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Hu Y, Ren B, Cheng L, Deng S, Chen Q. Candida species in periodontitis: A new villain or a new target? J Dent 2024; 148:105138. [PMID: 38906455 DOI: 10.1016/j.jdent.2024.105138] [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: 01/12/2024] [Revised: 05/24/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVES Recent research indicated that fungi might have a role in periodontitis alongside traditional periodontal pathogens. This state-of-the-art narrative review explores current concepts on the involvement of Candida species in periodontitis, and suggests the potential for ecological management of this disease. DATA, SOURCES AND STUDY SELECTION A literature search was conducted for a narrative review on Web of Science, PubMed, Medline and Scopus about periodontitis associated with Candida species. Published articles, including case reports, case series, observational and interventional clinical trials, and critical appraisals of the literature were retrieved and reviewed. CONCLUSIONS Several factors predispose individuals to periodontitis associated with Candida species. These include systemic diseases that lead to immunosuppression and oral environment changes such as cigarette smoking. While a consistent significant increase in the detection rate of Candida species in patients with periodontitis has not been universally observed, there is evidence linking Candida species to the severity of periodontitis and their potential to worsen the condition. Candida species may participate in the development of periodontitis in various ways, including cross-kingdom interactions with periodontal pathogens, changes in the local or systemic environment favoring the virulence of Candida species, and interactions between Candida-bacteria and host immunity. CLINICAL SIGNIFICANCE Mechanical plaque control is the most common treatment for periodontitis, but its effectiveness may be limited, particularly when dealing with systemic risk factors. Understanding the specific role of Candida in periodontitis illuminates innovative approaches for managing the ecological balance in periodontal health.
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Affiliation(s)
- Yao Hu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, China; State Key Laboratory of Oral Diseases & West China School of Stomatology & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases & West China School of Stomatology & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & West China School of Stomatology & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Shuli Deng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, China.
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou 310000, China; State Key Laboratory of Oral Diseases & West China School of Stomatology & National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.
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Zhao D, Sun Y, Li X, Wang X, Lu L, Li C, Pan Y, Wang S. Association between Periodontitis and HbA1c Levels in Non-Diabetic Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2649. [PMID: 37830686 PMCID: PMC10572398 DOI: 10.3390/healthcare11192649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND A high detection rate of diabetes among dental visitors has been reported recently. This systematic review aimed to evaluate the association between periodontitis and glycated hemoglobin (HbA1c) levels among non-diabetic individuals. METHODS The EMBASE, MEDLINE, Web of Science, Cochrane Library, PubMed, and Open GREY databases were searched, and observational studies published until 1st June 2023 were identified. A methodological quality assessment was conducted based on the original and modified versions of the Newcastle-Ottawa scale. Cohort, case-control, and cross-sectional studies that performed clinical periodontal examinations and measured HbA1c levels in non-diabetic adults were included. A meta-analysis was conducted to estimate the weighted mean difference (WMD) between individuals with and without periodontitis. RESULTS In total, 29 case-control and 5 cross-sectional studies were selected from 2583 potentially eligible articles. Among them, sixteen case-control and three cross-sectional studies with moderate to high quality were selected for the meta-analyses. The HbA1c levels in periodontitis patients were significantly higher than those in individuals with healthy periodontal conditions (WMD = 0.16; p < 0.001) among the non-diabetic populations. CONCLUSIONS This study reveals a significant association between periodontitis and HbA1c levels in non-diabetic populations. Thus, HbA1c screening may be recommended to detect potential hyperglycemia in non-diabetic periodontitis patients.
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Affiliation(s)
- Dan Zhao
- Department of Implant Dentistry, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China;
| | - Yangyang Sun
- Department of Periodontics, School of Stomatology, China Medical University, Shenyang 110002, China; (Y.S.); (L.L.); (C.L.); (Y.P.)
| | - Xin Li
- School of Public Health, National Institute for Data Science in Health and Medicine, Capital Medical University, Beijing 100069, China;
| | - Xiaoxiao Wang
- Department of Oral Implantology and Prosthodontics, Shenzhen Stomatology Hospital Affiliated to Shenzhen University, Shenzhen 518001, China;
| | - Lijie Lu
- Department of Periodontics, School of Stomatology, China Medical University, Shenyang 110002, China; (Y.S.); (L.L.); (C.L.); (Y.P.)
| | - Chen Li
- Department of Periodontics, School of Stomatology, China Medical University, Shenyang 110002, China; (Y.S.); (L.L.); (C.L.); (Y.P.)
| | - Yaping Pan
- Department of Periodontics, School of Stomatology, China Medical University, Shenyang 110002, China; (Y.S.); (L.L.); (C.L.); (Y.P.)
| | - Songlin Wang
- Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Beijing Laboratory of Oral Health and Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China
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Slazhneva E, Tikhomirova E, Tsarev V, Orekhova L, Loboda E, Atrushkevich V. Candida species detection in patients with chronic periodontitis: A systematic review and meta-analysis. Clin Exp Dent Res 2022; 8:1354-1375. [PMID: 35903878 PMCID: PMC9760140 DOI: 10.1002/cre2.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/10/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess the Candida species occurrence rate and concentration in periodontal pockets in chronic periodontitis (CP) by meta-analysis. MATERIALS AND METHODS A search was performed of articles published between January 1, 2010, and October 1, 2020, in English and in Russian, in the electronic databases MEDLINE-PubMed, Google Scholar, The Cochrane Library, ClinicalTrials.gov, Research Gate, eLIBRARY, and Cyberleninka (PROSPEROCRD42021234831). The odds ratio (OR), standardized mean difference (SMD), and 95% confidence interval (CI) were calculated using Review Manager 5.4.1 to compare the risk of CP when Candida spp. were detected in the gingival sulcus or periodontal pocket and to compare Candida spp. density counts in patients with CP and periodontally healthy patients. RESULTS Twenty-six studies were included in the systematic review and 11 were included in the meta-analysis. The results showed that Candida spp. may increase the chance of CP development by 1.76 times (OR = 1.76; 95% CI = 1.04-2.99; Z = 2.10; p = .04; I2 = 61%). More Candida spp. were found in patients with CP than in periodontally healthy patients (SMD = 1.58; 95% CI = 0.15-3.02; p = .03; I2 = 98%). No data were found relating to the statistically significant influence of Candida glabrata, Candida krusei and Candida tropicalis on CP development. CONCLUSION We found that Candida albicans insignificantly increased the risk of CP development but, due to the heterogeneity of the included studies, further research is necessary to determine the exact role of Candida spp. in the development and course of the inflammatory periodontal diseases.
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Affiliation(s)
- Ekaterina Slazhneva
- Department of PeriodontologyA.I. Yevdokimov Moscow State University of Medicine and DentistryМoscowRussian Federation
| | - Ekaterina Tikhomirova
- Department of PeriodontologyA.I. Yevdokimov Moscow State University of Medicine and DentistryМoscowRussian Federation
| | - Victor Tsarev
- Department of Microbiology, Virology, ImmunologyA.I. Yevdokimow Moscow State University of Medicine and DentistryMoscowRussian Federation,Laboratory of Molecular Biological ResearchResearch Medical and Dental InstituteМoscowRussian Federation
| | - Liudmila Orekhova
- Department of Restorative Dentistry and PeriodontologyFirst Pavlov State Medical University of St PetersburgSt PetersburgRussian Federation
| | - Ekaterina Loboda
- Department of Restorative Dentistry and PeriodontologyFirst Pavlov State Medical University of St PetersburgSt PetersburgRussian Federation
| | - Victoria Atrushkevich
- Department of PeriodontologyA.I. Yevdokimov Moscow State University of Medicine and DentistryМoscowRussian Federation
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Radunovic M, Barac M, Kuzmanovic Pficer J, Pavlica D, Jovanovic A, Pucar A, Petrovic S. Antifungal Susceptibility of Candida albicans Isolated from Tongue and Subgingival Biofilm of Periodontitis Patients. Antibiotics (Basel) 2022; 11:antibiotics11060802. [PMID: 35740208 PMCID: PMC9219811 DOI: 10.3390/antibiotics11060802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
The subgingival biofilm, as the most complex microbial community, has been proven to be reservoir of Candida spp. The main concept of this study was to investigate if there is a difference between the sensitivity of Candida albicans (C. albicans) isolated from tongue and subgingival areas of periodontitis patients to antifungal agents. The aim of the study was to determine: (1) the distribution of different Candida species in the tongue and subgingival samples of periodontitis patients; (2) the susceptibility of Candida albicans strains from tongue and subgingival biofilm to the effects of commonly used antifungal agents: fluconazole, amphotericin B and itraconazole; (3) the correlation between the susceptibility of Candida albicans and clinical periodontal parameters. Tongue and subgingival biofilm samples of periodontitis subjects (N = 163) were examined. Susceptibility was tested when the same Candida species was isolated from both sites (17 subjects). Candida spp. were isolated in 23.3% of tongue and 21.5% of the subgingival samples. All isolates were susceptible to amphotericin B, while 64.71% of tongue and 52.94% of subgingival isolates were susceptible to fluconazole. A low frequency of itraconazole susceptibility was observed for tongue (17.64%) and subgingival isolates (11.76%). The correlations between full-mouth plaque score and Minimal Inhibitory Concentration (MIC) for tongue isolates were strongly positive for all antimycotics. Positive correlation was also observed between moderate periodontal destruction and MICs for tongue and subgingival isolates. The susceptibility of C. albicans to antifungals correlate with oral hygiene and moderate periodontal destruction. There is no difference in antifungal susceptibility between tongue and subgingival isolates.
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Affiliation(s)
- Milena Radunovic
- Department of Microbiology and Immunology, School of Dental Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia;
- Correspondence: (M.R.); (S.P.); Tel.: +381-11-36-29-201 (M.R. & S.P.)
| | - Milena Barac
- Department of Oral Medicine and Periodontology, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 11000 Belgrade, Serbia; (M.B.); (A.P.)
| | - Jovana Kuzmanovic Pficer
- Department for Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia;
| | - Dusan Pavlica
- Department of Microbiology and Immunology, School of Dental Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia;
| | - Aleksandar Jovanovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska 51, 11000 Belgrade, Serbia;
| | - Ana Pucar
- Department of Oral Medicine and Periodontology, School of Dental Medicine, University of Belgrade, Dr Subotica 4, 11000 Belgrade, Serbia; (M.B.); (A.P.)
| | - Sanja Petrovic
- Department of Microbiology and Immunology, School of Dental Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia;
- Correspondence: (M.R.); (S.P.); Tel.: +381-11-36-29-201 (M.R. & S.P.)
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Oral Cavity and Candida albicans: Colonisation to the Development of Infection. Pathogens 2022; 11:pathogens11030335. [PMID: 35335659 PMCID: PMC8953496 DOI: 10.3390/pathogens11030335] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/01/2023] Open
Abstract
Candida colonisation of the oral cavity increases in immunocompromised individuals which leads to the development of oral candidiasis. In addition, host factors such as xerostomia, smoking, oral prostheses, dental caries, diabetes and cancer treatment accelerate the disease process. Candida albicans is the primary causative agent of this infection, owing to its ability to form biofilm and hyphae and to produce hydrolytic enzymes and candialysin. Although mucosal immunity is activated, from the time hyphae-associated toxin is formed by the colonising C. albicans cells, an increased number and virulence of this pathogenic organism collectively leads to infection. Prevention of the development of infection can be achieved by addressing the host physiological factors and habits. For maintenance of oral health, conventional oral hygiene products containing antimicrobial compounds, essential oils and phytochemicals can be considered, these products can maintain the low number of Candida in the oral cavity and reduce their virulence. Vulnerable patients should be educated in order to increase compliance.
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Souza JG, Costa RC, Sampaio AA, Abdo VL, Nagay BE, Castro N, Retamal-Valdes B, Shibli JA, Feres M, Barão VA, Bertolini M. Cross-kingdom microbial interactions in dental implant-related infections: is Candida albicans a new villain? iScience 2022; 25:103994. [PMID: 35313695 PMCID: PMC8933675 DOI: 10.1016/j.isci.2022.103994] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Candida albicans, an oral fungal opportunistic pathogen, has shown the ability to colonize implant surfaces and has been frequently isolated from biofilms associated with dental implant-related infections, possibly due to its synergistic interactions with certain oral bacteria. Moreover, evidence suggests that this cross-kingdom interaction on implant can encourage bacterial growth, leading to increased fungal virulence and mucosal damage. However, the role of Candida in implant-related infections has been overlooked and not widely explored or even considered by most microbiological analyses and therapeutic approaches. Thus, we summarized the scientific evidence regarding the ability of C. albicans to colonize implant surfaces, interact in implant-related polymicrobial biofilms, and its possible role in peri-implant infections as far as biologic plausibility. Next, a systematic review of preclinical and clinical studies was conducted to identify the relevance and the gap in the existing literature regarding the role of C. albicans in the pathogenesis of peri-implant infections.
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Affiliation(s)
- João G.S. Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Minas Gerais 39401-303, Brazil
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
- Corresponding author
| | - Raphael C. Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Aline A. Sampaio
- Department of Clinic, Pathology and Dental Surgery, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais 31270-901, Brazil
| | - Victória L. Abdo
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
| | - Bruna E. Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
| | - Nidia Castro
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
| | - Belén Retamal-Valdes
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
| | - Jamil A. Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, Sāo Paulo 07023-070, Brazil
| | - Valentim A.R. Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo 13414-903, Brazil
- Corresponding author
| | - Martinna Bertolini
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pennsylvania 15260, USA
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Shetty B, Ali D, Ahmed S, Ibraheem WI, Preethanath RS, Vellappally S, Divakar DD. Role of antimicrobial photodynamic therapy in reducing subgingival oral yeasts colonization in patients with peri-implant mucositis. Photodiagnosis Photodyn Ther 2022; 38:102803. [DOI: 10.1016/j.pdpdt.2022.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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Candida albicans and Candida dubliniensis in Periodontitis in Adolescents and Young Adults. Int J Microbiol 2022; 2022:4625368. [PMID: 35058983 PMCID: PMC8766183 DOI: 10.1155/2022/4625368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
Aim This study aims to evaluate the association of Candida albicans and Candida dubliniensis with periodontitis in adolescents and young adults in a Moroccan population. Methods 426 subjects aged between 12 and 25 years were recruited for the study. A pool of plaque sample was taken. Samples were cultured on Sabouraud Chloramphenicol medium at 37°C for 24–48 hours and then identified by the Vitek 2 YST system. Clinical data and presence of Candida albicans and Candida dubliniensis were analyzed using Jamovi (Version 1.8). Results Candida albicans was observed in 25 subjects among 68 diseased patients (37%) and in 60 subjects among 358 healthy patients (17%). It can be reported that under normal yeast conditions, there is a statistically significant difference between these two groups (P < 0.001). Candida dubliniensis was more prevalent in periodontitis than in healthy subjects (P=0.026). Regarding clinical variables, subgroups of periodontitis subjects showed significant statistical differences for periodontal probing depth, clinical attachment loss, and number of decayed teeth in advanced periodontitis in comparison with initial or mild periodontitis. The results also indicate that the presence of the two species of Candida is not related to gender or age (P > 0.05) nor related to the severity of the periodontal disease in this population. Conclusion Within the limits of our study, Candida albicans is more frequently associated with periodontitis. The potential role of C. albicans in periodontitis pathogenesis is very complex. More studies on biofilm associated with different forms of periodontitis are necessary. It is also important to assess the coexistence of periodontitis and caries and the associated biofilms.
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Fungi—A Component of the Oral Microbiome Involved in Periodontal Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1373:113-138. [DOI: 10.1007/978-3-030-96881-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Candida Spp. in Lower Respiratory Tract Secretions - A Ten Years Retrospective Study. J Crit Care Med (Targu Mures) 2021; 7:217-226. [PMID: 34722925 PMCID: PMC8519383 DOI: 10.2478/jccm-2021-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Lower respiratory tract secretions (LRTS) like sputum and tracheal aspirates are frequently sent to the microbiology laboratory from patients with various respiratory pathologies. Improper collection techniques can lead to false-positive results, resulting in improper therapy. Aim of the study To determine the percentage of contaminated samples sent to the microbiology laboratory, to establish the prevalence of Candida spp. in non-contaminated samples and therefore, the presence of Candida spp. originating in lower respiratory tract infections. Material and Methods A 10-year data survey was conducted to assess the differences in Candida prevalence from contaminated versus non-contaminated samples, assessed and categorised by Bartlett grading system, and to emphasise the importance of quality control for potentially contaminated samples. The data were analysed according to gender, age, referring departments, and the species of Candida. For the statistical analysis, Kruskal-Wallis and Fisher tests were used, and the alpha value was set for 0.5. Results The prevalence of Candida spp. in all analysed samples was 31.60%. After excluding the contaminated samples, the actual prevalence was 27.66%. Of all sputum samples, 31.6% were contaminated. Patients aged more than 40 years old were more prone to provide contaminated sputum samples. C. albicans is more prevalent in non-contaminated sputum samples. In both sputum and tracheal aspirates, the chances of identifying a single species are higher than the chances of identifying multiple species. Conclusions The study emphasises the importance of assessing the quality of sputum samples because of the high number of improperly collected samples sent to the microbiology laboratory.
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Frías-De-León MG, Hernández-Castro R, Conde-Cuevas E, García-Coronel IH, Vázquez-Aceituno VA, Soriano-Ursúa MA, Farfán-García ED, Ocharán-Hernández E, Rodríguez-Cerdeira C, Arenas R, Robledo-Cayetano M, Ramírez-Lozada T, Meza-Meneses P, Pinto-Almazán R, Martínez-Herrera E. Candida glabrata Antifungal Resistance and Virulence Factors, a Perfect Pathogenic Combination. Pharmaceutics 2021; 13:pharmaceutics13101529. [PMID: 34683822 PMCID: PMC8538829 DOI: 10.3390/pharmaceutics13101529] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
In recent years, a progressive increase in the incidence of invasive fungal infections (IFIs) caused by Candida glabrata has been observed. The objective of this literature review was to study the epidemiology, drug resistance, and virulence factors associated with the C. glabrata complex. For this purpose, a systematic review (January 2001-February 2021) was conducted on the PubMed, Scielo, and Cochrane search engines with the following terms: "C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis)" associated with "pathogenicity" or "epidemiology" or "antibiotics resistance" or "virulence factors" with language restrictions of English and Spanish. One hundred and ninety-nine articles were found during the search. Various mechanisms of drug resistance to azoles, polyenes, and echinocandins were found for the C. glabrata complex, depending on the geographical region. Among the mechanisms found are the overexpression of drug transporters, gene mutations that alter thermotolerance, the generation of hypervirulence due to increased adhesion factors, and modifications in vital enzymes that produce cell wall proteins that prevent the activity of drugs designed for its inhibition. In addition, it was observed that the C. glabrata complex has virulence factors such as the production of proteases, phospholipases, and hemolysins, and the formation of biofilms that allows the complex to evade the host immune response and generate fungal resistance. Because of this, the C. glabrata complex possesses a perfect pathogenetic combination for the invasion of the immunocompromised host.
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Affiliation(s)
- María Guadalupe Frías-De-León
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México 14080, Mexico; (R.H.-C.); (V.A.V.-A.)
| | - Esther Conde-Cuevas
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
| | - Itzel H. García-Coronel
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
| | - Víctor Alfonso Vázquez-Aceituno
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México 14080, Mexico; (R.H.-C.); (V.A.V.-A.)
| | - Marvin A. Soriano-Ursúa
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Eunice D. Farfán-García
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Esther Ocharán-Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima and University of Vigo, 36206 Vigo, Spain
- Campus Universitario, University of Vigo, 36310 Vigo, Spain
| | - Roberto Arenas
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Tlalpan, Ciudad de México 14080, Mexico
| | - Maura Robledo-Cayetano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
| | - Tito Ramírez-Lozada
- Servicio de Ginecología y Obstetricia, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico;
| | - Patricia Meza-Meneses
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (E.C.-C.); (I.H.G.-C.); (P.M.-M.)
- Servicio de Infectología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico
| | - Rodolfo Pinto-Almazán
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
- Correspondence: (R.P.-A.); (E.M.-H.); Tel.: +52-555-972-9800 (R.P.-A. or E.M.-H.)
| | - Erick Martínez-Herrera
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca 56530, Mexico; (M.G.F.-D.-L.); (M.R.-C.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón, Ciudad de México 11340, Mexico; (M.A.S.-U.); (E.D.F.-G.); (E.O.-H.)
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Correspondence: (R.P.-A.); (E.M.-H.); Tel.: +52-555-972-9800 (R.P.-A. or E.M.-H.)
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Monroy-Pérez E, Rodríguez-Bedolla RM, Garzón J, Vaca-Paniagua F, Arturo-Rojas Jiménez E, Paniagua-Contreras GL. Marked virulence and azole resistance in Candida albicans isolated from patients with periodontal disease. Microb Pathog 2020; 148:104436. [PMID: 32781099 DOI: 10.1016/j.micpath.2020.104436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/19/2020] [Accepted: 08/02/2020] [Indexed: 01/12/2023]
Abstract
Candida albicans is an opportunistic fungus frequently associated with periodontal diseases. The objective of this study was to determine the expression patterns of virulence genes associated with those of azole resistance among the strains of C. albicans isolated from patients with periodontal disease. We isolated 80 strains of C. albicans from patients with periodontal disease enrolled from two dental clinics and their antifungal susceptibilities were evaluated using the disc diffusion method. C. albicans and its virulence genes were identified using PCR. The expressions of the virulence genes of C. albicans were analyzed using real-time PCR post in vitro infection of the cell line A549. The phenotype for resistance against azoles such as ketoconazole and fluconazole was observed in all analyzed strains (n = 80), which coincided with the high frequency of occurrence of the genes CDR1 and MDR1 associated with resistance. The frequencies of detection and expression of the genes HWP1 (47/15), ALS1 (80/66), ALS3 (70/30), LIP1 (78/44), LIP4 (77/65), LIP5 (79/58), LIP6 (79/58), PLB1 (79/65), and PLB2 (80/66) were found to be higher in the strains of C. albicans isolated from patients with moderate periodontitis and different expression patterns associated with those for azole resistance were identified. It could be elucidated that the high expression of virulence markers associated with azole resistance in C. albicans might be contributing to the chronicity of periodontal infections.
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Affiliation(s)
- Eric Monroy-Pérez
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México. Av. de Los Barrios 1, Los Reyes Iztacala, Tlalnepantla, Estado de México, 54090, Mexico.
| | - Rosa María Rodríguez-Bedolla
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México. Av. de Los Barrios 1, Los Reyes Iztacala, Tlalnepantla, Estado de México, 54090, Mexico
| | - Javier Garzón
- Clínica de Endoperiodontología, FES Iztacala, Universidad Nacional Autónoma de México, Mexico
| | - Felipe Vaca-Paniagua
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México. Av. de Los Barrios 1, Los Reyes Iztacala, Tlalnepantla, Estado de México, 54090, Mexico; Laboratorio Nacional en Salud, Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico; Subdirección de investigación Básica, Instituto Nacional de Cancerología, CDMX, 14080, Mexico
| | - Ernesto Arturo-Rojas Jiménez
- Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico
| | - Gloria Luz Paniagua-Contreras
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México. Av. de Los Barrios 1, Los Reyes Iztacala, Tlalnepantla, Estado de México, 54090, Mexico.
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13
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Ruszkowski J, Kaźmierczak-Siedlecka K, Witkowski JM, Dębska-Ślizień A. Mycobiota of the human gastrointestinal tract. POSTEP HIG MED DOSW 2020. [DOI: 10.5604/01.3001.0014.3415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Fungi (Mycota) that colonize the human digestive tract are collectively referred to as gastrointestinal
mycobiota. The most common method of fungi identification is based on the culture
of a clinical sample with subsequent classic phenotypic identification detailed by biochemical
and/or molecular (e.g. sequencing of ITS regions of rDNA) tests in some cases. Additionally,
the culture-independent identification is gaining popularity, especially in scientific research.
The composition of the human mycobiota significantly differs across the digestive tract. In the oral cavity of healthy people, <i>Candida</i>, <i>Cladosporium</i>, <i>Auerobasidium</i>, and <i>Aspergillus</i> are
most often identified fungi genera; however, in recent studies the presence of Malassezia spp.
has been also emphasized. In the case of the lower gastrointestinal tract, <i>Candida</i>, <i>Saccharomyces</i>,
<i>Penicillium</i>, <i>Aspergillus</i>, <i>Cryptococcus</i>, <i>Malassezia</i>, <i>Cladosporium</i>, <i>Galactomyces</i>, <i>Debaryomyces</i>, and
<i>Trichosporon</i> genera are most often reported. This paper summarizes the factors that are associated with the composition of mycobiota in both children (age, type of delivery, breastfeeding) and adults (age, gender, diet, saliva flow rate and composition). Changes in the composition
of mycobiota also occur in pathological conditions, including both gastrointestinal diseases
(Crohn’s disease, oral lichen planus) and metabolic diseases (diabetes, obesity). Additionally,
this paper summarizes the already known, putative interactions between fungi and bacteria
colonizing the human digestive tract.
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Affiliation(s)
- Jakub Ruszkowski
- Katedra i Zakład Fizjopatologii, Wydział Lekarski, Gdański Uniwersytet Medyczny
| | | | - Jacek M. Witkowski
- Katedra i Zakład Fizjopatologii, Wydział Lekarski, Gdański Uniwersytet Medyczny
| | - Alicja Dębska-Ślizień
- Katedra i Klinika Nefrologii, Transplantologii i Chorób Wewnętrznych, Wydział Lekarski, Gdański Uniwersytet Medyczny
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Suresh Unniachan A, Krishnavilasom Jayakumari N, Sethuraman S. Association between Candida species and periodontal disease: A systematic review. Curr Med Mycol 2020; 6:63-68. [PMID: 33628985 PMCID: PMC7888513 DOI: 10.18502/cmm.6.2.3420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Periodontal diseases result in the inflammation of the supporting structures of the teeth, thereby leading to attachment loss and bone loss. One of the main etiological factors responsible for this condition is the presence of subgingival biofilms, comprising microorganisms, namely bacteria, viruses, and fungi. Candida species is one of the fungi reported to be found in periodontal disease which is suggestive of the presence of an association between these variables. The aim of this systematic review was to evaluate the association of Candida species with periodontal disease and determine the prevalence of these species in the patients affected with this disease. The articles related to the subject of interest were searched in several databases, including the PubMed, Web of Science, Google Scholar Medline, Embase, Cochrane Library, and Scopus. The search process was accomplished using three keywords, namely ‘‘Candida species’’, ‘‘Chronic periodontitis’’, and ‘‘Gingivitis’’. All the identified studies were comprehensively evaluated for the association of Candida species with periodontal disease. This systematic review included 23 articles, which assessed the prevalence of Candida species in periodontal diseases. The results of 21 studies were indicative of a positive association between Candida species and periodontal diseases. Accordingly, it was concluded that there is a strong association between the presence of Candida species and periodontal diseases
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Affiliation(s)
- Anjana Suresh Unniachan
- Department of Periodontics, Vydehi Institute of Dental Sciences and Research Center, Bangalore, India
| | | | - Shruthi Sethuraman
- Department of Periodontics, Vydehi Institute of Dental Sciences and Research Center, Bangalore, India
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Esteves CV, Freitas RSD, Campos WGD, Shimabukuro N, Thomaz DY, Cordas T, Benard G, Witzel AL, Lemos CA. Oral yeast colonization in patients with eating disorders: commensal acquisition or due to purgative habits? Rev Inst Med Trop Sao Paulo 2020; 62:e32. [PMID: 32491142 PMCID: PMC7266616 DOI: 10.1590/s1678-9946202062032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/27/2020] [Indexed: 11/22/2022] Open
Abstract
Oral problems are common in patients diagnosed with Eating Disorders (ED) and still require better elucidation. We aimed to analyze the prevalence of oral Candida spp in individuals with ED. The sample of the study was comprised of 30 women with purgative habits and 15 without purgative habits. Samples of the oral cavity were collected by sterile cotton swab rubbed on soft tissues and teeth. Yeasts were isolated on Sabouraud dextrose agar. Yeasts were isolated from the oral cavity of 53% of the patients yielding 75 yeast isolates; of these, 43 were identified by conventional mycological methods: C. parapsilosis (n=19), C. glabrata (n=16), Rhodotorula sp (n= 6), C. famata (n=2). The remaining 32 isolates were presumptively identified as C. albicans or C. dubliniensis and required mass spectrometry for the final differentiation: 28 isolates were confirmed as C. albicans and four as C. dubliniensis. Among the control group, only four subjects (26.7%) were found to harbor C. albicans. The four C. dubliniensis isolates were from two patients, one that was only colonized and the other, with severe ED, was diagnosed with an oral candidiasis as demonstrated by the presence of pseudohyphae on the direct mycological exam from different sites. The increased rate of isolation of non-albicans species, such as C. glabrata, C. parapsilosis, and C. dubliniensis in the oral cavity from ED patients with nutritional deficiency may suggest that purgative habits of these patients can lead to changes in normal flora and predispose to oral candidiasis.
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Affiliation(s)
- Camilla Vieira Esteves
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Roseli Santos de Freitas
- Laboratório de Micologia Médica, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Wladimir Gushiken de Campos
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Natali Shimabukuro
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Danilo Yamamoto Thomaz
- Laboratório de Micologia Médica, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Taki Cordas
- Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Gil Benard
- Laboratório de Micologia Médica, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Andrea Lusvarghi Witzel
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Celso Augusto Lemos
- Departamento de Estomatologia, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Alqahtani F. Role of oral yeasts in the etiopathogenesis of peri-implantitis: An evidence-based literature review of clinical studies. Arch Oral Biol 2020; 111:104650. [DOI: 10.1016/j.archoralbio.2020.104650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/27/2019] [Accepted: 01/04/2020] [Indexed: 12/11/2022]
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Alsahhaf A, Al‐Aali KA, Alshagroud RS, Alshiddi IF, Alrahlah A, Abduljabbar T, Javed F, Vohra F. Comparison of yeast species in the subgingival oral biofilm of individuals with type 2 diabetes and peri‐implantitis and individuals with peri‐implantitis without diabetes. J Periodontol 2019; 90:1383-1389. [DOI: 10.1002/jper.19-0091] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/22/2019] [Accepted: 04/13/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Abdulaziz Alsahhaf
- Department of Prosthetic Dental ScienceCollege of DentistryKing Saud University Riyadh Saudi Arabia
| | - Khulud Abdulrahman Al‐Aali
- Department of Clinical Dental SciencesCollege of DentistryPrincess Nourah Bint Abdulrahman University Riyadh Saudi Arabia
| | - Rana Saud Alshagroud
- Department of Oral Medicine and Diagnostic SciencesCollege of DentistryKing Saud University Riyadh Saudi Arabia
| | - Ibraheem F. Alshiddi
- Department of Prosthetic Dental ScienceCollege of DentistryKing Saud University Riyadh Saudi Arabia
| | - Ali Alrahlah
- Department of Restorative Dental SciencesCollege of DentistryKing Saud University Riyadh Saudi Arabia
- Engineer Abdullah Bugshan Research Chair for Dental and Oral RehabilitationCollege of DentistryKing Saud University Riyadh Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental ScienceCollege of DentistryKing Saud University Riyadh Saudi Arabia
- Engineer Abdullah Bugshan Research Chair for Dental and Oral RehabilitationCollege of DentistryKing Saud University Riyadh Saudi Arabia
| | - Fawad Javed
- Department of PeriodontologyStony Brook University Stony Brook NY USA
- Laboratory for Periodontal‐, Implant‐, Phototherapy (LA‐PIP)School of Dental MedicineStony Brook University Stony Brook NY USA
| | - Fahim Vohra
- Department of Prosthetic Dental ScienceCollege of DentistryKing Saud University Riyadh Saudi Arabia
- Engineer Abdullah Bugshan Research Chair for Dental and Oral RehabilitationCollege of DentistryKing Saud University Riyadh Saudi Arabia
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Alrabiah M, Alshagroud RS, Alsahhaf A, Almojaly SA, Abduljabbar T, Javed F. Presence of Candida species in the subgingival oral biofilm of patients with peri-implantitis. Clin Implant Dent Relat Res 2019; 21:781-785. [PMID: 30908836 DOI: 10.1111/cid.12760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/25/2019] [Accepted: 03/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no studies that have investigated the presence of Candida species in the subgingival oral biofilm (OB) of patients with peri-implantitis. PURPOSE The aim was to assess the presence of Candida species in the subgingival OB of patients with peri-implantitis. MATERIALS AND METHODS Individuals with (group A) and without (group B) peri-implantitis were included. Life style related and demographic data were collected using a questionnaire. In both groups, peri-implant plaque-index (PI), bleeding-on-probing (BOP), and probing-depth (PD) were evaluated and crestal bone loss (CBL) were measured on digital bitewing radiographs. In both groups, subgingival OB samples were collected using sterile paper points. Identification of Candida species was performed using ChromAgar medium and colony forming units per milliliter (CFU/mL) were determined. Statistical analysis was performed, and level of significance was set at P < 0.05. RESULTS The mean age of individuals in groups A (n = 43) and B (n = 41) were 52.2 ± 4.4 and 55.1 ± 2.3 years, respectively. All participants were male. In groups A and B, implants were in function for 7.4 ± 1.3 and 6.8 ± 0.6 years, respectively. Scores of peri-implant PI (P < 0.001), BOP (P < 0.001), PD (P < 0.001), and CBL (P < 0.001) were significantly higher in group A than group B. Subgingival Candida was isolated from the OB of 33 (76.7%) patients in group A and 5 (12.2%) individuals in group B. The most common yeast species was Candida albicans, which was isolated from 67.4% to 60% individuals in groups A and B, respectively. The number of subgingival oral yeasts CFU/mL were significantly higher in group A (3147.54 ± 1052.6 CFU/mL) compared with group B (496.68 ± 100.2 CFU/mL; P < 0.01). CONCLUSION Candida species (predominantly C. albicans) are present in the subgingival OB of patients with peri-implantitis. Community-based efforts toward routine oral hygiene maintenance are needed to improve oral health and minimize the risks of peri-implant diseases in populations.
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Affiliation(s)
- Mohammed Alrabiah
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Rana S Alshagroud
- Department of Oral Medicine and Diagnostic Science, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alsahhaf
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Saud A Almojaly
- Department of Dentistry, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of Periodontology, Stony Brook University, Stony Brook, New York.,Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, New York
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