Orofacial fungal infections. Nine pathogens that may invade during chemotherapy.

Immunosuppression due to antineoplastic drugs or malignant tumor leaves patients extremely vulnerable to infection. Opportunistic fungi that rarely infect healthy persons can have very severe consequences in these patients. Candida albicans is the pathogen found most often, but several other Candida species may cause infection as well.

Effect of antileukemia chemotherapy on marrow, blood, and oral granulocyte counts.

This study was designed to elicit the effects of antileukemia chemotherapy on marrow production, blood carriage, and oral extravasation of granulocytes, and on the phagocytic activity of those harvested from the mouth. Fifteen adult patients with various morphologic forms of acute leukemia were followed through one to four courses of chemotherapy. Oral saline rinse samples were obtained thrice weekly and prepared for enumeration in a hemocytometer.

The many faces of adult leukemia.

This article describes the facial complications of adult leukemia, as derived from a study of more than 3,000 patients treated at the University of Texas M.D. Anderson Hospital during the past 25 years.

The butterfly rash and the malar flush. What diseases do these signs reflect?

The butterfly rash and malar flush are common facial manifestations of several disorders. Systemic lupus erythematosus may produce a transient rash before any other signs. In pellagra, symmetric keratotic areas on the face are always accompanied by lesions elsewhere on the body.

Acral erythemas induced by chemotherapy and graft-versus-host disease in adults with hematogenous malignancies.

Acral erythema is being seen with increasing frequency in patients with hematologic malignancies, because of the administration of more aggressive high-dosage chemotherapy and the increasing use of allogeneic bone marrow transplantation, which may be followed by the development of cutaneous graft-versus-host disease. The varieties induced by both drugs and graft-versus-host disease are grossly similar but can be differentiated on the basis of symptoms, medical history, and response to therapy. Each also has to be differentiated from the painless palmar erythema commonly associated with pregnancy and with chronic liver disease.

Analysis of positive cultures from endodontically treated teeth: a retrospective study.

A study of 12,150 endodontically treated teeth from 11,797 patients in a private patient setup revealed an incidence of 10.2% positive cultures obtained just before obturation of the root canal. Streptococcal predominance was reflected by a presence of nearly 60% in the pure culture and nearly 98% in the mixed cultures.

Nutritional deficiencies in patients receiving cancer chemotherapy.

Cancer often causes malnutrition and specific vitamin and protein deficiencies. Chemotherapy also causes deficiencies by promoting anorexia, stomatitis, and alimentary tract disturbances. Antimetabolite drugs in particular inhibit synthesis of essential vitamins, purines, and pyrimidines.

Oral complications of cancer therapies. Description and incidence of oral complications.

No part of the body reflects the complications of cancer chemotherapy as visibly and as vividly as the mouth. The infectious, hemorrhagic, cytotoxic, nutritional, and neurologic signs of drug toxicity are reflected in the mouth by changes in the color, character, comfort, and continuity of the mucosa. The stomatologic complications of radiotherapy for oral cancer are physical and physiological in nature, transient or lasting in duration, and reversible or irreversible in type.

Dietary and nutritional counseling in the prevention and control of oral disease.

Diet, nutrition, and oral health are intimately interlinked. Oral tissues, like all tissues in the body, are diet- and nutrition-dependent. The diet provides the food chemicals that are converted into health and life-sustaining nutrients by metabolic processes.

Chemotherapy-induced acral erythema: desquamating lesions involving the hands and feet.

Patients receiving very high doses of chemotherapeutic drugs, particularly cytarabine (cytosine arabinoside, ara-C, Cytosar), may develop chemotherapy-induced acral erythema, a painful toxic rash of the palmar surfaces of the hands that progresses to edema, blister formation, and desquamation. In more severe cases, the feet are involved, and they show similar changes. Plastic surgeons may be consulted because of the hand involvement and the clinical resemblance, after desquamation, to a very superficial second-degree burn.

Intertriginous infections in adults receiving antileukemia chemotherapy.

Because intertriginous infections in patients receiving antileukemia chemotherapy may be life-threatening, all sites where skin contacts skin should be thoroughly examined daily. Early detection and immediate medical intervention designed to confine and cure the infection before it progresses to blood-borne dissemination of the infecting organisms are essential in these immunosuppressed patients.

The mouth as an indicator of internal nutritional problems.

The mouth is a uniquely sensitive repository of nutritional information reflecting past and present nutritional insults with a speed and to a degree unmatched by almost any other body site. Changes in the structural integrity of the teeth provide a history of exposure to deficiencies of vitamin A, vitamin C, vitamin D and iodine and to an excess of fluorides during the years of tooth formation. Changes in the structural integrity of the oral mucosa may signal ongoing deficiencies of riboflavin, niacin, folic acid, vitamin B6, vitamin B12, biotin, vitamin C, vitamin K, iron and protein calories.

Mucocutaneous herpetic infections during cancer chemotherapy.

Adults who are given immunosuppressive and myelosuppressive cancer chemotherapy have a heightened risk for development of herpetic infections during treatment. The impact is much greater in patients who are given antineoplastic drugs for leukemia and lymphoma than in those who are given such drugs for carcinoma and sarcoma. In the series reported here, the incidence of herpes simplex infections exceeded that of herpes zoster infections in patients treated for leukemia by a ratio of more than 12:1, compared to slightly more than 2:1 in patients treated for solid tumor.

External expressions of internal malignancy.

Paraneoplastic conditions are cancer-connected but are not produced as a direct effect of the tumor or metastasis. Some antedate the appearance of the internal malignancy; some run a course parallel to the tumor; some follow a pattern independent of the neoplasm. They occur in a small minority of patients with cancer and are, for the most part, of unknown cause.

Necrotizing dermatitis in patients receiving cancer chemotherapy.

Necrotizing dermatitis in patients being treated with cancer chemotherapeutic agents can be of several types. Microbial causes can include a variety of bacteria and fungi, the most common being Pseudomonas aeruginosa. Gangrene from occlusive causes is not uncommon among cancer patients with coexisting atheromatous, thromboembolic, or obliterative vascular disease.

Mucocutaneous granulocytic sarcomas of the head and neck.

Granulocytic sarcomas are malignant solid tumors composed of poorly differentiated myeloid cells that occur in association with myelocytic leukemia. The clinicopathologic characteristics of granulocytic sarcomas that presented in the oral mucosa and in the facial, scalp and neck skin of 8 patients in the acute phase of myelocytic leukemia are described and discussed. Although most of the tumors were demonstrably sensitive to cytosine arabinoside, alone or in combination with other antineoplastic drugs, the prognostic portent of these lesions was extremely poor.

Quantitative analysis of the oral complications of antileukemia chemotherapy.

Almost half of 1500 patients (46.9%) treated for acute leukemia developed chemotherapy-related oral infections, oral mucositis, and/or oral hemorrhages at some time during their hospitalization. The frequencies of 34.

Orofacial aspergillosis in acute leukemia.

The clinicopathologic characteristics of orofacial aspergillosis in thirteen hospitalized patients who developed the infection while receiving chemotherapy for acute leukemia are described. Clinically, the primary sites of infection, in decreasing order of frequency, were the paranasal sinuses, nasal cavity, mouth, and facial skin; the corresponding order for the secondary sites was orbit, nasal cavity, facial skin, and mouth. Pathologically, the fungal lesions in the nasal, oral and sinusoidal cavities were black, ulcerated, and escharotic due as a direct result of tissue destruction by the organism and an indirect result of thrombotic vascular infarction.