Factors influencing the presence of Candida dubliniensis and other non-albicans species in patients with oral lichen planus: a retrospective observational study

Abstract

Objectives The epidemiologic distribution of non-albicans species in the oral cavity of oral lichen planus (OLP) patients remains uncertain. Therefore, the aim of this study was to identify factors associated with the presence of C. dubliniensis and other non-albicans species. Furthermore, independent risk factors for Candida superinfection in OLP should be identified. Material and methods Epidemiologic data and microbiological findings from 268 symptomatic OLP patients who underwent continuous oral swab culture over a 5-year period (2015–2019) were retrospectively reviewed. Candida species identification and semi-quantification were obtained by culture on CHROMagar Candida, followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results C. albicans was the most frequently isolated species (72.3%), followed by C. glabrata (7.3%), C. dubliniensis (5.8%), C. krusei and C. parapsilosis (both 2.6%). The presence of C. dubliniensis was significantly associated with tobacco smoking. Other non-albicans spp. were significantly more often detected in patients using removable dentures. Increasing age and the intake of psychotropic drugs were identified as independent risk factors of Candida superinfection in OLP. Conclusion In OLP patients, certain local and systemic factors increase the risk of carrying potentially drug-resistant Candida species and the development of Candida superinfection of OLP lesions. Clinical relevance Due to the frequent detection of non-albicans species in OLP, resistance or at least reduced sensitivity to azole antifungals should be expected, especially in smokers and patients using removable dentures. In the case of oral complaints, a superinfection with Candida should be considered, whereby older patients and patients taking psychotropic drugs have an increased risk for oral infection with Candida.

Prevalence of and prognostic factors for Candida superinfection in oral lichen planus and lichenoid reactions: A retrospective cohort study

“…Furthermore, patients with ulcerative/erosive OLP were previously reported to have a high frequency of Candida species 15,19,22 and to be more likely to develop Candida superinfection. 21,23 In this study, the ulcerative type of OLP was also associated with Candida superinfection. In support of this finding, previous studies 21,22 explained that loss of mucosal integrity and alteration of the oral microenvironment promotes and facilitates the colonization and invasion of Candida species in patients with erosive OLP.…”

“…Candida species have been proven to increase over time and are frequently found in patients with OLP [23][24][25][26] and oral mucosal diseases. 27 In future studies, identification of albicans and non-albicans Candida species is necessary to more precisely determine the relationships of different Candida species with superinfection and the outcomes of corticosteroid therapy.…”

“…19 Furthermore, a large retrospective study showed that antihypertensive and antipsychotic drugs, which induce hyposalivation, were also associated with superinfection. 23 However, we did not collect data on current systemic medications; only oral dryness was assessed. Furthermore, there were high proportions of missing data for other local factors and systemic factors, such as smoking, dentures, or malnutrition (Tables 1, 2, and 3).…”

Secreted Aspartyl Proteinases Targeted Multi-Epitope Vaccine Design for Candida dubliniensis Using Immunoinformatics

“…Candida dubliniensis ( C. dubliniensis ) is an opportunistic fungal pathogen which was identified for the first time in Dublin in 1995 from the oral cavity of HIV-infected individuals; and since then the pathogen has been reported globally at the prevalence rate of 0.5–7.0% [ 1 , 2 , 3 , 4 ]. C. dubliniensis is found correlated with fungal pneumonia, chronic meningitis, spondylodiscitis, tricuspid valve endocarditis, oral lichen planus, and denture stomatitis in immunocompromised patients [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Moreover, C. dubliniensis has been associated with oral candidiasis in diabetic patients undergoing insulin treatment [ 12 ].…”

“…Recently, C. dubliniensis has been reported in SARS-CoV-2 infected patients [ 13 ]. The increased clinical awareness of C. dubliniensis is attributed due to antifungal drug resistance and reduced susceptibility to antifungal drugs; for instance, fluconazole, flucytosine, voriconazole, and amphotericin B [ 1 , 7 , 14 ].…”