1
|
Silva M, Santos ES, Pedroso CM, Epstein JB, Santos-Silva AR, Kowalski LP. Prevalence of oral diseases in patients under palliative care: a systematic review and meta-analysis. Support Care Cancer 2024; 32:607. [PMID: 39172259 DOI: 10.1007/s00520-024-08723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/05/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Oral alterations are frequently observed in patients undergoing palliative care and are linked to the direct or indirect effects of the primary medical condition, comorbidities and medical management, leading to oral pain, impacting oral intake, and affecting quality of life. This systematic review aims to assess the prevalence of oral disease in palliative care patients. METHODS The protocol was registered at the PROSPERO database, and a systematic review of the literature was performed based on the PRISMA statement. A thorough evaluation of studies from five databases and gray literature was conducted. The risk of bias in each study was assessed using the Joanna Briggs Institute checklist for cross-sectional and case-control studies. A quantitative analysis was conducted on five studies using meta-analysis, and the degree of certainty in the evidence was determined using the GRADE tool. RESULTS The sample consisted of 2,502 patients, with a slight male predominance (50.43%). The average age was 66.92 years. The prevalence of oral diseases among palliative care patients was as follows: caries 32% (95% CI, 0.11-0.56; I2 = 93%), and oral candidiasis 17% (95% CI,0.11-0.25; I2 = 74%). Gingivitis and stomatitis were also reported, but with less frequency. CONCLUSION Dental intervention should take place as early as possible, ideally from the time of the patient's initial admission to palliative care, with regular monitoring of oral health. This approach can enhance the patient's comfort and quality of life and help prevent more severe complications in the future.
Collapse
Affiliation(s)
- Marina Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Erison Santana Santos
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Joel B Epstein
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil.
| |
Collapse
|
2
|
Shimosato M, Kada S, Yase E, Sakane N. Oral candida lesions and Candida tropicalis: Potential prognostic markers in end-of-life cancer patients. SPECIAL CARE IN DENTISTRY 2024; 44:1097-1106. [PMID: 38168741 DOI: 10.1111/scd.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
AIMS Oral candidosis is common in patients with end-of-life cancer; however, its prognosis is unclear. We aimed to assess oral candidosis and Candida species as prognostic indicators in palliative care for these patients. METHODS We consecutively included palliative care patients, assessed for candidosis via microbiological techniques, and classified into three groups by the extent of oral lesions. The association between oral candidosis and overall survival was assessed using a Cox proportional hazards model adjusted by performance status (PS). RESULTS We studied 142 patients (median age 77; 52.8% women) with a 76.1% oral candidosis prevalence. Candida albicans (80.6%) was the most common species. Oral lesions were classified as none, grade 1 (28.7%), or ≥ grade 2 (14.8%). During follow-up, Cox models identified ≥grade 2 lesions (aHR = 2.04; 95% CI: 1.18-3.54; p = .011) and Candida tropicalis (aHR = 2.38; 95% CI: 1.03-5.55; p = .044) as predictors. CONCLUSION The extent of oral candidosis lesions or the presence of C. tropicalis may serve as prognostic indicator in patients with end-of-life cancer. Therefore, solely concentrating on the prevalence and frequency of fungal species may be insufficient for predicting life prognosis; it is advisable to assess these parameters through both visual examination and culture.
Collapse
Affiliation(s)
- Maiko Shimosato
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinpei Kada
- Department of Otolaryngology-Head and Neck Surgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
- Division of Clinical Research Planning and Management, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eriko Yase
- Department of Pharmacy, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| |
Collapse
|
3
|
Walsh M, Fagan N, Davies A. Xerostomia in patients with advanced cancer: a scoping review of clinical features and complications. BMC Palliat Care 2023; 22:178. [PMID: 37950188 PMCID: PMC10638744 DOI: 10.1186/s12904-023-01276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this project was to review the literature on dry mouth / xerostomia in patients with advanced cancer, with the objectives being to determine its prevalence, clinical features, and complications. METHODS Standard methodology was used to conduct this scoping review. Detailed searches of the Medline, Embase, CINAHL, and PsycInfo databases were conducted to identify relevant studies: eligible studies had to include patients with advanced cancer, and to contain details of clinical features and/or complications of xerostomia. Commercial bibliographic / systematic review software was used to support the process. RESULTS Forty-three studies were discovered from the database and hand searches. The studies included 23 generic symptom studies, eight "symptom cluster" studies, nine oral symptom / problem studies, and three xerostomia-specific studies. In depth data is described on the clinical features and complications of xerostomia, and on the "symptom clusters" including xerostomia, in this cohort of patients. CONCLUSION This review discovered a relatively small number of focused studies (involving a similarly small number of patients). Nonetheless, it demonstrates that xerostomia is a very common problem in patients with advanced cancer and is often associated with significant morbidity (and impairment of quality of life).
Collapse
Affiliation(s)
- Maria Walsh
- Marymount University Hospital & Hospice, Curraheen, Ireland
| | - Norah Fagan
- Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Andrew Davies
- Trinity College Dublin, University College Dublin & Our Lady's Hospice Dublin, Dublin, Ireland.
| |
Collapse
|
4
|
Bishop Browne S, Munn T, Cheng A, Lee JT. Oral candidiasis in a specialist palliative care unit: assessment, diagnosis, management. BMJ Support Palliat Care 2023:spcare-2023-004237. [PMID: 36963803 DOI: 10.1136/spcare-2023-004237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES To evaluate current clinical practices of assessment, diagnosis and management of oral candidiasis in a specialist palliative care unit to improve patient outcomes through compliance with the Australian Commission on Safety and Quality in Health Care Antimicrobial Stewardship Clinical Care Standard. METHODS A clinical audit cycle: review of 100 patient records preceded an educational intervention delivered over 4 weeks to clinical stakeholders, followed by a review of an additional 100 records. RESULTS Eleven patients in each cohort had oral candidiasis. A statistically significant improvement in documented rates of oral examination (33% to 51%, p=0.015) and appropriate microbiological testing (0% to 63.6%, p=0.004) was achieved. Documentation of oral symptoms and prescribing practices were unchanged. CONCLUSIONS Meaningful changes in practice relating to oral assessment and diagnosis of oral candidiasis are possible. Future iterations of the audit cycle may benefit from multimodal interventions to encourage further practice change.
Collapse
Affiliation(s)
- Sarah Bishop Browne
- Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Palliative and Supportive Care, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tanya Munn
- Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Anna Cheng
- Oral Health, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Oral Health Promotion, Sydney Dental Hospital, Surry Hills, New South Wales, Australia
| | - Jessica Tsuann Lee
- Palliative Care, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- University of Technology Sydney, Broadway, New South Wales, Australia
| |
Collapse
|
5
|
Wang X, Zhang W, Wu W, Wu S, Young A, Yan Z. Is Candida albicans a contributor to cancer? A critical review based on the current evidence. Microbiol Res 2023; 272:127370. [PMID: 37028206 DOI: 10.1016/j.micres.2023.127370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/01/2023]
Abstract
The association between Candida albicans (C. albicans) and cancer has been noticed for decades. Whether C. albicans infection is a complication of cancer status or as a contributor to cancer development remains to be discussed. This review systematically summarized the up-to-date knowledge about associations between C. albicans and various types of cancer, and discussed the role of C. albicans in cancer development. Most of the current clinical and animal evidence support the relationship between C. albicans and oral cancer development. However, there is insufficient evidence to demonstrate the role of C. albicans in other types of cancer. Moreover, this review explored the underlying mechanisms for C. albicans promoting cancer. It was hypothesized that C. albicans may promote cancer progression by producing carcinogenic metabolites, inducing chronic inflammation, remodeling immune microenvironment, activating pro-cancer signals, and synergizing with bacteria.
Collapse
|
6
|
Pispero A, Lombardi N, Manfredi M, Varoni EM, Sardella A, Lodi G. Oral infections in oral cancer survivors: A mini-review. FRONTIERS IN ORAL HEALTH 2022; 3:970074. [PMID: 36338574 PMCID: PMC9634540 DOI: 10.3389/froh.2022.970074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023] Open
Abstract
The oral cancer survivors are a group of special individuals whose disease affect anatomical structures with a key role in identity and communication and a fundamental role in basic human functions such as speaking, eating, swallowing and breathing. Thus, quality of life of these individuals can be impaired by the consequences of disease and treatments, in particular surgery and radiotherapy. Among others, infectious conditions of any nature, bacterial, viral, fungal, are a frequent finding among oral cancer survivors. In fact, the peculiar systemic and local conditions of these subjects are known to significantly modify the microbiota, which, besides facilitating opportunistic infections, can affect the cancer microenvironment, as well as alter the effects of the anti-cancer therapies. Similarly, mouth infections can also affect the prognosis of oral cancer survivors. Among the opportunistic infections, fungal are the most common infections affecting these subjects, since neutropenia resulting from cancer, as well as chemotherapy and/or radiotherapy treatments, promote the shift from the carrier state of Candida species, to pathogen state. Treatment of oral candidiasis can be difficult in oral cancer survivors, and good evidence supports clotrimazole as the most effective for prevention, and fluconazole as the one with the best risk-benefit profile. Probiotics, although promising, need better evidence to be considered an effective treatment or preventive measure.
Collapse
Affiliation(s)
- Alberto Pispero
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Niccolò Lombardi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy,Correspondence: Niccolò Lombardi
| | - Maddalena Manfredi
- Dipartimento di Medicina e Chirurgia, Centro di Odontoiatria, Università di Parma, Parma, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
7
|
Mussi MCM, Fernandes KS, Gallottini MHC. A call for further research on the relation between type 2 diabetes and oral candidiasis. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:206-212. [PMID: 35422408 DOI: 10.1016/j.oooo.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the relationship between oral candidiasis with salivary features, neutrophil function, and glycemic control in type 2 diabetes (T2D). DESIGN Twenty-nine individuals were included, 16 with T2D and 13 without the disease. The participants underwent clinical examination, neutrophilic function tests, fasting glycemia and glycated hemoglobin (A1c), stimulated and unstimulated saliva collection, and swab and exfoliative cytology. Salivary flow, pH, and total fungi count were evaluated on saliva, and identification of the Candida species was performed in saliva and swab samples. RESULTS There was no difference in unstimulated salivary flow and pH of the stimulated and unstimulated saliva for participants with T2D and controls (P > .05). Individuals from both groups presented no candidal lesions. The salivary fungal growth in the T2D group was higher than that in controls (P < .05). Only individuals with T2D presented alterations in the neutrophilic functions (14/16; 87.5%; P < .05). There was no relationship between high A1c values and neutrophil dysfunction with the presence of Candida spp. in both saliva and mucosa (P > .05). CONCLUSIONS High A1c level, reduction in neutrophil activity, salivary flow and pH, and increase in total salivary Candida spp. counts were not related to oral candidiasis in patients with T2D.
Collapse
|
8
|
Jones JA, Chavarri-Guerra Y, Corrêa LBC, Dean DR, Epstein JB, Fregnani ER, Lee J, Matsuda Y, Mercadante V, Monsen RE, Rajimakers NJH, Saunders D, Soto-Perez-de-Celis E, Sousa MS, Tonkaboni A, Vissink A, Yeoh KS, Davies AN. MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer. Support Care Cancer 2022; 30:8761-8773. [PMID: 35717462 PMCID: PMC9633484 DOI: 10.1007/s00520-022-07211-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer. METHODS This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and "category of guideline" (i.e., "recommendation", "suggestion" or "no guideline possible"). RESULTS Twelve generic suggestions (level of evidence - 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals. CONCLUSIONS This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.
Collapse
Affiliation(s)
- Jac A. Jones
- grid.416224.70000 0004 0417 0648Royal Surrey County Hospital, Guildford, UK
| | - Yanin Chavarri-Guerra
- grid.416850.e0000 0001 0698 4037Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - David R. Dean
- grid.34477.330000000122986657Department of Oral Medicine, University of Washington/Seattle Cancer Care Alliance, Seattle, USA
| | - Joel B. Epstein
- grid.50956.3f0000 0001 2152 9905City of Hope Comprehensive Cancer Center, Duarte & Cedars Sinai Health System, Los Angeles, USA
| | | | - Jiyeon Lee
- grid.15444.300000 0004 0470 5454College of Nursing & Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, South Korea
| | - Yuhei Matsuda
- grid.411621.10000 0000 8661 1590Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | | | - Ragnhild Elisabeth Monsen
- grid.5510.10000 0004 1936 8921Department of Medicine, Lovisenberg Diaconal Hospital & Department for Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Natasja J. H. Rajimakers
- grid.470266.10000 0004 0501 9982Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Deborah Saunders
- grid.436533.40000 0000 8658 0974Department of Dental Oncology, Health Services North, Northern Ontario School of Medicine, Sudbury, Canada
| | - Enrique Soto-Perez-de-Celis
- grid.416850.e0000 0001 0698 4037Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana S. Sousa
- grid.117476.20000 0004 1936 7611IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Arghavan Tonkaboni
- grid.411705.60000 0001 0166 0922Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Arjan Vissink
- grid.4830.f0000 0004 0407 1981Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Keng Soon Yeoh
- Special Needs Dental Unit, South Australia Dental Service, Adelaide, Australia
| | - Andrew N. Davies
- grid.8217.c0000 0004 1936 9705Trinity College Dublin, University College Dublin & Our Lady’s Hospice Dublin, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
9
|
Martins BNFL, Palmier NR, Prado-Ribeiro AC, de Goes MF, Lopes MA, Brandão TB, Rivera C, Migliorati CA, Epstein JB, Santos-Silva AR. Awareness of the risk of radiation-related caries in patients with head and neck cancer: A survey of physicians, dentists, and patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:398-408. [PMID: 34353769 DOI: 10.1016/j.oooo.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Radiation-related caries (RRC) is one of the most aggressive complications of radiotherapy (RT) in survivors of head and neck cancer (HNC). Lack of RRC awareness may contribute to the occurrence of this oral cavity complication. RRC may be considered a "forgotten oral complication" by patients with HNC, oncologists, and dentists. The present study aimed to assess the level of awareness of RRC among physicians, dentists, and patients. STUDY DESIGN Physicians (group 1, G1), dentists (group 2, G2), and patients with HNC undergoing RT (group 3, G3) answered questionnaires concerning their awareness of RRC. Physicians (G1) were divided into group 1A (oncological experience) and group 1B (general physicians/other specialties). Dentists (G2) were divided into group 2A (oncological experience) and group 2B (general dentists/other specialties). Personalized questionnaires were designed for each group. RESULTS Recruitment was as follows: physicians (n = 124): 1A (n = 64), 1B (n = 60); dentists: (n = 280), 2A (n = 160), 2B (n = 120). In addition, 58 patients answered the questionnaire. In terms of RRC awareness, 46.77% of physicians, 81.78% of dentists, and 24.13% of patients had some knowledge of the problem. CONCLUSION Patient awareness of RRC was poor. The heterogeneity of answers among physicians and dentists suggests an opportunity to improve patient education and prevention of this serious oral complication of RT.
Collapse
Affiliation(s)
| | - Natália Rangel Palmier
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil.
| | - Ana Carolina Prado-Ribeiro
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil
| | - Mario Fernando de Goes
- University of Campinas (UNICAMP), Oral Rehabilitation Department, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - Marcio Ajudarte Lopes
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil
| | - Thais Bianca Brandão
- Instituto do Câncer do Estado de São Paulo (ICESP-FMUSP), Dental Oncology Service, São Paulo, SP, Brazil
| | - Cesar Rivera
- Department of Basic Biomedical Sciences, Universidad de Talca, Talca, Chile
| | | | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Health System, Los Angeles, CA, USA; City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alan Roger Santos-Silva
- University of Campinas (UNICAMP), Oral Diagnosis Department, Piracicaba Dental School, Piracicaba, SP, Brazil.
| |
Collapse
|
10
|
Monsen RE, Herlofson BB, Gay C, Fjeld KG, Hove LH, Malterud KE, Saghaug E, Slaaen J, Sundal T, Tollisen A, Lerdal A. A mouth rinse based on a tea solution of Salvia officinalis for oral discomfort in palliative cancer care: a randomized controlled trial. Support Care Cancer 2021; 29:4997-5007. [PMID: 33586003 PMCID: PMC8295113 DOI: 10.1007/s00520-021-06021-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few clinical studies evaluate interventions to reduce oral discomfort among patients in palliative care. AIM This study examines the efficacy of a Salvia officinalis (SO) based herbal mouth rinse compared to conventional normal saline (NS) in order to improve oral health. DESIGN A block-randomized controlled trial. Data were collected before and after a 4-day intervention with either SO (n=44) or NS (n=44). Numerical rating scales (NRS, 0-10) and 12 items from the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Oral Health 17 (EORTC QLQ-OH17) measured patient-reported oral symptoms. An oral examination was performed before and after the intervention. SETTING/PARTICIPANTS This study included adult patients with late-stage cancer in an inpatient hospice unit. RESULTS Of the 88 patients included (mean age=63.9 years, SD=10.6), 73 (83%) completed the study. At baseline, 78% reported dry mouth on the EORTC QLQ-OH17, and 80% rated dry mouth ≥4 on the NRS. Total oral health scores based on the 12 EORTC QLQ-OH17 items improved similarly in both groups (p<0.001). However, dry mouth ratings on both the EORTC QLQ-OH17 (p=0.036) and NRS (p=0.045) improved more in the SO group than in the NS group. Plaque on the teeth improved in both the SO (p=0.008) and NS (p=0.018) groups, but plaque on the tongue and erythema only improved with NS. CONCLUSIONS This study did not detect an overall significant difference between SO and NS. Both mouth rinses improved oral health parameters, indicating that systematic assessment and oral care may reduce oral discomfort. TRIAL REGISTRATION NCT02067572.
Collapse
Affiliation(s)
- Ragnhild Elisabeth Monsen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. .,Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Caryl Gay
- Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.,Department of Family Health Care Nursing, University of California, San Francisco, CA, USA
| | - Katrine Gahre Fjeld
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Karl Egil Malterud
- Department of Pharmacy, Section Pharmaceutical Chemistry, University of Oslo, Oslo, Norway
| | | | - Joran Slaaen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tone Sundal
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anita Tollisen
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anners Lerdal
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.,Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway
| |
Collapse
|
11
|
Oral symptoms in patients with advanced cancer: an observational study using a novel oral symptom assessment scale. Support Care Cancer 2021; 29:4357-4364. [PMID: 33416995 DOI: 10.1007/s00520-020-05903-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION CancerTrials.gov registry reference number: NCT04404920.
Collapse
|
12
|
Maheronnaghsh M, Fatahinia M, Dehghan P, Teimoori A. Identification of Candida Species and Antifungal Susceptibility in Cancer Patients with Oral Lesions in Ahvaz, Southern West of Iran. Adv Biomed Res 2020; 9:50. [PMID: 33457333 PMCID: PMC7792871 DOI: 10.4103/abr.abr_214_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/11/2019] [Accepted: 12/22/2019] [Indexed: 12/30/2022] Open
Abstract
Background Oral candidiasis is a common disease in cancer patients subject to chemotherapy. The aim of this study was to evaluate the risk factors of rising oral candidiasis incidence and to identify the Candida species isolated from oral lesions of cancer patients and their antifungal sensitivity. Materials and Methods A total of 645 patients with cancer were examined. Several Candida species were isolated from specimens and identified by morphological and molecular methods. The susceptibility of isolates to amphotericin B, fluconazole, and nystatin was also investigated. Results A total of 74 isolates of Candida were recovered from oral cavity of 61 cancer patients with oral candidiasis. The isolates included Candida albicans (n = 56; 75.5%), Candida glabrata (n = 4; 5.4%), Candida krusei (n = 5; 7%), Candida tropical (n = 7; 9.4%), and Candida kefyr (n = 2; 2.7%). A total (n = 72; 98.65%) of isolates were susceptible to nystatin, (n = 58; 78.4%) of them were susceptible to fluconazole, and (n = 8; 10.8%) of susceptible dose-dependent isolates were specified, (n = 46; 62.16%) of isolates were susceptible to amphotericin B. Conclusion Finally, in addition to emphasis on topical nystatin application in the first stage of oral candidiasis in these patients, using alternative systemic drugs such as fluconazole and amphotericin B can be considered for the resistant candida isolates to nystatin.
Collapse
Affiliation(s)
- Mehrnoush Maheronnaghsh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahnaz Fatahinia
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Dehghan
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Teimoori
- Department of Virology, Hamedan University of Medical Sciences, Hamedan, Iran
| |
Collapse
|
13
|
Venkatasalu MR, Murang ZR, Ramasamy DTR, Dhaliwal JS. Oral health problems among palliative and terminally ill patients: an integrated systematic review. BMC Oral Health 2020; 20:79. [PMID: 32188452 PMCID: PMC7079519 DOI: 10.1186/s12903-020-01075-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High incidence of treatable oral conditions has been reported among palliative patients. However, a large proportion of palliative patients lose their ability to communicate their sufferings. Therefore, it may lead to under-reporting of oral conditions among these patients. This review systematically synthesized the published evidence on the presence of oral conditions among palliative patients, the impact, management, and challenges in treating these conditions. METHODS An integrative review was undertaken with defined search strategy from five databases and manual search through key journals and reference list. Studies which focused on oral conditions of palliative patients and published between years 2000 to 2017 were included. RESULTS Xerostomia, oral candidiasis and dysphagia were the three most common oral conditions among palliative patients, followed by mucositis, orofacial pain, taste change and ulceration. We also found social and functional impact of having certain oral conditions among these patients. In terms of management, complementary therapies such as acupuncture has been used but not well explored. The lack of knowledge among healthcare providers also posed as a challenge in treating oral conditions among palliative patients. CONCLUSIONS This review is first in its kind to systematically synthesize the published evidence regarding the impact, management and challenges in managing oral conditions among palliative patients. Although there is still lack of study investigating palliative oral care among specific group of patients such as patients with dementia, geriatric or pediatric advanced cancer patients, this review has however provided baseline knowledge that may guide health care professionals in palliative settings.
Collapse
Affiliation(s)
- Munikumar Ramasamy Venkatasalu
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Zaidah Rizidah Murang
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Divya Thirumalai Rajam Ramasamy
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam
| | - Jagjit Singh Dhaliwal
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam.
| |
Collapse
|
14
|
Dhaliwal J, Murang Z, Ramasamy DR, Venkatasalu M. Oral microbiological evidence among palliative patients: An integrated systematic review. Indian J Palliat Care 2020; 26:110-115. [PMID: 32132794 PMCID: PMC7017706 DOI: 10.4103/ijpc.ijpc_178_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022] Open
Abstract
Life-limiting diseases such as cancers and its related treatments often compromise normal oral microbial flora and predispose a palliative patient to diverse oral infections. Knowledge on microbial flora in the oral cavity of patients with life-limiting diseases is essential to develop treatment options for clinical practitioners. This review aimed to systematically synthesize the published evidence on the oral microbiology of palliative patients. An integrative review was undertaken with defined search strategy from five databases with manual search through key journals and reference list. Studies included were published during the year 2000–2017 focusing on microbiological evidence associated with oral conditions among palliative patients. Candida presence was reported in the oral cavity of terminally ill patients in seven of nine articles, with Candida albicans being the predominant species. The majority of the included studies used oral swabs as a technique for isolation of the organism. This review is first to systematically synthesize the published evidence on the oral microbial flora of palliative patients, taking into account the techniques for identification of the microbiota. Larger multicenter studies may help in developing standardized clinical guidelines for the oral care of these patients.
Collapse
|
15
|
de Oliveira MCQ, Lebre Martins BNF, Santos-Silva AR, Rivera C, Vargas PA, Lopes MA, Vechiato-Filho AJ, Brandão TB, Prado-Ribeiro AC. Dental treatment needs in hospitalized cancer patients: a retrospective cohort study. Support Care Cancer 2019; 28:3451-3457. [DOI: 10.1007/s00520-019-05202-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022]
|
16
|
Watanabe H, Taniguchi A, Yamamoto C, Odagiri T, Asai Y. Adverse Events Caused by Aspiration Implemented for Death Rattle in Patients in the Terminal Stage of Cancer: A Retrospective Observational Study. J Pain Symptom Manage 2018; 56:e6-e8. [PMID: 29653166 DOI: 10.1016/j.jpainsymman.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Hiroaki Watanabe
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan.
| | - Akiko Taniguchi
- Department of Nursing, Komaki City Hospital, Komaki, Aichi, Japan
| | - Chikayo Yamamoto
- Department of Nursing, Komaki City Hospital, Komaki, Aichi, Japan
| | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| | - Yasuyuki Asai
- Department of Palliative Care, Komaki City Hospital, Komaki, Aichi, Japan
| |
Collapse
|
17
|
Emmerson E, Knox SM. Salivary gland stem cells: A review of development, regeneration and cancer. Genesis 2018; 56:e23211. [PMID: 29663717 PMCID: PMC5980780 DOI: 10.1002/dvg.23211] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/13/2022]
Abstract
Salivary glands are responsible for maintaining the health of the oral cavity and are routinely damaged by therapeutic radiation for head and neck cancer as well as by autoimmune diseases such as Sjögren's syndrome. Regenerative approaches based on the reactivation of endogenous stem cells or the transplant of exogenous stem cells hold substantial promise in restoring the structure and function of these organs to improve patient quality of life. However, these approaches have been hampered by a lack of knowledge on the identity of salivary stem cell populations and their regulators. In this review we discuss our current knowledge on salivary stem cells and their regulators during organ development, homeostasis and regeneration. As increasing evidence in other systems suggests that progenitor cells may be a source of cancer, we also review whether these same salivary stem cells may also be cancer initiating cells.
Collapse
Affiliation(s)
- Elaine Emmerson
- The MRC Centre for Regenerative Medicine, The University of Edinburgh, 5 Little France Drive, Edinburgh, EH16 4UU, UK
| | - Sarah M. Knox
- Program in Craniofacial Biology, Department of Cell and Tissue Biology, University of California, 513 Parnassus Avenue, San Francisco, CA, 94143, USA
| |
Collapse
|
18
|
Bansal R, Pallagatti S, Sheikh S, Aggarwal A, Gupta D, Singh R. Candidal Species Identification in Malignant and Potentially Malignant Oral Lesions with Antifungal Resistance Patterns. Contemp Clin Dent 2018; 9:S309-S313. [PMID: 30294163 PMCID: PMC6169267 DOI: 10.4103/ccd.ccd_296_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Candidal species identification in malignant and potentially malignant oral lesions with antifungal susceptibility. Materials and Methods: Oral candidal carriage, strain diversity, and antifungal susceptibility of Candida were checked for the patients having oral cancer or precancer reporting to the clinics for 1½ year. Statistically significant patients were selected and a control group was taken. A total of 105 individuals were selected and divided into three different groups. Salivary samples were taken from all the individuals. Candida detection was done using Sabouraud's agar and candidal species detection on CHROMagar. In vitro antifungal sensitivity was done using antifungal disc diffusion method. Results: Candida was isolated from 88.6% of patients with oral cancer and 45.7% in oral precancerous group. C. albicans was the predominant species found in 100% of oral precancerous and 71% in oral cancerous patients. Other Candid a species found were C. tropicalis (9.7%) and C. krusei (19.6%). Antifungal susceptibility showed 4.3% sensitivity to fluconazole and 100% sensitivity to amphotericin B and nystatin. Conclusion: Oral Candida carriage was higher in oral cancerous group and majority of them were sensitive to amphotericin B and nystatin.
Collapse
Affiliation(s)
- Rahul Bansal
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| | - Shambulingappa Pallagatti
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| | - Soheyl Sheikh
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| | - Amit Aggarwal
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| | - Deepak Gupta
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| | - Ravinder Singh
- Department of Oral Medicine and Radiology, MM College of Dental Sciences and Research, Ambala, Haryana, India
| |
Collapse
|
19
|
Soni P, Parihar RS, Soni LK. Opportunistic Microorganisms in Oral Cavity According to Treatment Status in Head and Neck Cancer Patients. J Clin Diagn Res 2017; 11:DC14-DC17. [PMID: 29207704 DOI: 10.7860/jcdr/2017/27284.10635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022]
Abstract
Introduction Cancer patients receiving chemotherapy and/or radiation therapy are prone to many predisposing factors like immunosuppression, imbalance in the oral flora, hypo-salivation and local tissue damage. Therefore, considered to be at higher risk for oral bacterial and fungal infection than the general population. Aim To study oropharyngeal flora in head and neck cancer patients under treatment and to correlate their incidence according with Chemotherapy cycles and Radiochemotherapy. Materials and Methods Total 110 patients were selected for study, those were further divided into two groups, group I under Chemotherapy (CT) - 55 patients and group II under Radiochemotherapy (RCT) - 55 patients and 50 healthy individuals were taken as control. Saliva sample was collected from control and study group and inoculated on Blood agar, MacConkey agar and Sabouraud's Dextrose Agar (SDA). The identification of bacterial and fungal isolates was done by standard microbiological methods and result was calculated according to cycles of Chemotherapy and Radiochemotherapy combined. Significant differences between patients were tested using the Chi-square test or Fisher's exact test. A p-value less than 0.05 was considered as statistically significant. Result There were 149 culture isolates from 110 patient in which Gram Negative Bacilli (GNB) found in 63.6%, Candida spp. in 50%, Staphylococcus aureus in 8% and Normal commensal of oral cavity in 13.6% patients in study group and this was higher than control group and this difference was statistically significant in relation to all isolates individually. Relatively more microorganism were isolated during RCT (56%) in compare to CT alone (44%), among GNB- Pseudomonas (27.7%,32.3%) and Klebsiella (25%,29.4%) were most frequently isolated during CT, RCT respectively. Candida spp. were more commonly isolated from patient on RCT (63.6%) than CT (36.3%) when compared to control group (20%) among which C. tropicalis was more prevalent species. Both GNB & Candida spp. were more commonly isolated in later chemotherapy cycles (CT4, CT5 CT6). Conclusion Colonisation of Gram negative bacilli & Candida spp. is directly related to number of chemotherapy cycles and combined cancer therapy. Hence, prophylactic medication for these two organisms should be incorporated along with cancer therapy.
Collapse
Affiliation(s)
- Priyanka Soni
- Assistant Professor, Department of Microbiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Rajendra Singh Parihar
- Assistant Professor, Department of Microbiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Laxman Kumar Soni
- Assistant Professor, Department of Microbiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| |
Collapse
|
20
|
A retrospective study of 606 cases of nasopharyngeal carcinoma with or without oropharyngeal candidiasis during radiotherapy. PLoS One 2017; 12:e0182963. [PMID: 28797119 PMCID: PMC5552301 DOI: 10.1371/journal.pone.0182963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the clinical characteristics, treatment-related toxicities and survival in patients with nasopharyngeal carcinoma (NPC) with or without oropharyngealcandidiasis (OPC) during radiotherapy. Methods The current study was conducted with NPC patients undergoing radiotherapy at Sun Yat-Sen University Cancer Center between June 2011 and May 2012. A clinical diagnosis of candidiasis was determined on the basis of a positive potassium hydroxide (KOH) test and the presence of pseudomembranous (white) form of candidal overgrowth. The Cox proportional hazard regression model was used to test the association of OPC and related survival rates. Results Compared with the non-OPC group, the OPC group had significantly increased occurrence rates of grade 3–4 mucositis (14.5% vs. 7.4%, P = 0.049), anaemia (11.3% vs. 4.4%, P = 0.020), hepatotoxicity (4.8% vs. 1.1%, P = 0.021) and critical weight loss (85.5% vs. 56.6%, P<0.001) during radiotherapy. The OPC group had a significantly lower disease-free survival (DFS) (70.9% vs. 82.6%, P = 0.012), mainly as a result of a reduction in locoregional relapse-free survival (LRFS) (87.0%vs. 94.9%, P = 0.025). After stratification by T stage, the 5-year DFS in T3-4 patients were 82.0% and 68.8% in non-OPC and OPC groups, respectively (P = 0.022). Multivariate analyses indicated that OPC was a prognostic factor for LRFS and DFS. Conclusions OPC during radiotherapy may worsen the nutritional status of NPC patients according to weight loss and anaemia, leading to a negative impact on 5-year locoregional relapse-free survival and disease-specific survival. Further investigations are needed to explore whether prevention and treatment of OPC during radiotherapy will be useful.
Collapse
|
21
|
Scheibler E, Garcia MCR, Medina da Silva R, Figueiredo MA, Salum FG, Cherubini K. Use of nystatin and chlorhexidine in oral medicine: Properties, indications and pitfalls with focus on geriatric patients. Gerodontology 2017; 34:291-298. [DOI: 10.1111/ger.12278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 01/15/2023]
Affiliation(s)
- Elusa Scheibler
- Dental College; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre RS Brazil
| | - Maria Claudia Rosa Garcia
- Laboratório de Imunologia e Microbiologia; Faculdade de Biociências; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
| | - Renata Medina da Silva
- Laboratório de Imunologia e Microbiologia; Faculdade de Biociências; Pontifical Catholic University of Rio Grande do Sul (PUCRS); Porto Alegre RS Brazil
| | | | | | - Karen Cherubini
- Dental College; Pontifical Catholic University of Rio Grande do Sul; Porto Alegre RS Brazil
| |
Collapse
|
22
|
Astvad K, Johansen HK, Høiby N, Steptoe P, Ishøy T. Oropharyngeal Candidiasis in Palliative Care Patients in Denmark. J Palliat Med 2015; 18:940-4. [DOI: 10.1089/jpm.2015.29003.ka] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen Astvad
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Niels Høiby
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | | | | |
Collapse
|
23
|
Occurrence of oral Candida colonization and its risk factors among patients with malignancies in China. Clin Oral Investig 2015. [PMID: 26220512 DOI: 10.1007/s00784-015-1524-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Oral colonization of Candida could lead to later development of oropharyngeal candidiasis or candidemia among the immunocompromised patients. This study aims to describe the occurrence and risk factors of oral Candida colonization in patients with malignancies. MATERIALS AND METHODS From October 2012 to March 2013, 78 patients with pulmonary cancer (group I), 101 patients with gastrointestinal tract tumor (group II), 79 patients with hematopoietic system malignant tumor (group III), and 101 healthy controls were consecutively recruited in a hospital in Beijing, China. The oral rinse samples were taken and Candida species were identified; the enzymes activities were tested. RESULTS In total, 110 and 27 Candida strains were isolated from 91 patients and 26 controls, respectively. The oral colonization rate with Candida albicans in group III (12.7 %) was significant lower than that in group I (30.8 %), group II (33.7 %), and control group (25.7 %). The oral colonization rates with non-albicans Candida species in group I, group II, and group III were 15.4, 10.9, and 12.7 %, respectively, while only one non-albicans Candida strain was identified in control group. The non-albicans Candida species exhibited a lower virulence than C. albicans. Age was an independent risk factor for Candida colonization in patients with pulmonary cancer and digestive tract malignant tumor, "Teeth brush <1 time/day" was an independent risk factor for Candida colonization in patients with hematopoietic system tumor. CONCLUSIONS The differences of risk factors for oral Candida colonization in patients with different cancers require different strategies for the prevention and control of Candida infection. CLINICAL RELEVANCE Old aged patients with pulmonary cancer and digestive tract malignant tumor are high-risk population for Candida colonization. Increasing frequency of teeth brush might be helpful for preventing Candida colonization.
Collapse
|
24
|
Moreno A, Nuño G, Cuello S, Sayago JE, Alberto MR, Zampini C, Isla MI. Anti-inflammatory, Antioxidant and Antimicrobial Activity Characterization and Toxicity Studies of Flowers of “Jarilla”, a Medicinal Shrub from Argentina. Nat Prod Commun 2015. [DOI: 10.1177/1934578x1501000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Zuccagnia punctata Cav. (Fabaceae) is an Argentine medicinal aromatic shrub (jarilla pispito, puspus, lata and jarilla macho). The chalcones were identified as pigments responsible for the yellow color of the flowers. Hydroethanolic extracts were obtained both from fresh flowers and from flowers dried by lyophilization. The extracts were standardized by their phenolic and flavonoids content. Their fingerprints by HPLC-DAD indicated the presence of two chalcones as major compounds (2′,4′-dihydroxychalcone and 2′,4′-dihydroxy-3′-methoxychalcone). Both extracts showed the same total phenolic, non-flavonoid phenolic and flavonoid phenolic content and their phenolic profiles were similar. The polyphenolic extracts exhibited antioxidant (free radical scavenging and inhibitory activity on lipoperoxidation) and anti-inflammatory (inhibition of lipoxygenase and cyclooxygenase enzymes) activities. The flower extracts were active against six Candida species with MIC values between 60 and 120 μg GAE.mL−1 and were also active on methicillin-resistant Staphylococcus aureus (MIC: 250 μg GAE.mL−1) and Enterococcus faecalis (MIC: 500 μg GAE.mL−1). The extracts were neither toxic ( Artemia salina test) nor mutagenic (Ames test). Jarilla flowers could be considered as a new dietary supplement that could help to prevent pathologies associated with oxidative stress and the polyphenolic extract obtained from them could be considered as a standardized phytotherapeutic product with antimicrobial, antioxidant and anti-inflammatory activities.
Collapse
Affiliation(s)
- Alejandra Moreno
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - Gabriela Nuño
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - Soledad Cuello
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales e IML. Universidad Nacional de Tucumán. San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - Jorge E. Sayago
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales e IML. Universidad Nacional de Tucumán. San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - María Rosa Alberto
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales e IML. Universidad Nacional de Tucumán. San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - Catiana Zampini
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales e IML. Universidad Nacional de Tucumán. San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| | - María Inés Isla
- Instituto de Química del Noroeste Argentino (INQUINOA), CONICET, San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales e IML. Universidad Nacional de Tucumán. San Lorenzo 1469. San Miguel de Tucumán. Tucumán. Argentina
| |
Collapse
|
25
|
Associations between oral complications and days to death in palliative care patients. Support Care Cancer 2015; 24:157-161. [PMID: 25962615 DOI: 10.1007/s00520-015-2759-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Adverse oral symptoms gradually appear in advanced cancer patients as the disease progresses. We retrospectively investigated the associations between the incidence of oral problems and the days to death (DTD) in patients receiving palliative care. METHODS The dental assessment sheets and medical charts of 105 patients who had been admitted into the palliative care unit at our hospital were examined. Case data included evaluations of organic and functional oral conditions at the time of admission for all patients. The cohort was divided into two groups according to the DTD as the short group (<28 days from the time of dental assessment until death) and the long group (≥28 days). We compared the incidences of organic and functional oral problems between these groups. RESULTS Dry mouth, tongue inflammation, and bleeding spots were significantly more frequent in the short group than in the long group (78 vs. 54% for dry mouth, 67 vs. 46% for tongue inflammation, 35 vs. 14% for bleeding spots, respectively; p < 0.05). Tongue coating and candidiasis were comparable between the two groups. Dysphagia was significantly more common in the short group (43%) than in the long group (20%) (p = 0.01), as was assistance with oral health care (76 vs. 50%) (p = 0.01). CONCLUSIONS Our findings suggest that, during palliative care, oral complications appear more frequently when the DTD period is shorter. These symptoms may be useful indicators when deciding on the proper timing of intensive oral care intervention to decrease oral problems and pain in terminally ill patients.
Collapse
|
26
|
Hall RA. Dressed to impress: impact of environmental adaptation on the Candida albicans cell wall. Mol Microbiol 2015; 97:7-17. [PMID: 25846717 PMCID: PMC4973840 DOI: 10.1111/mmi.13020] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/27/2022]
Abstract
Candida albicans is an opportunistic fungal pathogen of humans causing superficial mucosal infections and life‐threatening systemic disease. The fungal cell wall is the first point of contact between the invading pathogen and the host innate immune system. As a result, the polysaccharides that comprise the cell wall act as pathogen associated molecular patterns, which govern the host–pathogen interaction. The cell wall is dynamic and responsive to changes in the external environment. Therefore, the host environment plays a critical role in regulating the host–pathogen interaction through modulation of the fungal cell wall. This review focuses on how environmental adaptation modulates the cell wall structure and composition, and the subsequent impact this has on the innate immune recognition of C. albicans.
Collapse
Affiliation(s)
- Rebecca A Hall
- School of Biosciences, Institute of Microbiology and Infection, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| |
Collapse
|
27
|
Gabriela N, Rosa AM, Catiana ZI, Soledad C, Mabel OR, Esteban SJ, Veronica B, Daniel W, Ines IM. The Effect of Zuccagnia punctata, an Argentine Medicinal Plant, on Virulence Factors from Candida Species. Nat Prod Commun 2014. [DOI: 10.1177/1934578x1400900712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Zuccagnia punctata Cav. has been used as a traditional medicine in Argentina for the treatment of bacterial and fungal infections. In this study, we evaluated the ability of Z. punctata extract (ZpE) and compounds isolated from it to inhibit the growth and virulence factors of Candida species. ZpE showed inhibitory activity against planktonic cells of all assayed Candida species with MIC values of 400 μg/mL and with MFC values between 400 and 1,200 μg/mL. The principal identified compounds by HPLC-MS/MS and UV-VIS were chalcones (2′,4′-dihydroxy-3′-methoxychalcone, 2′,4′- dihydroxychalcone), flavones (galangin, 3,7-dihydroxyflavone and chrysin) and flavanones (naringenin, 7-hydroxyflavanone and pinocembrine). These compounds were more effective as inhibitors than the extracts upon biofilm formation as well as on preformed Candida biofilm and yeast germ tube formation. Furthermore, ZpE and chalcones are able to inhibit exoenzymes, which are responsible for the invasion mechanisms of the pathogens. All these effects could moderate colonization, thereby suppressing the pathogen invasive potential. Our results indicate that ZpE and chalcones could be used in antifungal therapy.
Collapse
Affiliation(s)
- Nuño Gabriela
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Alberto María Rosa
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Zampini Iris Catiana
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Cuello Soledad
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Ordoñez Roxana Mabel
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Sayago Jorge Esteban
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| | - Baroni Veronica
- ISIDSA, SECyT; ICYTAC-CONICET; Facultad de Ciencias Químicas - Universidad Nacional de Córdoba, Córdoba. Argentina
| | - Wunderlin Daniel
- ISIDSA, SECyT; ICYTAC-CONICET; Facultad de Ciencias Químicas - Universidad Nacional de Córdoba, Córdoba. Argentina
| | - Isla María Ines
- INQUINOA (CONICET) Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Ciencias Naturales Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
- Facultad de Bioquímica, Química y Farmacia. Universidad Nacional de Tucumán. San Miguel de Tucumán. Tucumán. Argentina
| |
Collapse
|
28
|
Boros-Majewska J, Salewska N, Borowski E, Milewski S, Malic S, Wei XQ, Hayes AJ, Wilson MJ, Williams DW. Novel Nystatin A₁ derivatives exhibiting low host cell toxicity and antifungal activity in an in vitro model of oral candidosis. Med Microbiol Immunol 2014; 203:341-55. [PMID: 24924305 DOI: 10.1007/s00430-014-0343-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/21/2014] [Indexed: 12/21/2022]
Abstract
Opportunistic oral infections caused by Candida albicans are frequent problems in immunocompromised patients. Management of such infections is limited due to the low number of antifungal drugs available, their relatively high toxicity and the emergence of antifungal resistance. Given these issues, our investigations have focused on novel derivatives of the antifungal antibiotic Nystatin A1, generated by modifications at the amino group of this molecule. The aims of this study were to evaluate the antifungal effectiveness and host cell toxicity of these new compounds using an in vitro model of oral candidosis based on a reconstituted human oral epithelium (RHOE). Initial studies employing broth microdilution, revealed that against planktonic C. albicans, Nystatin A1 had lower minimal inhibitory concentration than novel derivatives. However, Nystatin A1 was also markedly more toxic against human keratinocyte cells. Interestingly, using live/dead staining to assess C. albicans and tissue cell viability after RHOE infection, Nystatin A1 derivatives were more active against Candida with lower toxicity to epithelial cells than the parent drug. Lactate dehydrogenase activity released by the RHOE indicated a fourfold reduction in tissue damage when certain Nystatin derivatives were used compared with Nystatin A1. Furthermore, compared with Nystatin A1, colonisation of the oral epithelium by C. albicans was notably reduced by the new polyenes. In the absence of antifungal agents, confocal laser scanning microscopy showed that C. albicans extensively invaded the RHOE. However, the presence of the novel derivatives greatly reduced or totally prevented this fungal invasion.
Collapse
Affiliation(s)
- Joanna Boros-Majewska
- Department of Pharmaceutical Technology and Biochemistry, Gdańsk University of Technology (GUT), 11/12 Narutowicza Street, 80-233, Gdańsk, Poland
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Fischer DJ, Epstein JB, Yao Y, Wilkie DJ. Oral health conditions affect functional and social activities of terminally ill cancer patients. Support Care Cancer 2014; 22:803-10. [PMID: 24232310 DOI: 10.1007/s00520-013-2037-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/28/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Oral conditions are established complications in terminally ill cancer patients. Yet despite significant morbidity,the characteristics and impact of oral conditions in these patients are poorly documented. The study objective was to characterize oral conditions in terminally ill cancer patients to determine the presence, severity, and the functional and social impact of these oral conditions. METHODS This was an observational clinical study including terminally ill cancer patients (2.5–3-week life expectancy). Data were obtained via the Oral Problems Scale (OPS) that measures the presence of subjective xerostomia, orofacial pain, taste change, and the functional/social impact of oral conditions and a demographic questionnaire. A standardized oral examination was used to assess objective salivary hypofunction, fungal infection, mucosal erythema, and ulceration. Regression analysis and t test investigated the associations between measures. RESULTS Of 104 participants, most were ≥50 years of age,female, and high-school educated; 45 % were African American, 43 % Caucasian, and 37 % married. Oral conditions frequencies were: salivary hypofunction (98 %), mucosal erythema (50 %), ulceration (20 %), fungal infection(36 %), and other oral problems (46 %). Xerostomia, taste change, and orofacial pain all had significant functional impact; p <.001, p =.042 and p <.001, respectively. Orofacial pain also had a significant social impact (p <.001). Patients with oral ulcerations had significantly more orofacial pain with a social impact than patients without ulcers (p =.003). Erythema was significantly associated with fungal infection and with mucosal ulceration (p <.001). CONCLUSIONS Oral conditions significantly affect functional and social activities in terminally ill cancer patients. Identification and management of oral conditions in these patients should therefore be an important clinical consideration.
Collapse
|
30
|
Khan MSA, Ahmad I, Sajid M, Cameotra SS. Current and Emergent Control Strategies for Medical Biofilms. SPRINGER SERIES ON BIOFILMS 2014. [DOI: 10.1007/978-3-642-53833-9_7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
31
|
Xu L, Zhang H, Liu J, Chen X. Investigation of the oral infections and manifestations seen in patients with advanced cancer. Pak J Med Sci 2013; 29:1112-5. [PMID: 24353702 PMCID: PMC3858927 DOI: 10.12669/pjms.295.3493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022] Open
Abstract
Objective: A prospective, observational study was undertaken to investigate the epidemiology of oral infection among the patients with advanced malignancies, and to investigate the effects of therapy strategies and risk factors on the incidence of oral infection. Methods: The patients with advanced malignancies were enrolled into the study. The incidence of oral infection with different malignant tumor groups or different treatment methods and the diagnoses of oral infection were confirmed. Demographic data on age, gender, bed rest time, nutritional status, smoking habit and the presence of oral prosthesis were also recorded. Results: Oral infection was prevalent in 46% (391/850) of all cancer patients, with the highest rate in oral and maxillofacial cancer group (67%), followed by Hematological malignancy group (58.6%) and other groups (ranging from 43.3% to 35.3%). Oral candidiasis, oral herpes simplex, and oral mucositis were the popular infectious diseases in the patients. Chemotherapy and radiotherapy, especially combined radio- and chemotherapy, resulted in more oral infections compared with palliative care and surgery. Poor nutritional status and oral prosthesis were identified as independent risk factors associated with oral infection. Conclusion: Oral infection is prevalent among advanced cancer patients and associated with therapy methods and risk factors. More oral health care should be carried out for the patients with advanced malignant tumor.
Collapse
Affiliation(s)
- Lihua Xu
- LihuaXu, General Medicine Department, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hualin Zhang
- Hualin Zhang, College of Stomatology, Ningxia Medical University, Yinchuan, China
| | - Jinsong Liu
- Jinsong Liu, Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325027, China
| | - Xiaowei Chen
- Xiaowei Chen, Gastroenterology and Hepatology Department, First Affiliated Hospital,Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
32
|
Coronado-Castellote L, Jiménez-Soriano Y. Clinical and microbiological diagnosis of oral candidiasis. J Clin Exp Dent 2013; 5:e279-86. [PMID: 24455095 PMCID: PMC3892259 DOI: 10.4317/jced.51242] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 09/26/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction: Candidiasis or oral candidiasis is the most frequent mucocutaneous mycosis of the oral cavity. It is produced by the genus Candida, which is found in the oral cavity of 53% of the general population as a common commensal organism. One hundred and fifty species have been isolated in the oral cavity, and 80% of the isolates correspond to Candida albicans, which can colonize the oral cavity alone or in combination with other species. Transformation from commensal organism to pathogen depends on the intervention of different predisposing factors that modify the microenvironment of the oral cavity and favor the appearance of opportunistic infection.
The present study offers a literature review on the diagnosis of oral candidiasis, with the purpose of establishing when complementary microbiological techniques for the diagnosis of oral candidiasis should be used, and which techniques are most commonly employed in routine clinical practice in order to establish a definitive diagnosis.
Materials and methods: A Medline-PubMed, Scopus and Cochrane search was made covering the last 10 years.
Results: The diagnosis of oral candidiasis is fundamentally clinical. Microbiological techniques are used when the clinical diagnosis needs to be confirmed, for establishing a differential diagnosis with other diseases, and in cases characterized by resistance to antifungal drugs. Biopsies in turn are indicated in patients with hyperplastic candidiasis. Staining (10% KOH) and culture (Sabouraud dextrose agar) are the methods most commonly used for diagnosing primary candidiasis. Identification of the individual species of Candida is usually carried out with CHROMagar Candida®. For the diagnosis of invasive candidiasis, and in cases requiring differentiation between C. albicans and C. dubliniensis, use is made of immunological and genetic techniques such as ELISA and PCR.
Key words:Clinical, oral candidiasis, microbiology.
Collapse
Affiliation(s)
- Laura Coronado-Castellote
- Dentistry. Master of Oral Medicine and Oral Surgery. Faculty of Medicine and Dentistry. University of Valencia. Spain
| | - Yolanda Jiménez-Soriano
- Associate Professor of the Department of Stomatology. Faculty of Medicine and Dentistry. University of Valencia. Spain
| |
Collapse
|
33
|
Mañas A, Cerezo L, de la Torre A, García M, Alburquerque H, Ludeña B, Ruiz A, Pérez A, Escribano A, Manso A, Glaria LA. Epidemiology and prevalence of oropharyngeal candidiasis in Spanish patients with head and neck tumors undergoing radiotherapy treatment alone or in combination with chemotherapy. Clin Transl Oncol 2012; 14:740-6. [PMID: 22960994 DOI: 10.1007/s12094-012-0861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 12/16/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the oropharyngeal candidiasis (OPC) prevalence in Spanish patients with head and neck cancer undergoing radiotherapy, alone or combined with chemotherapy. Secondary objectives were to determine the prevalence of Candida species colonization, and to explore whether different Candida species colonizing the oral cavity and the treatment were associated with a higher prevalence of OPC. METHODS This is an observational, cross-sectional, multicentre study, conducted in Spanish radiation oncology units. Patients were diagnosed with head and neck cancer and started a radiotherapy treatment alone or combined with chemotherapy at the moment of their inclusion (N = 92). RESULTS The OPC prevalence was 26 %. The identification of colonizing pathogens was performed in 49 patients, and Candida albicans was the dominant yeast (69 %), while non-albicans Candida was only found in 15 patients (31 %). Patients with C. albicans colonization had a significant higher prevalence of OPC compared to patients colonized by non-albicans Candida (p = 0.0273), but no difference was found regarding the OPC prevalence in patients receiving only radiotherapy compared to patients with both radiotherapy and chemotherapy treatments. CONCLUSIONS Our data represent a step further in the knowledge of Candida species present in Spanish patients with head and neck tumors under radiation therapy. This is an essential step to manage the prophylaxis and treatment of OPC, since it might lead to severe clinical complications causing treatment interruption and, thus, representing a reduction in anti-tumor efficacy.
Collapse
Affiliation(s)
- Ana Mañas
- Servicio de Oncología Radioterápica, Hospital Universitario La Paz, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hjermstad MJ, Bergenmar M, Fisher SE, Montel S, Nicolatou-Galitis O, Raber-Durlacher J, Singer S, Verdonck-de Leeuw I, Weis J, Yarom N, Herlofson BB. The EORTC QLQ-OH17: A supplementary module to the EORTC QLQ-C30 for assessment of oral health and quality of life in cancer patients. Eur J Cancer 2012; 48:2203-11. [DOI: 10.1016/j.ejca.2012.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/02/2012] [Accepted: 04/08/2012] [Indexed: 11/16/2022]
|
35
|
Panghal M, Kaushal V, Kadayan S, Yadav JP. Incidence and risk factors for infection in oral cancer patients undergoing different treatments protocols. BMC Oral Health 2012; 12:22. [PMID: 22817766 PMCID: PMC3499184 DOI: 10.1186/1472-6831-12-22] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 06/27/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Over the past decade, advances in cancer treatments have been counterbalanced by a rising number of immunosuppressed patients with a multitude of new risk factors for infection. Hence, the aim of this study was to determine risk factors, infectious pathogens in blood and oral cavity of oral cancer patients undergoing different treatment procedures. METHODS The present prospective cohort analysis was conducted on the patients undergoing treatment in the radiotherapy unit of Regional Cancer Institute, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, during the period of January 2007 to October 2009. Total 186 patients with squamous cell carcinoma of oral cavity were analyzed in the study. Based on treatment procedures patients were divided into three groups, group I were under radiotherapy, group II under chemotherapy and group III were of radio chemotherapy together. Clinical isolates from blood and oral cavity were identified by following general microbiological, staining and biochemical methods. The absolute neutrophile counts were done by following the standard methods. RESULTS Prevalent bacterial pathogens isolated were Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella pneumonia, Proteus mirabilis, Proteus vulgaris and the fungal pathogens were Candida albicans, Aspergillus fumigatus. The predominant gram negative bacteria, Pseudomonas aeruginosa and Klebsiella pneumonia were isolated from blood of radiotherapy and oral cavity of chemotherapy treated cases respectively. The predominance of gram positive bacteria (Staphylococcus aureus and Staphylococcus epidermidis) were observed in blood of chemotherapy, radio chemotherapy cases and oral cavity of radiotherapy, radio chemotherapy treated cases. Our study also revealed the presence of C. albicans fungi as most significant oral cavity pathogens in radiotherapy and radio chemotherapy cases. CONCLUSION Gram positive bacteria and Gram negative were reported from the blood of all the three groups of patients. Oral mucositis played a significant role in oral cavity infection and make patients more prone to C. albicans infection.
Collapse
Affiliation(s)
- Manju Panghal
- Department of Genetics, M. D. University, Rohtak, Haryana, India
| | - Vivek Kaushal
- Department of Radiotherapy, Regional Cancer Institute, Pt. B.D.S, Health University, Rohtak, Haryana, India
| | - Sangeeta Kadayan
- Department of Genetics, M. D. University, Rohtak, Haryana, India
| | | |
Collapse
|
36
|
Ramage G, Milligan S, Lappin DF, Sherry L, Sweeney P, Williams C, Bagg J, Culshaw S. Antifungal, cytotoxic, and immunomodulatory properties of tea tree oil and its derivative components: potential role in management of oral candidosis in cancer patients. Front Microbiol 2012; 3:220. [PMID: 22719736 PMCID: PMC3376416 DOI: 10.3389/fmicb.2012.00220] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/29/2012] [Indexed: 11/22/2022] Open
Abstract
Candida albicans forms oral biofilms that cause disease and are difficult to treat with conventional antifungal agents. Tea tree oil (TTO) is a natural compound with reported antimicrobial and immunomodulatory activities. The aims of the study were to evaluate the antifungal efficacy of TTO and key derivatives against C. albicans biofilms, to assess the toxicological effects of TTO on a clinically relevant oral cell line, and to investigate its impact on inflammation. TTO and its derivatives were examined against 100 clinical strains of C. albicans. Planktonic minimum inhibitory concentrations (MICs) were determined using the CLSI M-27A broth microdilution method. Sessile MICs were determined using an XTT reduction assay. Inhibition, time-kill, and mode of action studies were performed. OKF6-TERT2 epithelial cells were used for cytotoxicity and cytokine expression assays. Planktonic C. albicans isolates were susceptible to TTO, terpinen-4-ol (T-4-ol), and α-terpineol, with an MIC50 of 0.5, 0.25, and 0.25%, respectively. These three compounds also displayed potent activity against the 69 biofilm-forming strains, of which T-4-ol and α-terpineol displayed rapid kill kinetics. For all three compounds, 1 × MIC50 effectively inhibited biofilm growth when C. albicans were treated at 0, 1, and 2 h post adhesion. By scanning electron microscopy analysis and PI uptake, TTO and derivative components were shown to be cell membrane active. TTO and T-4-ol were cytotoxic at 1 × MIC50, whereas at 0.5 × MIC50 T-4-ol displayed no significant toxicity. Transcript and protein analysis showed a reduction of IL-8 when treated with TTO and T-4-ol. These data provide further in vitro evidence that TTO and its derivative components, specifically T-4-ol, exhibit strong antimicrobial properties against fungal biofilms. T-4-ol has safety advantages over the complete essential oil and may be suitable for prophylaxis and treatment of established oropharyngeal candidosis. A clinical trial of T-4-ol is worthy of consideration.
Collapse
Affiliation(s)
- Gordon Ramage
- Infection and Immunity Research Group, Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow Glasgow, UK
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Ribeiro DG, Pavarina AC, Dovigo LN, Machado AL, Giampaolo ET, Vergani CE. Prevalence of Candida spp. associated with bacteria species on complete dentures. Gerodontology 2012; 29:203-8. [DOI: 10.1111/j.1741-2358.2011.00578.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
38
|
Pinel B, Cassou-Mounat T, Bensadoun RJ. [Oropharyngeal candidiasis and radiotherapy]. Cancer Radiother 2012; 16:222-9. [PMID: 22537826 DOI: 10.1016/j.canrad.2011.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 11/04/2011] [Accepted: 11/14/2011] [Indexed: 10/28/2022]
Abstract
The oropharyngeal candidiasis is a common condition in cancer patients treated by irradiation, during and after their treatment. For example, almost 70% of patients treated with chemoradiation for head and neck cancer are colonized, and 40% of symptomatic patients have an oropharyngeal candidiasis. Furthermore, we noticed an increase in non-albicans Candida strains, which are present in almost 50% of samples. Cancer treatments, especially radiation therapy, and comorbidities are risk factors of oropharyngeal candidiasis. Oropharyngeal candidiasis has substantial effects on quality of life, and may limit treatment. Epidemiologic data, physiopathology, clinical diagnosis criteria, consequences and treatment of oropharyngeal candidiasis will be discussed in this article.
Collapse
Affiliation(s)
- B Pinel
- Service d'oncologie radiothérapique, CHU de Poitiers, France
| | | | | |
Collapse
|
39
|
Khan MSA, Ahmad I. Biofilm inhibition by Cymbopogon citratus and Syzygium aromaticum essential oils in the strains of Candida albicans. JOURNAL OF ETHNOPHARMACOLOGY 2012; 140:416-423. [PMID: 22326355 DOI: 10.1016/j.jep.2012.01.045] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/11/2012] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Oils of Cymbopogon citratus and Syzygium aromaticum have been used in traditional medicine to treat fungal infections of skin, mouth, urinary and vaginal tract in Asian countries particularly India and other developing countries. AIM OF THE STUDY To evaluate essential oils of Cymbopogon citratus and Syzygium aromaticum for their anti-biofilm activity against strong biofilm forming strains of Candida albicans. MATERIALS AND METHODS XTT reduction assay, Time kill assays, light microscopy and scanning electron microscopy (SEM) were employed to determine the effect of test oils on the Candida albicans biofilms. RESULTS Most of the Candida albicans strains tested displayed formation of moderate to strong biofilms. Preformed Candida biofilms showed ≥1024 times increased resistance to antifungal drugs, 2 times to Syzygium aromaticum, but no increased tolerance for Cymbopogon citratus. Test oils were more active against preformed biofilms compared to amphotericin B and fluconazole. At 0.5× MIC, Cymbopogon citratus followed by Syzygium aromaticum were most inhibitory against biofilm formation. Light and electron microscopic studies revealed the deformity of three dimensional structures of biofilms formed in the presence of sub-MICs of Cymbopogon citratus. The cell membranes appeared to be the target site of compounds in sessile cells as displayed by SEM observations. CONCLUSION Our data had demonstrated promising in vitro anti-biofilm activity by Cymbopogon citratus and Syzygium aromaticum and confirm the ethnopharmacological use of these oils in muco-cutaneous Candida infections. Furthermore, it suggests exploitation of these oils as new anti-biofilm products to deal with the problem of drug-resistance and recurrent infection associated with biofilm mode of growth of Candida spp.
Collapse
Affiliation(s)
- Mohd Sajjad Ahmad Khan
- Department of Agricultural Microbiology, Aligarh Muslim University, Aligarh 202002, India
| | | |
Collapse
|
40
|
Oral health is an important issue in end-of-life cancer care. Support Care Cancer 2012; 20:3115-22. [PMID: 22434497 DOI: 10.1007/s00520-012-1441-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 03/12/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims to assess the prevalence of oral morbidity in patients receiving palliative care for cancers outside the head and neck region and to investigate if information concerning oral problems was given. METHODS Patients were recruited from two Norwegian palliative care inpatient units. All patients went through a face-to-face interview, completed the Edmonton Symptom Assessment System (ESAS) covering 10 frequent cancer-related symptoms, and went through an oral examination including a mouth swab to test for Candida carriage. RESULTS Ninety-nine of 126 patients (79 %) agreed to participate. The examined patients had a mean age of 64 years (range, 36-90 years) and 47 % were male. Median Karnofsky score was 40 (range, 20-80) and 87 % had metastatic disease. Estimated life expectancy was <3 months in 73 %. Dry mouth was reported by 78 %. The highest mean scores on the modified 0-10 ESAS scale were 4.9 (fatigue), 4.7 (dry mouth), and 4.4 (poor appetite). Clinical oral candidiasis was seen in 34 % (86 % positive cultures). Mouth pain was reported by 67 % and problems with food intake were reported by 56 %. Moderate or rich amounts of dental plaque were seen in 24 %, and mean number of teeth with visible carious lesions was 1.9. One patient was diagnosed with bisphosphonate-related osteonecrosis of the jaw. Overall, 78 % said they had received no information about oral adverse effects of cancer treatment. CONCLUSION Patients in palliative care units need better mouth care. Increased awareness among staff about the presence and severity of oral problems is necessary. Systematic information about oral problems is important in all stages of cancer treatment.
Collapse
|
41
|
Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, Höhl R, Horré R, Karthaus M, Kujath P, Willinger B, Presterl E, Rath P, Ritter J, Glasmacher A, Lass-Flörl C, Groll AH. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54:279-310. [PMID: 21672038 DOI: 10.1111/j.1439-0507.2011.02040.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
Collapse
Affiliation(s)
- Markus Ruhnke
- Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
de Oliveira MA, Martins E Martins F, Wang Q, Sonis S, Demetri G, George S, Butrynski J, Treister NS. Clinical presentation and management of mTOR inhibitor-associated stomatitis. Oral Oncol 2011; 47:998-1003. [PMID: 21890398 DOI: 10.1016/j.oraloncology.2011.08.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/28/2011] [Accepted: 08/01/2011] [Indexed: 11/19/2022]
Abstract
Anti-cancer agents that inhibit the mTOR pathway are associated with a number of unique toxicities, with one of the most significant and potentially dose-limiting being stomatitis. The objective of this study was to report the clinical features and management outcomes of a series of cancer patients who developed painful mTOR inhibitor-associated stomatitis (mIAS). Seventeen cancer patients developed mIAS while being treated with everolimus- or ridaforolimus-containing protocols at the Dana-Farber Cancer Institute and were referred to the oral medicine clinic for evaluation and management. Clinical characteristics, toxicity management, and outcomes were summarized. In addition, the frequency and rationale for dose reductions and therapy discontinuation were assessed. The median duration of mTOR inhibitor therapy was 80 days (range 9-187 days). The median time to development of mouth ulcers was 10 days (range 4-25 days). Five patients required protocol-directed dose reductions due to grades 2 and 3 stomatitis and one patient discontinued cancer treatment due to mouth ulcers. Clinical improvement and pain relief was reported in 86.6% of patients following topical, intralesional, or systemic corticosteroid therapy, with side effects limited to secondary candidiasis (n=2). Mouth ulcers are a common and potentially dose limiting toxicity associated with the use of mTOR inhibitors in cancer treatment. This case series demonstrates that local and systemic corticosteroid therapy is an effective approach to managing patients with symptomatic mIAS. Prospective studies are necessary to evaluate the effectiveness of treatment and prevention strategies with the ultimate goal of improving overall cancer treatment outcomes.
Collapse
|
43
|
Khan MSA, Malik A, Ahmad I. Anti-candidal activity of essential oils alone and in combination with amphotericin B or fluconazole against multi-drug resistant isolates of Candida albicans. Med Mycol 2011; 50:33-42. [PMID: 21756200 DOI: 10.3109/13693786.2011.582890] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Therapy for candidiasis is becoming problematic due to the toxicities of currently available antifungal agents and the increasing prevalence of resistance among the etiologic agents. Therefore, new antifungals and alternative approaches are needed. In this study, 20 fluconazole-resistant strains of Candida albicans were found to have varying levels of resistance to other azoles, i.e., itraconazole (MIC of 4-128 μg/ml) and ketoconazole (2-256 μg/ml). In addition, 13 of these isolates appeared resistant to amphotericin B (32-128 μg/ml). A total of 21 plant essential oils were screened for their antifungal activity against these multi-drug resistant isolates. The oils of Cymbopogon martini, i.e., citral and cinnamaldehyde, exhibited strong inhibitory activity with minimum inhibitory concentrations (MIC(50)) ranging from 90-100 μg/ml. The test oils were more effective than fluconazole and amphotericin B in inhibiting azole- and amphotericin B-resistant, as well as amphotericin B-susceptible isolates. The test oils and especially eugenol, exhibited significant synergy with fluconazole or amphotericin B against the test isolates. These findings suggest the possible effective use of certain oils alone or in combination with fluconazole or amphotericin B, against multi-drug resistant isolates of C. albicans.
Collapse
Affiliation(s)
- Mohd Sajjad Ahmad Khan
- Department of Agricultural Microbiology, Faculty of Agricultural Sciences, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India.
| | | | | |
Collapse
|
44
|
Bouchaert P, Jardel P, Osdoit S, Bodard AG, Gangneux JP, Scotté F, Salino S, Bensadoun RJ. Candidoses oropharyngées en oncologie : enjeux diagnostiques. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Gligorov J, Bastit L, Gervais H, Henni M, Kahila W, Lepille D, Luporsi E, Sasso G, Varette C, Azria D. Prevalence and Treatment Management of Oropharyngeal Candidiasis in Cancer Patients: Results of the French Candidoscope Study. Int J Radiat Oncol Biol Phys 2011; 80:532-9. [DOI: 10.1016/j.ijrobp.2010.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 01/25/2010] [Accepted: 02/04/2010] [Indexed: 01/31/2023]
|
46
|
Bensadoun RJ, Patton LL, Lalla RV, Epstein JB. Oropharyngeal candidiasis in head and neck cancer patients treated with radiation: update 2011. Support Care Cancer 2011; 19:737-44. [PMID: 21479787 DOI: 10.1007/s00520-011-1154-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 03/28/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oropharyngeal candidiasis (OPC) is a major cause of morbidity in patients with malignancies. It is a common complication of head and neck radiation therapy and can result in pain, dysgeusia (taste changes), anorexia, malnutrition, and esophageal or systemic dissemination. Clinicians should be aware of current epidemiology, elements of diagnosis, and therapeutic trials guiding the recent recommendations for prophylaxis and management of OPC, a disease often incorrectly perceived as benign. METHODS This review discusses OPC with focus in head and neck cancer patients receiving radiotherapy. RESULTS Local treatments are recommended as first-line therapy in milder forms of OPC. In the setting of local therapy, products that provide prolonged contact time and are not sucrose sweetened may result in successful prevention and management with low risk of oral/dental complications. CONCLUSION Diagnosis and management of OPC is required in head and neck cancer patients treated with radiation. Local therapy is suggested as first-line treatment for OPC, unless severe clinical infection or high risk immune suppression necessitate systemic therapy. The availability of effective locally delivered (topical) medications may provide potential for prophylaxis for carriers of Candida species in head and cancer patients during radiation therapy.
Collapse
Affiliation(s)
- Rene-Jean Bensadoun
- Radiation Oncology Department, Poitiers University Hospital and Faculty of Medicine, 2 rue de la Milétrie, BP 577, 86021, Poitiers Cedex, France.
| | | | | | | |
Collapse
|
47
|
Candidoses oropharyngées (COP) et cancers solides. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
48
|
Masaki M, Sato T, Sugawara Y, Sasano T, Takahashi N. Detection and identification of non-Candida albicans species in human oral lichen planus. Microbiol Immunol 2011; 55:66-70. [PMID: 21175776 DOI: 10.1111/j.1348-0421.2010.00285.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Candida species were detected and identified in samples from the buccal mucosa, dorsal surface of the tongue and supragingival plaque of subjects with oral lichen planus (OLP). The Candida in the samples were cultured on selection agars, and identified by sequence analyses of 18S, 5.8S and 25/28S rRNA. The isolation frequency of Candida was higher in subjects with OLP than in those with healthy oral mucosa. Non-C. albicans were only isolated from people with OLP. These results support the notion that subjects with OLP are more likely to have oral colonization with Candida, and that non-C. albicans are specifically present in subjects with this condition.
Collapse
Affiliation(s)
- Mika Masaki
- Division of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
| | | | | | | | | |
Collapse
|
49
|
[Candida albicans infection in patients with oral squamous cell carcinoma]. VOJNOSANIT PREGL 2010; 67:766-70. [PMID: 20954415 DOI: 10.2298/vsp1009766c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Systemic candidiasis in intensive care units remains an improtant problem due to antifungal resistance. Patients undergoing radiotherapy for head and neck cancer are at increased risk of developing oral candidiasis and they more frequent have prior fungi colonization. Due to identification of specific risk factors predisposing to fungal infection in order to threat such patients the aim of this study was to determine the presence of Candida species in patients with oral squamous cell carcinoma and compare it to the control subjects (patients with benign oral mucosal lesions). METHODS A total number of 30 consecutive oral cancer examined patients were included in this prospective study (24 men and 6 women with a mean age of 61.47 years, range 41-81 years). The control group consisted of 30 consecutive patients with histologically proven benign oral mucosal lesions (16 men and 14 women with a mean age of 54.53 years, range 16-83 years). The samples for mycological examination were obtained by using sterile cotton swabs from the cancer lesion surface and in the patients of the control group from the benign mucosal lesion surface. Samples were inoculated in Sabouraud dextrose agar. For identification purposes, Mackenzie germ tube test was performend on all isolates. RESULTS The prevalence of Candida was significantly higher in oral cancer patients than in control subjects (chi2 = 5.455, p = 0.020). Candida was found on nine of the 30 cancer surfaces; 5 (16.7%) were identified as non-albicans Candida and 4 (13.3%) as Candida albicans. In the control group, only Candida albicans was isolated from 2 (6.7%) patients. In this study, no statistically significant differences in the presence of Candida species was found with respect to gender, age, smoking, alcohol consumption, wearing of dental protheses and the site of cancer lesion. CONCLUSION The increased prevalence of yeasts on the surfaces of oral carcinoma indicates a need for their suppression before any cancer treatment. There was no evidence for an association between gender, age, smoking, alcohol consumption, wearing of dental protheses, the site of cancer lesion and the yeast presence.
Collapse
|
50
|
Farah CS, Lynch N, McCullough MJ. Oral fungal infections: an update for the general practitioner. Aust Dent J 2010; 55 Suppl 1:48-54. [PMID: 20553244 DOI: 10.1111/j.1834-7819.2010.01198.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Oral candidosis is the most common fungal infection encountered in general dental practice. It manifests in a variety of clinical presentations which may mimic more sinister diseases, and can occasionally be refractory to treatment requiring the attention of an oral medicine specialist. Management of oral candidosis should always include a thorough investigation of underlying predisposing conditions, as the disease often presents when the patient is systemically compromised. This update highlights the pathogenesis, clinical presentation, and management strategies of oral Candidal lesions commonly encountered in dental practice.
Collapse
Affiliation(s)
- C S Farah
- School of Dentistry, The University of Queensland, Brisbane.
| | | | | |
Collapse
|