Abstract
ObjectivesThe epidemiologic distribution of non-albicans species in the oral cavity of oral lichen planus (OLP) patients remains uncertain. Therefore, the aim of this study was to identify factors associated with the presence of C. dubliniensis and other non-albicans species. Furthermore, independent risk factors for Candida superinfection in OLP should be identified.Material and methodsEpidemiologic data and microbiological findings from 268 symptomatic OLP patients who underwent continuous oral swab culture over a 5-year period (2015–2019) were retrospectively reviewed. Candida species identification and semi-quantification were obtained by culture on CHROMagar Candida, followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).ResultsC. albicans was the most frequently isolated species (72.3%), followed by C. glabrata (7.3%), C. dubliniensis (5.8%), C. krusei and C. parapsilosis (both 2.6%). The presence of C. dubliniensis was significantly associated with tobacco smoking. Other non-albicans spp. were significantly more often detected in patients using removable dentures. Increasing age and the intake of psychotropic drugs were identified as independent risk factors of Candida superinfection in OLP.ConclusionIn OLP patients, certain local and systemic factors increase the risk of carrying potentially drug-resistant Candida species and the development of Candida superinfection of OLP lesions.Clinical relevanceDue to the frequent detection of non-albicans species in OLP, resistance or at least reduced sensitivity to azole antifungals should be expected, especially in smokers and patients using removable dentures. In the case of oral complaints, a superinfection with Candida should be considered, whereby older patients and patients taking psychotropic drugs have an increased risk for oral infection with Candida.
Highlights
Due to the frequent and preventive use of antifungal drugs in immunocompromised patients and due to more precise and faster methods for the identification of Candida species, the emergence of non-albicans species has been observed in recent years [1]
It has been shown that nonalbicans species are more frequently present in oral lichen planus (OLP) patients compared to healthy subjects [16]
The binomial logistic regression analysis, including age, autoimmune diseases and removable dentures confirmed, that only the presence of removable dentures was statistically significant (p = 0.001), increasing the likelihood for the presence of non-albicans species other than C. dubliniensis in OLP patients (OR = 4.19, 95% CI [1.78, 9.88])
Summary
Due to the frequent and preventive use of antifungal drugs in immunocompromised patients and due to more precise and faster methods for the identification of Candida species, the emergence of non-albicans species (spp.) has been observed in recent years [1]. Clinical Oral Investigations this organism to epithelial cells increases in the presence of fluconazole [8, 9] Oral mucosal diseases, such as oral lichen planus (OLP), may be influenced by the presence of Candida spp. It has been shown that nonalbicans species are more frequently present in OLP patients compared to healthy subjects [16]
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