Oral pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash

Oral pseudomembranous candidiasis (OPC) was evaluated in 61 patients receiv ing head and neck radiotherapy (RT). Herpes simplex virus-1 (HSV-1) reactiv ation was also investigated in :14 patients. According to the agreed protoc ol, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash was administered in 46 patients with radiation-induced ulcers. Candidiasis was diagnosed in 31 patients. Candida albicans was the most frequent isolate. Multiple Candida species were isolated from the lesions of four patients. C oncurrent candidiasis and radiation-induced ulcers were observed in 17 pati ents. Viral culture and the polymerase chain reaction disclosed the presenc e of HSV-1 in five patients. Twenty of the 46 patients, with initial mucosi tis grade OO and grade III, completed RT with mucositis grade I, indicating a beneficial effect of GM-CSF mouthwash, although further controlled studi es are necessary to verify that. In conclusion, OPC was an important infect ion in patients undergoing radiotherapy. The role of HSV-1 in oral mucositi s during head and neck radiotherapy needs additional study.