Abstract
BackgroundOpportunistic infections due to Candida species occur frequently in cancer patients because of their inherent immunosuppression. The aim of the present study was to investigate the epidemiology of yeast species from the oral cavity of patients during treatment for oncological and haematological malignancies.MethodsMALDI-TOF was performed to identify yeasts isolated from the oral cavity of 350 cancer patients. Moreover, antifungal susceptibility testing was performed in according to CLSI guidelines (M27-A3).ResultsAmong 162 yeasts and yeast-like fungi isolated from the oral cavity of cancer patients, Candida albicans was the most common species (50.6%), followed by Candida glabrata (24.7%), Pichia kudriavzevii (Candida krusei (9.9%)), Candida tropicalis (4.3%), Candida dubliniensis (3.7%), Kluyveromyces marxianus (Candida kefyr (3.7%)) and Candida parapsilosis (1%). In addition, uncommon yeast species i.e., Saprochaete capitata, Saccharomyces cerevisiae, Clavispora lusitaniae (C. lusitaniae) and Pichia kluyveri (C. eremophila) were recovered from oral lesions. Oral colonization by C. albicans, non-albicans Candida species and uncommon yeasts were as follow; 55%, 44% and 1%, whereas oral infection due to C. albicans was 33.3%, non-albicans Candida species 60.6%, and uncommon yeasts 6.1%. Poor oral hygiene and xerostomia were identified as independent risk factors associated with oral yeast colonization. The overall resistance to fluconazole was 11.7% (19/162). Low MIC values were observed for anidulafungin for all Candida and uncommon yeast species.ConclusionsThis current study provides insight into the prevalence and susceptibility profiles of Candida species, including emerging Candida species and uncommon yeasts, isolated from the oral cavity of Iranian cancer patients. The incidence of oral candidiasis was higher amongst patients with hematological malignancies. The majority of oral infections were caused by non-albicans Candida species which were often more resistant to anti-fungal agents. Our findings suggest that anidulafungin should be used as antifungal of choice for prophylaxis in clinically high-risk patients with documented oral colonization or infection.
Highlights
Opportunistic infections due to Candida species occur frequently in cancer patients because of their inherent immunosuppression
The latter factors are important, because of the cytotoxic effects they have on mucosal immune defense mechanisms, and because they change the physiology and microbial ecology of the oral environment to prolonged xerostomia and hyposalivation leading to intra-oral colonization, facilitating overgrowth of fungal pathogens leading to significant patient morbidity [2, 3]
C. albicans is responsible for the vast majority of oral colonizations and infections, non-albicans Candida species belong to diverse species complexes, i.e., Candida parapsilosis, Candida glabrata, Candida tropicalis, Kluyveromyces marxianus (Candida kefyr), Pichia kudriavzevii (Candida krusei), Meyerozyma guilliermondii (Candida guilliermondii) and other uncommon yeast species with a reduced susceptibility to triazoles and echinocandins become a serious clinical challenge and the isolates need to be properly identified [8,9,10,11,12]
Summary
Opportunistic infections due to Candida species occur frequently in cancer patients because of their inherent immunosuppression. Worldwide the incidence of mild to severe fungal infections (FI) has dramatically increased in the last several decades, especially in patients infected with human immunodeficiency virus (HIV), those that prolongedly use broadspectrum antibiotics, patients undergoing hematopoietic stem cell transplantation (HSCT), and those receiving intensive chemo- and /or radiotherapy [1, 2] The latter factors are important, because of the cytotoxic effects they have on mucosal immune defense mechanisms, and because they change the physiology and microbial ecology of the oral environment to prolonged xerostomia and hyposalivation leading to intra-oral colonization, facilitating overgrowth of fungal pathogens leading to significant patient morbidity [2, 3]. In vitro antifungal susceptibilities were determined against 162 clinically isolates of Candida species and uncommon other yeast species from Iranian cancer patients
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