The oral cavity as a source of febrile neutropenia

Cancer is one of the leading causes of death worldwide, with 19.3 million new cases and 10 million deaths reported in 2020. In Europe, including the Netherlands, it is the primary cause of premature mortality. Many patients diagnosed with solid tumors or lymphoma undergo myelosuppressive chemotherapy (CT), which carries significant risks, including febrile neutropenia (FN). FN is a life-threatening condition characterized by fever during a period of neutropenia caused by CT. Diagnosing FN is challenging, as a bacterial cause is identified in fewer than 30% of cases.
This dissertation explores the potential contribution of oral infections and inflammation to the development of FN. Chapter 2 discusses how oral infections and oral side effects of CT, like oral mucositis (OM), may contribute to the development of FN.
Chapter 3 focuses specifically on OM, a painful inflammation of the oral mucosa caused by CT, and the consequences and possible treatment of this condition. Chapter 4 studies the potential contribution of oral infection before and during CT-regimen in the development of FN. Additionally, chapter 5 investigates the value of using an orthopantomogram to detect foci of infection before the start of CT.
Finally, chapter 6 shows that the oral microbiome undergoes significant changes during CT, particularly in patients with OM and FN. Further studies are needed to confirm these findings.