Abstract
Oropharyngeal candidiasis is one of the common manifestations seen in cancer patients on cytotoxic therapy and invasion into deeper tissues can occur if not treated promptly. Emergence of antifungal drug resistance is of serious concern owing to the associated morbidity and mortality. The present study aims at evaluation of clinicomycological association and antifungal drug susceptibility among the 180 recruited patients with cancer on chemotherapy and/or radiotherapy with signs or symptoms suggestive of oral candidiasis. Speciation and antifungal susceptibility was done by Microbroth dilution method for fluconazole, Itraconazole, and Amphotericin B as per standard microbiological techniques. Chi-square test was used for statistical analysis (p < 0.05 was considered statistically significant). Candida albicans was the predominant species isolated (94) (58%) followed by Candida tropicalis (34) (20.9%). Fluconazole and Itraconazole showed an overall resistance rate of 14% and 14.8%, respectively. All the isolates were susceptible to Amphotericin B. There was a significant association between the presence of dry mouth and isolation of Candida (p < 0.001). Such clinicomicrobiological associations can help in associating certain symptoms with the isolation of Candida. Species level identification with in vitro antifungal susceptibility pattern is essential to choose the appropriate drug and to predict the outcome of therapy.
Highlights
Oropharyngeal candidiasis is a common fungal infection in immunocompromised individuals
Cancer patients on chemotherapy and/or radiotherapy attending either outpatient or inpatient oncology clinic with signs and symptoms suggestive of oral candidiasis like presence of white plaque, erythematous lesion, ulcerative lesion, dryness of mouth, pain, altered taste sensation, and halitosis were included in the study
Patients with oral cancer comprised the major percentage of cases followed by gastrointestinal tract (GIT) malignancy (Table 1)
Summary
Oropharyngeal candidiasis is a common fungal infection in immunocompromised individuals. Conditions like malignancies, chemotherapy, and radiotherapy compromise the cell mediated immunity predisposing the person to fungal infections [1]. Candida species are normally present as commensals in the oral cavity and their transition to become an opportunistic infective agent may be associated with certain virulence determinants [2]. Incidence of oral candidiasis has been reported to be ranging from 7 to 52% among cancer patients (head and neck malignancy, hematopoietic malignancy, and solid tumors) on chemotherapy and or radiotherapy [1]. A higher incidence of oral colonisation with non-Candida albicans has been reported in patients with advanced stage of cancer [3]. The colonised Candida can invade the underlying mucosa and enter the blood stream leading
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