title: Appearance of multidrug-resistant opportunistic bacteria on the gingiva during leukemia treatment.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathophysiology, Periodontal Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Soga
authors.forename: Takashi
authors.initials: T
authors.lastname: Saito
authors.forename: Fusanori
authors.initials: F
authors.lastname: Nishimura
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Ishimaru
authors.forename: Junji
authors.initials: J
authors.lastname: Mineshiba
authors.forename: Fumi
authors.initials: F
authors.lastname: Mineshiba
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takaya
authors.forename: Hideaki
authors.initials: H
authors.lastname: Sato
authors.forename: Chieko
authors.initials: C
authors.lastname: Kudo
authors.forename: Susumu
authors.initials: S
authors.lastname: Kokeguchi
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Fujii
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
authors.forename: Shogo
authors.initials: S
authors.lastname: Takashiba
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D017809:Fatal Outcome; D005260:Female; D005882:Gingival Diseases / Q000382:microbiology*; D005891:Gingivitis / Q000188:drug therapy; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000382:microbiology*; D010518:Periodontitis / Q000188:drug therapy; D011206:Povidone-Iodine / Q000627:therapeutic use; D018805:Sepsis / Q000382:microbiology; D020615:Stenotrophomonas maltophilia / Q000187:drug effects*; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D008911:Minocycline