The impact of the oral cavity in febrile neutropenia and infectious complications in patients treated with myelosuppressive chemotherapy

Support Care Cancer. 2019 Oct;27(10):3667-3679. doi: 10.1007/s00520-019-04925-8. Epub 2019 Jun 20.

Abstract

Febrile neutropenia (FN) is an inflammatory response causing fever that may develop during cancer therapy-induced neutropenia. FN may herald life-threatening infectious complications and should therefore be considered a medical emergency. Patients presenting with FN are routinely subjected to careful history taking and physical examination including X-rays and microbiological evaluations. Nevertheless, an infection is documented clinically in only 20-30% of cases, whereas a causative microbial pathogen is not identified in over 70% of FN cases. The oral cavity is generally only visually inspected. Although it is recognized that ulcerative oral mucositis may be involved in the development of FN, the contribution of infections of the periodontium, the dentition, and salivary glands may be underestimated. These infections can be easily overlooked, as symptoms and signs of inflammation may be limited or absent during neutropenia. This narrative review is aimed to inform the clinician on the potential role of the oral cavity as a potential source in the development of FN. Areas for future research directed to advancing optimal management strategies are discussed.

Keywords: Cancer chemotherapy; Dental health; Febrile neutropenia; Oral infection; Oral mucositis.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Dentition
  • Febrile Neutropenia / chemically induced*
  • Febrile Neutropenia / microbiology*
  • Female
  • Fever / chemically induced
  • Fever / microbiology
  • Humans
  • Male
  • Mouth / microbiology*
  • Mouth / pathology
  • Neoplasms / drug therapy
  • Periodontium / microbiology
  • Salivary Glands / microbiology
  • Stomatitis / microbiology*
  • Stomatitis / pathology

Substances

  • Antineoplastic Agents