Abstract
Background Candida-associated denture stomatitis (CADS) is a common fungal infection in people who wear dentures. The main objective of this study was to make molecular identification of causative agents of CADS and in vitro antifungal susceptibility testing (AFST) in the Iranian patients with denture stomatitis. Methods A total of 134 Candida spp. were obtained from patients with denture stomatitis. The Candida spp. were identified using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) involving the universal internal transcribed spacer (ITS1 and ITS4) primers, which were subjected to digestion with MspI and BlnI restriction enzymes. The in vitro antifungal susceptibility of Candida spp. to fluconazole (FLC), terbinafine (TRB), itraconazole (ITC), voriconazole (VRC), posaconazole (POS), ketoconazole (KET), amphotericin B (AMB), and caspofungin (CAS) was evaluated using the Clinical and Laboratory Standards Institute M27-A3 and M27-S4 guidelines. Results Overall, C. albicans was the most commonly isolated species (n = 84; 62.6%), followed by C. glabrata (n = 23; 17.2%), C. tropicalis (n = 16; 12%), and C. parapsilosis (n = 11; 8.2%). Posaconazole had the lowest geometric mean minimum inhibitory concentration (MIC) (0.03 μg/ml), followed by AMB (0.05 μg/ml), ITC (0.08 μg/ml), VRC (0.11 μg/ml), CAS (0.12 μg/ml), KET (0.15 μg/ml), and FLC (0.26 μg/ml). Discussion Our study showed that C. albicans was most prevalent in Iranian patients with CADS and was susceptible to both azoles and amphotericin B. In addition, POS could be an appropriate alternative to the current antifungal agents used for the treatment of CADS, as well as in the treatment of recurrent candidiasis.
Highlights
Candida-associated denture stomatitis (CADS) is a chronic atrophic complication of the oral cavity that mainly affects people who wear removable dentures [1]
Several evidencebased studies have shown that Candida albicans is the main etiological agent of denture stomatitis (DS), followed by C. tropicalis, C. parapsilosis, and C. glabrata [2,3,4]
CADS is an infection initiated by the oral colonization of Candida spp.; the most frequently identified species is C. albicans, C. glabrata, C. guilliermondii, C. parapsilosis, C. krusei, and C. tropicalis are less commonly seen [28, 29]
Summary
Candida-associated denture stomatitis (CADS) is a chronic atrophic complication of the oral cavity that mainly affects people who wear removable dentures [1]. Several evidencebased studies have shown that Candida albicans is the main etiological agent of denture stomatitis (DS), followed by C. tropicalis, C. parapsilosis, and C. glabrata [2,3,4]. The early diagnosis of pathogenic fungal agents and the determination of their susceptibility to antifungal drugs are critical to the treatment of the infection and to establish preventive healthcare-associated strategies [5, 6]. The main objective of this study was to make molecular identification of causative agents of CADS and in vitro antifungal susceptibility testing (AFST) in the Iranian patients with denture stomatitis. The in vitro antifungal susceptibility of Candida spp. to fluconazole (FLC), terbinafine (TRB), itraconazole (ITC), voriconazole (VRC), posaconazole (POS), ketoconazole (KET), amphotericin B (AMB), and caspofungin (CAS) was evaluated using the Clinical and Laboratory Standards Institute M27-A3 and M27-S4 guidelines. POS could be an appropriate alternative to the current antifungal agents used for the treatment of CADS, as well as in the treatment of recurrent candidiasis
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