Prospective evaluation of HSV, Candida spp., and oral bacteria on the severity of oral mucositis in pediatric acute lymphoblastic leukemia

Background Oral mucositis is a common collateral effect among the secondary complications resulting from chemotherapy. The objective of this study was to prospectively evaluate the association of HSV-1, Candida spp., and oral bacteria on the severity of oral mucositis in pediatric acute lymphoblastic leukemia (ALL). Procedure Seventy-one prospective patients were included. Analyses of oral microbiota were conducted on days 14 (D14) and 56 (D56) of the Brazilian GBTLI-99 treatment protocol. Herpes simplex virus (HSV) identification was performed by PCR followed by DNA sequencing analysis. Bacteria and fungi identification was obtained by standard microbiological culture tests. Results HSV-1 was found in 10.37% of individual patient samples. One sample was positive for HSV-4. On D14, we found an association between the severity of mucositis and the presence of HSV (p=0.0347) and Candida spp. (p=0.0078). At D56, we found an association between the severity of mucositis and the presence of HSV on D14 (p<0.0001) and HSV presence (p=0.0317). Conclusion The presence of HSV, mainly HSV-1, and Candida spp. was associated with mucositis severity in pediatric ALL. No association could be found between bacterial CFU and severity of mucositis.