This study characterized the subgingival microbial flora associated with 27 acute exacerbations of preexistent
periodontal disease in 24 patients with
chemotherapy-induced myelosuppression. All but two acute periodontal
infections developed at low granulocyte levels (less than 1,000/microL). Suspected pathogens were detected in high concentrations in subgingival plaque specimens in 17 episodes of acute periodontal
infection; a single pathogen was recovered in ten acute
infections, and more than one pathogen was recovered in seven acute
infections. Staphylococcus epidermidis, Candida albicans, S aureus, and Pseudomonas aeruginosa predominated, with combinations of these detected in some patients. Concomitant
bacteremias developed in two of these patients. The subgingival microflora associated with ten acute periodontal
infections was characterized by predominantly indigenous microorganisms, which in nine episodes were in abnormal proportions compared with microbial profiles in noncancer patients with similar degrees of
periodontal disease. These data demonstrate that pathogens normally associated with
infections in myelosuppressed
cancer patients, as well as indigenous oral flora, are associated with acute periodontal
infections during
granulocytopenia. This finding is important, since this body site has not commonly been recognized as a source for acute
infection in these patients.