Identification of Candida species in patients with oral lesion undergoing chemotherapy along with minimum inhibitory concentration to fluconazole

Maheronnaghsh, Mehrnoush; Tolouei, Sepideh; Dehghan, Parvin; Chadeganipour, Mostafa; Yazdi, Maryam

Identification of Candida species in patients with oral lesion undergoing chemotherapy along with minimum inhibitory concentration to fluconazole

Authors

¹ Department of Parasitology and Mycology, School of Medicine, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Various species of Candida, especially Candida albicans was known as the most important etiological agent of fungal infections. Oral candidiasis is the most common fungal infection in patients undergoing chemotherapy. The purpose of this study was to identify Candida species from oral lesions of these patients and antifungal susceptibility of the clinical isolates.
Materials and Methods: Among 385 patients with cancer, 55 (14.3%) showed oral lesions. Oral swabs were performed to identify the yeasts using direct smear and CHROMagar medium. Micro dilution method was prepared in different concentrations of fluconazole and minimum inhibitory concentration and minimum fungicidal concentration of each species were compared.
Results: Oral candidiasis confirmed in 36 cases by direct examination and culture. C. albicans and non-albicans represented in 26 (72.2%) and 10 (27.8%) of the isolates, respectively. 76.5% of C. albicans and 23.5% non-albicans isolates were resistant to fluconazole. Data were shown that 62% and 30.7% of resistant strains of C. albicans were found in patient with gastrointestinal cancer and lymphoma respectively.
Conclusion: Data were shown that C. albicans is the most commonly identified species in oral candidiasis and majority of fluconazole resistant C. albicans were found in patients with gastrointestinal cancer and lymphoma. Therefore, we recommend an alternative drug instead of fluconazole as a first line of treatment for these type of cancers and administration of fluconazole in patients undergoing chemotherapy should be prescribed in accordance with the type of cancer.

Keywords

References

1.	Jackson BE, Wilhelmus KR, Hube B. The role of secreted aspartyl proteinases in Candida albicans keratitis. Invest Ophthalmol Vis Sci 2007;48:3559-65.
2.	Wu T, Mitchell B, Carothers T, Coats D, Brady-McCreery K, Paysse E, et al. Molecular analysis of the pediatric ocular surface for fungi. Curr Eye Res 2003;26:33-6.
3.	Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev 2010;23:253-73.
4.	Rosenbach A, Dignard D, Pierce JV, Whiteway M, Kumamoto CA. Adaptations of Candida albicans for growth in the Mammalian intestinal tract. Eukaryot Cell 2010;9:1075-86.
5.	López-Martínez R. Candidosis, a new challenge. Clin Dermatol 2010;28:178-84.
6.	Kontoyiannis DP, Mantadakis E, Samonis G. Systemic mycoses in the immunocompromised host: An update in antifungal therapy. J Hosp Infect 2003;53:243-58.
7.	Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: A propensity analysis. Clin Infect Dis 2005;41:1232-9.
8.	Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev 2011;24:141-73.
9.	Pfaller MA, Diekema DJ. Rare and emerging opportunistic fungal pathogens: Concern for resistance beyond Candida albicans and Aspergillus fumigatus. J Clin Microbiol 2004;42:4419-31.
10.	Samaranayake LP, MacFarlane TW, Lamey PJ, Ferguson MM. A comparison of oral rinse and imprint sampling techniques for the detection of yeast, coliform and Staphylococcus aureus carriage in the oral cavity. J Oral Pathol 1986;15:386-8.
11.	Farah CS, Ashman RB, Challacombe SJ. Oral candidosis. Clin Dermatol 2000;18:553-62.
12.	Ghannoum MA, Radwan SS. Candida Adherence to Epithelial Cells. Florida, USA: CRC Press; 1990.
13.	Abu-Elteen KH, Abu-Alteen RM. The prevalence of Candida albicans populations in the mouths of complete denture wearers. New Microbiol 1998;21:41-8.
14.	Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: Epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 1992;15:414-21.
15.	Jackson BE, Wilhelmus KR, Mitchell BM. Genetically regulated filamentation contributes to Candida albicans virulence during corneal infection. Microb Pathog 2007;42:88-93.
16.	Naglik JR, Moyes DL, Wächtler B, Hube B. Candida albicans interactions with epithelial cells and mucosal immunity. Microbes Infect 2011;13:963-76.
17.	Safdar A, Armstrong D. Infectious morbidity in critically ill patients with cancer. Crit Care Clin 2001;17:531-70.
18.	Orozco AS, Higginbotham LM, Hitchcock CA, Parkinson T, Falconer D, Ibrahim AS, et al. Mechanism of fluconazole resistance in Candida krusei. Antimicrob Agents Chemother 1998;42:2645-9.
19.	Ostrosky-Zeichner L, Rex JH, Pfaller MA, Diekema DJ, Alexander BD, Andes D, et al. Rationale for reading fluconazole MICs at 24 hours rather than 48 hours when testing Candida spp. by the CLSI M27-A2 standard method. Antimicrob Agents Chemother 2008;52:4175-7.
20.	Mikulska M, Del Bono V, Ratto S, Viscoli C. Occurrence, presentation and treatment of candidemia. Expert Rev Clin Immunol 2012;8:755-65.
21.	Maccallum DM. Hosting infection: Experimental models to assay Candida virulence. Int J Microbiol 2012;2012:363764.
22.	Miceli MH, Díaz JA, Lee SA. Emerging opportunistic yeast infections. Lancet Infect Dis 2011;11:142-51.
23.	Davies AN, Brailsford S, Broadley K, Beighton D. Oral yeast carriage in patients with advanced cancer. Oral Microbiol Immunol 2002;17:79-84.
24.	Cheng MF, Yang YL, Yao TJ, Lin CY, Liu JS, Tang RB, et al. Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis 2005;5:22.
25.	Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: A potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005;49:3640-5.
26.	Meis JF, Verweij PE. Current management of fungal infections. Drugs 2001;61 Suppl 1:13-25.
27.	Livermore DM. The need for new antibiotics. Clin Microbiol Infect 2004;10 Suppl 4:1-9.
28.	Rex JH, Rinaldi MG, Pfaller MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother 1995;39:1-8.
29.	Rex JH, Pfaller MA, Rinaldi MG, Polak A, Galgiani JN. Antifungal susceptibility testing. Clin Microbiol Rev 1993;6:367-81.
30.	Clarkson JE, Worthington HV, Eden TO. Interventions for preventing oral candidiasis for patients with cancer receiving treatment. Cochrane Libr 2007.
31.	Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48:503-35.
32.	Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D'Amato-Palumbo S, Fischer DJ, et al. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 2010;18:985-92.

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