Candida species diversity in oral cavity of type 2 diabetic patients and their In vitro antifungal susceptibility

Abstract

Objective:To identify and compare the species variation and Colony Forming Units of the species and antifungal susceptibility from oral rinse samples of individuals in poorly-controlled, moderately-controlled and well controlled diabetes patients with control group.Subjects and Methods:Study group comprised of well-controlled, moderately-controlled and poorly controlled Type II diabetic patients grouped according to the level of glycated hemoglobin concentration with 50 patients in each group and 50 healthy individuals. Oral rinse samples were collected in a sterile container with phosphate-buffered saline and then transported immediately for various mycological investigations and antifungal susceptibility tests. Statistical analysis was performed.Results:There was a significant difference in frequency of Candida in poorly controlled diabetes when compared to moderately controlled diabetes, well controlled diabetes and normal patients (P = 0.045). A higher number of colony count was seen among poorly controlled diabetes than well controlled, moderately controlled and non diabetic subjects. A comparatively low number of non-albicans were seen in healthy individuals. C. albicans showed an increased resistance to fluconazole in DM patients in comparison to control group (P = 0.001). Other species showed a variable sensitivity pattern.Conclusion:The decreased immunity and change in oral habitat in diabetic patients creates a diversification in various species of Candida. These non albicans vary in their susceptibility and pathogenesis. A definite identification of these diverse species in the oral cavity of such patients and their susceptibility mandates proper management to avoid recurrence and drug resistance.

Association of Type 2 Diabetes Mellitus and Candidiasis : A Ten Years Systematic Review

“…Oral candidiasis is a common fungal infection in type 2 diabetics that presents as discrete and confluent white plaques on the buccal mucosa, tongue, and sometimes the palate, gingivae, and floor of the mouth; these plaques may be wipeable. 9 Many studies have reported that Candida species are the most common yeast isolated from diabetic foot ulcers. However, few studies have reported C. albicans as the most common species.…”

“…Bhuyan, L et al (2018) 9 showed a higher proportion of strains different from C. albicans species isolated from unstimulated saliva and their variable susceptibility to the commonly prescribed antifungals in diabetes indicate the necessity of the special mode of diagnostic and therapeutic management. This highlights the importance of routine candidal speciation and appropriate selection of prophylactic antifungal regimen after susceptibility testing, especially during intermittent visits.…”

A case–control study to evaluate candidal parameters in the oral cavity of patients with type 2 diabetes mellitus

“…Bhuyan and Hassan[ 8 ] reported that a comparatively low number of non-albicans were seen in healthy individuals. Candida albicans showed increased resistance to fluconazole in patients with DM.…”

Challenges in Antifungal Therapy in Diabetes Mellitus

“…to voriconazole and amphotericin B [ 31 ]. Reduced susceptibility to antifungals in diabetic patients has also been demonstrated in the clinical setting [ 32 , 33 , 34 ]. Bhuyan et al [ 32 ] observed a significant difference in the number of C. albicans and C. parapsilosis that is resistant to fluconazole in diabetes patients compared to healthy controls.…”