Systemic antimycotic therapy of patients with mycosis of the oral mucosa and periodontal Сandida etiology

Abstract

Candidiasis is the most common mycosis. Оral candidiasis occurs in the form of stomatitis, including the so-called prosthetic stomatitis. Somewhat less often, fungi of the genus Candida are detected with gingivitis and periodontitis, manifestations of red lichen planus on the oral mucosa.The purpose of the work: to analyze the results of mycological studies and determine the sensitivity of fungi isolated from the oral cavity in vari-ous oral pathologies to the main antimycotics, as well as the formation on this basis of an algorithm for antimycotic therapy of candidal lesions of the oral mucosa and periodontium.Material and methods. The paper uses the results of studies of patients with candidiasis of the oral mucosa (127 patients), prosthetic stomatitis (136 patients), candida-associated periodontitis (168 patients). Primary inoculation was performed quantitatively on Sabouraud’s medium and duplicated on M1297 chromogenic medium (Himedia Labs, India).To study the biofilm formed on the oral mucosa, fixed preparations of gold-coated scrapings were prepared for scanning electron microscopy, which was performed using a Quanta 200 3D bi-beam microscope (USA). Sensitivity to antimycotics was assessed using the traditional method of disks.The results of the study. When studying the species composition of yeast-like fungi isolated from the material, it was found that the species C. albicans was isolated in 80% of patients, in association with other species: C. Krusei, C. guilliermondii and C. glabrata. The second place was taken by the species C. Krusei, which was detected in 13.3% of patients. Representatives of this genus of yeast fungi are characterized by the formation of a biofilm with a pronounced mantle, which protects the microorganism from aggressive factors, including antimycotics and antiseptics. All the studied preparations showed fungicidal activity against these strains of yeast-like fungi. When registering the results, it was found that the most pronounced sensitivity of yeast-like fungi of this species was to drugs from the group of azole derivatives. The most pronounced antifungal activity was noted by us in voriconazole.Conclusion. Based on the obtained data, an algorithm of systemic antimycotic therapy for oral candidiasis has been developed.