Abstract
Oral leukoplakias are histopathologically-diagnosed as Candida leukoplakia or non-Candida leukoplakia by the presence or absence of hyphae in the superficial epithelium. Candida leukoplakia lesions have significantly increased malignant potential. Candida albicans is the most prevalent fungal species associated with oral leukoplakia and may contribute to malignant transformation of Candida leukoplakia. To date, no detailed population analysis of C. albicans isolates from oral leukoplakia patients has been undertaken. This study investigated whether specific C. albicans genotypes were associated with Candida leukoplakia and non-Candida leukoplakia in a cohort of Irish patients. Patients with histopathologically-defined Candida leukoplakia (n = 31) or non-Candida leukoplakia (n = 47) were screened for Candida species by culture of oral rinse and lesional swab samples. Selected C. albicans isolates from Candida leukoplakia patients (n = 25), non-Candida leukoplakia patients (n = 19) and oral carriage isolates from age and sex matched healthy subjects without leukoplakia (n = 34) were subjected to multilocus sequence typing (MLST) and ABC genotyping. MLST revealed that the clade distribution of C. albicans from both Candida leukoplakia and non-Candida leukoplakia lesions overlapped with the corresponding clade distributions of oral carriage isolates and global reference isolates from the MLST database indicating no enrichment of leukoplakia-associated clones. Oral leukoplakia isolates were significantly enriched with ABC genotype C (12/44, 27.3%), particularly Candida leukoplakia isolates (9/25, 36%), relative to oral carriage isolates (3/34, 8.8%). Genotype C oral leukoplakia isolates were distributed in MLST clades 1,3,4,5,8,9 and 15, whereas genotype C oral carriage isolates were distributed in MLST clades 4 and 11.
Highlights
Several Candida species cause opportunistic infections in humans, the most prevalent and pathogenic of which is Candida albicans
The purpose of the present study was to characterise the population of C. albicans isolates recovered from histopathogicallydefined Candida leukoplakia (CL) and non-Candida leukoplakia (NCL) lesions from a cohort of Irish oral leukoplakia patients using multilocus sequence typing (MLST) and ABC genotyping in order to determine if these lesions could be associated with specific C. albicans lineages
Oral leukoplakia and healthy control subjects Clinical details of the oral leukoplakia patients are shown in Candida detection by oral rinse sampling Candida isolates were recovered from oral rinse samples in 55/78 oral leukoplakia patients (70.5%)
Summary
Several Candida species cause opportunistic infections in humans, the most prevalent and pathogenic of which is Candida albicans. Candida albicans is the most common Candida species isolated from the oral cavity as both a commensal and pathogenic organism in healthy individuals and those with underlying disease [1]. Oral leukoplakia is used as a general, clinical descriptive term to describe oral white patches or lesions of questionable risk, having excluded other known diseases that carry no increased risk for cancer [2]. These lesions can be further defined based on histopathological diagnosis or clinical history. The commissure is the most common site affected, but it may affect the palate and tongue These lesions may be associated with angular cheilitis. Candida albicans is by far the most prevalent species associated with oral leukoplakia lesions [5]
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