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Objectives: This systematic review and meta‐analysis aimed to evaluate the clinical and mycological effectiveness of mucoadhesives as vehicles for drugs or natural products in the treatment of oral candidiasis. Materials and methods: The search for articles was carried out in the Medline/PubMed, SCOPUS, EMBASE, Web of Science, Cochrane Library, and SciELO databases before August 2023. We selected the studies, extracted the data, evaluated the study quality, graded the evidence, performed the risk of bias, and carried out meta‐analysis. Results: A total of 389 potentially relevant articles were identified, and 11 studies (1869 participants) met the inclusion criteria of the systematic review. The overall risk of bias was considered low. The most common presentation of mucoadhesives was tablets, with miconazole being the most frequently drug used in the delivery system. Mucoadhesives demonstrated comparable efficacy with topical or systemic antifungal agents, with no significant differences between treatments in terms of clinical (RR = 0.907; 95CI = 0.3–1.297; p = 0.591; I2 = 64.648) or mycological (RR = 0.95; 95CI = 0.667–1.360; p = 0.789; I2 = 73.271) efficacy. Conclusions: Mucoadhesives may be a suitable alternative to conventional treatments, with the advantage of reducing the frequency of application by up to 5 times and the daily dosage by up to 20 times. [ABSTRACT FROM AUTHOR]

Oral candidiasis is an opportunistic infection caused by fungi of the genus Candida. Nystatin, fluconazole, and miconazole are the most widely used antifungal drugs in dentistry, but in recent years, they have been shown to be less effective due to the increase in the resistance to antifungal drugs. The growing challenge of antifungal resistance emphasizes the importance of exploring not only alternative strategies in the fight against Candida spp. infections but also supportive treatment for pharmacological treatment for oral candidiasis. This review aims to evaluate and compare the in vitro reports on antifungal efficacy against Candida spp. exhibited by mouthwashes distributed on the European market. The research question was elaborated through the PEO framework recommended by PRISMA 2020. A bibliographic search strategy was developed for the scientific online databases Pubmed and ScienceDirect. According to the eligibility criteria, 21 papers were included in this study over a 27-year period. Mouthwashes containing chlorhexidine digluconate, cetylpyridinium chloride, hexetidine, and fluorine compounds among others, and natural antimicrobials, such as menthol, thymol, eucalyptol, and Glycyrrhiza glabra extracts, have demonstrated antifungal effectiveness. Nonetheless, the methodological variance introduces ambiguity concerning the comparative efficacy of distinct molecules or mouthwash formulations and complicates the evaluation and the comparison of results between studies. Some mouthwashes commercially available in Europe have the potential to be used in anti-Candida therapy and prevention since they have shown antifungal effect. [ABSTRACT FROM AUTHOR]

Introduction: Despite the rising concern with fungal resistance, a myriad of molecules has yet to be explored. Geraniol, linalool, and citronellal are monoterpenes with the same molecular formula (C10H18O), however, neither the effect of these compounds on inflammatory axis induced by Candida spp. nor the antibiofilm Structure-Activity Relationship (SAR) have been well-investigated. Herein we analyzed geraniol, linalool and citronellal antifungal activity, cytotoxicity, and distinctive antibiofilm SAR, also the influence of geraniol on Candida spp induced dysregulated inflammatory axis, and in vivo toxicity. Methods: Minimal inhibitory (MIC) and fungicidal (MFC) concentrations against Candida spp were defined, followed by antibiofilm activity (CFU-colony forming unit/mL/g of dry weight). Cytotoxic activity was assessed using human monocytes (THP-1) and oral squamous cell (TR146). Geraniol was selected for further analysis based on antifungal, antibiofilm and cytotoxic results. Geraniol was tested using a dual-chamber co-culture model with TR146 cells infected with C. albicans, and THP-1 cells, used to mimic oral epithelium upon fungal infection. Expression of Candida enzymes (phospholipase-PLB and aspartyl proteases-SAP) and host inflammatory cytokines (interleukins: IL-1ß, IL-6, IL-17, IL-18, IL-10, and Tumor necrosis factor-TNF) were analyzed. Lastly, geraniol in vivo toxicity was assessed using Galleria mellonella. Results: MIC values obtained were 1.25-5 mM/mL for geraniol, 25-100 mM/mL for linalool, and 100-200 mM/mL for citronellal. Geraniol 5 and 50 mM/mL reduced yeast viability during biofilm analysis, only 500 mM/mL of linalool was effective against a 72 h biofilm and no biofilm activity was seen for citronellal. LD50 for TR146 and THP-1 were, respectively: geraniol 5.883 and 8.027 mM/mL; linalool 1.432 and 1.709 mM/mL; and citronellal 0.3006 and 0.1825 mM/mL. Geraniol was able to downregulate expression of fungal enzymes and host proinflammatory cytokines IL-1ß, IL-6, and IL-18. Finally, safety in vivo parameters were observed up to 20 mM/Kg. Discussion: Despite chemical similarities, geraniol presented better antifungal, antibiofilm activity, and lower cytotoxicity when compared to the other monoterpenes. It also showed low in vivo toxicity and capacity to downregulate the expression of fungal enzymes and host pro-inflammatory cytokines. Thus, it can be highlighted as a viable option for oral candidiasis treatment. [ABSTRACT FROM AUTHOR]

Background: Vulvovaginal candidiasis is a common fungal infection that affects the female lower genital tract. This study determined the major risk factors associated with vulvovaginal infection (VVI) in the Ashanti region of Ghana and also determined the antifungal resistance patterns of Candida albicans isolates to some antifungals. Methods: Three hundred and fifty (350) high vaginal swab (HVS) samples were collected from women who presented with signs and symptoms of VVI. A structured questionnaire was administered to one hundred and seventy-two (172) of the women. HVS samples were cultured on Sabouraud dextrose agar with 2% chloramphenicol. The polymerase chain reaction was employed to confirm C. albicans. Antifungal susceptibility testing was performed and the susceptibility of C. albicans isolates to fluconazole, clotrimazole, amphotericin B, nystatin, miconazole and 5-flurocytosine were assessed. Results: Vaginal infection was most prevalent amongst females in their reproductive age (21 to 30 years; 63.0%). The study found a significant association between vaginal infections and some risk factors such as sexual practices (p < 0.001), antibiotic misuse (p < 0.05), poor personal hygiene (p < 0.005) and birth control methods (p < 0.049). Out of the 350 HVS samples collected, 112 yielded yeast cells with 65 (58%) identified as C. albicans. The C. albicans isolates were resistant to 5' flucytosine (100%), fluconazole (70%), voriconazole (69.2%), miconazole (58.5%) and nystatin (49.2%). C. albicans isolates were more susceptible to amphotericin B (53.8%) and clotrimazole (45.1%), although an appreciable number of isolates showed resistance (46.1% and 52.3%, respectively). Conclusion: There should be nationwide education on all associated risk factors of VVI. Also, use of the various antifungal agents in vaginal candidiasis should proceed after antifungal susceptibility testing to ensure efficacious use of these agents. [ABSTRACT FROM AUTHOR]

Background: Oral candidiasis (OC) is a prevalent opportunistic infection in patients with human immunodeficiency virus (HIV) infection. The increasing resistance to antifungal agents in HIV-positive individuals suffering from OC raised concerns. Thus, this study aimed to investigate the prevalence of drug-resistant OC in HIV-positive patients. Methods: Pubmed, Web of Science, Scopus, and Embase databases were systematically searched for eligible articles up to November 30, 2023. Studies reporting resistance to antifungal agents in Candida species isolated from HIV-positive patients with OC were included. Baseline characteristics, clinical features, isolated Candida species, and antifungal resistance were independently extracted by two reviewers. The pooled prevalence with a 95% confidence interval (CI) was calculated using the random effect model or fixed effect model. Results: Out of the 1942 records, 25 studies consisting of 2564 Candida species entered the meta-analysis. The pooled prevalence of resistance to the antifungal agents was as follows: ketoconazole (25.5%, 95% CI: 15.1–35.8%), fluconazole (24.8%, 95% CI: 17.4–32.1%), 5-Flucytosine (22.9%, 95% CI: -13.7-59.6%), itraconazole (20.0%, 95% CI: 10.0–26.0%), voriconazole (20.0%, 95% CI: 1.9–38.0%), miconazole (15.0%, 95% CI: 5.1–26.0%), clotrimazole (13.4%, 95% CI: 2.3–24.5%), nystatin (4.9%, 95% CI: -0.05-10.3%), amphotericin B (2.9%, 95% CI: 0.5–5.3%), and caspofungin (0.1%, 95% CI: -0.3-0.6%). Furthermore, there were high heterogeneities among almost all included studies regarding the resistance to different antifungal agents (I2 > 50.00%, P < 0.01), except for caspofungin (I2 = 0.00%, P = 0.65). Conclusions: Our research revealed that a significant number of Candida species found in HIV-positive patients with OC were resistant to azoles and 5-fluocytosine. However, most of the isolates were susceptible to nystatin, amphotericin B, and caspofungin. This suggests that initial treatments for OC, such as azoles, may not be effective. In such cases, healthcare providers may need to consider prescribing alternative treatments like polyenes and caspofungin. Registration: The study protocol was registered in the International Prospective Register of Systematic Reviews as PROSPERO (Number: CRD42024497963). [ABSTRACT FROM AUTHOR]

Background: Candida, a common oral microbiota, can cause opportunistic fungal infections. With rising Candida infections and limited effective antifungals, new treatments are needed. This study investigates carvacrol essential oil's effect on oral candidiasis, alone and with nystatin, compared to nystatin alone. Materials and methods: In this study, oral samples were collected from dental clinic patients, especially denture users. The presence of Candida was confirmed and cultured from these samples. Candidiasis was detected by observing Candida colonies. Drug sensitivity was tested on 100 positive samples. The minimum concentration of inhibition and lethality of each isolate was evaluated using nystatin and carvacrol. The results were compared using two-way analysis of variance. Finally, the minimum inhibitory concentration (MIC) of nystatin and carvacrol was calculated individually and in combination. Results: The present study found that Candida albicans and non-albicans species were equally prevalent. Carvacrol showed significant biological activity against all Candida species, with an average MTT of 50.01%. The average MIC value of carvacrol was 24.96 µg/ml, indicating its potential to inhibit Candida growth. The mean Minimum Fungicidal Concentration (MFC) value of carvacrol was 23.48 µg/ml, suggesting its effectiveness in killing the fungi. Conclusion: The study's findings reveal that the MIC of carvacrol was significantly lower than that of nystatin and the combination of nystatin and carvacrol. This suggests that carvacrol holds potential as an effective herbal remedy for candidiasis. [ABSTRACT FROM AUTHOR]

Background: Candida species, commonly present in the human body, can result in severe infections. Non-albicans Candida (NAC) species, with increasing antifungal resistance, pose a growing concern. Aims and Objectives: This study aims to evaluate candidiasis prevalence and antifungal susceptibility in isolated Candida species among suspected patients at tertiary care hospitals in Butwal, emphasizing early identification and appropriate treatment to avoid unnecessary use of toxic antifungal drugs. Materials and Methods: In a descriptive study on 303 patients with clinical symptoms of Candida infections, specimens underwent direct microscopic examination and culture on Sabouraud dextrose agar. Species identification involved phenotypic methods such as chromogenic character on CHROMagar Candida media, germ tube examination, and microscopic characteristics. Subsequently, isolated species were tested for antifungal susceptibility using the disc diffusion method. Results: Among the 303 samples tested, 80 (26.4%) were positive for candidal infection. NAC species were the most commonly isolated, with Candida albicans and Candida krusei being the most virulent. The isolates exhibited the highest sensitivity to fluconazole (77.5%) followed by itraconazole (75%), whereas amphotericin B showed the lowest effectiveness with 63.75% resistance. Conclusion: The rising prevalence of NAC species, particularly their growing resistance to Amphotericin B, has become a significant concern, as these species are frequently detected in various clinical samples. These findings underscore the importance of diligent monitoring and judicious selection of antifungal agents to ensure effective treatment strategies. [ABSTRACT FROM AUTHOR]

This article explores the treatment options for cutaneous infestations, a condition characterized by symptoms such as itching, burning, and the presence of dots or fibers on the skin. While the cause of the infestation is unknown, the article highlights the use of older psychiatric medications, like aripiprazole and trifluoperazine, as effective antimicrobials. The article also mentions that prescribed stimulants and cocaine may interfere with the effectiveness of the treatment. The authors stress the importance of taking these patients and their condition seriously and recommend involving mental health providers for emotional support. Additionally, the article discusses the potential use of phenothiazine derivatives, commonly used as antipsychotic drugs, for their antimicrobial and antiviral properties. These compounds have shown inhibitory effects on bacterial and viral infections, including antibiotic-resistant bacteria and SARS-CoV-2. However, more research is needed to fully understand their mechanisms of action and evaluate their efficacy in clinical settings. [Extracted from the article]

Background: Oral thrush is the most common occurring fungal infection in the oral cavity in uncontrolled diabetic patients, it is treated by various antifungal drugs according to each case. This study aimed to evaluate the therapeutic effects of topical application of miconazole and miconazole-loaded chitosan nanoparticles in treatment of diabetic patients with oral candidiasis. Methods: In this randomized controlled clinical trial. A total of 80 diabetic patients presenting with symptomatic oral candidiasis were randomly assigned into two treatment groups: miconazole and miconazole-loaded chitosan nanoparticles. The patients were treated for 28 days, and clinical assessments were conducted at baseline, 7, 14, 21 and 28 days. Clinical parameters, including signs and symptoms of oral candidiasis were evaluated and microbiological analysis was performed to determine the Candida species and assess their susceptibility to the antifungal agents. Statistical analysis was done to the categorical and numerical data using chi-square test and Kruskal Wallis test. Results: The antifungal efficacy between the miconazole and miconazole-loaded chitosan nanoparticles (CS-MCZ) groups insignificant difference (P > 0.05) was observed. Both treatment modalities exhibited comparable effectiveness in controlling oral candidiasis symptoms and reducing Candida colonization as miconazole-loaded chitosan nanoparticles group showed a significant difference in the clinical improvement in respect of both signs and symptoms from baseline (70%) until the end of study at 28 days (5%) (P < 0.05) Moreover, miconazole-loaded chitosan nanoparticles, there was a significant reduction in the number of colonies forming units of Candida albicans from baseline until the end of the study at 28-day with P value < 0.000. Conclusions: This randomized controlled clinical trial and microbiological analysis demonstrate that both miconazole and miconazole-loaded chitosan nanoparticles are effective in the treatment of oral candidiasis in diabetic patients with no adverse reactions. Trial registration: NCT06072716 with first registration first registration in 10/10/2023. [ABSTRACT FROM AUTHOR]

The aim of the present study was to characterize biofilms formed by Candida spp. clinical isolates (n = 19), isolated from the oral mucosa of HIV-positive patients. For characterizing the biofilms formed by several Candida sp. strains, isolated from HIV-positive patients, in terms of formed biomass, matrix composition and antifungal susceptibility profile, clinical isolates (n = 19) were collected from oral mucosa and identified. The biofilm of the samples was cultured with fluconazole (1250 mg/L), voriconazole (800 mg/L), anidulafungin (2 mg/L) or amphotericin B (2 mg/L). Afterwards, the quantification of the total biomass was performed using crystal violet assay, while the proteins and carbohydrates levels were quantified in the matrix. The results showed a predominance of C. albicans, followed by C. krusei. Around 58% of the Candida spp. biofilm had susceptibility to fluconazole and voriconazole (800 mg/L), 53% to anidulafungin and 74% to amphotericin B. C. krusei presented both the lowest and the highest biofilm matrix contents in polysaccharides and proteins. The low resistance to antifungal agents reported here was probably due to the fact that none of the participants had a prolonged exposure to these antifungals. A predominance of less virulent Candida spp. strains with low or no resistance to antifungals was observed. This can be attributed to a low fungal selective pressure. This most probably happened due to a low fungal selective pressure but also due to a good adherence to HAART therapy, which guarantees a stable and stronger immune patient response. [ABSTRACT FROM AUTHOR]

Background: Photodynamic therapy (PDT) has been recently proposed as a promising alternative therapy for Denture Stomatitis (DS). The present systematic review and meta-analysis investigated the current available evidence regarding the efficacy of PDT in the management of DS. Materials and methods: PubMed, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 7, 2023. All relevant clinical trials were included. RevMan software was used for the statistical analyses. Results: Elven randomized clinical trials (460 DS patients) were included. Eight studies assessed the efficacy of PDT vs. topical antifungal therapy, while three studies assessed the adjunctive use of PDT (PDT + antifungal therapy) vs. topical antifungal therapy alone. The results revealed comparable efficacy of PDT and conventional antifungal therapy on candida colonization at 15 days (MD: 0.95, 95% CI: -0.28, 2.19, p = 0.13) and at the end of follow-up (MD: -0.17, 95% CI: -1.33, 0.98, p = 0.77). The pooled two studies revealed relatively better efficacy of adjunctive use of PDT with antifungal therapy on candida colonization compared to antifungal therapy alone at 15 days (MD: -6.67, 95% CI: -15.15, 1.82, p = 0.12), and at the end of follow-up (MD: -7.14, 95% CI: -19.78, 5.50, p = 0.27). Additionally, the results revealed comparable efficacy of PDT and topical antifungal therapy on the clinical outcomes. Conclusions: PDT might be considered a viable option for DS either as an adjunct or as an alternative to the topical antifungal medications. Further studies with adequate sample sizes and standardized PDT parameters are warranted. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Oral candidiasis is one of the most common fungal opportunistic infections in the mouth caused by a fungus called Candida, and it presents as commensals in all humans. Over the last few decades, the increasing incidence of Candida infections parallels the growing numbers of immunocompromised patients. This trend is aggravated by the fact that there is a reckless use of antifungals. To combat this trend, the use of natural antifungals which have fewer side effects is recommended. Black grape seed extract (GSE) has shown a promise in this regard. Materials and Methods: Candida species such as Candida krusei, Candida glabrata, Candida tropicalis, and Candida albicans were used in the study. Fungal strains were passaged in the agar Sabouraud dextrose environment from 24 h to have live and fresh strains for the test. Black GSE was obtained. Minimum inhibitory concentration (MIC), of GSE, amphotericin B and fluconazole drugs on the included fungi was examined using disc diffusion method. Then, the plates were incubated for 24 h at 37°C. Finally, growth inhibitory zone was examined. Results: The analysis of the results revealed that the growth of C. albicans and C. krusei had been stopped at the concentration of 6.25 μg/mL, but the growth of C. glabrata and C. tropicalis was inhibited at a concentration of 12.25 μg/mL and 0.8 μg/mL respectively. Conclusion: The results obtained from the present study showed that both disc diffusion method and the maximum inhibitory concentration of MIC (Macro dilution) confirms the antimicrobial susceptibility of four species of candida to GSE. We conclude the possibility of GSE as an effective alternative measure for commercial antifungal agents, especially among immunocompromised patients, However, more laboratory and clinical studies need to be conducted to validate our findings. [ABSTRACT FROM AUTHOR]

Background: Vulvovaginal candidiasis (VVC), one of the commonest fungal infections in women of reproductive age group, can become recurrent if not managed appropriately. Recently, production of biofilm, which reduces the susceptibility to anti-fungal agents, has also been implicated in its pathogenesis. Hence, the study was planned to determine the prevalence of VVC in cases of vulvovaginitis, identify the pre-dominant candida species, find out their antifungal susceptibility pattern and to detect biofilm production in the candida isolates. Methods: In this cross-sectional study, all isolates were identified and confirmed by various basic microbiological methods followed by the VITEK-2 system. Biofilm formation was detected by Congo red agar method and Tube method. Descriptive statistical methods were used to evaluate the data collected. Results: Out of total 25 patients, 7 were positive with VVC out of which 2 cases were caused by C.albicans and 5 by Candida Non Albicans (3 by C.glabrata and 2 by C.tropicalis). As compared to NAC, C. albicans is still partially sensitive to fluconazole. Fortunately, both C. albicans and C. tropicalis are still 100% sensitive to voriconazole although resistance has developed partially in C. glabrata. Biofilm production was observed in 3 cases. Conclusion: Majority of cases of VVC were due to NAC predominantly C. glabrata which has grave therapeutic implications as they show decreased susceptibility to all antifungals. Voriconazole is still effective but needs to be used rationally to avoid developing resistance to it also. The evidence of biofilm production could be an important contributor towards increased incidence of antifungal drug resistance. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the antifungal and antioxidant activities of Chamaecyparis obtusa (C. obtusa) extract (COE) against Candida albicans (C. albicans). Methods: The antioxidant activity was determined using three methods based on 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) scavenging, total polyphenol measurement, and total flavonoid measurement. In addition, the survival rate of human keratinocytes (HaCaT) was checked to confirm their stability. A one-way ANOVA also confirmed the antifungal activity of COE against C. albicans and its proliferative effect on HaCaT cells. In addition, to confirm the difference between each group, the Tukey HSD test was performed as a post hoc analysis, and the significance level was set at 0.05 as a two-tailed test. Results: COE was found to contain 424.150 mg GAE/g of polyphenols, 127.566 mg CE/g of flavonoids, and 83.594% of radical scavenging activity. Furthermore, 30 mg/mL of this extract exhibited complete antifungal activity. In addition, a noticeable killing effect on C. albicans was observed as the concentration of the extract increased. For instance, at a 2.5 mg/mL dosage of COE, HaCaT cells were safe, but C. albicans showed a distinct antifungal effect. Conclusions: COE has antioxidant and antifungal activity, so it has a high potential as an effective natural antifungal agent. Therefore, oral gargle containing COE is expected to be a safe and effective treatment in oral candidiasis in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Oral candidiasis is an infection that follows colonization of oral cavity by Candida species mostly Candida albicans. About 90% of HIV-infected persons develop this disease during the course of HIV infection and could serve as early sign of HIV-related immunodeficiency. Treatment involves the use of antifungal drugs. The objectives of this study are to determine the prevalence of oral candidiasis and the susceptibility of isolated Candida species to available antifungal agents among selected HIV-infected patients in a mission hospital, southeast Nigeria. Methodology: This was a descriptive cross-sectional study of 150 consecutively selected HIV-infected patients attending the Heart-to-Heart clinic of Iyi-Enu mission hospital Ogidi, Anambra State, Nigeria, between December 2022 and February 2023. Demographic information of each participant was obtained using structured questionnaire. Five milliliters of whole blood were drawn from the antecubital vein of each participant for CD4+ estimation. Mouth specimens were collected using two sterile cotton swabs for microscopy and culture on Sabouraud Dextrose Agar, and Candida species were identified after subculture on CHROMAgar. Antifungal susceptibility testing was performed by Kirby-Bauer disk diffusion method using fluconazole, clotrimazole, ketoconazole, and nystatin disks, and results interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. Results: A total of 98 (65.3%) HIV-infected participants were positive for oral candidiasis, with 4 species of Candida isolated; Candida albicans (62.2%), Candida glabrata (18.4%), Candida tropicalis (12.2%) and Candida krusei (7.1%). Fifty-nine (60.2%) of the 98 participants had CD4+ cell count ˂ 200, 33 (33.7%) had counts in the range of 200-399, and 6 (6.1%) had counts in the range of 400-499 cells/µL (p=0.001). The prevalence of candidiasis was not significantly different between the female (67.0%, 65/97) and male (62.3%, 33/53) participants (p=0.6598), but the prevalence was significantly higher (p<0.05) in participants age group 21-30 years (80.7%, 42/52), divorced (100%, 1/1) and married (75%, 45/60), those with primary school level education (73.7%, 42/57), civil servants (85.7%, 18/21), and those who performed mouth hygiene once daily (71.9%, 69/96). Nystatin (77.6%, 76/98) showed the highest while fluconazole and ketoconazole (68.4%, 62/98) showed the lowest in vitro antifungal activity Conclusion: Oral candidiasis is prevalent among HIV-infected patients in the study population, with evidence of in vitro resistance of the Candida isolates to available antifungal drugs. Proper diagnosis, susceptibility testing and treatment of infection will be helpful in managing oral candidiasis infection among HIV infected patients. [ABSTRACT FROM AUTHOR]

Introduction: Candida albicans (C. albicans) is the most common fungus found in the human oral cavity. This fungus has the ability to form a biofilm that causes infectious diseases in the oral cavity. Nowadays, the incidence of infectious diseases caused by C.albicans was increasing due to resistance to antifungal drugs. This study aimed to investigate the effect of Moringa oleifera ethyl acetate extract on the inhibition of C. albicans planktonic cell growth and biofilm formation in vitro. Methods: C. albicans (ATCC 10231) was the fungus used in this study. Determination of inhibition planktonic cell growth by microdilution method. The polystyrene microplate assay method was used to test the inhibition of C. albicans biofilm formation. The extract concentrations used in this study were 25%, 12.5%, 6.25%, 3.13%, and 1.57%, respectively. A crystal violet (CV) assay assessed the biofilm's inhibitory activity. Results: The minimal inhibitory concentration of Moringa oleifera leaf ethyl acetate extract against the planktonic form of C.albicans was found to be 1.57%. Starting at 6.25% concentration, Moringa leaf ethyl acetate extract inhibits the formation of C. albicans biofilm. Conclusion: Since Moringa oleifera leaf ethyl acetate extract inhibits C. albicans planktonic and biofilm formation, it has the potential to be developed as an alternative anti-fungal agent. [ABSTRACT FROM AUTHOR]

Copyright of Iraqi Journal of Laser is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chenopodium murale (Syn. Chenopodiastrum murale) (amaranthaceae) is used in the rural Egypt to treat oral ulcers in newborn children. The current study aimed to discover new natural products suitable for treating candidiasis disease with minimal side effects. Characterization of bioactive compounds by LC-QTOF-HR-MS/MS from Chenopodium murale fresh leaves' juice (CMJ) was carried out in order to elucidate their potential anti-fungal and immunomodulatory effects in oral candidiasis in immunosuppressed rats. An oral ulcer candidiasis model was created in three stages: (i) immunosuppression by drinking dexamethasone (0.5 mg/L) for two weeks; (ii) Candida albicans infection (3.00 × 106 viable cell/mL) for one week; and (iii) treatment with CMJ (0.5 and 1.0 g/kg orally) or nystatin (1,000,000 U/L orally) for one week. Two doses of CMJ exhibited antifungal effects, for example, through a significant reduction in CFU/Petri (236.67 ± 37.86 and 4.33 ± 0.58 CFU/Petri), compared to the Candida control (5.86 × 104 ± 1.21 CFU/Petri), p ≤ 0.001. In addition, CMJ significantly induced neutrophil production (32.92% ± 1.29 and 35.68% ± 1.77) compared to the Candida control level of 26.50% ± 2.44. An immunomodulatory effect of CMJ at two doses appeared, with a considerable elevation in INF-γ (103.88 and 115.91%), IL-2 (143.50, 182.33%), and IL-17 (83.97 and 141.95% Pg/mL) compared with the Candida group. LC-MS/MS analysis operated in negative mode was used for tentative identification of secondary (SM) metabolites based on their retention times and fragment ions. A total of 42 phytoconstituents were tentatively identified. Finally, CMJ exhibited a potent antifungal effect. CMJ fought Candida through four strategies: (i) promotion of classical phagocytosis of neutrophils; (ii) activation of T cells that activate IFN-γ, IL-2, and IL-17; (iii) increasing the production of cytotoxic NO and H2O2 that can kill Candida; and (iv) activation of SOD, which converts superoxide to antimicrobial materials. These activities could be due to its active constituents, which are documented as anti-fungal, or due to its richness in flavonoids, especially the active compounds of kaempferol glycosides and aglycone, which have been documented as antifungal. After repetition on another type of small experimental animal, their offspring, and an experimental large animal, this study may lead to clinical trials. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the impact of Nystatin oral rinse on salivary and supragingival microbiota in adults with oral candidiasis and identify predictive factors related to individuals' responses to Nystatin. The trial involved twenty participants who used 600,000 International Units/application of Nystatin oral rinse for seven days, four times a day, and were followed up at one week and three months after the rinse. The salivary and plaque microbiome of the participants were assessed via 16S rDNA amplicon sequencing. Overall, salivary and plaque microbiomes remained stable. However, among the participants (53 percent) who responded to Nystatin rinse (defined as free of oral Candida albicans post treatment), Veillonella emerged as a core genus alongside Streptococcus and Actinomyces in supragingival plaque at the 3-month follow-up. Furthermore, statistical models were fit to identify predictive factors of Nystatin rinse success (elimination of C. albicans) or failure (remaining C. albicans). The results revealed that an increased level of salivary Interferon (IFN)-γ-inducible protein (IP-10), also known as C-X-C motif chemokine ligand 10 (CXCL10), was an indicator of a failure of responding to Nystatin rinse. Future clinical trials are warranted to comprehensively assess the impact of antifungal treatment on the oral flora. [ABSTRACT FROM AUTHOR]

Candida species are considered the most common opportunistic human fungal pathogen due to the presence of various virulence factors, including its ability to form a biofilm that aids in oral candidiasis. Pediatric patients are more susceptible to oral candidiasis than healthy pediatric because of the factors that encourage Candida oral carriage. This current study aims to isolate, evaluated the antifungal effect on Candida spp. and participated in oral candidiasis of pediatric patients in Sulaymaniyah and Kirkuk city. The study was performed from September 2021 to February 2022 on two groups of pediatrics which including pediatric patients (n=160) and healthy pediatric (n=50) as a control group. Oral swabs were obtained from 210 participants in the Kurdistan Region of Iraq at the Pediatric teaching hospital of the Sulaymaniyah and Kirkuk governorates. To culture the swabs, Sabouraud dextrose agar (SDA) medium was used. HiCrome™ Candida Differential agar used to identify Candida isolated, then depending on the internal transcribed spacer (ITS) region using confirmed polymerase chain reaction. Antifungal sensitivity was done for all C. albicans and non)albicans isolates using five common antifungal disks. Among of the 160 sample of pediatric patient 62 (38.8%) positive for Candida spp. which it is including 17 (27.4 %) and 26 (41.9%), 19 (30.6%) breast feeding, bottle feeding and mixing respectively. While within 50 samples of control group 13 (26%) were positive for Candida spp. which including 2 (15.4%), 9(69.2%), 2(15.4%) of same respectively feeding types. Regarding to the antifungal susceptibility the results showed that C. albicans had higher resistance rates against itraconazole, ketoconazole, and clotrimazole than the non-albicans Candida species However, highly resistant rate were detected in Itraconazole and Ketoconazole with 23.7% and 54.4% respectively, for all Candida species. The Current study concluded that oral candidiasis was more predominant in pediatric patients in compare to healthy pediatric also, and C. albicans is the most prevalent etiologic agent. However, higher rate of sensitivity were detected between Candida species for nystatin, which may suggest as the main treatment for oral Candida infections. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease undergoing hemodialysis are often colonized by Candida species with high possibility of fungal infections. The purposes of this study were to determine the prevalence of Candida species, evaluate antifungal susceptibility profile, biofilm formation, proteinase and phospholipase activities, and the frequency of virulence genes in the Candida species isolated from the oral mucosa of hemodialysis diabetic (DM) and non-diabetic (non-DM) patients. Methods: This study identified several species of Candida isolated from 69 DM and 58 non-DM patients on hemodialysis using phenotypic methods and PCR–RFLP technique. The identification of C. albicans and C. glabrata complex was performed by HWP1 gene and four oligonucleotides (UNI-5.8S, GLA-f, BRA-f, and NIV-f), respectively. Antifungal susceptibility to amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin was assessed according to CLSI M27-A3/S4. The biomass, metabolic activity of biofilm, proteinase (Prz), phospholipase (Pz), and molecular study for virulence genes were assessed using crystal violet, XTT assay, agar-based hydrolytic enzyme, and PCR technique, respectively. Results: Candida prevalence was 44.9% with 47.8% and 41.4% among DM and non-DM patients, respectively (P =.045). The species identified were C. albicans (49.5%), C. glabrata (16.5%), C. tropicalis (12%), C. kefyr (8.8%), C. parapsilosis (6.6%), C. dubliniensis (3.3%), and C. lusitaniae (3.3%). The antifungal susceptibility profile showed that all Candida isolates were sensitive to amphotericin B, itraconazole, voriconazole, and caspofungin whereas fluconazole resistance was observed in 6.3% (MIC ≥ 64 μg/mL) of C. albicans and 6.6% of C. glabrata (MIC ≥ 64 μg/mL). The susceptible- dose-dependent rate was found in 10.5% of C. albicans. The Prz values of C. albicans ranged from 0.37 to 0.66 for the DM and 0.44–0.73 for the non-DM group (P < 0.05). The non-albicans Candida (NAC) species produced higher degree of biomass and metabolic activity compared to C. albicans (P < 0.05). Furthermore, significant (p < 0.05) correlations were detected between the biofilm formation with Prz values and fluconazole MICs. The most detected virulence factors were ALS3 and Sap5. Conclusions: These results showed the importance of prevalence of NAC species in hemodialysis patients. Investigating antifungal susceptibility profile made a better understanding of the role of virulence markers in the pathogenesis of Candida strains. [ABSTRACT FROM AUTHOR]

The incidence of superficial infections, including oral candidiasis, has recently increased significantly. Their treatment is quite difficult due to the growing resistance of Candida spp. to antifungal agents. Therefore, it is necessary to search for novel antimycotics or alternative antifungal therapies. The purpose of the study was to evaluate the antifungal activity of natural terpene—linalool (LIN)—against both reference fungi belonging to yeasts and Candida spp. isolates from the oral cavities of immunocompromised, hemato-oncology patients. Moreover, its mechanism of action and interactions with selected antifungal drugs or antiseptics were investigated. The broth microdilution technique, ergosterol or sorbitol tests, and a checkerboard method were used for individual studies. The LIN showed potential activity toward studied strains of fungi with a minimal inhibitory concentration (MIC) in the range of 0.5–8 mg/mL and fungicidal effect. This compound was also found to bind to ergosterol in the yeast cell membrane. Additionally, the interactions between LIN with antiseptics such as chlorhexidine, cetylpyridinium, and triclosan showed beneficial synergistic effect (with FIC = 0.3125–0.375), or an additive effect with silver nitrate and chlorquinaldol (FIC = 0.625–1). Moreover, statistically significant differences in MIC values were found for the synergistic combinations of LIN. No interaction was indicated for nystatin. These results confirm that the LIN seems to be a promising plant component used alone or in combination with other antimycotics in the prevention and treatment of superficial fungal infections. However, further clinical trials are required. [ABSTRACT FROM AUTHOR]

Background: Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity. Methods: An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014–2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied. Results: Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2–3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin. Conclusion: C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer. Trail registration: The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014. [ABSTRACT FROM AUTHOR]

Oral candidiasis (OC) is an opportunistic fungal infection of the oral mucosae, sustained by Candida albicans or other non-albican Candida species (NAC), usually eradicated by conventional antifungals of the classes of azoles, polyenes, or derivative from echinocandins. OC usually occurs under predisposing local or systemic factors. C. lusitaniae is an opportunistic strain that is rarely responsible for human infection and occurs mainly in severe immunocompromised states. The present work reported an unconventional case of OC in an otherwise healthy immunocompetent woman sustained by C. lusitaniae and a multi-resistant strain of C. albicans. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance related to the misuse of antibiotics is a well-known current topic. Their excessive use in several fields has led to enormous selective pressure on pathogenic and commensal bacteria, driving the evolution of antimicrobial resistance genes with severe impacts on human health. Among all the possible strategies, a viable one could be the development of medical features that employ essential oils (EOs), complex natural mixtures extracted from different plant organs, rich in organic compounds showing, among others, antiseptic properties. In this work, green extracted essential oil of Thymus vulgaris was included in cyclic oligosaccharides cyclodextrins (CD) and prepared in the form of tablets. This essential oil has been shown to have a strong transversal efficacy both as an antifungal and as an antibacterial agent. Its inclusion allows its effective use because an extension of the exposure time to the active compounds is obtained and, therefore, a more marked efficacy, especially against biofilm-producing microorganisms such as P. aeruginosa and S. aureus, was registered. The efficacy of the tablet against candidiasis opens their possible use as a chewable tablet against oral candidiasis and as a vaginal tablet against vaginal candidiasis. Moreover, the registered wide efficacy is even more positive since the proposed approach can be defined as effective, safe, and green. In fact, the natural mixture of the essential oil is produced by the steam current method; therefore, the manufacturer employs substances that are not harmful, with very low production and management costs. [ABSTRACT FROM AUTHOR]

Oryza punctata is an annual grass in the rice genus Oryza also known as red rice. Phyllostachysbambusoides (Bamboo Rice) have antifungal properties, primarily due to compounds found in bamboo shoots. Bamboo shoots contain various bioactive compounds, including phenolic compounds and flavonoids, that are known to possess antimicrobial and antifungal properties. [ABSTRACT FROM AUTHOR]

Background: Topical infectious are among of global challenges which propelled up with antimicrobial resistances. This scenario compels for drug discovery and development. Herbal formulation is one of important struggle in the drug development with the purpose of overcoming various diseases distressing health care settings. Thus, this study aimed to formulate and evaluate herbal cream from leaf methanolic extracts of Tephrosia vogelii Hook.f for topical therapies. Methods: Herbal cream was prepared by homogeneously mixing up cream base and methanolic leaf extracts of Tephrosia vogelii. Physicochemical properties and in vitro antimicrobial activities of the cream were evaluated. The stability, colour change, washability and texture were parameters used evaluate physicochemical properties of cream. Disc diffusion method was employed to evaluate antimicrobial activities of the cream against Candida albicans (ATCC 90,028), Escherichia coli (ATCC29953) and Staphylococcus aureus (ATCC25923). Results: Formulated herbal creams; CBTV1, CBTV2 and CBTV3 with methanolic extracts concentrations content of Tephrosia vogelii 0.05%, 0.10% and 0.25%, respectively, were prepared. All cream formulations were stable, washable by water, green in colour and soft. The CBTV3 product exhibited with high prominent antimicrobial activity compared to the rest, henceforth promisingly to be effective for topical skin therapy. Conclusion: The herbal cream formulation of methanolic leaf extract of Tephrosia vogelii at 0.25% appeared to have more antimicrobial performance. Therefore, it is considered as minimal concentration for the herbal cream formulation in future for clinical trials as a potential antifungal and antibacterial agent product for treatment of skin infections. [ABSTRACT FROM AUTHOR]

Fungal infection is a serious health problem, involved with the life threatening mycosis and mortality. Emerging of resistance and limited antifungal drugs against most antifungal agents lead to the requirement for development of effective and alternate strategies to fight fungal infections. The aim of this study is to investigate the antifungal activity of clove oil extract against systemic induced infection In vivo by Candida albicans in mice. Fifty mice were used to induce systemic infection by injecting 1 ml of 1×106 C.albicans suspension intra-peritoneally for seven days consecutive, then sacrificed to observe the incidence of infection in internal organs (gross lesion) and measure the level of IL-6 and serum creatinine plus histopathological changes. The development of systemic infection with C. albicans (1 × 106 cells) was observed daily for 14 days which was accompanied with clinical signs of infection, including weight loss, depression, and ruffled appearance. IL-6 level showed no significant difference in all group before treatment and after inducing infection the level of IL-6 showed significant increase (P=0.01) in control positive group while group treated with clove oil 5 mg/kg and 10 mg/kg showed significant decrease in the level compared with infected group and fluconazole treated group. Serum creatinine concentration was within the normal values in all groups (p>0.01) before the infection. There were an increase significantly (P=0.01) in the level in all infected mice after 7 days of infection. The serum creatinine values of treated group with clove oil extract 5 mg/kg and 10 mg/kg showed decreased in the creatinine concentration. The present results demonstrated that the essential oil of clove extract rich with eugenol has great antifungal power. This extract can be suggested as antimicrobial and antifungal to treat candidemia and reduce the incidence of mortality rate due to systemic candidiasis. [ABSTRACT FROM AUTHOR]

Candida albicans is the fungus responsible for oral candidiasis, a prevalent disease. The development of antifungal-based delivery systems has always been a major challenge for researchers. This study was designed to develop a nanostructured lipid carrier (NLC) of sesame oil (SO) loaded with miconazole (MZ) that could overcome the solubility problems of MZ and enhance its antifungal activity against oral candidiasis. In the formulation of this study, SO was used as a component of a liquid lipid that showed an improved antifungal effect of MZ. An optimized MZ-loaded NLC of SO (MZ-SO NLC) was used, based on a central composite design-based experimental design; the particle size, dissolution efficiency, and inhibition zone against oral candidiasis were chosen as dependent variables. A software analysis provided an optimized MZ-SO NLC with a particle size of 92 nm, dissolution efficiency of 88%, and inhibition zone of 29 mm. Concurrently, the ex vivo permeation rate of the sheep buccal mucosa was shown to be significantly (p<.05) higher for MZ-SO NLC (1472 mg/cm2) as compared with a marketed MZ formulation (1215 mg/cm2) and an aqueous MZ suspension (470 mg/cm2). Additionally, an in vivo efficacy study in terms of the ulcer index against C. albicans found a superior result for the optimized MZ-SO NLC (0.5 ± 0.50) in a treated group of animals. Hence, it can be concluded that MZ, through an optimized NLC of SO, can treat candidiasis effectively by inhibiting the growth of C. albicans. [ABSTRACT FROM AUTHOR]

Candida albicans is a common commensal fungus and fourth most frequent causative agent of nosocomial infections including life-threatening invasive candidiasis in humans. The effectiveness of present antifungal therapies using azoles, polyenes, flucytosine and echinocandins has plateaued in managing fungal infections. The limitations of these antifungal drugs are related to polymorphic morphology, biofilm formation, emergence of drug-resistant strains and production of several virulence factors. Development of new antifungal agents, which can particularly afflict multiple cellular targets and limiting evolving resistant strains are needed. Recently, metal nanoparticles have emerged as a source of new antifungal agents for antifungal formulations. Furthermore, green nanotechnology deals with the use of biosynthetic routes that offer new avenue for synthesizing antifungal nanoparticles coupled with less toxic chemical inventory and environmental sustainability. This article reviews the recent developments on C. albicans pathogenesis, biofilm formation, drug resistance, mode of action of antifungal drugs and antifungal activities of metal nanoparticles. The antifungal efficacy and mode of action of metal nanoparticles are described in the context of prospective therapeutic applications. [Display omitted] • Biofilm formation and resistance to antifungals pose challenges to treat Candida albicans infections. • Emerging antifungal resistance warrant urgent need for alternate treatment strategies. • The challenges faced in antifungal therapies were discussed in this review. • Potential use of biogenic metal nanoparticles for controlling C. albicans infections were discussed. [ABSTRACT FROM AUTHOR]

Keywords: nystatin; oral candidiasis; denture stomatitis; systematic review; meta-analysis; photodynamic therapy; treatment duration EN nystatin oral candidiasis denture stomatitis systematic review meta-analysis photodynamic therapy treatment duration 1677 16 11/17/22 20221101 NES 221101 1. Like the present study, even in the systematic review conducted by Lyu et al. [[25]], it was found that nystatin was superior to placebo in treating denture stomatitis, but in infants and immunocompromised patients fluconazole was more effective than nystatin suspension for oral candidiasis. The clinical practice guidelines for the management of oral candidiasis were given by the Infectious Diseases Society of America recommending the usage of nystatin suspension having a concentration of 100,000 IU/mL with a dosage of 4-6 mL four times a day or one to two nystatin pastilles (200,000 IU) to be given four times a day for one to two weeks for mild oral/oropharyngeal candidiasis [[57]]. Combinations of various keywords like "oral candidiasis" OR "oral candidosis" OR "oropharyngeal candidiasis" OR "candidal stomatitis" AND "nystatin" OR "antifungal agents" OR "polyenes" were used to extract all pertinent studies. [Extracted from the article]

Fungal infections are one of the main causes of mortality and morbidity worldwide and taking into account the increasing incidence of strains resistant to classical antifungal drugs, the development of new agents has become an urgent clinical need. Considering that thioxanthones are bioisosteres of xanthones with known anti-infective actions, their scaffolds were selected for this study. A small library of synthesized aminothioxanthones (1–10) was evaluated for in vitro antifungal activity against Candida albicans, Aspergillus fumigatus, and Trichophyton rubrum; for the active compounds, the spectrum was further extended to other clinically relevant pathogenic fungi. The results showed that only compounds 1, 8, and 9 exhibited inhibitory and broad-spectrum antifungal effects. Given the greater antifungal potential presented, compound 1 was the subject of further investigations to study its anti-virulence activity and in an attempt to elucidate its mechanism of action; compound 1 seems to act predominantly on the cellular membrane of C. albicans ATCC 10231, altering its structural integrity, without binding to ergosterol, while inhibiting two important virulence factors—dimorphic transition and biofilm formation—frequently associated with C. albicans pathogenicity and resistance. In conclusion, the present work proved the usefulness of thioxanthones in antifungal therapy as new models for antifungal agents. [ABSTRACT FROM AUTHOR]

Introduction: Irrational antifungals prescription results in inappropriate use of antifungals, leading to emergence of antifungal resistance. Aim: To determine the prescription patterns of antifungal agents in gynaecology and oncology departments of the tertiary hospital in Tanzania. Materials and Methods: This was a retrospective hospital-based study involving files of patients who attended gynaecology and oncology department of Bugando Medical Centre between January 2017 and December 2017. All files of patients with fungal infections were analysed. Checklist was used to collect information such as clinical diagnosis, age, name of antifungal, number of antifungals, dosage form and dose frequency. Descriptive analysis was done using STATA version 13.0. Results: A total of 1,070 files of patients who attended gynaecology and oncology departments in the year 2017 were retrieved, of which 860 (80.4%) were from patients who attended gynaecology department. A total of 156 (14.6%) files out of 1,070 were of patients with fungal infections. Of the patients from gynaecology 116 (n=860, 13.48%) had fungal infection. While of the patients from oncology 40 (n=210, 19.1%) had fungal infection. The most common fungal infection diagnosed were vaginal candidiasis 112 (96.6%) and oral candidiasis 33 (82.5%) from gynaecology and oncology department, respectively. Common antifungal prescribed were azoles (clotrimazole 56.9% in gynaecology and fluconazole 37.5% in oncology). The prevalence of irrational antifungal prescription in gynaecology and oncology departments was 22.4% (26/116) and 20% (8/40), respectively. Conclusion: About one in five antifungal prescriptions for vaginal candidiasis in gynaecology and oral candidiasis in oncology are irrational as evidenced in standard treatment guideline. Clinicians should adhere to the national standard treatment guidelines in order to reduce irrational prescriptions of antifungal agents. [ABSTRACT FROM AUTHOR]

Objective: Oral candidiasis is an opportunistic fungal infection in the oral cavity caused by an overgrowth of Candida species, especially Candida albicans. Various herbal agents have been designed to target Candida albicans. The aim of this study was to evaluate the antifungal activity of Jaftex mouthwash and nystatin suspension on the growth of Candida albicans. Methods and materials: In the present in vitro study, a standard strain of Candida albicans was prepared in the form of lyophilized ampoules. Jaftex mouthwash was prepared with an active ingredient (10 g per 100 cc) of aqueous extract of oak fruit hull (Jaft), Zataria multiflora and Satureja bachtiarica. Nystatin oral suspension (100,000 IU/mL) was also prepared. Both mouthwashes were serially diluted using the two-fold serial dilution method (Jaftex: eight-fold dilutions; nystatin suspension: nine-fold dilutions). A volume of 10 µL of each dilution of Jaftex mouthwash and nystatin suspension was placed on the discs that were linearly inoculated on culture medium and stored in an incubator for 24 hours at 37 °C. The minimum inhibitory concentration (MIC) of the two antifungal agents was determined using the modified E-test. Data were analyzed using SPSS Version 26.0. A p-value less than 0.05 was considered statistically significant. Results: The mean MIC values of Jaftex mouthwash and nystatin suspension were 0.0625 (mg/mL) and 0.0015 (mg/mL), respectively. There was a significant difference between the antifungal effect of Jaftex mouthwash and nystatin suspension on the growth of Candida albicans. Nystatin showed the lowest MIC and greater antifungal activity compared with Jaftex mouthwash. Conclusion: Nystatin increasingly suppressed the growth of Candida albicans. Jaftex mouthwash inhibited the growth of Candida albicans. Since nystatin may show allergic reactions, Jaftex mouthwash can be used as an alternative to nystatin. Due to the synergistic effect of nystatin with thymol, Jaftex mouthwash can be prescribed with nystatin. [ABSTRACT FROM AUTHOR]

Purpose: Systemic immune activation has been recently linked to chronic inflammatory disorders of the oral cavity, particularly to periodontitis. The purpose of this study was to determine whether treatment of a fungus-induced oral inflammation, namely denture-related stomatitis (DRS), can affect the activation of the systemic immune response.Materials and Methods: Peripheral blood from patients with denture-related stomatitis caused by Candida albicans infection (n = 15) was collected at three time points: before treatment with nystatin, at the end of therapy and 2 months after finishing therapy. Activation of T cells and monocytes was assessed by flow cytometry.Results: The percentages of peripheral lymphocytes, T cells and their subpopulations, as well as monocytes were similar before, immediately following and two months after nystatin treatment. Cells expressing early activation marker CD69 and RANTES C-C chemokine receptor type 5 significantly increased immediately after treatment and returned to baseline levels after two months. Th17 cells, which have been implicated in the pathogenesis of DRS, remained unchanged. Central memory CD4+ subset and intermediate subset of monocytes were lower after therapy and this effect was sustained for two months.Conclusion: Treatment of denture-related stomatitis does not seem to affect the general state of the cellular components of the immune system. The results suggest a potential proinflammatory effect of the antifungal agent, nystatin. Although transient and not intense, this effect might be of particular clinical importance, because of relationships between inflammation and certain diseases. Further studies are required to clarify this aspect. [ABSTRACT FROM AUTHOR]

Oral candidiasis has a variety of symptoms and is difficult to diagnose. For example, Erythematous candidiasis is easily misdiagnosed as inflammation, and even Candida-related diseases tend to be intractable if treated without considering the involvement of Candida. Therefore, I wrote a review on oral candidiasis and treatment based on my long time clinical experience and on scientific evidence. Since Candida is a resident oral microorganism, it is difficult to completely eradicate it. However, if colonizing and invasive forms of Candida pseudohyphae are eradicated, the passing forms of yeast forms of Candida do not remain locally in the oral cavity due to the antibacterial action such as the self-cleansing action of saliva, so the symptoms are improved. The aim and goal of antifungal therapy is to eliminate Candida hyphae by antifungal agents to leave only Candida yeast. [ABSTRACT FROM AUTHOR]

The effectiveness of antifungal agents may be insufficient against resistant strains in some cases of oral candidiasis. The aim of this study was to evaluate the antifungal effect of thymoquinone against Candidaalbicans, Candidatropicalis, Candidaglabrata and Candidakrusei strains and the synergistic antifungal activity of these strains in combination with nystatin. To evaluate in vitro antifungal activity and interactions between thymoquinone and nystatin, substances were tested against Candidaalbicans ATCC 10,231, C.tropicalis ATCC 750, C.krusei ATCC 6258 and C.glabrata ATCC 2001 standard strains both individually and combinationally via microdilution method. MIC and ΣFIC index value were analysed. The Kruskal Wallis test and Bonferroni test were used for statistical evaluations. Statistical significance was set at p < 0.05. A statistically significant difference was observed between the mean ranks of all Candida species and doses of thymoquinone, nystatin, and the combination thymoquinone-nystatin (p < 0.05). MIC values for thymoquinone were determined as 15 μg/mL for C.albicans, C.tropicalis and C.krusei while it was 30 μg/mL for C.glabrata. Moreover, MIC for nystatin was found as 1.875 μg/mL for C.albicans, C.tropicalis and C.krusei, whereas it was 7.5 μg/mL in C. glabrata. Interaction assays and ΣFIC index value revealed that, TQ and nystatin have a synergistic effect against to all strains. Thymoquinone was found to have antifungal activity on Candida species and synergistic effect when combined with nystatin. [ABSTRACT FROM AUTHOR]

Objectives: Oral candidiasis is the most common oral infection that affects the oral mucosa. The most common oral thrush is caused by the fungus Candida albicans, but it can also be caused by Candida glabrata or Candida tropicalis. This study aimed to evaluate the antifungal effect of thymol-loaded chitosan nanocomposite in comparison with nystatin control drug on C. Albicans. Material and Methods: The obtained nanocomposite was characterized by scanning electron microscope (SEM), nanosizer-Zetasizer, and Fourier-transform infrared spectroscopy. Anti-Candida effects of thymol-loaded chitosan nanocomposite were assessed by evaluating the minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) using broth microdilution method, according to the modified M60 protocol on yeasts, proposed by the Clinical and Laboratory Standards Institute. Results: Based on the results of SEM analysis, thymol-loaded chitosan nanocomposite with synthesized chitosan base shows a spherical shape. According to the size of the synthesized nanoparticles, the results showed that the size of nanoparticles varies from 100 to 600 nm, while most nanoparticles were between 200 and 300 nm with an average size of 295 nm. The lowest and the best MIC and MFC were related to the combination of nanoparticles + nystatin with 0.158 and 0.208 μg/ml, respectively. The results showed that the combination of nanoparticles + nystatin in comparison with nystatin group as a controlled drug showed a significant antiCandida effect. Conclusion: The findings of the present in vitro study showed that thymol-loaded chitosan nanocomposite particularly along with nystatin showed promising antifungal effect against C. albicans as the main cause of oral candidiasis. Nevertheless, further investigations are required to elucidate the precise mechanism as well as systemic toxicity, especially in clinical settings. [ABSTRACT FROM AUTHOR]

Background and Objective: Candidiasis is one of the most common diseases in the oral cavity. Due to the side effects of chemical mouthwashes, the use of antifungal herbs has increased significantly. Therefore, this study was performed to evaluate the effect of Ginger (Vi-one) mouthwash on the growth of Candida albicans under in vitro conditions. Methods: In this experimental in vitro study, 32 special solid culture media were prepared. 15 special solid culture media containing discs and wells impregnated with ginger mouthwash (Vi-one) and 15 special solid culture media with discs and wells of nystatin extract were prepared. Moreover, two blank sterile cultures with disks and wells containing no mouthwash or extract were prepared. These plates were placed in microaerophilic conditions with the presence of carbon dioxide and were transferred to the incubator at 37°C for 48 hours. After 48 hours, the zone of inhibition was determined using standard methods. Findings: Agar well diffusion method revealed that the zone of inhibition for ginger mouthwash equaled 23.6±0.33mm and for Nystatin equaled 28.2±1.2. Agar disc diffusion method revealed that zone of inhibition for ginger mouthwash equaled 18.3±1 and for Nystatin equaled 28.3±0.1 (p<0.0001). Conclusion: Based on the results of this study, it seems that ginger mouthwash (Vi-one) compared to nystatin extract can be effective against the growth of Candida albicans under in vitro conditions. [ABSTRACT FROM AUTHOR]

Background: Oral candidiasis is an opportunistic disease caused by fungi of the Candida genus. The occurrence of Candida spp. resistance to the commercial antifungal drugs points to the search for alternative treatments. Propolis has been successfully used in the treatment of infectious diseases for centuries. It has been proposed that an ultrasound pretreatment in the propolis extraction protocol can enhance the concentrations of molecules with antimicrobial activities in the final extract. Thus, this study aimed to compare the antifungal activity against oral Candida spp. isolates of green and red propolis extracts submitted or not to an ultrasound pretreatment before the extraction procedure. Methods: Candida spp. were isolated from denture stomatitis lesions and identified by sequencing. Oral Candida spp. isolates and reference strains were submitted to broth microdilution assays using commercial antifungals and Brazilian green and red propolis extracts submitted or not to an ultrasound pretreatment. Minimal Inhibitory Concentrations (MIC) and Minimal Fungicide Concentrations (MFC) were determined and biofilm formation interference was evaluated for resistant isolates. Results: C. albicans, Candida tropicalis and Candida dubliniensis were isolated from denture stomatitis lesions. Growth inhibition was observed in all Candida isolates incubated with all green and red propolis extracts. At lower doses, red propolis extracts presented significant antifungal activity. The ultrasound pretreatment did not promote an increase in the antifungal activity of green or red propolis. Three isolates, which were highly resistant to fluconazole and itraconazole, were susceptible to low doses of red propolis extracts. These same three specimens had their biofilm formation inhibted by red propolis ethanolic extract. Conclusions: Thus, red propolis can be faced as a promising natural product to be used in the auxiliary antifungal therapy of denture stomatitis. [ABSTRACT FROM AUTHOR]

Objectives: To study the association of Candida and antifungal therapy with pro-inflammatory cytokines (PIC) in oral leukoplakia (OL). Materials and methods: A prospective observational study where immunocompetent adult subjects with OL (30 homogenous (HL), 30 non-homogenous (NHL)) and 30 age and sex-matched healthy controls (C) with no predisposing factors for oral Candida infection were recruited. Sterile cotton swabs and ophthalmic sponges were used to sample the lesion surface in OL and buccal mucosa in C, for direct microscopy and culture for Candida and to determine levels of PIC (IL-6, IL-8. IL-17, TNF-α) by ELISA, respectively. Sampling for PIC was repeated at same sites in OL, 2 weeks after antifungal therapy. Results: Candida was associated with 55.3% of NHL, 23.3% of HL and 13.3% of C. The oral secretary levels of PIC were raised in NHL as compared to HL and C. The levels of IL-6, IL-8, TNF-α (p<0.001) and IL-17 (p<0.01) were significantly raised in Candida positive NHL while IL-6 (p<0.05) and TNF-α (p<0.01) were significantly raised in Candida positive HL before antifungal treatment. After antifungal treatment, there was significant reduction in PIC in Candida positive NHL and HL. Conclusions: Candida infection contributes to the inflammatory milieu in Candida associated OL which increases the risk of carcinogenesis. Antifungal therapy reduces the PIC in Candida associated OL. Clinical relevance: Identification and elimination of predisposing factors for Candida infection, like cessation of harmful habits, maintenance of oral/denture hygiene, surveillance for Candida and antifungal therapy at intervals, are recommended in OL. Clinical trial registration: ClinicalTrials.gov Identifier: NCT04712929 [ABSTRACT FROM AUTHOR]

Objective: This review examined the comparative efficacy and safety of antifungal agents in preventing oral candidiasis among patients on cancer treatment. Methods: We performed a systematic review and network meta‐analysis based on randomised controlled trials that compared antifungal agents to placebo or other antifungal agents used in patients undergoing cancer treatment. Relative ranking of antifungal agents was evaluated with surface under the cumulative ranking (SUCRA) probability score. A total of 20 randomised controlled trials (3,215 participants) comparing 11 interventions were included. Results: Compared with placebo, clotrimazole was ranked the best agent for preventing the incidence of oral candidiasis (risk ratio (RR), 0.21 [95% CI 0.08 to 0.55]; SUCRA = 0.89). Fluconazole was ranked the safest among other antifungal agents (SUCRA = 0.80), whereas clotrimazole (SUCRA = 0.36) and amphotericin B (SUCRA = 0.18) were ranked low for safety. Amphotericin B was associated with highest risk of adverse events (RR, 3.52 [95% CI 1.27 to 9.75]). Conclusion: Clotrimazole is the most effective in preventing oral candidiasis, whereas fluconazole has the most favourable risk‐benefit profile in patients undergoing cancer treatment. However, we are unable to recommend clotrimazole as the best choice to prevent oral candidiasis due to unavailability of studies comparing clotrimazole with other antifungal agents. [ABSTRACT FROM AUTHOR]

The antifungal resistence of oral candidiasis is a serious clinical issue. The in vivo efficacy of farnesol combined with antifungals for oral candidiasis remains unknown. The possible therapeutic effects of a combination of farnesol and antifungal drugs and the regulation of inflammatory cytokines in murine oral candidiasis were investigated in this study. An experimental oral candidiasis model was constructed using ICR mice. Farnesol at 25 and 50 μM did not change IL-17, IFN-γ and TNF-α production during oral candidiasis compared with that of the control infected mice. The co-applications of farnesol (50 μM) and nystatin, farnesol (4 μM, 8 μM) and itraconazole, farnesol (25, 50 μM), and fluconazole enhanced the therapeutic activity of the antifungal agents alone against oral candidiasis. The effective combinations reduced the number of colony forming units (CFU) of Candida albicans isolated from the oral cavity and oral lesions on the tongue. [ABSTRACT FROM AUTHOR]

Use of natural products with medicinal properties, derived from plants, animals or microorganisms has found significant popular acceptance in recent years. 'Propolis' is one such natural substance, a resin procured from honeybees collected from plants, buds and exudates has a spectrum of effects like antiviral, antioxidant, antitumor, antibacterial, antifungal, antitumor and immune enhancing properties. Considering oral health, propolis has been utilised in the management of dental caries, pulpitis, aphthous ulcers, plaque, periodontitis, halitosis, stomatitis, dentinal hypersensitivity, oral candidiasis, acute necrotizing ulcerative gingivitis (ANUG), pulp therapy, intra canal medicament and in oral cancer therapy. Pubmed, Google scholar and Medline databases were searched for articles related to propolis and dentistry, which is presented in this review. [ABSTRACT FROM AUTHOR]

Background: Secukinumab is a human monoclonal antibody immunoglobulin that neutralises interleukin (IL)-17A, and as such, is effective in the treatment of psoriasis. However, as IL-17A is essential in protection against fungal infections, patients treated with this drug may develop candidiasis. This report presents a case of atypical oral candidiasis occurring during targeted drug immunotherapy with an interleukin 17 (IL-17) inhibitor (secukinumab), with the aim of emphasisinge the necessity of periodical oral health assessment and monitoring. It provides a rational clinical approach to therapeutic protocol in the treatment of side effects associated with novel medications for autoimmune diseases. Case presentation: Symptomatic tongue lesions were observed in a 50-year-old female patient on a monthly systemic treatment of 300 mg of secukinumab, which appeared after 60 days of using the medication. Two inconclusive biopsies and an unsuccessful application of oral corticosteroids made the diagnostic process challenging. Papillae on the back of the tongue were atrophied, forming a well-defined erythema and white non-detachable plaques on the lateral border of the tongue. Cytopathological and histopathological exam results were compatible with a diagnosis of oral candidiasis. Topical antifungal medication led to subsequent regression of the tongue lesions. During asymptomatic period and follow up for 7 months, a reduced monthly dose 150 mg of secukinumab was administered. Conclusions: Patients undergoing treatment with IL-17 blockers, such as secukinumab, should be carefully monitored in order to avoid oral side effects resulting from the use of this medication. [ABSTRACT FROM AUTHOR]

Purpose: Azole antimycotics and nystatin oral solution are used to treat oral candidiasis. Azoles inhibit cytochrome (CYP) P450-dependent metabolism of warfarin, which could increase the anticoagulant effect of warfarin. Nystatin is not expected to interfere with warfarin metabolism, but current data are conflicting. With this study, we aimed to explore the potential drug-drug interactions between warfarin and azole antimycotics used in the treatment of oral candidiasis, that is, systemic fluconazole, miconazole oral gel, and nystatin oral solution.Methods: By linking clinical data on international normalized ratio (INR) measurements with administrative data on filled prescriptions of warfarin and antimycotics during 2000-2015, we explored INR changes in warfarin users relative to initiation of systemic fluconazole (n = 413), miconazole oral gel (n = 330), and nystatin oral solution (n = 399).Results: We found a significant increase in mean INR of 0.83 (95% confidence interval [CI] 0.61-1.04) and 1.27 (95% CI 0.94-1.59) following initiation of systemic fluconazole and miconazole oral gel, respectively. Also, the proportion of patients experiencing an INR-value above 5 was increased after initiation of fluconazole (from 4.3% to 15.3%) and miconazole (from 5.5% to 30.1%). INR was unaffected by initiation of nystatin oral solution (mean change 0.08; 95% CI -0.10 to 0.25).Conclusion: Initiation of systemic fluconazole and miconazole oral gel was associated with increased INR in warfarin users. A similar association was not found for nystatin oral solution, which thus appears to be the safest alternative when treating oral candidiasis in warfarin users. [ABSTRACT FROM AUTHOR]

Oral candidiasis is an opportunistic fungal infection commonly encountered in immunocompromised individuals. The oral cavity harbours numerous microbes and along with immunity saliva also maintains oral health. The Candida species form biofilm over the tissue and prosthetic surfaces. The biofilm formation results in persistent colonisation and persistent infection. The saliva in the oral cavity maintains the integrity of the oral environment by washing away the microbes through its flow and with its antimicrobial agents. The significant role of salivary histatins as an antifungal agent diminishes with hyposalivation. The importance of saliva in preventing fungal colonisation and infection is discussed in this review. [ABSTRACT FROM AUTHOR]

In this literature review, we present the main scientific findings on the antifungal activity of essential oils (EOs) applicable for a new drug formulation to treat oral candidiasis. Seven literature databases were systematically searched for eligible in vitro and clinical trials. Selected articles were screened for biological activity, botanical species, phytochemical composition, study design, and methodological quality. A total of 26 articles were included in the review, of which 21 were in vitro studies and 5 clinical trials. The most promising EOs were obtained from Allium tubeorosum, Cinnamomum cassia, Cinnamomum zeylanicum, and Coriandrum sativum L. Among the phytochemicals, citral and thymol were the most active. Clinical trials indicated that the EOs from Pelargonium graveolens and Zataria multiflora are potentially effective to treat oral candidiasis. Further nonclinical and clinical studies with these EO are warranted to determine their potential use and safety for the treatment of oral candidiasis. [ABSTRACT FROM AUTHOR]