The pathogenesis and clinical significance of cytologically detectable oralCandida in acute leukemia

Abstract

Using serial examination and oral cytology, 50 adult patients undergoing induction therapy for acute leukemia were studied for oral colonization with candida species. Ninety percent of patients were found to be colonized with Candida, with most of these colonizations present by day 14. The 30 patients exhibiting colonization with pseudohyphae received ketoconazole 400 mg daily by mouth. Of 20 patients in this group treated for 5 or more days, Candida organisms were eradicated in nine. Sixteen patients from the above group with persistent colonization on ketoconazole were treated by independent clinical decision for sustained fever and neutropenia with Amphotericin B, but only one responded by elimination of colonization. Seven of the 15 patients who did not initially receive ketoconazole developed Candida dissemination in contrast to two of 30 who received ketoconazole initially (P = 0.003, Fisher's exact test). No patient who initially had or acquired a negative cytology developed oral or disseminated candidiasis. Clinical oral candidiasis occurred in three patients, all of whom were receiving amphotericin B. Approximately 90% of these patients have or develop oral colonization with Candida organisms as identified by oral cytology. Those with colonization, both with and without pseudohyphae present, are at risk for dissemination. Amphotericin B does not eliminate colonization remaining after treatment with 400 mg of ketoconazole daily. More effective diagnostic and therapeutic strategies are needed to identify and eliminate Candida organisms and to prevent disseminated candidiasis in this population of patients.

Oral candidiasis

“…Immunosuppressive drugs such as the antineoplastic agents have been shown in several studies to predispose to oral candidiasis by altering the oral flora, disrupting the mucosal surface and altering the character of the saliva. 13 45 46 Other factors are smoking, diabetes, Cushing's syndrome, immunosuppressive conditions such as HIV infection, malignancies such as leukaemia, and nutritional deficienciesvitamin B deficiencies have been particularly implicated. Ninane found that 15%-60% of people with malignancies will develop oral candidiasis while they are immunosuppressed.…”

“…In the general population, carriage rates have been reported to range from 20% to 75% 4 without any symptoms. The incidence of C albicans isolated from the oral cavity has been reported to be 45% in neonates, 6 45%-65% of healthy children, 7 30%-45% of healthy adults, 8 9 50%-65% of people who wear removable dentures, 9 65%-88% in those residing in acute and long term care facilities, [9][10][11][12] 90% of patients with acute leukaemia undergoing chemotherapy, 13 and 95% of patients with HIV. 14 C albicans is a normal commensal of the mouth and generally causes no problems in healthy people.…”

Development and evaluation of cationic amphiphilic antimicrobial 2,5‐diketopiperazines

“…This highlights the role of the innate defense also in tissues with a negligible adaptive immune cell presence . Many published papers about antifungal peptides describe investigations directed toward oral candidiasis caused by Candida albicans , which is a major human pathogen often associated with serious conditions such as leukemia and HIV/AIDS . Candida species are also among the most frequent nosocomial pathogens leading to bloodstream infections, and they contribute significantly to mortality rates .…”

Commensal and pathogen: Candida albicans

“…(1) It was found that Candida albicans isisolated from the oral cavity of 45% neonates, 45%-65% of healthy children, 30%-45% of healthy adults,50%-65% of people who wear removable dentures, 65%-88% of people those are under acute and long term care facilities, 90% of patients with acute leukaemia undergoing chemotherapy, and 95% of HIV patients. (2)(3)(4)(5)(6)(7)(8) Candida albicans causes 4 th most common nosocomial infection with mortality rate of 39% in year 1995 and it is 3 rd most common nosocomial infection in ICUs with mortality rate of 47%. (9) …”