Oral Candidiasis among Cancer Patients Attending a Tertiary Care Hospital in Chennai, South India: An Evaluation of Clinicomycological Association and Antifungal Susceptibility Pattern

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.

Oral Candida colonization in xerostomic postradiotherapy head and neck cancer patients

“…The most common NACS detected in this study was C. tropicalis followed by C. glabrata , which were also commonly reported in other population (Hertel, Schmidt‐Westhausen, & Strietzel, ; Jayachandran et al, ; Thaweboon et al, ). In addition, we detected C. dubliniensis , C. parapsilosis, and C. krusei.…”

“…krusei was reported to be intrinsically less susceptible to azoles (Jayachandran et al, 2016;Lalla et al, 2010). Moreover, C. glabrata, C. tropicalis, and K. ohmeri were also reported to be able to develop resistant to azole drugs (Jayachandran et al, 2016;Lalla et al, 2010;Pfaller, 2012;Schmalreck et al, 2014;Yang et al, 2009). These underline the importance of Candida species identification and antifungal susceptibility test in these patients when infection arises, especially in cases unresponsive to azoles.…”

“…These NACS were shown to cause more complex fungal infections with increased virulence and increased drug resistance that are, therefore, more difficult to treat (Jayachandran et al, ; Lalla et al, ; Papon, Courdavault, Clastre, & Bennett, ; Pfaller, ; Sadeghi, Ebrahimi‐Rad, Mousavi, Shams‐Ghahfarokhi, & Razzaghi‐Abyaneh, ). NACS detected in patients with cancer from previous studies varied from 37% to 51% among different study populations, detection methods, and geographic areas.…”

In Vitro Antidrug Susceptibility Testing of Candida Species Isolated from Aseptic Body Fluids

“…(19). For fluconazole, 18.1% of the isolates were resistant, and this rate was similar to the result of a population-based surveillance in India (14.8%) (28). However, the proportion of ketoconazoleor itraconazole-resistant isolates was significantly higher compared to fluconazole-resistant isolates.…”

Lactobacillus rhamnosusinhibitsCandida albicansvirulence factorsin vitroand modulates immune system inGalleria mellonella

“…Junqueira et al (2012) verified that 42% of HIV-positive patients were colonized with one or more Candida sp. These species mostly showed resistance to the antifungal agents commonly used for the treatment of candidemia, such as fluconazole and amphotericin B (Dagi et al 2016;Jayachandran et al 2016;Lotfali et al 2016;Zaidi et al 2016).…”