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Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy treatment for head and neck squamous cell carcinoma

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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.

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Acknowledgements

The authors would like to thank financial support from Conselho Nacional de Desenvolvimento Tecnológico (CNPq; grant no. 443004/2014-5 and Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP; grants no. 2012/04303-5 and no. 2015/03906-6.)

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Authors and Affiliations

  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

    Michelle Palmieri, Victor Adriano de Oliveira Martins, Bruna Baraldi Romano, Luciana Corrêa & Paulo Henrique Braz-Silva

  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

    Laura Masami Sumita, Tania Regina Tozetto-Mendoza, Clarisse Martins Machado, Claudio Sergio Pannuti & Paulo Henrique Braz-Silva

  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

    Thaís Bianca Brandão & Ana Carolina Prado Ribeiro

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  1. Michelle Palmieri
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Correspondence to Paulo Henrique Braz-Silva.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Palmieri, M., Martins, V.A.d.O., Sumita, L.M. et al. Oral shedding of human herpesviruses in patients undergoing radiotherapy/chemotherapy treatment for head and neck squamous cell carcinoma. Clin Oral Invest 21, 2291–2301 (2017). https://doi.org/10.1007/s00784-016-2022-x

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  • DOI: https://doi.org/10.1007/s00784-016-2022-x

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