Soga Yoshihiko, Saito Takashi, Nishimura Fusanori, Ishimaru Fumihiko, Mineshiba Junji, Mineshiba Fumi, Takaya Hirokazu, Sato Hideaki, Kudo Chieko, Kokeguchi Susumu, Fujii Nobuharu, Tanimoto Mitsune, Takashiba Shogo
Department of Pathophysiology, Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
J Periodontol. 2008 Jan;79(1):181-6. doi: 10.1902/jop.2008.070205.
Dentists generally recognize the importance of periodontal treatment in patients with leukemia, with the most attention paid to preventing the development of odontogenic infection. For physicians, the worst type of infection is one caused by multidrug-resistant bacteria. Here, we report a patient with an abnormal increase in multidrug-resistant opportunistic bacteria in the gingiva during hematopoietic cell transplantation (HCT).
A 53-year-old woman receiving HCT for leukemia had an insufficient blood cell count for invasive periodontal treatment before HCT. Even brushing caused difficulties with hemostasis. Therefore, frequent pocket irrigation and local minocycline administration were performed.
The multidrug-resistant opportunistic bacterium Stenotrophomonas maltophilia was detected first in phlegm 2 days before HCT, and it was detected in a gingival smear and a blood sample 7 and 11 days after HCT, respectively. The patient developed sepsis on day 11 and died 14 days after HCT. Frequent irrigation and local antibiotic application were ineffective against S. maltophilia on the gingiva. Inflammatory gingiva without scaling and root planing showed bleeding tendency, and this interfered with the eradication of this bacterium.
The gingiva in patients undergoing leukemia treatment acts as sites of proliferation and reservoirs for multidrug-resistant opportunistic bacteria. Severe systemic infection by multidrug-resistant bacteria in such patients with leukemia also may involve the gingiva. To prevent abnormal increases in such bacteria on the gingiva, scaling and/or root planing before chemotherapy, which reduces bleeding on brushing during the neutropenic period caused by chemotherapy, may contribute to infection control in such patients, although it was impossible in this case.
牙医普遍认识到白血病患者牙周治疗的重要性，其中最受关注的是预防牙源性感染的发生。对于医生来说，最严重的感染类型是由多重耐药菌引起的感染。在此，我们报告一例造血细胞移植（HCT）期间牙龈中多重耐药机会性细菌异常增加的患者。
一名53岁接受白血病HCT的女性在HCT前血细胞计数不足，无法进行侵入性牙周治疗。即使刷牙也会导致止血困难。因此，进行了频繁的龈袋冲洗和局部应用米诺环素。
多重耐药机会性细菌嗜麦芽窄食单胞菌在HCT前2天首次在痰液中检测到，分别在HCT后7天和11天在牙龈涂片和血液样本中检测到。患者在第11天发生败血症，并在HCT后14天死亡。频繁冲洗和局部应用抗生素对牙龈上的嗜麦芽窄食单胞菌无效。未进行龈上洁治和根面平整的炎性牙龈有出血倾向，这妨碍了该细菌的根除。
接受白血病治疗患者的牙龈是多重耐药机会性细菌的增殖部位和储存库。此类白血病患者中由多重耐药菌引起的严重全身感染也可能累及牙龈。为防止牙龈上此类细菌异常增加，化疗前进行龈上洁治和/或根面平整，可减少化疗引起的中性粒细胞减少期刷牙时的出血，这可能有助于此类患者的感染控制，尽管在本病例中无法实施。
