Identification of Candida species in the oral cavity of diabetic patients

Candida albicans skin infection in diabetic patients: An updated review of pathogenesis and management

Candida species, commensal residents of human skin, are recognized as the cause of cutaneous candidiasis across various body surfaces. Individuals with weakened immune systems, particularly those with immunosuppressive conditions, are significantly more susceptible to this infection. Diabetes mellitus, a major metabolic disorder, has emerged as a critical factor inducing immunosuppression, thereby facilitating Candida colonization and subsequent skin infections. This comprehensive review examines the prevalence of different types of Candida albicans-induced cutaneous candidiasis in diabetic patients. It explores the underlying mechanisms of pathogenicity and offers insights into recommended preventive measures and treatment strategies. Diabetes notably increases vulnerability to oral and oesophageal candidiasis. Additionally, it can precipitate vulvovaginal candidiasis in females, Candida balanitis in males, and diaper candidiasis in young children with diabetes. Diabetic individuals may also experience candidal infections on their nails, hands and feet. Notably, diabetes appears to be a risk factor for intertrigo syndrome in obese individuals and periodontal disorders in denture wearers. In conclusion, the intricate relationship between diabetes and cutaneous candidiasis necessitates a comprehensive understanding to strategize effective management planning. Further investigation and interdisciplinary collaborative efforts are crucial to address this multifaceted challenge and uncover novel approaches for the treatment, management and prevention of both health conditions, including the development of safer and more effective antifungal agents.

Mixed oral candidiasis in type 2 diabetic patients: Identification and spectrum of sensitivity

Introduction

Patients with type 2 diabetes mellitus are susceptible to acquire Candida spp. infections, sometimes involving more than one species. The resistance of some species to antimycotic agents can cause treatment failure.

Objectives

To determine the frequency and clinical varieties of mixed oral candidiasis in patients with type 2 diabetes mellitus, the involved species, and its sensitivity spectra when exposed to antifungals used as candidiasis treatment.

Material and methods

We developed an analytical cross-sectional study with 72 patients with type 2 diabetes mellitus with hyperglycemia (HbA1C ≥ 7%) and an oral candidiasis diagnosis. The causal species of oral candidiasis were identified through microbiological techniques, and sensitivity tests were carried out using the diffusion method in a plate with strips (E-test ®).

Results

We included 72 patients in the study, 32 (44%) males and 40 (56%) females. Patients were divided into three age groups: young adults (17%), adults (74%), and older adults (9%). The mean age of the patients was 51 years. No significant differences were found between mixed oral candidiasis and groups (sex and age), or between mixed oral candidiasis and gender, glycosylated hemoglobin level (HbA1C), antihyperglycemic treatment, or type 2 diabetes mellitus time of diagnosis. We found a correlation between the adult group and development of mixed or simple oral candidiasis. The results showed eight (13%) cases of mixed oral candidiasis: seven with a coinfection of two species and one with a coinfection of three species. The identified species were Candida albicans, C. glabrata, C. dubliniensis, C. kefyr, C. tropicalis, and C. krusei. Most of these species presented sensitivity against ketoconazole and fluconazole, and higher resistance to itraconazole.

Conclusions

Mixed oral candidiasis occurs in approximately 10% of the patients with type 2 diabetes mellitus and its treatment can be ineffective when the etiological agent is not identified.

Oral candidiasis in patients hospitalised in the intensive care unit: Diagnosis through clinical and cytopathological examinations

OBJECTIVE

To evaluate the prevalence and clinical aspects of oral candidiasis in patients hospitalised in the intensive care unit.

METHODS

This is a longitudinal and prospective study that included 48 participants hospitalised in the intensive care unit. Sociodemographic data, presence of systemic disorders, use of medications, laboratory tests, cause of hospital admission, type of breathing, and length of hospital stay were obtained from medical records. Oral clinical inspection and cytopathological examinations were performed on all participants. The diagnosis of clinical candidiasis was based on the presence of clinical alterations together with positive cytopathological examination results. The diagnosis of subclinical candidiasis was based on the absence of clinical lesions and a positive cytopathological examination. The absence of oral candidiasis was considered when the participant did not present oral lesions and had a negative cytopathological examination.

RESULTS

Clinical candidiasis was present in 18.8% of the 48 participants, and 45.8% of them had the subclinical form. Levels of urea (P = 0.005), creatinine (P = 0.009), haemoglobin (P = 0.009), haematocrit (P = 0.011), bands (P = 0.024), international normalised ratio (INR; P = 0.034), types of breathing (P = 0.017), length of hospital stay (P = 0.037), and outcome (P = 0.014) demonstrated statistically significant differences between the groups with and without oral candidiasis.

CONCLUSIONS

Clinical and subclinical forms of oral candidiasis are frequent in intensive care unit patients. Levels of urea, creatinine, haemoglobin, haematocrit, bands, INR, type of breathing, length of hospital stay, and outcome can be associated with the presence of candidiasis.

Oral Microbiota-One Habitat or Diverse Niches? A Pilot Study of Sampling and Identification of Oral Bacterial and Fungal Biota in Patients with Type I Diabetes Mellitus Treated with Insulin Pump

OBJECTIVE

The oral microbiota is a very complex and dynamic microbial ecosystem. Alterations of its balance can result in oral and systemic diseases. We aimed to characterize the microbiota in particular niches of the oral cavity in adult type 1 diabetes patients treated with continuous infusion of insulin with insulin pump (IP). In addition, we aimed to determine optimal sites of oral microbiota sampling in studies of large research groups of patients with DM I.

DESIGN

In this pilot study, we sampled the buccal and soft palate mucosa, tongue, palatal and buccal dental surfaces and gingival pockets of adult DM I patients treated with IP.

RESULTS

In total, 23 patients were recruited. The oral microbiota was dominated by Streptococus and Neisseria, with a low incidence of cariogenic S. mutans and Lactobacillus, as well as periodontal pathogens such as Prevotella. There were significant differences in overall CFU counts of all strains, Gram-positive, Staphylococci, Streptococci and S. oralis strains between mucosal and dental surface sites. The overall CFU counts of all strains and Gram-positive strains were higher in dental sites vs. mucosal sites (both p < 0.001). CFU counts of S. oralis were significantly higher in dental sites vs. gingival pocket sites (p = 0.013). Candida species were rare. The mucosal sites on the buccae presented lower diversity and bacterial counts.

CONCLUSIONS

In the study group of adult DM I patients treated with IP, the microbiota in particular niches of the oral cavity was significantly different. Three distinct and optimally appropriate sampling sites for oral microflora were identified: buccal and palatal mucosa, dental surface and gingival pockets. The results of this study may be the basis for further studies of large groups of patients with DM I.

Molecular Mapping of Antifungal Mechanisms Accessing Biomaterials and New Agents to Target Oral Candidiasis

Oral candidiasis has a high rate of development, especially in immunocompromised patients. Immunosuppressive and cytotoxic therapies in hospitalized HIV and cancer patients are known to induce the poor management of adverse reactions, where local and systemic candidiasis become highly resistant to conventional antifungal therapy. The development of oral candidiasis is triggered by several mechanisms that determine oral epithelium imbalances, resulting in poor local defense and a delayed immune system response. As a result, pathogenic fungi colonies disseminate and form resistant biofilms, promoting serious challenges in initiating a proper therapeutic protocol. Hence, this study of the literature aimed to discuss possibilities and new trends through antifungal therapy for buccal drug administration. A large number of studies explored the antifungal activity of new agents or synergic components that may enhance the effect of classic drugs. It was of significant interest to find connections between smart biomaterials and their activity, to find molecular responses and mechanisms that can conquer the multidrug resistance of fungi strains, and to transpose them into a molecular map. Overall, attention is focused on the nanocolloids domain, nanoparticles, nanocomposite synthesis, and the design of polymeric platforms to satisfy sustained antifungal activity and high biocompatibility with the oral mucosa.

Efficacy of Extracts of Cyanthillium Cinereum, Khaya senegalensis and Lippia multiflora on Candida Strains Isolated From Urine Samples in Benin (West Africa)

The search for new bioactive molecules with antifungal properties to combat resistance to classical antifungals represents a great challenge. This study aimed to explore the virulence factors and resistance profile of Candida species isolated from urine samples in Benin and the in vitro efficacy of organic extracts of Cyanthillium cinereum (L.) H.Rob., Lippia multiflora Moldenke and Khaya senegalensis (Desv.) A.Juss. on the growth of these Candida spp. The study focused on Candida strains isolated from urine samples collected from patients admitted to the bacteriological analysis laboratories of hospitals in Southern Benin. The sensitivity of these strains to classical antifungal agents was determined by the simple diffusion method. Their pathogenicity was investigated via several virulence factors (gelatinase, hemolysin, hydrophobicity, adhesin, biofilm and lecithinase). The in vitro efficacy of the aqueous, ethanolic and hydro-ethanolic extracts of the plants on Candida albicans ATCC 90028 and on six clinical strains was evaluated by the method of determination of the inhibition diameters. The results obtained showed that 51 different Candida strains were isolated from the collected urine samples with a respective predominance of Candida albicans (52.94%) and Candida glabrata (17.64%) species. All identified species were sensitive to amphotericin B and nystatin but 20% are resistant to fluconazole and present 15 different resistance profiles. Six different virulence factors were identified with a high frequency of hydrophobicity (96.08%) and adhesin (94.12%). Antifungal tests revealed that at 100 mg/mL the plant extracts were active on the tested strains with better activity for Cyanthilium cinereum and Khaya senegalensis. Cyanthilium cinereum, Khaya senegalensis and Lippia multiflora showed antifungal activity on virulent Candida strains suggesting the possibility to explore them further for the discovery of new antifungal molecules.

Effects of benzydamine and mouthwashes containing benzydamine on Candida albicans adhesion, biofilm formation, regrowth, and persistence

Objectives

To assess the effects of benzydamine and mouthwashes (MoWs) containing benzydamine on different stages of Candida albicans biofilm: adhesion, formation, persistence, and regrowth (if perturbed).

Materials and methods

C. albicans CA1398, carrying the bioluminescence ACT1p-gLUC59 fusion product, was employed. Fungal cells were exposed for 1′, 5′, or 15′ to 4 different benzydamine concentrations (0.075 to 0.6%) to 2 mouthwashes (MoWs) containing benzydamine and to a placebo MoW (without benzydamine). Treated cells were tested for adhesion (90 min) and biofilm formation (24-h assay). Next, 24- and 48-h-old biofilms were exposed to benzydamine and MoWs to assess regrowth and persistence, respectively. The effects of benzydamine, MoWs containing benzydamine, and placebo on different biofilm stages were quantified by bioluminescence assay and by the production of quorum sensing (QS) molecules.

Results

Benzydamine and MoWs containing benzydamine impaired C. albicans ability to adhere and form biofilm, counteracted C. albicans persistence and regrowth, and impaired a 48-h-old biofilm. Some of these effects paralleled with alterations in QS molecule secretion.

Conclusions

Our results show for the first time that benzydamine and MoWs containing benzydamine impair C. albicans capacity to form biofilm and counteract biofilm persistence and regrowth.

Clinical relevance

Benzydamine and MoWs containing benzydamine capacity to affect C. albicans biofilm provides an interesting tool to prevent and treat oral candidiasis. Likely, restraining C. albicans colonization through daily oral hygiene may counteract colonization and persistence by other critical oral pathogens, such as Streptococcus mutans, whose increased virulence has been linked to the presence of C. albicans biofilm.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04330-8.

Candida Pneumonia with Lung Abscess as a Complication of Severe COVID-19 Pneumonia

A South Asian male patient in his mid-forties presented with symptoms of severe 2019-nCoV (COVID-19) and recent brain infarction. Subsequently, he was found to have evidence of sepsis, underlying undetected diabetes mellitus (DM) and oral candida mucositis, possibly leading to the rare occurrence of direct spread to the lung, manifesting as a necrotizing candida lung abscess. We describe the diagnosis, clinical course, and management of the unique complication in this case that occurred during his admission, hospitalization, and eventual successful discharge from the hospital. This case highlights the importance of early identification and treatment of suspected COVID-19 infection based on clinical and radiological assessments before the confirmation of COVID-19 by real-time polymerase chain reaction (rtPCR) test result, especially in patients with hyperglycemia. It also indicates the complications that can occur due to COVID-19 such as arteriovenous manifestations and the rare occurrence of pulmonary candida lung abscess. Early detection and prompt management by interdisciplinary teams in the emergency room, followed by close monitoring of complications in the intensive care unit (ICU), can lead to successful outcomes in severe/critical COVID-19 infection.

Oral candidal carriage and its association with dental carious lesions in asymptomatic adults: a cross-sectional study from the UAE

BACKGROUND

Candida's potential association with dental caries has previously been reported in children. This research aimed at investigating the associations between Candida species in whole saliva and dental and periodontal health indices in a sample of adult patients.

METHODS

A cross-sectional study involving 160 patients investigated the associations between Candida species collected by oral rinse technique, and Decayed, Missing, and Filled Surfaces (DMFS), and periodontal health indices. Chi-square and Independent Samples t-test were used to assess the associations between Candida carriage and confounding variables. Binary logistic regression was used to assess association strengths between Candida carriage and DMFS, adjusted for socio-demographic variables, diabetes mellitus and plaque index.

RESULTS

Candida colonies were identified in 49 (30.6%) patients with CFUs ranging from 10³ to 10⁵ colonies per mL. The quantity of Candida CFUs increased with age (r = 0.200; p < 0.05). Among all dental and periodontal health indices, only DMFS was significantly associated with higher values of Candida carriage (p = 0.034), and this association was independent from sex, age, smoking, diabetes mellitus and plaque index (OR: 1.014; 95% CI 1.0-1.03; p = 0.048).

CONCLUSION

The association between Candida species in whole saliva and DMFS reported here supports an etiological role of Candida in dental cariogenesis among adults.

The Interplay Between Sugar and Yeast Infections: Do Diabetics Have a Greater Predisposition to Develop Oral and Vulvovaginal Candidiasis?

Diabetes mellitus (DM) is one of the most common chronic diseases impacting individuals of both developing and developed nations. DM patients have a weaker immune system in comparison to healthy subjects, rendering them more prone to develop infections. Even the typical gut microflora can become pathogenic in such immunocompromised conditions. Microorganisms belonging to Candida species are capable of causing infections in DM subjects. A comprehensive review of the literature was undertaken. The PubMed database was searched using well-defined search terms. Predefined inclusion and exclusion criteria were applied to classify relevant manuscripts. The results of the review show that DM patients have an increased susceptibility to Candida sp. This paper will summarize the previously conducted research discussing the relationship between DM and candidiasis, features specific to Candida species that make it pathogenic, and compare oral and vulvovaginal candidiasis (VVC) morbidity in diabetics versus healthy subjects.

Clinical Characteristics and Relevance of Oral Candida Biofilm in Tongue Smears

Dimorphic Candida exist as commensal yeast carriages or infiltrate hyphae in the oral cavity. Here, we investigated the clinical relevance of Candida hyphae in non-pseudomembranous oral candidiasis (OC) by smears of tongue biofilms. We conducted a retrospective study of 2829 patients who had had tongue smears regardless of OC suspicion. Clinical characteristics were evaluated using a novel method of assessing hyphae. Clinical factors (moderate/severe stimulated pain, pain aggravated by stimulation, tongue dorsum appearance and initial topical antifungal use) were highly significant in the high-grade hyphae group but were statistically similar in the low-grade hyphae and non-observed hyphae group, suggesting low-grade hyphae infection as a subclinical OC state. In addition to erythematous candidiasis (EC), a new subtype named "morphologically normal symptomatic candidiasis" (MNSC) with specific pain patterns and normal tongue morphology was identified. MNSC had a significantly higher proportion of moderate and severe stimulated pain cases than EC. Low unstimulated salivary flow rate (<0.1 mL/min) was found to be a common risk factor in MNSC and EC. In non-pseudomembranous OC, pain patterns were dependent on Candida hyphae degree regardless of tongue dorsum morphology. Morphologic differences seen in high-grade hyphae infection were not associated with systemic diseases or nutritional deficiencies.

Fungal Infection among Diabetic and Nondiabetic Individuals in Nepal

Background

Low immunity, comorbid clinical conditions, and metabolic disorders may be the underlying factors that determine the severity of infection. Diabetes increases the risk of infection and multiple organ damage. In Nepal, the actual burden of fungal infections has not been estimated or is in a limited progress. This study aimed to investigate the status of fungal infection in diabetic and nondiabetic individuals in Bhaktapur, Nepal.

Materials and Methods

A total of 670 samples were collected from 134 participants. From each participant, five samples were collected from different sites like an oral wash, toe swab, midstream urine, hair shaft, and nail scrapings. All samples were cultured on Sabouraud dextrose agar. Gram stain was used to observe yeast cells and lactophenol cotton blue stain was used for hyphae. Chlamydospore production by Candida species was observed in cornmeal agar medium by Dalmau Plate method. Candida species isolated were characterized by germ-tube test and differentiated using CHROM agar Candida medium. Candida species isolates were tested for antibiotic susceptibility.

Results

Overall, 19.4% of the samples showed fungal growth. The prevalence of fungal infection was higher in diabetic (34.0%) than nondiabetic individuals (4.7%). Fungal growth was found to be higher in oral wash followed by toe, urine, hair, and nail samples. Predominant fungi were Candida species (57.5%), Aspergillus species (28.4%), and Trichophyton species (10.7%). Oral wash, toe, and urine samples in diabetics had a significantly higher fungal prevalence when compared between both groups, p value < 0.05. In Candida isolates, higher resistance was seen against fluconazole 36.8% and ketoconazole 28.9%, whereas other drugs showed low resistance.

Conclusion

Diabetic participants are more susceptible to fungal infection than the nondiabetics. Overall, Candida species and Aspergillus species are highly predominant fungi. Candida species are highly resistant to fluconazole and ketoconazole.

Evaluation of Dental Health in Terminally Ill Patients

Dental health plays an imperative role in the general health and well-being of an individual. Terminally ill patients due to a compromised immune response are susceptible to a wide array of oral complications, which may affect their ability to speak and chew, leading to malnutrition. The present study was conducted to evaluate dental health and various oral manifestations in terminally ill patients. One hundred twenty terminally ill patients hospitalized with diseases of the respiratory tract, gastrointestinal tract, circulatory system, liver, and endocrinal disorders were included in the study. The evaluation of oral manifestations and their prevalence was done by a single examiner. The oral health was evaluated according to symptoms exhibited by the patients and clinical presentation. Of the patients included in the study, 78 were male, and 42 were female. All the individuals were adults between 25 to 55 years of age. Out of 120 admitted terminally ill patients, 27 subjects had respiratory diseases, 17 had gastrointestinal disorders, 5 had disorders of the circulatory system, 39 had liver disorders, and 32 had endocrine disorders. A need for added comprehension is mandatory to link the inter-relationships between dentistry and medicine to further perk up the management of the overall health of patients, which will further reinforce the partnership between dental and medical communities.

Management of an emergency tooth extraction in diabetic patients on the dental chair

Background and objective

Approximately 75% of diabetic patients in Saudi Arabia had poor glycaemic control. A high proportion of these patients will attend dental surgery clinics for treatment. Therefore, dentists should be well-prepared to control any complications they might arise on the dental chair during the dental procedures. Management of the associated risk factors is important to limit disease complications and improve the health of patients with diabetes.The objectives of this review were to determine the maximum acceptable level of blood glucose for tooth removal in diabetics, show a systematic technique for the management of patients with diabetes on the dental chair. By using PRISMA guidelines, analysis of the published articles and reports across the world is considered one of the most appropriate available methods to obtain strong evidence about the acceptable levels of blood glucose where teeth extraction can be done safely.

Results

A total of 1080 studies were retrieved using the search strategy. After screening 185 titles, abstracts and 85 full-text articles, 36 studies were included. The outcome of this systematic review revealed that fasting blood glucose level of 240 mg/dl is a critical point for any dental treatment because the warning signs of diabetes start coming out. Maximum acceptable levels of blood glucose for removal of teeth in diabetics are 180 mg/dl (before meal) and 234 mg/dl (2 h after a meal). High blood glucose levels reduce the secretion of nitric oxide (powerful vasodilator) in the body which leads to poor circulation and slow-healing socket. Uncontrolled diabetics are at high risk of infection because of the high ketone levels in the blood.

Conclusion

Fasting blood glucose level of 180 mg/dl is a cut-off point for any selective dental extraction. However, Random blood glucose level of 234 mg/dl (13 mmol/l) is a cut-off point for an emergency tooth extraction. Tightly controlled diabetic patients (blood glucose level below 70 mg/dl) are susceptible to hypoglycemia.

Filamentous Non-albicans Candida Species Adhere to Candida albicans and Benefit From Dual Biofilm Growth

Non-albicans Candida species (NACS) are often isolated along with Candida albicans in cases of oropharyngeal candidiasis. C. albicans readily forms biofilms in conjunction with other oral microbiota including both bacteria and yeast. Adhesion between species is important to the establishment of these mixed biofilms, but interactions between C. albicans and many NACS are not well-characterized. We adapted a real-time flow biofilm model to study adhesion interactions and biofilm establishment in C. albicans and NACS in mono- and co-culture. Out of five NACS studied, only the filamenting species C. tropicalis and C. dubliniensis were capable of adhesion with C. albicans, while C. parapsilosis, C. lusitaniae, and C. krusei were not. Over the early phase (0-4 h) of biofilm development, both mono- and co-culture followed similar kinetics of attachment and detachment events, indicating that initial biofilm formation is not influenced by inter-species interactions. However, the NACS showed a preference for inter-species cell-cell interactions with C. albicans, and at later time points (5-11 h) we found that dual-species interactions impacted biofilm surface coverage. Dual-species biofilms of C. tropicalis and C. albicans grew more slowly than C. albicans alone, but achieved higher surface coverage than C. tropicalis alone. Biofilms of C. dubliniensis with C. albicans increased surface coverage more rapidly than either species alone. We conclude that dual culture biofilm of C. albicans with C. tropicalis or C. dubliniensis offers a growth advantage for both NACS. Furthermore, the growth and maintenance, but not initial establishment, of dual-species biofilms is likely facilitated by interspecies cell-cell adherence.

Cell wall mannan of Candida krusei mediates dendritic cell apoptosis and orchestrates Th17 polarization via TLR-2/MyD88-dependent pathway

Dendritic cells (DCs) abundantly express diverse receptors to recognize mannans in the outer surface of Candida cell wall, and these interactions dictate the host immune responses that determine disease outcomes. C. krusei prevalence in candidiasis worldwide has increased since this pathogen has developed multidrug resistance. However, little is known how the immune system responds to C. krusei. Particularly, the molecular mechanisms of the interplay between C. krusei mannan and DCs remain to be elucidated. We investigated how C. krusei mannan affected DC responses in comparison to C. albicans, C. tropicalis and C. glabrata mannan. Our results showed that only C. krusei mannan induced massive cytokine responses in DCs, and led to apoptosis. Although C. krusei mannan-activated DCs underwent apoptosis, they were still capable of initiating Th17 response. C. krusei mannan-mediated DC apoptosis was obligated to the TLR2 and MyD88 pathway. These pathways also controlled Th1/Th17 switching possibly by virtue of the production of the polarizing cytokines IL-12 and IL-6 by the C. krusei mannan activated-DCs. Our study suggests that TLR2 and MyD88 pathway in DCs are dominant for C. krusei mannan recognition, which differs from the previous reports showing a crucial role of C-type lectin receptors in Candida mannan sensing.

Chronic Mucocutaneous Candidiasis in Autoimmune Polyendocrine Syndrome Type 1

Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is an autosomal recessive disease caused by mutations in the autoimmune regulator (AIRE) gene, characterized by the clinical triad of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency. CMC can be complicated by systemic candidiasis or oral squamous cell carcinoma (SCC), and may lead to death. The role of chronic Candida infection in the etiopathogenesis of oral SCC is unclear. Long-term use of fluconazole has led to the emergence of Candida albicans strains with decreased susceptibility to azoles. CMC is associated with an impaired Th17 cell response; however, it remains unclear whether decreased serum IL-17 and IL-22 levels are related to a defect in cytokine production or to neutralizing autoantibodies resulting from mutations in the AIRE gene.

Molecular characterization of Candida dubliniensis and Candida albicans in the oral cavity of drug abusers using duplex polymerase chain reaction

Background and Purpose:

Candida dubliniensis is closely related to the most pathogenic and prevalent yeast, namely C. albicans.Candida species can opportunistically overgrow in vulnerable individuals and cause a variety of diseases. The current study aimed to identify and isolate C. dubliniensis species present in the Candida albicans species complex identified in the oral cavity of drug abusers.

Materials and Methods:

This study was conducted on 53 strains of C. albicans species complex, isolated from the oral mucosa of drug abusers in Isfahan, Iran. DNA extraction was accomplished through boiling procedure. Duplex polymerase chain reaction (PCR) was performed to amplify ITS1-5.8S-ITS2 region using four specific primers. Fungal species were identified based on the difference in the size of the bands created in the Agarose gel.

Results:

Out of the 53 isolates under study, 30 (56.6%) and 14 (26.4%) samples were identified as C. albicans and C. dubliniensis, respectively. In the remaining 9 samples (17%), both types of Candida species were confirmed.

Conclusion:

The findings of the present study revealed the presence of a noticeable amount of C. dubliniensis in the oral cavity of drug abusers. Therefore, the probable presence of this fungus should be considered during the examination of oral infection among this group. To date, no research has directly investigated this issue in Iran.

Candida Species Diversity in Oral Cavity of Type 2 Diabetic Patients and their In vitro Antifungal Susceptibility

Objective:

To identify and compare the species variation and Colony Forming Units of the species and antifungal susceptibility from oral rinse samples of individuals in poorly-controlled, moderately-controlled and well controlled diabetes patients with control group.

Subjects and Methods:

Study group comprised of well-controlled, moderately-controlled and poorly controlled Type II diabetic patients grouped according to the level of glycated hemoglobin concentration with 50 patients in each group and 50 healthy individuals. Oral rinse samples were collected in a sterile container with phosphate-buffered saline and then transported immediately for various mycological investigations and antifungal susceptibility tests. Statistical analysis was performed.

Results:

There was a significant difference in frequency of Candida in poorly controlled diabetes when compared to moderately controlled diabetes, well controlled diabetes and normal patients (P = 0.045). A higher number of colony count was seen among poorly controlled diabetes than well controlled, moderately controlled and non diabetic subjects. A comparatively low number of non-albicans were seen in healthy individuals. C. albicans showed an increased resistance to fluconazole in DM patients in comparison to control group (P = 0.001). Other species showed a variable sensitivity pattern.

Conclusion:

The decreased immunity and change in oral habitat in diabetic patients creates a diversification in various species of Candida. These non albicans vary in their susceptibility and pathogenesis. A definite identification of these diverse species in the oral cavity of such patients and their susceptibility mandates proper management to avoid recurrence and drug resistance.

Identification of Candida albicans and Candida dubliniensis Species Isolated from Bronchoalveolar Lavage Samples Using Genotypic and Phenotypic Methods

Background

Candida dubliniensis is a newly diagnosed species very similar to Candida albicans phenotypically and first discovered in the mouth of people with AIDS in 1995. Among the different phenotypic and genotypic methods, a cost-effective method should be selected which makes it possible to differentiate these similar species.

Materials and Methods

Polymerase chain reaction (PCR)-restriction fragment length polymorphism with MspI enzyme and the Duplex-PCR method were done by DNA extraction using boiling. The sequencing of the amplified ribosomal region was used to confirm the C. dubliniensis species. Direct examination and colony count of the yeasts were applied for bronchoalveolar lavage (BAL) samples and the growth rate of the yeasts were studied at 45°C. To understand the ability formation of chlamydoconidia in yeast isolates, they were separately cultured on the sunflower seed agar, wheat flour agar, and corn meal agar media.

Results

Fifty-nine (49.2%) yeast colonies were identified from the total of 120 BAL specimens. Twenty-nine isolated yeasts; including 17 (58.6%) of C. albicans/dubliniensis complex and 12 (41.4%) of nonalbicans isolates produced pseudohypha or blastoconidia in direct smear with a mean colony count of 42000 CFU/mL. C. albicans with the frequency of 15 (42.9%) were the most common isolated yeasts, whereas C. dubliniensis was identified in two nonHIV patients.

Conclusion

Sequencing of the replicated gene fragment is the best method for identifying the yeasts, but the determination of the species by phenotypic methods such as the creation of chlamydoconidia in sunflower seeds agar and wheat flour agar media can be cost-effective, have sensitivity and acceptable quality.

Isolation and Speciation of Candida in Type II Diabetic Patients using CHROM Agar: A Microbial Study

INTRODUCTION

Newer Candida species are now becoming increasingly predominant commensal in the oral cavity.

AIM

Aim of the study was to identify and compare different Candida species in the oral cavity of Type II diabetic individuals.

MATERIALS AND METHODS

The present microbial study was carried out for the duration of three months. Sixty participants were included in the study and divided into two groups of 30 individual each. Group I consisted of patients with Type II diabetes while Group II consisted of healthy individuals without diabetes or any other systemic disease. A total of 3 ml of unstimulated whole saliva was collected from them and centrifuged at 5000 rpm for fives minutes. This pellet was plated onto CHROM agar medium plates and incubated at 37°C for at least 3-4 days. CHROM agar plates were visualized daily at 24 hours, 72 hours and followed up to seven days to check for growth. Candida speciation was done by counting the different coloured creamy colonies. Comparison of Candida spp. between two groups was done by applying the Student's t-test. A p-value<0.05 was considered as statistically significant.

RESULTS

All the species of Candida, namely, Candida albicans, Candida glabrata, Candida dubliniensis, Candida krusei, Candida parapsilosis except for Candida tropicalis showed a significantly higher (p<0.001) occurrence in the diabetic group compared to the healthy group. The highest identified species is C. parapsilosis, second being C. albicans in both the groups.

CONCLUSION

C. parapsilosis is now considered as one of the significant causes of Candida infection in the oral cavity. This increased virulence will affect the global burden of Candidiasis as few treatment options are available for this new pathogen.