Avaliação epidemiológica e do perfil microbiológico de lesões de mucosite oral radioinduzida em pacientes com câncer de cabeça e pescoço

Abstract

Oral mucositis is one of the main acute side effects induced by head and neck’s radiotherapy (RT). It is characterized by oral burning and erythema, followed by intense pain, requiring, in some situations, radiotherapy treatment interruption. The aim of this research was to characterize the epidemiological and behavioral aspects and the main microbial groups isolated from patients with cancer in the head and neck region (HNC) submitted to radiotherapy associated or not with to chemotherapy and / or to surgery in the presence of Oral Mucositis (OM). It was included in this study patients with HNC undergoing RT. Three samples, using a sterile swab, were performed before, on 20th day and on the last day of RT. The place of sampling was the buccal mucosa or along the OM lesions, if present. In the absence of lesions the buccal mucosa was sampled. Phenotypic identification was performed by Vitek ® 2 Compact automated system. This study was composed of 22 patients, mostly males (81.8%), with an average age of 58.1 years (± 12.7); 59% of them declared themselves white; 86.3% reported to be ex-smokers and 90.9% ex-alcoholic. Patients with teeth corresponded to 59.1% and 40.9% were total edentulous. A strong negative correlation was found between the number of teeth and age (p <0.01), suggesting that, with the increasing of age, there was a decrease in the number of teeth. The most prevalent site was the oropharynx (40.9%) and the stage IV represented 81.8%. Concomitant chemo-radiotherapy were predominant (59.1%). Hospitalizations due to medical intercurrences occurred in 31.8%, as well as the use of nasoenteric probe was observed in 36.4% of the sample. The values of the Body Mass Index (BMI) had a statistically significant reduction throughout the samplings (p <0.01). In 68.1% the highest degree of OM observed was grade III. It was observed a change in the oral environment due to RT, innitialy Gram-positive bacteria prevayled (68.2%) over Gram-negative (22.7%) and gradually there were a decrease on Gram-positive and an increase on Gram-negative (47.1% of the isolates on third sampling). The presence of multiresistant microorganisms (44,3%) and the isolation of opportunistic pathogens related to nosocomial infections (50%) were observed. Our findings suggested a reduction of microorganisms associated with oral health during treatment and an increase of opportunistic pathogens associated with nosocomial infection. These changes may influence the lesions’evolution and the patients general health status. From the present study, an elaborated questionnaire is proposed and could be use in future researchers in public and private institutions.