Patients with Advanced Cancer. J Palliat Care 2019. [DOI: 10.1177/082585978900500102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disturbances caused by lesions of the oral cavity play an important part in the alteration of the qualtity of life of cancer patients. The main complications affecting the oral cavity are infections (fungal, viral, bacterial), neutropenic ulcers, drug-induced stomatitis, dry mouth, and taste alteration. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little known about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented and approaches to management are suggested.
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Affiliation(s)
- Franco De Conno
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
| | - Carla Ripamonti
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
| | - Alberto Sbanotto
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
| | - Vittorio Ventafridda
- Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy
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A systematic review of oral herpetic viral infections in cancer patients: commonly used outcome measures and interventions. Support Care Cancer 2016; 25:687-700. [PMID: 27853930 DOI: 10.1007/s00520-016-3477-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To review the literature for outcome measures for oral viral infections in cancer patients. A secondary aim was to update the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of oral viral infections in cancer patients. METHODS Databases were searched for articles published in the English language, 1981-2013. Studies that met the eligibility criteria were reviewed systematically. The data about the outcome measures were classified according to the aim of the study: prevention, treatment, or non-interventional. The results of interventional studies were compared to the 2010 MASCC/ISOO publication. RESULTS Multiple clinical and laboratory tests were used to measure oral viral infections, with great variability between studies. Most of the studies were about Herpes Simplex Virus (HSV). The outcome measure that was most commonly used was the presence of HSV infection diagnosed based on a combination of suggestive clinical presentation with a positive laboratory result. HSV culture was the most commonly reported laboratory outcome measure. Acyclovir and valacyclovir were consistently reported to be efficacious in the management of oral herpetic infections. No new data on the quality of life and economic aspects was found. CONCLUSIONS Considering the variability in outcome measures reported to assess oral herpetic infections the researcher should select carefully the appropriate measures based on the objective of the study. Acyclovir and valacyclovir are effective in the management of oral herpetic infections in patients receiving treatment for cancer. Studies on newer anti-viral drugs may be useful to address the issue of anti-viral resistance.
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Correia AVL, Coêlho MRCD, de Oliveira Mendes Cahú GG, de Almeida Silva JL, da Mota Vasconcelos Brasil C, de Castro JFL. Seroprevalence of HSV-1/2 and correlation with aggravation of oral mucositis in patients with squamous cell carcinoma of the head and neck region submitted to antineoplastic treatment. Support Care Cancer 2014; 23:2105-11. [PMID: 25547479 DOI: 10.1007/s00520-014-2558-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 12/07/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Oral mucositis (OM) is a frequent side effect resulting from antineoplastic treatment and is described as an acute alteration characterized by ulcerative lesions, with the presence of a persistent chronic inflammatory infiltrate, erythema, and pain. AIMS The purpose of the study was to evaluate the presence of the herpes simplex virus (HSV-1/2) in patients with squamous cell carcinoma of the head and neck region (SCC) and its influence on the aggravation of oral mucositis after radiotherapy or radio/chemotherapy treatment. METHODS In this prospective cohort study, 91 patients were evaluated with regard to their serological status for IgG before treatment (initial time interval--TI) and for IgM before treatment (T1) and on the 30th day after the first day of radiotherapy application/radiation therapy (final time interval--TF), using immunoenzymatic assay (ELISA), and the results were correlated with the intensity of OM. RESULTS The seroprevalence for IgG was 97.8 %. IgM (TI) was positive in 18.7% and IgM (TF) in 20.9% of patients. All the patients developed some degree of oral mucositis; however, there was statistically significant correlation between positivity for IgM and degree of severity of OM, irrespective of the type of treatment to which the patient was submitted. CONCLUSION The reactivation of HSV-1/2 was shown to be relatively infrequent and there was no correlation between presence of the virus and aggravation of oral mucositis resulting from antineoplastic treatment.
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A systematic review of viral infections associated with oral involvement in cancer patients: a spotlight on Herpesviridea. Support Care Cancer 2010; 18:993-1006. [PMID: 20544224 DOI: 10.1007/s00520-010-0900-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 04/28/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Our aim was to evaluate the literature for the prevalence of and interventions for oral viral infections and, based on scientific evidence, point to effective treatment protocols. Quality of life (QOL) and economic impact were assessed if available in the articles reviewed. METHODS Our search of the English literature focused on oral viral infections in cancer patients within the timeframe of 1989-2007. Review methods were standardized. Cohort studies were used to determine the weighted prevalence of oral viral infection in cancer patients. The quality of selected articles were assessed and scored with respect to sources of bias, representativeness, scale validity, and sample size. Interventional studies were utilized to determine management guidelines. Literature search included measures of QOL and economic variables. RESULTS Prevalence of oral herpes simplex virus (HSV) infection in neutropenic patients was higher than in patients treated with radiotherapy for head and neck cancer (49.8% vs. 0%, respectively). In patients treated with radiochemotherapy for head and neck cancer, the prevalence of oral HSV infection increases up to 43.2% (CI, 0-100%). Prevalence of HSV infection was higher when oral ulcers existed. Information about other oral viral infections is sparse. There was a significant benefit of using acyclovir to prevent HSV oral infection (at 800 mg/day). Various dosing protocols of valacyclovir achieved prevention of HSV reactivation (500 or 1,000 mg/day). The prevalence of HSV reactivation was similar for acyclovir and valacyclovir. No information about impact on QOL and economic burden was available. CONCLUSIONS Acyclovir and valacyclovir are equally effective in preventing oral HSV infection. Neutropenic patients, who were primarily treated for hematological malignancies in the studies reviewed, are at a greater risk for viral infection.
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8
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Arduino PG, Porter SR. Oral and perioral herpes simplex virus type 1 (HSV-1) infection: review of its management. Oral Dis 2006; 12:254-70. [PMID: 16700734 DOI: 10.1111/j.1601-0825.2006.01202.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Herpes simplex virus type 1 (HSV-1) gives rise to a variety of clinical disorders and is a major cause of morbidity and mortality worldwide. HSV-1 infections are common in oral and perioral area. The aim of the present report was to critically examine the published literature to evaluate the advantages and limitations of therapy of HSV-1 infection in both immunocompetent and immunocompromised patients. Systemic antiviral therapy has been widely accepted as effective for primary herpetic gingivostomatitis. Aciclovir (ACV) 5% cream seems to be the accepted standard topical therapy for herpes labialis, being both effective and well tolerated, although penciclovir 1% cream has been proposed as a potentially useful treatment. Systemic ACV may be effective in reducing the duration of symptoms of recurrent HSV-1 infection, but the optimal timing and dose of the treatment are uncertain. Aciclovir and famciclovir may be of benefit in the acute treatment of severe HSV-1 disease in immunocompromised patients. There is also evidence that prophylactic oral ACV may reduce the frequency and severity of recurrent attack of herpetic infection in immunocompromised patients, but the optimal timing and duration of treatment is uncertain and can vary in different situations.
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Affiliation(s)
- P G Arduino
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy.
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Abstract
Oral complications are common among patients with advanced cancer, though relatively little research has been undertaken in this field. This review article discusses the common problem of xerostomia among the terminally ill, together with an overview of oral candidosis, oral viral infections, chemotherapy- and radiotherapy-associated mucositis, and alterations in taste sensation among those with advanced cancer. Suggested management regimes, based on the limited clinical trial data available, are provided where appropriate.
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Affiliation(s)
- M P Sweeney
- University of Glasgow Dental School, Glasgow, Scotland
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McCarthy GM, Awde JD, Ghandi H, Vincent M, Kocha WI. Risk factors associated with mucositis in cancer patients receiving 5-fluorouracil. Oral Oncol 1998; 34:484-90. [PMID: 9930359 DOI: 10.1016/s1368-8375(98)00068-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Oral mucositis is a dose-limiting toxicity of 5-fluorouracil (5-FU). This prospective cohort study investigated factors associated with mucositis in patients receiving 5-FU for cancer of the digestive tract. Sixty-three patients (mean age 65 years) completed self-administered questionnaires and had interviews, oral examinations and unstimulated whole salivary flow measurements at baseline and follow-up appointments. The duration of follow-up was 2 months. Predictor variables included sociodemographic data, body surface area, diabetes, smoking, alcohol consumption, salivary flow, oral hygiene, presence of prostheses, performance status, regimen of cytotoxic drugs, hematological data, and herpes simplex virus antibody titer. Forty-six per cent of patients developed at least one episode of oral mucositis during cytotoxic treatment. Pearson's chi-square analysis showed that mucositis was significantly associated with xerostomia at baseline, xerostomia during chemotherapy, and lower baseline neutrophil counts (P < or = 0.05). Multiple logistic regression analysis indicated that xerostomia at baseline (odds ratio, OR = 10.0), or baseline neutrophil level under 4000 cells/mm3 (OR = 3.9) were significant predictors of mucositis. Taking into account the effect of neutrophil level at baseline, xerostomia during chemotherapy (OR = 4.5) was also a significant predictor of mucositis. The results showed that xerostomia and lower baseline neutrophil levels are significantly associated with oral mucositis. These variables should be taken into consideration in the design of intervention studies to reduce the frequency and severity of mucositis. More research is required to investigate the role of saliva and neutrophils in the pathogenesis of chemotherapy-induced mucositis.
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Affiliation(s)
- G M McCarthy
- Department of Epidemiology and Biostatistics, Faculty of Medicine & Dentistry, University of Western Ontario, Canada.
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11
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Epstein JB, Van der Meij EH. Complicating mucosal reactions in patients receiving radiation therapy for head and neck cancer. SPECIAL CARE IN DENTISTRY 1997; 17:88-93. [PMID: 9582709 DOI: 10.1111/j.1754-4505.1997.tb00874.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Radiation mucositis is characterized by erythema, pseudomembranes, and ulceration of mucosa in the irradiated field. We present two cases of oral mucosal changes in patients treated with radiotherapy in the head and neck region, which included mucosal erythema and ulceration outside of the radiated fields. One case was confirmed as herpes virus infection, and the other was diagnosed as Sweet's syndrome. When mucositis extends beyond the radiation fields, the clinician should consider other causes of mucosal inflammation and erythema in order to begin appropriate management.
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Affiliation(s)
- J B Epstein
- Division of Dentistry, British Columbia Cancer Agency, Vancouver, Canada
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12
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Woo SB, Lee SF. Oral recrudescent herpes simplex virus infection. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 83:239-43. [PMID: 9117756 DOI: 10.1016/s1079-2104(97)90011-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this study is to determine the frequency of involvement of different intraoral sites by oral recrudescent herpes simplex virus in immunocompromised patients and whether keratinized intraoral sites are always affected by this virus. STUDY DESIGN The records of 30 hospitalized patients who had oral ulcers culture positive for herpes simplex virus were reviewed for the location of oral ulcers, febrile episodes, and medical diagnoses. RESULTS The data revealed that oral recrudescent herpes simplex virus may involve any intraoral site in immunocompromised patients with nonkeratinized sites representing approximately half of all sites; this is more frequent than has been previously reported. Twenty-six (86.7%) of 30 patients had no evidence of herpes labialis, and 13 (43.3%) of 30 patients were afebrile. CONCLUSION It is recommended that all oral ulcers, in immunocompromised patients should be cultured for herpes simplex virus regardless of their location. Early diagnosis reduces patient morbidity because effective treatment in the form of acyclovir is readily available.
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Affiliation(s)
- S B Woo
- Brigham and Women's Hospital and Harvard School of Dental Medicine, Boston, Mass., USA
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Scully C. New aspects of oral viral diseases. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 1996; 90:29-96. [PMID: 8791748 DOI: 10.1007/978-3-642-80169-3_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- C Scully
- Eastman Dental Institute for Oral HealthCare Sciences, University of London, England
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14
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McCarthy GM, Skillings JR. Orofacial complications of chemotherapy for breast cancer. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1992; 74:172-8. [PMID: 1324459 DOI: 10.1016/0030-4220(92)90378-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The National Institutes of Health recently recommended research initiatives to investigate oral complications of cancer chemotherapy. This prospective cohort study investigated orofacial complications of combination chemotherapy (cyclophosphamide, methotrexate, fluorouracil, vincristine, and prednisone) in women with breast cancer. Thirty-four patients were given baseline interviews and examinations. Each patient was given weekly orofacial examinations and biweekly interviews for the first seven cycles of cytotoxic treatment. The orofacial complications included neurotoxicity caused by vincristine, mucositis, and candidiasis. Neurotoxicity affected 22 of 34 (65%) patients, was significantly associated with age less than 50 years (p less than 0.05), and manifested as pain in 19 of 34 (56%) patients. Mucositis affected 7 of 34 (21%) patients and was significantly associated with the occurrence of lesions of the oral mucosa at baseline examination; and smaller body surface area--indicating a dose-related toxicity (p less than 0.05). In four of the patients with mucositis (57%) granulocytopenia developed during the 7 days after the onset of mucositis. Intraoral candidiasis affected 4 of 34 (12%) patients.
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Affiliation(s)
- G M McCarthy
- Division of Oral Biology, Faculty of Dentistry, University of Western Ontario, London, Canada
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15
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Ruskin JD, Green JG. Perioperative Considerations in the Immunocompromised Patient. Oral Maxillofac Surg Clin North Am 1992. [DOI: 10.1016/s1042-3699(20)30623-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Epstein JB, Scully C. Herpes simplex virus in immunocompromised patients: growing evidence of drug resistance. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1991; 72:47-50. [PMID: 1653925 DOI: 10.1016/0030-4220(91)90188-i] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Antiviral drugs have proven effective in treatment of herpesvirus infections and in prevention of reactivation of latent virus. The prototype drug is acyclovir. Herpes simplex virus (HSV) is susceptible to acyclovir. There is increasing evidence in immunocompromised patients of acyclovir-resistant HSV causing clinical disease. Mechanisms of HSV resistance to acyclovir are known. These findings have implications for the future development and clinical use of antiviral drugs.
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Affiliation(s)
- J B Epstein
- Cancer Control Agency of British Columbia, Vancouver, Canada
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Abstract
Oral herpes simplex virus infection is a common complication of cardiac transplantation. Lesions are secondary to reactivation of the virus, are atypical in appearance, and can involve any oral and perioral surface. Diagnosis on clinical grounds is difficult and should be confirmed with laboratory testing. A case report and review of the literature are presented to support the features of this infection.
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Affiliation(s)
- S W Redding
- University of Texas, Health Science Center Dental School at San Antonio 78284-7906, USA
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Schubert MM, Peterson DE, Flournoy N, Meyers JD, Truelove EL. Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 70:286-93. [PMID: 2170891 DOI: 10.1016/0030-4220(90)90142-f] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study analyzed factors associated with acute oropharyngeal herpes simplex virus (HSV) infection in 627 patients who had undergone allogeneic bone marrow transplantation for leukemia, lymphoma, or aplastic anemia. HSV infection developed in 233 (37%) of the patients; all but two were seropositive for HSV before transplant. Sixty-two percent of the seropositive patients had at least one episode of HSV reactivation during the first 100 days after transplant. Other factors that placed patients at increased risk for HSV infection were a pretransplant diagnosis of leukemia, being in remission at the time of transplant, and/or having been conditioned for transplant with chemoradiotherapy. Recognition of factors that may predispose patients to HSV infection helps determine those transplant recipients who might benefit most from antiviral prophylaxis or other approaches to prevention of HSV reactivation.
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Affiliation(s)
- M M Schubert
- Fred Hutchinson Cancer Research Center, Seattle, Wash
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19
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Epstein JB, Sherlock C, Page JL, Spinelli J, Phillips G. Clinical study of herpes simplex virus infection in leukemia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 70:38-43. [PMID: 2164654 DOI: 10.1016/0030-4220(90)90175-r] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Twenty-nine patients with leukemia were observed for the development of and recovery from oral herpes simplex virus (HSV) lesions. In patients with seropositive test results, lymphocyte and monocyte counts may provide a guide to predict the onset of HSV infections and to indicate when to institute acyclovir prophylaxis. When HSV developed, acyclovir was effective in preventing progression of the lesions, which did not resolve until white cell counts had recovered.
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Affiliation(s)
- J B Epstein
- Division of Oral Medicine and Clinical Dentistry, Vancouver General Hospital, British Columbia, Canada
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20
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Redding SW, Luce EB, Boren MW. Oral herpes simplex virus infection in patients receiving head and neck radiation. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1990; 69:578-80. [PMID: 2159138 DOI: 10.1016/0030-4220(90)90239-o] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- S W Redding
- Department of General Practice, School of Dentistry, University of Texas Health Science Center, San Antonio
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Scully C. Orofacial herpes simplex virus infections: current concepts in the epidemiology, pathogenesis, and treatment, and disorders in which the virus may be implicated. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 68:701-10. [PMID: 2556674 DOI: 10.1016/0030-4220(89)90159-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Herpes simplex virus (HSV) is the causal agent of herpetic stomatitis, recurrent herpes labialis, and the recurrent intraoral infections seen particularly in the immunocompromised patient. HSV has also been implicated in some erythema multiforme, cranial neuropathies, Behçet's syndrome, and oral squamous carcinoma. Recent advances in understanding of HSV, epidemiology, pathogenesis, and treatment are reviewed because there have been numerous advances over the past 5 years.
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Affiliation(s)
- C Scully
- University Department of Oral Medicine, Surgery, and Pathology, Bristol Dental Hospital and School
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22
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Rosenstein DI, Chiodo GT. Recurrent herpes simplex virus and the acceleration of the wasting syndrome: report of case. J Am Dent Assoc 1989; Suppl:43S-45S. [PMID: 2556466 DOI: 10.14219/jada.archive.1989.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D I Rosenstein
- Department of Public Health Dentistry, School of Dentistry, Oregon Health Sciences University, Portland 97201
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23
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Redding SW, Montgomery MT. Acyclovir prophylaxis for oral herpes simplex virus infection in patients with bone marrow transplants. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 67:680-3. [PMID: 2544843 DOI: 10.1016/0030-4220(89)90008-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Reactivation of herpes simplex virus (HSV) appears to play a significant role in oral mucositis resulting from bone marrow transplantation. The acyclic guanosine derivative acyclovir has been shown to be effective in treating and protecting against HSV infection in this group. The purpose of this study was to determine the role of HSV reactivation in oral mucositis in patients undergoing bone marrow transplantation who were seronegative for HSV or who received acyclovir prophylaxis. The results suggest that HSV plays an insignificant role in oral mucositis in these patients.
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Affiliation(s)
- S W Redding
- Department of General Practice, University of Texas Health Science Center, San Antonio, Texas
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24
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Barrett AP. Recognition and management of invasive pharyngeal candidiasis in acute leukemia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 67:275-8. [PMID: 2927922 DOI: 10.1016/0030-4220(89)90353-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Invasive fungal infection is a potentially fatal complication in severely neutropenic patients with acute leukemia. Two cases are presented to demonstrate specific clinical signs and symptoms that should alert the clinician to the possibility of aggressive invasive candidiasis of the oropharynx.
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Affiliation(s)
- A P Barrett
- Westmead Hospital Dental Clinical School, New South Wales, Australia
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De Conno F, Ripamonti C, Sbanotto A, Ventafridda V. Issues in symptom control. Part 4. Oral complications in patients with advanced cancer. J Pain Symptom Manage 1989; 4:20-30. [PMID: 2649619 DOI: 10.1016/0885-3924(89)90060-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Disturbances caused by lesions of the oral cavity play an important part in the alteration of the quality of life of cancer patients. The main complications affecting the oral cavity are infections (fungal, viral, bacterial), neutropenic ulcers, drug-induced stomatitis, dry mouth, and taste alteration. Most of the information available about these entities has been acquired in the cancer patient without advanced disease. The little knowledge about the epidemiology and physiopathology of such lesions in the advanced phase of cancer is presented, and approaches to management are suggested.
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Barrett AP. Chronic indolent orofacial herpes simplex virus infection in chronic leukemia: a report of three cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1988; 66:387-90. [PMID: 3050711 DOI: 10.1016/0030-4220(88)90251-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Orofacial mucocutaneous infections caused by herpes simplex virus (HSV) may exhibit a distinct chronic indolent pattern of behavior in some immunosuppressed patients as opposed to the more familiar aggressive patterns. Three patients with chronic leukemia who illustrate this chronic indolent pattern are presented. These cases should alert the clinician to the variable clinical appearance that HSV may adopt in the immunosuppressed patient.
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Affiliation(s)
- A P Barrett
- Westmead Hospital Dental Clinical School, New South Wales, Australia
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27
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Naylor GD, Terezhalmy GT. Oral complications of cancer chemotherapy: prevention and management. SPECIAL CARE IN DENTISTRY 1988; 8:150-6. [PMID: 2978774 DOI: 10.1111/j.1754-4505.1988.tb00722.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cancer chemotherapy is used to destroy rapidly proliferating cells. However, normal cells with high mitotic indexes are also affected by chemotherapy, particularly those in the oral and gastrointestinal mucosa and the hemopoietic system. Ultimately, this may lead to certain oral complications of cancer chemotherapy such as mucositis, infection, hemorrhage, xerostomia, and neurologic and nutritional disorders. The prevention and management of these oral complications that may result from the chemotherapeutic management of cancer are discussed here.
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28
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Epstein JB, Page JL, Anderson GH, Spinelli J. The role of an immunoperoxidase technique in the diagnosis of oral herpes simplex virus infection in patients with leukemia. Diagn Cytopathol 1987; 3:205-9. [PMID: 3311663 DOI: 10.1002/dc.2840030306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Laboratory techniques are often used to confirm a clinical diagnosis of oral herpes simplex virus (HSV) infection in patients with leukemia. In the present study, an immunoperoxidase technique (IPT) was used to examine smears taken from the oral mucosa of 44 patients with leukemia at Vancouver General Hospital. It was found that the IPT was as sensitive and specific as viral culture in confirming the presence of HSV. The IPT was found to be more predictive of symptomatic oral HSV disease than viral culture because it did not give positive results if there was only viral shedding in the absence of clinical disease. As the IPT is rapid and inexpensive as well as being specific, sensitive, and predictive, it has a definite role in the laboratory confirmation of oral HSV lesions in leukemics.
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Affiliation(s)
- J B Epstein
- Cancer Control Agency of British Columbia and Vancouver General Hospital, Canada
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29
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Barrett AP, Buckley DJ. Oral complications of high-dose melphalan in multiple myeloma. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1987; 64:264-7. [PMID: 3476906 DOI: 10.1016/0030-4220(87)90102-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Four patients with multiple myeloma refractory to conventional chemotherapy received high-dose melphalan. All experienced multiple oral complications. Extensive neutropenic ulceration and orofacial herpes simplex virus infection caused considerable morbidity in three patients during prolonged periods of neutropenia.
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30
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Barrett AP. Clinical characteristics and mechanisms involved in chemotherapy-induced oral ulceration. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1987; 63:424-8. [PMID: 3472141 DOI: 10.1016/0030-4220(87)90253-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The clinical characteristics of chemotherapy-induced oral mucosal ulceration in a group of patients with acute leukemia were examined in detail in a long-term prospective clinical study. Differences in regional susceptibility within the mouth to the effects of chemotherapy were apparent. A reconstruction of the probable mechanisms involved is presented.
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Abstract
Thirty patients hospitalized for induction chemotherapy of acute leukemia were studied for incidence, severity, and clinical features of oral herpes simplex virus infections. In 50% of the patients with evidence of past herpes infection, recurrent oral herpes developed during the study. Herpes simplex virus was the major cause of oral mucosal lesions seen in patients with leukemia. A majority of the episodes involved multiple oral sites and caused large atypical lesions. All lesions healed after topical or intravenous acyclovir therapy. Herpes simplex infection should be ruled out in all cases of oral ulcers detected in patients being treated for leukemia.
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Barrett AP. A long-term prospective clinical study of oral complications during conventional chemotherapy for acute leukemia. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1987; 63:313-6. [PMID: 3495768 DOI: 10.1016/0030-4220(87)90196-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Oral complications were detected during 89% of hospital admissions for treatment of acute leukemia in adults. Changes that reflected the underlying myelosuppression and general immunosuppression predominated. Hemorrhagic phenomena (77%), neutropenic ulceration (49%), and herpes simplex virus infections (39%) were the most common.
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Abstract
Herpes simplex virus infections in immunocompromised individuals have clinical features that are often quite different from primary and secondary HSV infections in otherwise healthy people. These infections should be recognized early and treated promptly to prevent progression of the lesions and the possible systemic dissemination of the virus. Cytological and biopsy examination frequently discloses changes characteristic of HSV-1, HSV-2, or Varicella-zoster virus. To ensure the most precise diagnosis, however, these examinations should be complemented by viral isolation and serological studies.
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