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Xeroderma pigmentosum (XP) is a rare autosomal disorder characterized by extreme sensitivity to ultraviolet radiation. DNA repair mechanisms are impaired, and minimal sun exposure can lead to the development of cutaneous neoplasms in very young patients. Intraoral carcinomas are uncommon and, when present, are located mainly at the tongue tip. We report an unprecedented case of squamous cell carcinoma (SCC) in the floor of mouth of a 23-year-old woman with XP. The patient was referred to the oncologist, and 2 months after surgical resection, she underwent a single session of chemotherapy plus radiotherapy. However, she died 73 hours after undergoing her first chemotherapy session. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments (especially cisplatin-based chemotherapy) in patients with XP and reviewed the main characteristics of the disease, especially cases with oral manifestations reported in the literature.

Osteoradionecrosis (ORN) is one of the most severe oral complications after the head and neck cancer treatment. Tooth extraction, through its traumatic stimulation, is identified as an important predisposing factor. Indications and preventive methods for carrying out these procedures in irradiated patients are questioned, thus, establishing appropriate protocols is essential. This article reports a case of multiple tooth extractions in a cancer patient whose preventive measures were taken without the occurrence of complications. Based on a literature review, this paper accounts the appropriate indications of this procedure, the risk of developing osteoradionecrosis, and the prevention possibilities for this sequela. In addition, this report addresses a viable oral rehabilitation alternative after this kind of surgery by using overdenture on the lower jaw teeth.

BackgroundTraditionally known as a common contaminant, Rhodotorula mucilaginosa is among the leading causes of invasive fungal infections by non-candida yeasts. They affect mainly immunocompromised individuals, often mimicking the cryptococcosis infection, despite invasive infections by Rhodotorula are still not well explained. Thus, here we aimed to characterize microbiologically clinical isolates of R. mucilaginosa isolated from colonization of a patient with chronic renal disease (CKD), as well as to evaluate their phylogeny, antifungal susceptibility, virulence, and pathogenicity in order to infer the potential to become a possible infection.Methodology/Principal FindingsFor this study, two isolates of R. mucilaginosa from oral colonization of a CKD patient were isolated, identified and characterized by classical (genotypic and phenotypic) methods. Susceptibility to conventional antifungals was evaluated, followed by biofilm production, measured by different techniques (total biomass, metabolic activity, colony forming units and extracellular matrix quantification). Finally, the pathogenicity of yeast was evaluated by infection of Tenebrio molitor larvae.All isolates were resistant to azole and sensitive to polyenes and they were able to adhere and form biofilm on the abiotic surface of polystyrene. In general, similar profiles among isolates were observed over the observed periods (2, 24, 48 and 72 hours). Regarding extracellular matrix components of biofilms at different maturation ages, R. mucilaginosa was able to produce eDNA, eRNA, proteins, and polysaccharides that varied according to time and the strain. The death curve in vivo model showed a large reduction in the survival percentage of the larvae was observed in the first 24 hours, with only 40% survival at the end of the evaluation.Conclusions/SignificanceWe infer that colonization of chronic renal patients by R. mucilaginosa offers a high risk of serious infection. And also emphasize that the correct identification of yeast is the main means for an efficient treatment.Author SummaryThe genus Rhodotorula is known to be a common contaminant, however, it has been increasing in the last years, reports of different forms infections by this yeast, reaching mainly individuals with secondary diseases or with low immunity. However, very little is known about the mechanism that triggers the disease. Thus, this study aims to characterize microbiologically clinical isolates of R. mucilaginosa isolated from a patient with chronic renal disease, as well as to evaluate their phylogeny, antifungal susceptibility, virulence, and pathogenicity in order to infer the potential to become a possible infection. It was possible to characterize in general the clinical isolates, to determine that they are resistant to an important class of the antifungal agents which are the azoles. In addition, they are able to adhere and to form biofilm on abiotic surfaces, this skill represents an important factor of virulence, which would guarantee their presence in medical devices, such as catheters, surfaces. These biofilm works as true reservoirs of these fungi disseminate and cause serious infections. This pathogenic potential was reinforced by a great reduction of survival in the larvae infected with this yeast. Therefore our results infer a high risk of infection to patients who are colonized by R. mucilaginosa.

The objective of this study was to investigate tongue coating (TC) frequency and its colonization by yeasts in a group of chronic kidney disease (CKD) patients. Clinical examination of the oral mucosa of 33 CKD patients was performed to investigate oral and tongue lesions. TC was diagnosed according to its clinical characteristics. Stimulated saliva and TC samples were collected to verify the salivary flow, and determine yeast frequency, species and counts. TC was found in 18/33 of the patients (54.55 %) and was the most frequent oral lesion found. Of 18 patients with TC, 13 (72.22 %) presented positive cultures for yeasts on the tongue dorsum, and one (5.55 %) in the saliva only. Yeasts were significantly more frequent in the tongue dorsum when compared to the saliva (p = 0.0106). The most frequent yeast species found was C. albicans (55.55 %), while C. parapsilosis comprised 50 % of non-albicans Candida species. This study demonstrated high amounts of yeasts on the cultures from TC samples of CKD patients, strongly suggesting that TC is a clinical representation of a polymicrobial biofilm, which could serve as a gateway for disseminated infection in immunosuppressed patients undergoing frequent hospitalization.

We report a case of a 23-year-old woman with xeroderma pigmentosum (XP) and a painless endophytic ulcer on the mouth floor, measuring approximately 2 cm, with 8 months of evolution. She had a family history of a brother with XP who underwent lower lip resection and denied neurologic disturbances or prior surgical procedures. Weak photophobia and numerous hyperpigmented ephelides throughout the body were observed. Histopathologic examination of the incisional biopsy confirmed the diagnosis of squamous cell carcinoma. It is known that intra-oral carcinomas are uncommon in XP individuals and, when present, are located mainly at the tongue tip. The patient was referred to the oncologist and 2 months after surgical resection underwent a single chemotherapy and radiotherapy session. However, she died in less than 72 hours after this procedure. Considering the unexpected outcome of this case, we also investigated possible exacerbated adverse effects of antineoplastic treatments in XP patients.

Background Patients with chronic kidney disease, stage 5, undergoing hemodialysis treatment are frequently colonized by yeasts, with high chance of developing fungal infections. The objective of this study was to assess the presence of yeasts in the oral cavity of these individuals, associating findings with the presence of oral lesions and the use of dental prostheses. Methods Clinical examinations of the oral mucosa were performed in 52 patients, when the use of removable dental prostheses and the presence of oral lesions were observed and recorded. Saliva samples were collected to identify yeast specimens and colony-forming units. Results Colonization by yeasts was found in 42.31% of the patients, 100% of which belonging to the genus Candida, with the predominance of C. albicans (69.23%). Half of the patients (26) presented some type of oral lesion, the majority (63.33%) suggestive of candidiasis, which was confirmed in 57.89% of cases. The chance that these patients carried yeast colonies in the presence of dental prostheses and oral lesions was 6.33 and 2.62 times higher, respectively. Conclusions Patients investigated in this study presented a high incidence of yeasts in the oral cavity, with those with oral lesions and dental prostheses being more likely to carry yeasts. When oral lesions are detected in patients undergoing hemodialysis treatment, particularly in those who are prosthesis users, early diagnosis and treatment of this type of lesion, in association with systemic investigations, should be performed to mitigate possible unfavorable prognoses.