Risk Factors For Oral Candidiasis Research Articles

Management of Oral Thrush in an Infant with Cleft Lip and Palate (A Case Report)

Oral candidiasis is the most common human fungal infection seen with a wide range of carrier rates ranging from 2% to as high as 95% among various age groups, especially in children and the elderly, often found in immunocompromised individuals but can also occur in healthy individuals. Although considered a pathogen, Candida albicans is a commensal organism that usually colonizes the oral mucosa and is isolated in the oral cavity of healthy individuals. Several risk factors for oral candidiasis in cleft lip and palate patients include changes in oral microflora, variations in hard and soft tissue anatomy, immunocompromised state, and high number of frequent hospitalizations. Candida albicans adhering to the oral cavity can be a cause of infection, however, removal of adherent candida cells from the mucosal surface through the effects of salivary flow and swallowing is the most important factor in preventing candida overgrowth. The aim of this paper is to evaluate the management of oral thrush in infant with cleft lip and palate.

Molecular identification and antifungal susceptibility profiles of etiologic agents of oral candidiasis among HIV-positive patients: A multicenter study.

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a serious risk factor for oral candidiasis (OC). In this regard, the present study aimed to investigate the frequency of Candida species collected from the oropharyngeal cavity of HIV-positive patients and the sensitivity of these isolates to antifungal drugs. Oral samples were collected from 169 HIV-positive patients. In addition to culture-based methods, a molecular assay via the polymerase chain reaction-restriction fragment length polymorphism method was applied to identify isolates using the MspI restriction enzyme. The disk diffusion method determined the susceptibility of isolated yeasts to common antifungal drugs according to the CLSI M44-A2 protocol. In total, 81 participants (47.92%) were positive for OC, and Candida albicans was the most prevalent yeast (53.98%). The median age of patients was 36 years old (IQR=10.5; 17-59), and it was found that women are 27% more susceptible to HIV-associated OC (OR=1.268; 95% CI: 0.685-2.348). Patients who received antifungal therapy had a 97.3% reduced chance for OC (OR: 0.027; 95% CI: 0.008-0.091; P-value: 0.000). Antifungal therapy reduced the risk of OC by 97.3% (OR=0.027; 95% CI=0.008-0.091; P=0.000), and antiretroviral therapy decreased the chance of OC 4.42 times (OR=4.423; 95% CI=1.697-11.528; P=0.002). The resistance rates for antifungals, namely fluconazole, ketoconazole, itraconazole, amphotericin B, and nystatin were 15.93%, 8.85%, 7.96%, 5.31%, and 4.42%, respectively. Although several decades have passed since the emergence of HIV/AIDS, little information is available about fungal colonization and infections in this population. Further investigations are suggested using novel and reference molecular identification methods, such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry and sequencing, respectively. In addition, more reliable methods for antifungal susceptibility testing are recommended.

Factors Associated with Oral Candidiasis in People Living with HIV/AIDS: A Case Control Study.

BackgroundOral candidiasis (OC) is the most frequent opportunistic infection of the oral cavity caused by Candida species overgrowth. A wide variety of risk factor that contributes to yeast infection especially candidiasis. It might be acting as an early marker for people living with HIV/AIDS (PLWHA). There are some risk factors for PLWHA associated OC at Wangaya hospital in Denpasar, Bali, Indonesia.AimTo identify risk factors of OC in PLWHA at Wangaya Hospital in Denpasar, Bali, Indonesia.Settings and DesignCase control study was conducted from March 1, 2016 and July 30, 2019, included 448 participants (207 cases and 241 controls). Consecutive recruitment was employed.MethodsCases were PLWHA (18 to 60 years old) with OC and controls without OC. Diagnosis of OC based on the clinical features which are the pseudomembranous candidiasis; oral thrush. An interviewer administered a structured questionnaire used to collect information on risk factors. Statistical analysis used: bivariate analysis was performed on all variables. Chi-square test with statistically significant was at a level of 0.05.ResultsThe participants included 207 (46.20%) PLWHA with OC and 241 (53.80%) PLWHA who did not have OC. The majority participants, 293 (65.40%) were male. OC was associated with age [p = 0.03; OR = 0.66 (95% CI:0.45–0.95)]; sex [p = 0.002; OR = 1.88 (95% CI:1.26–2.80)]; Xerostomia [p = 0.000; OR = 4.15 (95% CI:2.76–6.23)]; smoking [p = 0.000; OR = 6.83 (95% CI: 4.46–10.44)]; alcohol consumption [p = 0.000; OR = 5.76 (95% CI: 3.74–8.83)]; antibiotic usage [p = 0.000; OR = 4.49 (95% CI: 2.93–6.90)]; CD4 count [p = 0.000; OR = 3.29 (95% CI:2.24–4.86)]; HIV clinical stage [p = 0.000; OR = 3.58 (95% CI 2.39–5.37)]. No significant association between prothesis with OC.ConclusionWe found that age, sex, xerostomia, smoking, alcohol consumption, antibiotic usage, CD4 counts and advanced HIV Clinical stage (AIDS) were significant associated risk factors for OC in PLWHA.

Association between oral candidiasis and bacterial pneumonia: A retrospective study.

To investigate associated risk factors for oral candidiasis in elderly patients hospitalized in a community-based acute-care hospital with no dental units. Two hundred and twenty-eight elderly patients (male: 105, female: 123), who were hospitalized with several systemic diseases in a community-based acute-care hospital from May 2014 to October 2016, were retrospectively analysed by multiple logistic regression. Multiple logistic regression analysis shows that bacterial pneumonia has a statistically strong relationship with oral candidiasis (p = 0.000, OR: 5.173, 95% CI: 2.368-11.298). The order followed is poor oral hygiene (p = 0.001, OR: 6.095, 95% CI: 2.003-18.545) and severe dry mouth (p = 0.043, OR: 2.507, 95% CI: 1.031-6.098). Other correlated factors including diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care and use of inhalation steroids, were not statistically significant in this study. Bacterial pneumonia correlates with oral candidiasis.

BACTERIAL PNEUMONIA IS A POSSIBLE RISK FACTOR FOR ORAL CANDIDIASIS IN OLDER ADULTS: A RETROSPECTIVE COHORT STUDY.

Both aspiration pneumonia and oral candidiasis are caused by opportunistic infection of intraoral commensals and have many similar risk factors linked to oral health in older adults. Candida albicans forms biofilms with respiratory bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa. The aim of our study was to determine the relationship between bacterial pneumonia, including aspiration pneumonia, and oral candidiasis in older patients who were hospitalized with several systemic diseases in a community-based acute care hospital without a dental unit. We retrospectively analyzed 228 older patients (male: 105, female: 123) using multiple logistic regression. The mean age of the patients was 81.3 (SD: 11.1) years. Forty-four patients were oral candidiasis positive, and 78 patients suffered from bacterial pneumonia, including aspiration pneumonia. Results showed that bacterial pneumonia had the strongest statistical relationship with oral candidiasis (p=0.000, OR: 5.173, 95 % CI: 2.368–11.298). This was followed by poor oral hygiene (p=0.001, OR: 6.095, 95 % CI: 2.003–18.545) and severe dry mouth (p=0.043, OR: 2.507, 95 % CI: 1.031–6.098). Other conventional risk factors for oral candidiasis, such as diabetes mellitus, denture wearer, dysphagia, malnutrition, requiring care, use of inhalation steroids, were not statistically significant in this study. Fifteen species of bacteria, including Klebsiella pneumoniae and Pseudomonas aeruginosa, were detected by pharyngeal sputum culture in 24 of 31 patients who were diagnosed with both oral candidiasis and bacterial pneumonia. In conclusion, bacterial pneumonia is a possible new risk factor for oral candidiasis in older adults.

The association between oral candidiasis and severity of chemoradiotherapy-induced dysphagia in head and neck cancer patients: A retrospective cohort study

Background and purposeConcurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC) is a risk factor for oral candidiasis (OC). As Candida spp. are highly virulent, we conducted a retrospective study to determine whether OC increases the severity of dysphagia related to mucositis in HNC patients. Patients and methodsWe retrospectively analyzed the cases of consecutive patients with carcinomas of the oral cavity, pharynx, and larynx who underwent CCRT containing cisplatin (CDDP) at our hospital. The diagnosis of OC was based on gross mucosal appearance. We performed a multivariate analysis to determine whether OC was associated with the development of grade 3 dysphagia in the Radiation Therapy Oncology Group (RTOG) Acute Toxicity Criteria. The maximum of the daily opioid doses was compared between the patients with and without OC. ResultsWe identified 138 HNC patients. OC was observed in 51 patients (37%). By the time of their OC diagnosis, 19 (37%) had already developed grade 3 dysphagia. Among the 30 patients receiving antifungal therapy, 12 (40%) showed clinical deterioration. In the multivariate analysis, OC was independently associated with grade 3 dysphagia (OR 2.75; 95%CI 1.22–6.23; p = 0.015). The patients with OC required significantly higher morphine-equivalent doses of opioids (45 vs. 30 mg/day; p = 0.029). ConclusionCandida infection causes refractory dysphagia. It is worth investigating whether antifungal prophylaxis reduces severe dysphagia related to candidiasis.

Factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas: a retrospective multicenter study of 326 patients.

The present retrospective multicenter study intended to investigate the factors associated with severe oral mucositis and candidiasis in patients undergoing radiotherapy for oral and oropharyngeal carcinomas. A total of 326 patients who underwent radiotherapy for oral and oropharyngeal cancers were enrolled in the study. The patients' age, sex, body mass index, primary site, diabetes, serum albumin, creatinine, hemoglobin, leukocyte and lymphocyte, concurrent cisplatin or cetuximab, method of radiation, total radiation dose, feeding route, use of spacers, pilocarpine hydrochloride, and corticosteroid ointment were examined, and the associations of each variable with oral mucositis and candidiasis were analyzed by multivariate Cox regression analysis. Grade 3 oral mucositis occurred in 136 (41.7%) patients. Male sex, oropharyngeal cancer, low hemoglobin levels, low leukocytes or lymphocytes, concurrent cisplatin or cetuximab, and oral feeding were found to be significantly associated with a higher incidence of severe oral mucositis. Oral candidiasis occurred in 101 (31.0%) patients. Oropharyngeal cancer, low leukocyte count, and oral mucositis of grade 2 or higher were found to be significantly associated with a higher incidence of oral candidiasis. The use of a topical steroid ointment was not found to be a risk factor for oral candidiasis. The present retrospective study demonstrated that certain factors may predispose patients with oral and oropharyngeal cancers receiving radiotherapy to develop severe oral mucositis and oral candidiasis. A preventive strategy for severe oral mucositis needs to be established in the future for high-risk cases.

A retrospective study of factors associated with the development of oral candidiasis in patients receiving radiotherapy for head and neck cancer: Is topical steroid therapy a risk factor for oral candidiasis?

The aims of this study were to investigate the incidence and risk factors for oral candidiasis in patients receiving radiotherapy for head and neck cancer, and to determine the influence of topical steroid therapy on the development of oral candidiasis.We conducted a retrospective study of 300 patients receiving radiotherapy to the head and neck region. The primary endpoint was the incidence of oral candidiasis during radiotherapy. Associations between the incidence of oral candidiasis and various clinical factors were investigated. The cumulative incidence rate of oral candidiasis was calculated using the Kaplan–Meier method and analyzed by the log-rank test and Cox regression. Propensity score-matched analysis was used to assess the influence of topical steroid therapy on the development of oral candidiasis.Oral candidiasis occurred in 75 (25.0%) of the 300 patients. Multivariate analysis identified minimum lymphocyte count and severity of oral mucositis during radiotherapy as independent risk factors for the development of oral candidiasis. Topical steroid therapy for oral mucositis was not associated with the incidence of oral candidiasis according to multivariate and propensity score matching analyses.Oral candidiasis was associated with the suppression of the host's immunity and severe oral mucositis, but not topical steroid therapy. Proper oral health care during radiotherapy and the prevention of severe oral mucositis may reduce the incidence of oral candidiasis.

Prevention of Oral Candidiasis After Free Flap Surgery: Role of 3% Sodium Bicarbonate Saline in Oral Care

Relevant reports about oral candidiasis status and prevention measures after free flap surgery for the oral and maxillofacial region are limited. The present study explored oral candidiasis status after free flap surgery and its prevention through a prospective comparative study. One hundred four patients were randomized to a control group (n= 54) and an experimental group (n= 50). Compared with the control group, the experimental group was provided an additional 3% sodium bicarbonate saline solution for oral care after free flap surgery. The incidence of oral candidiasis was evaluated by objective examination (saliva culture and salivary pH measurement) and subjective evaluation (clinical signs of oral candidiasis) at admission and from postoperative days 1 to14. The salivary pH values of the 2 groups were lower than the normal salivary pH, and postoperative salivary pH values were always lower than the active range of oral lysozymes in the control group. The salivary pH values of the experimental group were higher than those of the control group from postoperative days 6 to 14 (P < .05). The incidence of oral candidiasis was 13.0% in the control group, which was higher than that in the experimental group (2.0%; P < .05). In addition, advanced age, use of a free flap for the simultaneous repair of intraoral and paraoral defects, and a combination of 2 antibiotic types were risk factors for oral candidiasis. Oral candidiasis was common in patients after free flap reconstruction surgery, and the use of 3% sodium bicarbonate saline solution for oral care effectively prevented it.

Oral candidiasis in systemic lupus erythematosus

We assessed the frequency of oral candidiasis and the association between demographic variables, disease-related variables, corticosteroid treatment, other treatments and the occurrence of oral candidiasis in the Hopkins Lupus Cohort. In this large prospective cohort study of 2258 patients with systemic lupus erythematosus (SLE), demographic and clinical associates of oral candidiasis were estimated by univariate, multivariate and within-person regression models. There were 53,548 cohort visits. Oral candidiasis was diagnosed at 675 visits (1.25%) in 325 (14%) of the patients. In the multivariate analyses, oral candidiasis was associated with African-American ethnicity, SELENA-SLEDAI disease activity, high white blood cell count, a history of bacterial infection, prednisone use and immunosuppressive use. The urine protein by urine dip stick was higher in SLE patients with oral candidiasis. Considering only patients who had candidiasis at some visits in a 'within-person' analysis, candidiasis was more frequent in visits with higher SELENA-SLEDAI disease activity, high white blood cell count, proteinuria by urine dip stick, a history of bacterial infection and prednisone use. The use of hydroxychloroquine was associated with a lower risk of oral candidiasis, but was not statistically significant (p = 0.50) in the within-person analysis models. This study identified multiple risk factors for oral candidiasis in SLE. Inspection of the oral cavity for signs of oral candidiasis is recommended especially in SLE patients with active disease, proteinuria, high white blood cell count, taking prednisone, immunosuppressive drugs or antibiotics.

Smoking Is an Independent Risk Factor for the Development of Oral Candidiasis (OC) in HIV-1 Infected Persons

Article title and bibliographic information Smoking as a risk factor for oral candidiasis in HIV-infected adults. Chattopadhyay A, Patton LL. J Oral Pathol Med 2013;42(4):302-08 . Reviewers Caroline H. Shiboski, DDS, MPH, PhD, Stephen C. Shiboski, PhD Purpose/Question Is smoking an independent risk factor for OC among adults with HIV/AIDS, and does smoking modify the relationship between OC and other important risk factors like CD4 cell count? Source of funding This investigation was supported by USPHS Grant 5T32DE07191, P30-HD27360, and R29DE11369 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA Type of study/Design Cohort study Level of evidence Level 2: Limited-quality, patient-oriented evidence Strength of recommendation grade Not applicable

Smoking as a risk factor for oral candidiasis in HIV-infected adults

Smoking as a risk factor for oral candidiasis in HIV-infected adults

Oral candidiasis in patients with renal transplants

Objectives: Oral candidiasis (OC) is a frequent oral lesion in renal transplant patients (RTPs). Despite the increased prevalence of OC in RTPs, no study has examined related risk factors. The aims of this study were to analyze the prevalence of and risk factors for OC in RTPs compared with age- and gender-matched healthy control group (HC) as well as determine the incidence of OC after transplantation. Study Design: We analyzed the prevalence and risk factors of OC in a group of 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HC subjects (314 men, 187 women, mean age 52.25 years). Demographic and pharmacological data were recorded for all subjects. Incident cases of OC were ascertained retrospectively from outpatient clinical records only in the RTP group. Results: The prevalence of OC was 7.4% in RTPs compared with 4.19% in HC (P<0.03). The most frequent type of OC in the two groups was denture stomatitis. Statistical association was found between OC and age, mycophenolate mofetil dose and blood levels, dentures and tobacco. The multiple logistic regression model only chose for denture variable. According to the outpatient clinical records, 24 RTPs suffered OC during the first moth post-transplant. Severe lesions affecting the oral cavity and pharynx appeared in 79% of the OC cases. Conclusions: This study shows a lower prevalence of OC in RTPs than previous reports. Denture stomatitis was the most frequent OC prevalence form described in RTPs. Severe candidiasis is more frequent in the immediate posttransplant period. The presence of denture is an important risk factor of OC. These results emphasise the importance of adequate pre- and post-transplant oral health and denture cleaning and adjustment is recommended for these subjects to prevent this infection. Key words:Oral candidiasis, immunosuppressive therapy, renal transplantation.

Risk factors for oral candidiasis in Brazilian HIV-infected adult patients

Aim: The goals of this study were: 1) to estimate the prevalence of oral candidiasis (OC) in a sample of Brazilian HIV-infected adult patients, and 2) to investigate the risk factors for HIVassociated OC in this sample. Methods: This case-control study included 112 HIV-infected patients treated between 2002 and 2004 at a clinic for sexually transmitted diseases. Data were collected from medical records and clinical examinations. Diagnosis of OC was performed in accordance with the International Classification System and cytological features. Seventeen clinical and laboratorial variables were registered. Univariate analyses were performed on all variables. Multiple logistic regression techniques were used to develop a model and identify the set of variables that may predict risk factors in HIV-infected adult patients with OC. Results: Prevalence of OC was 31.3%. OC was associated with oral hairy leukoplakia (OHL) [p<0.001; odds ratio (OR) = 10.2 (95%CI: 4.0-26.0)], previous use of fluconazole [p<0.001; OR=27.4 (95%CI: 8.1-92.0)] and viral load [p=0.042; OR=2.3 (95%CI: 1.0-5.3)]. Conclusions: These results are important for the development of strategies to eliminate these risk factors and significantly reduce OC in HIV-infected patients.

Survey of hospital doctors' attitudes and knowledge of oral conditions in older patients

The study was designed to assess the views and knowledge of hospital doctors in general and geriatric medicine on oral health in older people. Eighty two doctors in general and...

Regulation of Candida albicans growth and adhesion by saliva

To examine the local regulation of oral Candida albicans growth, we examined non-stimulated and stimulated salivary flow rates (SFRs) and the C. albicans growth and adhesion inhibitory activities of saliva in 60 patients with oral candidiasis (divided into two groups: 25 patients with oral candidiasis only [group OC] and 35 patients with oral candidiasis and systemic diseases [group CS]) and 30 healthy control subjects. Both non-stimulated and stimulated SFRs in patients, especially in group CS, were decreased in comparison with those in the healthy control subjects. The levels of secretory immunoglobulin A (sIgA) in group OC and group CS and the lactoferrin level in group CS were decreased as compared with those in control individuals, although there were no differences in transferrin and total secretory component (SC) levels between the three groups. The secretion amounts (μg/min) of these proteins were statistically significantly decreased in the patients, especially in group CS. Saliva from the patients showed a lesser inhibitory effect on C. albicans growth and adhesion to HeLa cells than did saliva from the control subjects. In addition, polymorphonuclear leukocytes (PMNs) in patients' saliva generated smaller amounts of superoxide than did those in control subjects' saliva, and phagocytic and C. albicans killing activities were suppressed in the patients. These results indicate that the decreases in SFR, secretion of antimicrobial proteins in saliva, and salivary PMN activity are risk factors for oral candidiasis associated with aging and systemic diseases. (J Lab Clin Med 2000;136:66-73)