Pseudomembranous Type of Oral Candidiasis is Associated with Decreased Salivary Flow Rate and Secretory Immunoglobulin A Levels

Abstract

Saliva plays an important role in maintaining microbial homeostasis in the oral cavity, while salivary gland hypofunction predisposes the oral mucosa to pathologic alteration and increases the risk for oral candidiasis. This study sought to determine the salivary flow rate (SFR) and secretory immunoglobulin A (SIgA) levels in HIV-positive and HIV-negative individuals and evaluate their relationship with the determinants of oral candidiasis. Sixty HIV-positive (30 with and 30 without oral candidiasis) and 30 healthy HIV-negative individuals were enrolled. Cotton pellet was weighed pre- and post-saliva collection for the assessment of SFR, while SIgA levels were estimated by commercial ELISA (Diametra, Italy) kit. The mean ± SD, SFR and SIgA levels in HIV-positive individuals with candidiasis, without candidiasis and HIV-negative controls were 0.396 ± 0.290, 0.546 ± 0.355 and 0.534 ± 0.214 ml/min and 115.891 ± 37.621, 136.024 ± 51.075 and 149.418 ± 31.765 µg/ml, respectively. A positive correlation between low CD4 counts (indicator of immunodeficiency) and SIgA was observed in HIV-positive individuals with candidiasis (r = 0.373, p = 0.045). We also report here for the first time the significant decrease in SFR and SIgA levels in individuals presenting with pseudomembranous type of oral candidiasis and Candida albicans infection.

Immunological and epidemiological factors affecting candidiasis in HIV patients beginning antiretroviral therapy in an Asian clinic

“…These changes promote growth of Candida (Torres et al, 2002). Here the reduced salivary flow rate in HIV patients is in accord with previous studies (Mahajan, Bagul & Desai, 2015). These authors considered it plausible that decreased salivary flow rate may increase Candida albicans adherence to buccal epithelial cells and hence the risk of OPC, but causation was not established.…”

Oral candidiasis profile of the Indonesian HIV-infected pediatric patients at UPIPI Dr. Soetomo General Hospital, Surabaya, Indonesia

“…Xerostomia is mainly caused (though not absolute) by the lack of salivary gland secretion (hyposalivation). This condition causes antimicrobial molecules, such as secretory immunoglobulin A (sIgA) and beta-defensin, which play important roles in preventing the adhesion and significantly reducing the colonization of Candida to oral mucosa [28][29][30]. All of these factors might increase the probability of oral candidiasis, although CD4 value was not directly affected.…”

Levels of sIgA and LF against Candida spp. in the saliva of patients with complete dentures, lined with silicone-based elastic materials

“…On the other hand, the significant differences in sIgA levels among patients with Candida albicans and non-albicans Candida, established by the authors mentioned above (7) did not find confirmation in our study. However, we should note that Mahajan et al (7) investigate immunosuppressed patients with candidiasis, unlike us. The significant differences established in present study in the salivary LF concentration in patients with different levels of Candida spp.…”

“…Some authors (3) found higher levels of sIgA in saliva in the presence of Candida spp., others reported that there was no relation between sIgA values and the presence or absence of fungi in the oral cavity (4,5,6). Mahajan et al (7) reported a decrease in sIgA levels in pseudomembranous oral candidiasis, as well as that the sIgA values in Candida non-albicans were higher than these of C. albicans.…”