Michelle Palmieri1, Victor Adriano de Oliveira Martins1, Laura Masami Sumita2, Tania Regina Tozetto-Mendoza2, Bruna Baraldi Romano1, Clarisse Martins Machado2, Claudio Sergio Pannuti2, Thaís Bianca Brandão3, Ana Carolina Prado Ribeiro3, Luciana Corrêa1, Paulo Henrique Braz-Silva4,5. 1. Division of Pathology, Department of Stomatology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227-Cidade Universitária, São Paulo, SP, 05508-000, Brazil. 2. Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470-Jd. América, São Paulo, SP, 05403-000, Brazil. 3. Division of Dentistry, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, Av. Dr. Arnaldo, 251-Cerqueira César, São Paulo, SP, 01246-000, Brazil. 4. Division of Pathology, Department of Stomatology, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes, 2227-Cidade Universitária, São Paulo, SP, 05508-000, Brazil. pbraz@usp.br. 5. Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470-Jd. América, São Paulo, SP, 05403-000, Brazil. pbraz@usp.br.
Abstract
OBJECTIVE: Opportunistic infections may affect the oral mucosa of patients undergoing radio/chemotherapy through exacerbation of oral mucositis. The aim of this study is to evaluate the oral shedding of all eight human herpesviruses and its possible association with oral mucositis. MATERIALS AND METHODS: In this prospective cohort study, we analyzed oral rinse samples, collected weekly, from 20 patients during radiotherapy treatment. Serologic status to HSV1 and HSV2, EBV, CMV, and VZV in three different periods was performed by ELISA assay. PCR and enzymatic digestion was performed to detect HSV1, HSV2, EBV, CMV, VZV, HHV6, HHV7, and HHV8. Oral mucositis was evaluated according to the WHO criteria. RESULTS: Oral shedding of EBV, HHV6, and HHV7 was observed in all weeks of radiotherapy. Considering the episodes of shedding, the highest frequency was found in patients with EBV excretion (55.0%). No virus reactivation was observed by serological analysis. EBV oral shedding frequency was significantly higher than that of other viruses and showing a positive correlation with oral mucositis grade ≥2. CONCLUSIONS: There was a positive correlation between EBV oral shedding and oral mucositis grade ≥2, particularly after 3 weeks of radiotherapy, a period in which the severity of mucositis was statistically higher. These findings allow us to infer that the local inflammatory environment in mucositis grade ≥2 is more favorable for EBV replication. CLINICAL RELEVANCE: Mucositis is a frequent and important side effect of radio/chemotherapy treatment. Understanding the possible participation of viruses in the mechanism of this condition is important to develop strategies for treatment and prevention.
OBJECTIVE: Opportunistic infections may affect the oral mucosa of patients undergoing radio/chemotherapy through exacerbation of oral mucositis. The aim of this study is to evaluate the oral shedding of all eight human herpesviruses and its possible association with oral mucositis. MATERIALS AND METHODS: In this prospective cohort study, we analyzed oral rinse samples, collected weekly, from 20 patients during radiotherapy treatment. Serologic status to HSV1 and HSV2, EBV, CMV, and VZV in three different periods was performed by ELISA assay. PCR and enzymatic digestion was performed to detect HSV1, HSV2, EBV, CMV, VZV, HHV6, HHV7, and HHV8. Oral mucositis was evaluated according to the WHO criteria. RESULTS: Oral shedding of EBV, HHV6, and HHV7 was observed in all weeks of radiotherapy. Considering the episodes of shedding, the highest frequency was found in patients with EBV excretion (55.0%). No virus reactivation was observed by serological analysis. EBV oral shedding frequency was significantly higher than that of other viruses and showing a positive correlation with oral mucositis grade ≥2. CONCLUSIONS: There was a positive correlation between EBV oral shedding and oral mucositis grade ≥2, particularly after 3 weeks of radiotherapy, a period in which the severity of mucositis was statistically higher. These findings allow us to infer that the local inflammatory environment in mucositis grade ≥2 is more favorable for EBV replication. CLINICAL RELEVANCE: Mucositis is a frequent and important side effect of radio/chemotherapy treatment. Understanding the possible participation of viruses in the mechanism of this condition is important to develop strategies for treatment and prevention.
Entities:
Keywords:
Human herpesviruses; Oral mucositis; Radiotherapy; Squamous cell carcinoma
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