Oropharyngeal Candida Colonization in Patients with Acute Myeloid Leukemia
Objectives: Oral candidiasis has increased in recent years because of the increasing number of high-risk populations. The prevalence of Candida species is different worldwide because of the difference between population characteristics, sampling protocols, and geographic regions. Therefore, determining the more prevalent Candida species in different geographic regions seems essential. This study aimed to determine the more prevalent Candida species in acute myeloid leukemia (AML) patients in comparison with healthy individuals in Iran in 2016.
Materials and Methods: Fifty-one patients with AML and 62 healthy controls participated in this cross-sectional study. Samples were collected using a swab rubbed softly on the dorsal surface of the tongue and the oropharynx. The samples were cultured on CHROMagar Candida for 2 to 4 days. For differentiation between albicans and non-albicans species, positive samples were linearly inoculated on Corn Meal Agar with Tween-80. Candida species were identified using a microscope. Data were analyzed using chi-square and Fisher’s exact tests.
Results: Candida colonization was more frequent in AML patients (41.2%) in comparison with healthy participants (38.7%). Candida glabrata (C. glabrata; 27.5%) and Candida albicans (C. albicans; 32.3%) were the most common isolated species in the AML patients and the controls, respectively. There was a significant decrease in the frequency of C. albicans (P=0.022) and a significant increase in the frequency of C. glabrata (P=0.002) in the AML patients in comparison with the controls.
Conclusion: AML patients are more susceptible to candidiasis. C. glabrata is the dominant Candida species in AML patients.
1. Coronado Castellote L, Jiménez Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent. 2013;5:279-86.
2. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;13 (10): 95-105.
3. Dongari‐Bagtzoglou A, Dwivedi P, Ioannidou E, Shaqman M, Hull D, Burleson J. Oral Candida infection and colonization in solid organ transplant recipients. Oral Microbiol Immunol. 2009;24(3):249-54.
4. Al-Attas SA AS. Candidal colonization, strain diversity, and antifungal susceptibility among adult diabetic patients. Ann Saudi Med. 2010;30(2):101–8.
5. Gullo A. Invasive fungal infections. Drugs. 2009;69(1):65-73.
6. Bensadoun R-J, Patton LL, Lalla RV, Epstein JB. Oropharyngeal candidiasis in head and neck cancer patients treated with radiation: update 2011. Support Care Cancer. 2011;19(6):737-44.
7. Tanaka T, Okutomi T, Wakabayashi H, Ishibashi H, Tansho S, Ninomiya K, et al. Condition for effective inhibition of Candida albicans growth by lactoferricin B and its therapeutic activity with fluconazole against oral candidiasis in mice. MMR. 2011;2(1):33-41.
8. Sun H, Chen Y, Zou X, Li H, Yin X, Qin H, et al. Occurrence of oral Candida colonization and its risk factors among patients with malignancies in China. Clin Oral Investig. 2015;20(3):1-9.
9. Bagg J, Sweeney M, Lewis MA, Jackson M, Coleman D, Al Mosaid A, et al. High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer. J Palliat Med. 2003;17(6):477-81.
10. Krcmery V, Barnes A. Non-albicans Candida spp. causing fungemia: pathogenicity and antifungal resistance. J Hosp Infect. 2002;50(4):243-60.
11. JR W. Importance of Candida species other than C. albicans as pathogens in oncology patients. Clin Infect Dis. 1995;20(1):115-25.
12. Perfect JR, Hachem R, Wingard JR. Update on epidemiology of and preventive strategies for invasive fungal infections in cancer patients. Clin Infect Dis. 2014;59(suppl 5): S352-S5.
13. Ellepola A, Morrison CJ. Laboratory diagnosis of invasive candidiasis. J Med Microbiol. 2005;43(5):65-84.
14. Inaba H, Gaur AH, Cao X, Flynn PM, Pounds SB, Avutu V, et al. Feasibility, efficacy, and adverse effects of outpatient antibacterial prophylaxis in children with acute myeloid leukemia. Cancer. 2014;120(13):1985-92.
15. Wu CJ, Lee HC, Yang YL, Chang CM, Chen HT, Lin CC, et al. Oropharyngeal yeast colonization in HIV‐infected outpatients in southern Taiwan: CD4 count, efavirenz therapy and intravenous drug use matter. Clin Microbiol Infect 2012;18(5):485-90.
16. Sánchez-Vargas LO, Ortiz-López NG, Villar M, Moragues MD, Aguirre JM, Cash at-Cruz M, et al. Oral Candida isolates colonizing or infecting human immunodeficiency virus-infected and healthy persons in Mexico. J Med Microbiol. 2005;43(8):4159-62.
17. Khubnani H, Sivarajan K, Khubnani A. Application of lactophenol cotton blue for identification and preservation of intestinal parasites in fecal wet mounts. Indian J Pathol Microbiol. 1998;41(2):157-62.
18. Fidel PL, Vazquez JA, Sobel JD. Candida glabrata: a review of epidemiology, pathogenesis, and clinical disease with comparison to. albicans. Clin Microbiol Rev. 1999;12(1):80-96.
19. Dongari-Bagtzoglou A, Fidel P. The host cytokine responses and protective immunity in oropharyngeal candidiasis. J Dent Res. 2005;84(11):966-77.
20. Torres SR, Peixoto CB, Caldas DM, Akita T, Barreiros MGC, Uzeda Md, et al. A prospective randomized trial to reduce oral Candida spp. colonization in patients with hyposalivation. Braz Oral Res 2007;21(2):182-7.
21. Martin D, Persat F, Piens M-A, Picot S. Candida species distribution in bloodstream cultures in Lyon, France, 1998–2001. Eur J Clin Microbiol Infect Dis 2005;24(5):329-33.
22. Epstein JB, Freilich MM, Le ND. Risk factors for oropharyngeal candidiasis in patients who receive radiation therapy for malignant conditions of the head and neck. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1993;76(2):169-74.
23. Yang Y, Law S, Wang A, Chen H, Cheng W, Lo H. Characterization of yeasts colonizing in healthy individuals. Med Mycol J. 2011;49(1):103-6.
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