povidone-iodine and Leukemia--Myeloid--Acute

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.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Female; Gingival Diseases; Gingivitis; Gram-Negative Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Middle Aged; Minocycline; Opportunistic Infections; Periodontitis; Povidone-Iodine; Sepsis; Stenotrophomonas maltophilia; Transplantation Conditioning; Whole-Body Irradiation

From November 1987 to October 1990, we investigated the efficacy of povidine iodine gargle solution (Isodine Gargle) for preventing stomatitis in 26 patients (19 males and 7 females; mean age 53.2 years) with acute myelogenous leukemia (AML). The patients were given a concentrated preparation of the gargle solution which they had to dilute 50 times, and were asked to use it 8 times/day for one year. Twenty patients (76.9%) frequently suffered from stomatitis despite the gargling. Therefore, in the second year they were instructed to use the gargle solution at a higher concentration (30-fold dilution). On the third year, they were asked to increase the frequency of gargling to 10 times/day; this resulted in a significant decrease in frequency of the episodes of stomatitis. Severe and painful stomatitis no longer occurred. Gargling with povidine iodine gargle solution was thus considered effective for preventing stomatitis in AML patients.

Topics: Adult; Aged; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mouthwashes; Povidone-Iodine; Stomatitis, Aphthous