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Smokeless Tobacco Products can Not Only Cause Cancer and But also Opportunistic Infections

Smokeless Tobacco Products can Not Only Cause Cancer and But also Opportunistic Infections

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  • Smokeless tobacco product is a tobacco product that is not burned.
  • Bacteria found in smokeless tobacco present health concerns to well being.
  • Smokeless tobacco causes cancer, oral problems and cardiovascular problems.
  • Recent study indicates that Smokeless tobacco product also has bacteria that cause opportunistic infections.

Bacteria present in smokeless tobacco products are associated with opportunistic infections i.e infections in people with weak immunity.

In the United States an estimated 8 million people use smokeless tobacco products. But, there has been little data on the microbial populations that exist within the smokeless tobacco products. A study conducted by Steven Foley and team helps understand the potential microbiological risks associated with the use of smokeless tobacco products.


What is Smokeless Tobacco?

  • Smokeless tobacco is not burned
  • The tobacco is sucked or chewed
  • Contains nicotine
  • Comes in flavors such as apple, berry, cinnamon and vanilla

Types of Smokeless Tobacco

  • Chewing tobacco includes loose leaf, plug or twist
  • Snuff is finely ground tobacco that can be moist, dry or packaged
  • Dissolvable products that slowly dissolve in the mouth (lozenges, sticks)

Smokeless Tobacco Use Among Students

In 2015
  • Nearly two of every 100 middle school students use smokeless tobacco
  • Six of every 100 high school students use smokeless tobacco

Bacillus Species that Present Health Concerns and Cause Opportunistic Infections

Bacillus licheniformis and Bacillus pumilus are Gram-positive rod-shaped bacteria found commonly in the soil. A study published in Clinical and Diagnostic Laboratory Immunology finds that 5 Bacillus species including Bacillus licheniformis and Bacillus pumilus found in chewing tobacco sold in the US evoked plasma exudation from oral mucosa.

Staphylococcus epidermidis and Staphylococcus hominis reduce nitrates to nitrites which lead to the formation of carcinogenic, tobacco-specific N'-nitrosamines within the tobacco products. Both the species of Staphylococci were previously been reported to cause heart valve infection. The gum disease enables bacterial entry into the bloodstream, which is how they could arrive at the heart.

What are Opportunistic Infections (OIs)?

Opportunistic infections are infections caused by bacteria, viruses, fungi or protozoa in people with weakened immune system. Aspergillus, Candida, Cryptosporidium Streptococcus are some of the pathogens that cause opportunistic infections.

Common opportunistic infections include

  • Candidiasis - fungal infection of the mouth, throat or vagina
  • Cytomegalovirus (CMV) disease - CMV virus can affect multiple parts of the body and cause pneumonia, encephalitis (infection) of the brain and retinitis.
  • Herpes simplex virus (HSV) is a very common virus and is sexually transmitted or acquired from the mother during childbirth. HSV can cause painful cold sores.
  • Toxoplasmosis is caused by the parasite Toxoplasma gondii that affects the brain.
  • Tuberculosis (TB) is caused by bacterium Mycobacterium tuberculosis.
Other Bacillus species also present health concerns, said co-author Steven Foley, PhD, research microbiologist, the National Center for Toxicological Research, US Food and Drug Administration. Some species have been identified as causative agents in spice-related outbreaks of diarrhea and vomiting. Additionally, they produce a mild toxin which, in large quantities could cause illness.

Microbial risk from smokeless products arises when the users hold the products in their mouths in close contact with the mucus membranes for a prolonged period of time. This allows the nicotine to pass into the bloodstream; and the user is exposed to bacteria present in the product.

Health Risks of Smokeless Tobacco

Using any kind of smokeless tobacco is a major health risk. No form of smokeless tobacco is a safe alternative for cigarettes.


People who use smokeless tobacco are exposed to at least 30 carcinogens that are known to cause cancer. Tobacco-specific nitrosamines (TSNAs) are the cancer causing substances present in smokeless tobacco. Higher the level of TSNAs greater is the cancer risk.

Cancers linked to smokeless tobacco include oral, gum, esophageal and pancreatic cancer.

Study published in Systematic Reviews journal finds the link between smokeless tobacco use and oral potentially malignant disorders in South Asia. Smokeless tobacco is a major risk factor for developing pancreatic adenocarcinoma, according to a study conducted by Burkey et al (2014).

Oral Problems

Leukoplakia is a condition in which thick, white patches form on the tongue and the lining of the cheeks of the mouth. Leukoplakia can become cancerous in the course of time.

Smokeless tobacco products can cause gingivitis (gum disease), tooth decay, tooth loss. Research conducted by Heikkinen et al found that snuff causes changes in the oral mucosal membrane, gingival recession and root surface caries.

Heart Disease

Some forms of smokeless tobacco increase the risk of heart attack, stroke, hypertension (high blood pressure). A link between smokeless tobacco and risk of fatal ischaemic heart disease and stroke was identified in study published in European Journal of Preventive Cardiology.

The research hopes to provide useful information regarding the US Food and Drug Administration's regulatory decision making around smokeless tobacco products. The study could provide a baseline microbiological risk profile of smokeless tobacco products.

The findings of the study are published in Applied and Environmental Microbiology , a journal of the American Society for Microbiology.

Source: Medindia

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