Márta Alberth

Significance of oral Candida infections in children with cancer

Candidiasis is common in children with cancer, particularly during periods of severe immunosuppression and neutropenia. Our aim was to study the microbiological changes in the oral cavity of children with newly diagnosed cancer. The study group consisted of 30 consecutive children and adolescents, 16 with acute lymphoblastic leukemia and 14 with solid tumors. Oral cultures to detect fungi and bacteria were conducted for all patients before treatment, during and after neutropenic episodes. In 23 patients developing fever simultaneous throat, urine and blood sampling was carried out. No pathogens were found in the cultures taken before the outset (30 cultures) or after recovery from (30 cultures) the neutropenic episodes. In the 45 oral cultures taken during the neutropenic episodes 38 (84.4%) proved positive. Fungi were the most frequently isolated oral pathogens: 33/38 yeast and 6/38 bacterial infections were identified. There was no association between the underlying malignancy and the occurrence of the positive cultures. Of the 30 patients, all 23 (76.7%) who have developed moderate-to-severe neutropenia, developed oral fungal colonization or clinically obvious fungal infection at least on one occasion during the study. In addition to oral samples, fungi were identified in 9/23 pharyngeal swabs, 6/23 urine and 1/23 blood cultures. The initial fungal pathogen was exclusively (33/33)Candida albicans. In extended severe neutropenic states,C. albicans was replaced by non-albicans species (C. kefyr, C. lusitaniae, C. sake, C. tropicalis) in 5 patients between 4 to 6 days of the neutropenic episodes. Four of the nonalbicansCandida strains were resistant to azole-type antifungal agents. Neutropenic episodes of children with cancer are associated with an increased risk of developing oral and even systemic infections withC. albicans that can be replaced by azole-resistant nonalbicans strains in prolonged neutropenia contributing to morbidity of these patients.

Oral health of long‐term childhood cancer survivors

As survival rate of children with cancer improved considerably during the past decades, late effects of antineoplastic therapy gained an increasing importance. Oral and dental care seem to be neglected areas resulting in considerable impairment of quality of life in adolescents and young adults cured from cancer. Even literature data surveying oral and dental status of childrenwith preceding neoplastic and hematologic disease are sparse. Here we report on the oral and dental status of longterm cancer survivors followed-up at the Outpatient Hematology-Oncology Clinic of the Department of Pediatrics, University of Debrecen, Medical and Health Science Center (UDMHSC). Forty-five children in long-term remission, previously treated for neoplastic diseases at the Division of Hematology-Oncology, Department of Pediatrics, UDMHSC were included into the study. The survey was performed in the Institute of Dental Sciences of the UDMHSC. Of the 45 patients, 25 boys and 20 girls, aged 4–25 years (mean 12.9 years), were examined. At the time of diagnosis, the age ranged from 1 to 22 years (mean 6.9 years). Mean survival time was 1–14 years (mean 5.9 years) at the time of the survey. The underlying diseases were 23/45 acute lymphoblastic leukemia, 5/45 acute myeloblastic leukemia, and 17/45 solid tumors. Patients were treated according to standard protocols as accepted by the Hungarian Pediatric Oncology Group (HPOG). In course of the combined cytotoxic treatment, out of 28 patients (ALL, AML) 13 received cranial irradiation (12 and 18 Gy, respectively) in addition to chemotherapy; while out of 17 patients (solid tumors), 11 received additional irradiation (18–40 Gy). The irradiation field of solid tumor patients did not involve the cranium. For each patient, an age and sex-matched control was chosen randomly from kindergarden and school children of similar socio-economic background attending at the Department of Pediatric Dentistry, MHSCUD. Oral and dental status, including X-ray imaging, was assessedwith informed consent. TheDMF numeric scores are generally accepted in the stomatologic literature to quantify the extent of dental disorders [1]. The scores represent the total number of decayed (D), missing (M) or filled (F) permanent teeth (DMF-T) and, allowing a more precise evaluation of dental status, the tooth surfaces (DMF-S). Of these indices, we used the combined DM scores (i.e., the number of decayedþmissing teeth/ surfaces within the denture of a proband) and F scores characteristic for dental pathology and treatment, respectively. In addition to the numeric score system, we also recorded congenital and acquired oral and dental malformations. DMandF data points did not follownormal distribution as checked with Kolmogorov–Smirnov test, therefore, we used nonparametric tests for the further statistical analysis of our data. Differences and correlations were considered significant if P-values were below 0.05. Before testing the difference of DM and F indexes of teeth and surface between patient and control group, we investigated the effect of age to these differences. We found strong and statistically significant, positive correlation between age and the DM differences (Spearman correlation, Corr1⁄4 0.463, P< 0.003 for teeth, Corr1⁄4 0.523, P< 0.001 for surface). To control for this effect of age, we created three age groups: 4–11, 12–15, and 16– 25 years. To check the relevance of these age intervals, we