Search

Aims: Oral candidosis is common in patients with end‐of‐life cancer; however, its prognosis is unclear. We aimed to assess oral candidosis and Candida species as prognostic indicators in palliative care for these patients. Methods: We consecutively included palliative care patients, assessed for candidosis via microbiological techniques, and classified into three groups by the extent of oral lesions. The association between oral candidosis and overall survival was assessed using a Cox proportional hazards model adjusted by performance status (PS). Results: We studied 142 patients (median age 77; 52.8% women) with a 76.1% oral candidosis prevalence. Candida albicans (80.6%) was the most common species. Oral lesions were classified as none, grade 1 (28.7%), or ≥ grade 2 (14.8%). During follow‐up, Cox models identified ≥grade 2 lesions (aHR = 2.04; 95% CI: 1.18–3.54; p =.011) and Candida tropicalis (aHR = 2.38; 95% CI: 1.03–5.55; p =.044) as predictors. Conclusion: The extent of oral candidosis lesions or the presence of C. tropicalis may serve as prognostic indicator in patients with end‐of‐life cancer. Therefore, solely concentrating on the prevalence and frequency of fungal species may be insufficient for predicting life prognosis; it is advisable to assess these parameters through both visual examination and culture. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of palatal brushing in the treatment of denture-related erythematous stomatitis (DES) in complete denture wearers. Methods: This two-parallel-arm RCT was conducted in three university clinics in Brazil, Canada, and Chile. Participants (n=77) were randomly allocated to receive (i) instructions for palatal brushing and standard oral/denture hygiene (“intervention”); or (ii) standard oral/denture hygiene instructions only (“control”). Data collection was carried out at the baseline and at 3 and 6 months after intervention. Outcomes included the magnitude of oral Candida carriage and the degree of inflammation of denture-bearing tissues. Groups were compared using generalized estimating equations and chi-square test (α=0.05). Results: Palatal inflammation levels were reduced significantly in the “intervention” compared to “control” group at 6 months (intervention: 70%, control: 40%; chi-square, p=0.04). There was no between-group significant difference in the Candida count from denture and palatal biofilms; however, a subgroup analysis restricted to baseline Candida carriers showed further reduction with the intervention at 6 months. No adversity was observed by trialist or reported by participants. Conclusions: Including palatal brushing in oral instructions for denture wearers has positive impact on DES-related mucosal inflammation. Thus, our findings endorse the inclusion of palatal brushing in standard oral hygiene instructions to treat DES. [ABSTRACT FROM AUTHOR]

Aim: To identify the antifungal susceptibility profile of Candida spp. isolated from the human oral cavity was assessed with meta-analyses of observational studies that collected samples from the oral cavity of human subjects. Material and methods: Isolated Candida albicans tested by E-test®; disk diffusion test; microdilution and macrodilution; Sensititre YeastOne; and/or FungiTest. Search strategies were conducted on the MEDLINE, Embase, CINAHL, Dentistry, and Oral Sciences, Central, Scopus, and LILACS databases, and gray literature sources. Articles were initially screened by title and then their abstracts. Articles that met the conditions for inclusion were read in full, followed by data extraction. A descriptive analysis was conducted of each study, and the data were tabulated. A first meta-analysis was conducted to assess the resistance of antifungals regardless of systemic comorbidities. An additional stratified analysis was conducted by systemic comorbidity groups for the outcome "resistance" to the antifungals. Results: When not grouping Candida albicans isolates by systemic conditions, the lowest resistance rates to the antifungals tested were observed for amphotericin B, nystatin, flucytosine, and caspofungin. In contrast, the highest resistance rates were observed for miconazole and econazole. There was a high degree of heterogeneity and low resistance in general in all analyses, except for the "several associated comorbidities" group, which had high resistance rates. Conclusions: Clinical C. albicans isolates had low antifungal resistance. Clinical relevance: The presence of concomitant systemic comorbidities appears to be an essential factor that should be considered when evaluating resistance to antifungals for oral isolates. [ABSTRACT FROM AUTHOR]

Oral candidosis is the most common fungal infection that frequently occurs in patients debilitated by other diseases or conditions. No candidosis happens without a cause; hence oral candidosis has been branded as a disease of the diseased. Prior research has identified oral candidosis as a mark of systemic diseases, such as hematinic deficiency, diabetes mellitus, leukopenia, HIV/AIDS, malignancies, and carbohydrate-rich diet, drugs, or immunosuppressive conditions. An array of interaction between Candida and the host is dynamic and complex. Candida exhibits multifaceted strategies for growth, proliferation, evasion of host defenses, and survival within the host to induce fungal infection. Oral candidosis presents a variety of clinical forms, including pseudomembranous candidosis, erythematous candidosis, angular cheilitis, median rhomboid glossitis, cheilocandidosis, juxtavermillion candidosis, mucocutaneous candidosis, hyperplastic candidosis, oropharyngeal candidosis, and rare suppurative candidosis. The prognosis is usually favorable, but treatment failure or recurrence is common due to either incorrect diagnosis, missing other pathology, inability to address underlying risk factors, or inaccurate prescription of antifungal agents. In immunocompromised patients, oropharyngeal candidosis can spread to the bloodstream or upper gastrointestinal tract, leading to potentially lethal systemic candidosis. This review therefore describes oral candidosis with regard to its pathophysiology and best practice for diagnosis, practical classification, and successful management [ABSTRACT FROM AUTHOR]

Aim of study: The authors describe three types of infections in the oral mucosa caused by fungus Candida albicans. The first type are acute infections, among which we include the acute pseudomembranous candidiasis and the acute erythematous candidiasis. The second type are chronic infections, which include: chronic pseudomembranous form, erythematous form, plaque-like form and nodular form. The third group of infections consists of cheilitis angularis, stomatitis prothetica and glossitis rhombica mediana. The authors conclude that the presented division of infections specifies the clinical diagnosis and improves the quality of differential diagnosis and thus improves treatment practices.

Oral candidosis is the most common opportunistic fungal infection encountered in dentistry. Normally a benign inhabitant of mucous membranes, the fungal organism, Candida albicans, may present serious, even life-threatening infection in specific patient populations. As an opportunistic organism. Candida albicans is extremely responsive to any process resulting in immune-suppression. The clinical manifestations of oral candidosis are variable, occasionally complicating the clinical diagnosis and management. Treatment is often initially rendered based on a provisional clinical diagnosis and supplemented with adjunctive laboratory tests. Specific therapeutic intervention should be tailored to the individual patient, based on the current health status of the patient and the clinical presentation and severity of the infection. (Quintessence Int 2002;33:521-532) [ABSTRACT FROM AUTHOR]

Abstract Background Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians. Methods/design A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle. Discussion This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES. Trial registration ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016.

Iron deficiency (ID) is the most common cause of anemia. The aim of this study was to investigate patients with oral mucosa alterations as the initial manifestation of ID or ID anemia (IDA). Methods: Sixty-four patients (50 IDA and 14 ID) with a wide range of sore mouth were diagnosed and treated. The oral and physical manifestations as well as iron studies and anemia classification based on the mean and heterogeneity of red cell size were assessed. Results: ID predisposed 64 patients to a high incidence of Candida infection (85%) and showed a variety of oral manifestations including angular cheilitis (63%), atrophic glossitis (AG; 59%), pseudomembranous candidosis (44%), erythematous candidosis (41%), median rhomboid glossitis (5%), chronic mucocutaneous candidosis (5%), papillary hyperplastic candidosis (3%), and cheilocandidosis (3%). Others included pale oral mucosa (31%), burning mouth (28%), and recurrent oral ulcers (6%). Colorectal cancers in two patients were diagnosed. The values of hemoglobin (Hb) in 64 ID patients varied from normal to life-threatening levels, but none had developed advanced systemic symptoms except fatigue. All had low serum iron and ferritin. Sixty (94%) patients had transferrin saturation

Management of oral candidosis, most frequently caused by Candida albicans, is limited due to the relatively low number of antifungal drugs and the emergence of antifungal tolerance. In this study, the antifungal activity of a range of commercial essential oils, two terpenes, chlorhexidine and triclosan was evaluated against C. albicans in planktonic and biofilm form. In addition, cytotoxicity of the most promising compounds was assessed using murine fibroblasts and expressed as half maximal inhibitory concentrations (IC50). Antifungal activity was determined using a broth microdilution assay. The minimum inhibitory concentration (MIC) was established against planktonic cells cultured in a range of concentrations of the test agents. The minimal biofilm eradication concentration (MBEC) was determined by measuring re-growth of cells after pre-formed biofilm was treated for 24 h with the test agents. All tested commercial essential oils demonstrated anticandidal activity (MICs from 0.06% (v/v) to 0.4% (v/v)) against planktonic cultures, with a noticeable increase in resistance exhibited by biofilms (MBECs > 1.5% (v/v)). The IC50s of the commercial essential oils were lower than the MICs, while a one hour application of chlorhexidine was not cytotoxic at concentrations lower than the MIC. In conclusion, the tested commercial essential oils exhibit potential as therapeutic agents against C. albicans, although host cell cytotoxicity is a consideration when developing these new treatments. [ABSTRACT FROM AUTHOR]

İnsan immün sistemindeki bozulma sonucu candida enfeksiyonları ortaya çıkabilir. Ağız içi candidal enfeksiyonlar olarak tanımlanan oral candidosis tablosu, sıklıkla konak ve konağa bağlı lokal ya da sistemik durumlara bağlı olarak gelişir. Lokal faktörler, tükrük akışının azalması, zayıf oral hijyen, protez kullanımı olarak sayılabilirken; endokrin hastalıklar, beslenme bozuklukları, HIV enfeksiyonu gibi durumlar candidal enfeksiyona yol açan sistemik faktörler arasındadır. Oral candidosis sıklıkla lokal faktörlere bağlı, daha nadiren de sistemik nedenli ortaya çıkar. Bu derlemede, candidal enfeksiyon açısından predispozan faktörler, klinik görünüm, teşhis ve tedavi yaklaşımları tartışılmıştır

The incidence of oral candidosis has increased in recent years due to the escalation in HIV-infection, cancer treatments, organ transplantation, and diabetes. In addition, corticosteroid use, dentures, and broad-spectrum antibiotic use have also contributed to the problem. Treatment of oral candidosis has continued to be problematic because of the potential toxicity of antifungals in clinical use, and, above all, development of drug resistance among patients. In this study, the antifungal effect of magnolol was investigated against 64 strains of Candida spp. (four standard and 60 oral isolates) through minimum inhibitory concentration (MIC) and growth curve assays. Insight into the mechanisms of the antifungal action has been gained through ultrastructural studies using confocal scanning laser microscopy (CSLM), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Molecular docking was done for predicting the interactions of magnolol with ergosterol at supramolecular level. The toxicity of magnolol on human erythrocytes was measured by in vitro hemolytic assay. MIC values of magnolol ranged from 16-64 μg/ml, respectively. All tested isolates showed a marked sensitivity towards magnolol in growth curve assays. Biofilm results suggested that magnolol showed strong anti-biofilm activity. The results obtained for four different Candida spp. demonstrated that MBIC values of magnolol showed the average biofilm inhibition by 69.5%, respectively. CLSM experiments showed that cells exposed to magnolol (MIC) exhibited cell membrane disruption. SEM analysis of magnolol treated cells resulted in deformed cells. TEM micrographs showed rupturing of the cell wall and plasma membrane, releasing the intracellular content, and swelling of the cell wall. Hemolytic activity of magnolol is 11.9% at its highest MIC compared to an activity level of 25.4% shown by amphotericin B (Amp B) at 1 μg/ml. Lipinski's parameters calculated for magnolol suggested its good oral bioavailability. Docking studies indicated that magnolol might be interacting with ergosterol in the fungal cell membranes. Together, the present study provides enough evidence for further work on magnolol so that better strategies could be employed to treat oral candidosis. [ABSTRACT FROM AUTHOR]

Background: Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians.Methods/design: A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle.Discussion: This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES.Trial Registration: ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016. [ABSTRACT FROM AUTHOR]

This is the first Romanian investigation of oral candidosis in patients suffering of HIV-infection or type 1 diabetes mellitus (T1DM).Candida albicans was the dominant species in both types of isolates: n = 14 (46.7%) in T1DM, n = 60 (69.8%) in HIV. The most frequent non-albicans Candida spp. were Candida kefyr (n = 6; 20%) in T1DM and Candida dubliniensis (n = 8; 9.3%) in HIV. Resistance to fluconazole was detected only in the HIV non-albicans Candida group (n = 8; 9.3%). All isolates were susceptible to VOR. The experimental drug MXP had MIC values equal or close to the ones of VOR. Echinocandin resistance was more frequent than azole resistance.

Background: Oral candidiasis is the mostly found oral manifestation in HIV/AIDS infected patient caused by immunocompromised especially immunodeficiency. Clinical symptoms is severe pain in oral cavity and dry mouth because of xerostomia which cause the loss of appetite. Candida albicans (C. albicans) is normal flora in oral cavity which plays as opportunistic pathogen and also the cause of oral candidiasis. Almost 90% of HIV–infected patient have oral candidiasis. This condition is clinical problem which has not been well-managed yet. C. albicans colonized oral mucous cavity has different genetic variability for each strain. Phenotype of C. albicans has been determined by genetic factor and environtment. This condition stimulate differences of genotype among various strain of C. albicans in the world. Purpose: The purpose of this research is to analyze the genetic variability of C.albicans which colonized in the mucous oral cavity of HIV/AIDS patient in Surabaya in the treatment with and without ARV therapy and non HIV/AIDS. Methods: This research has been identify and characterize the prevalent strain of C. albicans isolat in Surabaya (East Java) in HIV/AIDS infected patient with oral candidiasis by method of Iatron candidal check. The highlight of this research including cytology examination by Papanicoloau staining, C. albicans culture, spheroplast making, DNA isolation and genetic variability checking by randomly amplyfied polymorphism DNA (RAPD). Results: C. albicans colonizing oral mucosa of non-HIV patients had a predisposition of farther genetic relationship (genetic distance of 0.452) with C. albicans colonizing oral mucosa of HIV ARV and HIV non-ARV patients. The genetic distance was ranging between 0 and 1, where 9 was long genetic distance and 1 was short genetic distance. In contrast, C. albicans colonizing oral mucosa of HIV ARV have predisposition of closer genetic relationship (genetic distance of 0.762) with C. albicans colonizing oral mucosa of HIV non-ARV patients. Conclusion: The conclusion of this research were C.albicans colonizing HIV/AIDS patiens with and without ARV showed no high genetic variability between C.albicans isolate in HIV patients. There fore, the character of C.albicans colonizing HIV ARV and HIV non-ARV patients had similar genotype predisposition of closer relationship value with C.albicans colonizing oral mucosa non HIV patients.Latar belakang: Oral candidiasis merupakan manifestasi kelainan rongga mulut yang paling sering timbul pada penderita HIV/AIDS karena kondisi immunocompromised terutama defisiensi imun. Gejala klinisnya berupa nyeri hebat di rongga mulut dan mulut kering karena xerostomia yang menyebabkan hilangnya nafsu makan. Candida albicans (C. albicans) berperan sebagai patogen oprtunistik dan merupakan penyebab Kandidiasis rongga mulut. Hampir 90% penderita terinfeksi HIV mengalami kandidiasis rongga mulut. Kondisi ini merupakan masalah klinis yang belum teratasi dengan baik. Kolonisasi C. albicans di mukosa rongga mulut mempunyai variabilitas genetic yang berbeda untuk tiap strainnya. Fenotip C. albicans ditentukan oleh faktor genetic dan lingkungan. Kondisi ini menstimulir perbedaan genotip di antara berbagai strain C. albicans di dunia. Tujuan: Tujuan penelitian ini adalah meneliti korelasi antara hubungan genetik yang menunjukkan variasi genetik kolonisasi C. albicans pada rongga mulut dan insidens kandidiasis rongga mulut pada penderita HIV/AIDS dan non-HIV/AIDS. Metode: Penelitian ini mengidentifikasi dan mengkarakterisasi strain Candida albicans isolat Surabaya (Jawa Timur) pada penderita HIV/AIDS dengan kandidiasis rongga mulut dengan metode iatron candidal check. Penekanan dalam penelitian ini termasuk pada pemeriksaan sitologi dengan pengecatan Papanicoloau, kultur C. albicans, pembuatan spheroplast, isolasi DNA dan pemeriksaan variabilitas genetik dengan randomly amplified polymorphism DNA (RAPD). Hasil: C. albicans yang berkolonisasi di rongga mulut pada penderita non-HIV mempunyai predisposisi hubungan genetik (jarak genetik 0.452) dengan C. albicans yang berkolonisasi di rongga mulut pada penderita HIV yang mendapatkan terapi ARV dan non ARV. Jarak genetic bervariasi antara 0 dan 1, dimana 9 dalah jarak genetik terpanjang and 1 adalah jarak genetik terpendek. Sebaliknya, C. albicans yang berkolonisasi di rongga mulut pada penderita HIV yang menerima terapi ARV memiliki predisposisi hubungan genetic yang lebih dekat (jarak genetic 0.762) dibandingkan C. albicans yang berkolonisasi di rongga mulut pada penderita HIV non-ARV. Kesimpulan: Sebagai kesimpulan, penelitian ini menunjukkan bahwa C. albicans isolate Surabaya yang mengkolonisasi penderita HIV/AIDS dengan ARV dan non ARV memiliki hubungan kekerabatan genetik yang sama dibanding dengan pasien non HIV/AIDS.

Oral infections caused by yeast of the genus Candida and particularly Candida albicans (oral candidoses) have been recognised throughout recorded history. However, since the 1980s a clear surge of interest and associated research into these infections have occurred. This has largely been due to an increased incidence of oral candidosis over this period, primarily because of the escalation in HIV-infection and the AIDS epidemic. In addition, changes in medical practice leading to a greater use of invasive clinical procedures and a more widespread use of immunosuppressive therapies have also contributed to the problem. Whilst oral candidosis has previously been considered to be a disease mainly of the elderly and very young, its occurrence throughout the general population is now recognised. Candida are true ‘opportunistic pathogens’ and only instigate oral infection when there is an underlying predisposing condition in the host. Treatment of these infections has continued (and in some regards continues) to be problematic because of the potential toxicity of traditional antifungal agents against host cells. The problem has been compounded by the emergence of Candida species other than C. albicans that have inherent resistance against traditional antifungals. The aim of this review is to give the reader a contemporary overview of oral candidosis, the organisms involved, and the management strategies that are currently employed or could be utilised in the future.

Background: Oral candidosis is an infection caused by mainly Candida albicans. Candida species are common normal flora in the oral cavity and have been reported to be present in 40% to 60% of the population. Candida is predominantly an opportunistic infectious agent. Infection frequency has increased because of the presence of both local and systemic risk factors. The elderly age and diabetes mellitus may decrease the amount of saliva (xerostomia) and potentially increase the risk of colonization and secondary infection by Candida. Herpes Zoster (HZ) is a manifestation of the reactivation of latent varicella zoster virus. It is characterized by unilateral, painful, vesicular rash with a dermatomal distribution. The clinical manifestations of this disease can erupt to the skin and mucous membrane. If maxillary nerve is involved, the lesion can appear on unilateral facial skin and oral mucous membrane. Purpose: The purpose of this paper is to report and discuss the difficulties in managing the oral candidosis in elderly patient (57 year old male) who suffered from maxillary Herpes Zoster and diabetes mellitus. Case management: At first, the patient was treated with 2% chlorhexidine gluconate and mycostatin oral suspension as topical antimycotic and reffered to dermathology clinic for viral infection treatment, however the oral candidosis did not improved. Subsequently, ketokonazole tablet was given three times daily for three weeks and regulated blood glucose level. In systemic antifungi (ketokonazole) treatment the oral candidosis disappeared. Conclusion: In this case, it is conclude that the management of oral candidosis are adequate, antiviral, blood glucose level regulating and systemic antifungal therapy.

The rubra variety of Alpinia galanga rhizome extract were compatible to the fibroblast tissue, non toxic, and potent in inhibiting Candida albicans growth. The purpose of this study was to find out the effect of the rubra variety of Alpinia galangal rhizome extract as a treatment to oral candidosis. The patients involved in this study were 20 diabetic patients, men and women. There were sixteen patients showed white patches of flecks on the tongue surface. After clinical examination, a direct smear was made and there were mass of candida hyphae on Periodoc Acid Schiff staining. For patient comfort, the extract of Alpinia galangal 30% was prepared as a cream in a tube. The cream was used topically on the flack, 4-5 times daily for 14 days. In case of the flecks persisted, the treatment was continued to 21 days. Mc Nemar test showed a significant difference between the group before and after treatment (p

Copyright of Dental Forum is the property of Dental Forum 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.)

Background/purpose: Iron deficiency (ID) is the most common cause of anemia. The aim of this study was to investigate patients with oral mucosa alterations as the initial manifestation of ID or ID anemia (IDA).Methods: Sixty-four patients (50 IDA and 14 ID) with a wide range of sore mouth were diagnosed and treated. The oral and physical manifestations as well as iron studies and anemia classification based on the mean and heterogeneity of red cell size were assessed.Results: ID predisposed 64 patients to a high incidence of Candida infection (85%) and showed a variety of oral manifestations including angular cheilitis (63%), atrophic glossitis (AG; 59%), pseudomembranous candidosis (44%), erythematous candidosis (41%), median rhomboid glossitis (5%), chronic mucocutaneous candidosis (5%), papillary hyperplastic candidosis (3%), and cheilocandidosis (3%). Others included pale oral mucosa (31%), burning mouth (28%), and recurrent oral ulcers (6%). Colorectal cancers in two patients were diagnosed. The values of hemoglobin (Hb) in 64 ID patients varied from normal to life-threatening levels, but none had developed advanced systemic symptoms except fatigue. All had low serum iron and ferritin. Sixty (94%) patients had transferrin saturation < 16%; however, 19 (30%) patients remained normocytic and 14 (22%) patients were nonanemic.Conclusion: The study demonstrates that oral mucosa alterations accompanying oral candidosis are a sensitive indicator of ID. All oral changes can be successfully ameliorated by iron therapy plus antifungals when candidosis exists. Investigating the origin of IDA is necessary, because it may be the first sign of a more serious disease, particularly malignancy. [ABSTRACT FROM AUTHOR]

Aim Candida adherence is implicated in the pathogenesis of oral candidosis. Adhesion to buccal epithelial cells ( BEC), germ tube ( GT) formation, and relative cell surface hydrophobicity ( CSH) are colonization attributes of candidal pathogenicity. Candida dubliniensis ( C. dubliniensis) is allied with recurrent oral candidosis, which can be treated with nystatin, amphotericin B, ketoconazole, and fluconazole. Due to the diluent effect of saliva and the cleansing effect of the oral musculature in the oral cavity C. dubliniensis isolates undergo brief and sequential exposure to antifungal agents during therapy. Thus, in the present study, we evaluated the adhesion to BEC, GT formation, and the CSH of oral isolates of C. dubliniensis following brief and sequential exposure to nystatin, amphotericin B, ketoconazole, and fluconazole. Methods After determining the minimum inhibitory concentration ( MIC) of the aforementioned drugs, 20 oral isolates of C. dubliniensis were briefly (1 h), and sequentially (10 days) exposed to subcidal concentrations of these drugs. Following drug removal, adhesion to BEC, GT formation, and CSH of these isolates were determined. Results The percentage reduction of adhesion to BEC, GT formation, and CSH of the isolates following exposure to antifungal agents were as follows: nystatin: 53.55%, 33.98%, and 29.83% ( P < 0.001); amphotericin B: 53.84%, 36.23%, and 28.97% ( P < 0.001); ketoconazole: 37.43%, 20.51%, and 16.49% ( P < 0.001); and fluconazole: 8.93% ( P < 0.001), 1.6%, and 0.63% ( P > 0.05). Conclusions Brief and sequential exposure of C. dubliniensis to antifungal agents would continue to wield an antifungal effect by altering its adhesion attributes, and elucidate possible pharmacodynamics by which antifungal agents might operate in modulating candidal adherence. [ABSTRACT FROM AUTHOR]

Management of oral candidosis, most frequently caused by Candida albicans, is limited due to the relatively low number of antifungal drugs and the emergence of antifungal tolerance. In this study, the antifungal activity of a range of commercial essential oils, two terpenes, chlorhexidine and triclosan was evaluated against C. albicans in planktonic and biofilm form. In addition, cytotoxicity of the most promising compounds was assessed using murine fibroblasts and expressed as half maximal inhibitory concentrations (IC50). Antifungal activity was determined using a broth microdilution assay. The minimum inhibitory concentration (MIC) was established against planktonic cells cultured in a range of concentrations of the test agents. The minimal biofilm eradication concentration (MBEC) was determined by measuring re-growth of cells after pre-formed biofilm was treated for 24 h with the test agents. All tested commercial essential oils demonstrated anticandidal activity (MICs from 0.06% (v/v) to 0.4% (v/v)) against planktonic cultures, with a noticeable increase in resistance exhibited by biofilms (MBECs > 1.5% (v/v)). The IC50s of the commercial essential oils were lower than the MICs, while a one hour application of chlorhexidine was not cytotoxic at concentrations lower than the MIC. In conclusion, the tested commercial essential oils exhibit potential as therapeutic agents against C. albicans, although host cell cytotoxicity is a consideration when developing these new treatments.

Objetivo. Estimar la prevalencia de lesiones bucales y su asociación con el estado serológico del VIH. Material y métodos. Estudio transversal, descriptivo y doble ciego, hecho, entre 1998 y 1999 en México, D.F., con 512 personas que acudieron a dos centros de información del Centro Nacional para la Prevención del VIH/SIDA e ITS (CONASIDA) y a quienes se les practicó examen bucal sin conocer aún su estado serológico con respecto al VIH. Se utilizaron las pruebas de t-Student, exacta de Fisher y ji². Se calculó la razón de productos cruzados. Resultados. Se examinaron 512 individuos, 68 resultaron positivos al VIH. En 65% (44/68), se observaron lesiones bucales asociadas con el VIH (LB), 95% correspondieron a candidosis bucal (CB) y leucoplasia vellosa (LV). La asociación de CB y LV con el estado serológico positivo al VIH fue estrecha. Conclusiones. La CB y la LV fueron las lesiones más fuertemente asociadas con el VIH.Objective. To estimate the prevalence of oral lesions and its association with HIV serological status. Material and Methods. A cross-sectional descriptive study was conducted between 1998 and 1999 in Mexico City, among 512 subjects attending two information centers of Centro Nacional para la Prevención del VIH/SIDA e ITS (CONASIDA, National Center for Prevention of HIV/AIDS and Sexually Transmitted Infections) for HIV serologic testing. The oral examination was performed without knowledge of the HIV status. Statistical analysis was conducted using Student's t test, Fisher's exact test and the chi² test; odds ratios and 95% CI were also calculated. Results. A total of 512 individuals were examined, 68 of whom were HIV-positive. HIV-related oral lesions (OL), were evident in 65% (44/68) of the HIV-positive individuals; 95% of them consisted in oral candidosis (OC) and hairy leukoplakia (HL). OC and HL were strongly associated with seropositivity to HIV. Conclusions. OC and HL were the oral lesions most strongly associated to HIV seropositivity.

El reconocimiento de las lesiones orales asociadas con el VIH es de gran importancia, ya que pueden representar el primer signo de la infección y servir como predictoras de inmunosupresión y del desarrollo de sida en pacientes infectados. Se realizó un estudio descriptivo de 314 pacientes con VIH que eran atendidos en el programa integral del Hospital San Juan de Dios de Bogotá. Se les practicó examen fisico completo y examen oral; se registró el tipo de lesión, el lugar de presentación, el género y la edad. De los sujetos examinados, 285 (90,8%) eran del sexo masculino y 29 (9,2%) del femenino. El promedio de edad fue de 31 años (rango: 15 a 64). No se encontraron lesiones orales asociadas en 91 (29%), mientras que en los restantes 223 (71%) se anotaron una o mas lesiones; la más frecuente fue la candidosis oral en 207 personas (65,8%). Al subdividirla en sus cuatro variedades, se encontró la forma seudomembranosa en 94 pacientes (29,9%); la eritematosa en 66 (21%); la queilitis angular en 38 (12.1%) y la hiperplásica en 9 (2.8%) Le siguió en frecuencia la leucoplasia vellosa en 67 sujetos (21.3%), la gingivitis y la periodontitis en 54 (17.1%), el sarcoma de Kaposi en 28 (8.9%) y la estomatitis aftosa recurrente en 26 (8,2%). Los lugares mas afectados fueron el paladar duro y blando en 108 sujetos (34,4%), la lengua en 101 (32.2%), la mucosa yugal en 48 (15.3%), la encia marginal en 36 (11.5%), la comisura labial en 34 (10,8%) y la orofaringe en 25 (8%). Estos hallazgos permiten definir el perfil especifico de morbilidad oral de los pacientes del Hospital San Juan de Dios en Bogotá para el período estudiado.

Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data. [ABSTRACT FROM AUTHOR]

A case report on a 70-year-old male patient with atypical candidal infection on the palate that was misdiagnosed for a tumour based on clinical examination. The lesion was an accidental finding when the patient was at a registered dentist for a preventive check-up.

Candida albicans forms oral biofilms that cause disease and are difficult to treat with conventional antifungal agents. Tea tree oil (TTO) is a natural compound with reported antimicrobial and immunomodulatory activities. The aims of the study were to evaluate the antifungal efficacy of TTO and key derivatives against C. albicans biofilms, to assess the toxicological effects of TTO on a clinically relevant oral cell line, and to investigate its impact on inflammation. TTO and its derivatives were examined against 100 clinical strains of C. albicans. Planktonic minimum inhibitory concentrations (MICs) were determined using the CLSI M-27A broth microdilution method. Sessile MICs were determined using an XTT reduction assay. Inhibition, time-kill and mode of action studies were performed. OKF6-TERT2 epithelial cells were used for cytotoxicity and cytokine expression assays. Planktonic C. albicans isolates were susceptible to TTO, terpinen-4-ol (T-4-ol) and α-terpineol, with an MIC50 of 0.5, 0.25 and 0.25%, respectively. These three compounds also displayed potent activity against the 69 biofilm-forming strains, of which T-4-ol and α-terpineol displayed rapid kill kinetics. For all three compounds, 1 × MIC50 effectively inhibited biofilm growth when C. albicans were treated at 0, 1 and 2 h post adhesion. By SEM analysis and PI uptake, TTO and derivative components were cell membrane active. TTO and T-4-ol were cytotoxic at 1 × MIC50, whereas at 0.5 × MIC50 T-4-ol displayed no significant toxicity. Transcript and protein analysis showed a reduction of IL-8 when treated with TTO and T-4-ol. These data provide further in vitro evidence that TTO and its derivative components, specifically T-4-ol, exhibit strong antimicrobial properties against fungal biofilms. T-4-ol has safety advantages over the complete essential oil and may be suitable for prophylaxis and treatment of established oropharyngeal candidosis. A clinical trial of T-4-ol is worthy of consideration.

Acetaldehyde is a carcinogenic product of alcohol fermentation and metabolism in microbes associated with cancers of the upper digestive tract. In yeast acetaldehyde is a by-product of the pyruvate bypass that converts pyruvate into acetyl- Coenzyme A ( Co A) during fermentation. The aims of our study were: (i) to determine the levels of acetaldehyde produced by Candida albicans in the presence of glucose in low oxygen tension in vitro; (ii) to analyse the expression levels of genes involved in the pyruvate-bypass and acetaldehyde production; and (iii) to analyse whether any correlations exist between acetaldehyde levels, alcohol dehydrogenase enzyme activity or expression of the genes involved in the pyruvate-bypass. Candida albicans strains were isolated from patients with oral squamous cell carcinoma ( n = 5), autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy ( APECED) patients with chronic oral candidosis ( n = 5), and control patients ( n = 5). The acetaldehyde and ethanol production by these isolates grown under low oxygen tension in the presence of glucose was determined, and the expression of alcohol dehydrogenase ( ADH1 and ADH2), pyruvate decarboxylase ( PDC11), aldehyde dehydrogenase ( ALD6) and acetyl- Co A synthetase ( ACS1 and ACS2) and Adh enzyme activity were analysed. The C. albicans isolates produced high levels of acetaldehyde from glucose under low oxygen tension. The acetaldehyde levels did not correlate with the expression of ADH1, ADH2 or PDC11 but correlated with the expression of down-stream genes ALD6 and ACS1. Significant differences in the gene expressions were measured between strains isolated from different patient groups. Under low oxygen tension ALD6 and ACS1, instead of ADH1 or ADH2, appear the most reliable indicators of candidal acetaldehyde production from glucose. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare biofilm formation by Candida glabrata and Candida albicans on acrylic, either individually or when combined (single and dual species) and then examine the antimicrobial effects of silver nanoparticles and nystatin on these biofilms. Candidal adhesion and biofilm assays were performed on acrylic surface in the presence of artificial saliva (AS) for 2 h and 48 h, respectively. Candida glabrata and C. albicans adherence was determined by the number of colony forming units (CFUs) recovered from the biofilms on CHROMagar® Candida. In addition, crystal violet (CV) staining was used as an indicator of biofilm biomass and to quantify biofilm formation ability. Pre-formed biofilms were treated either with silver nanoparticles or nystatin and the effect of these agents on the biofilms was evaluated after 24 h. Results showed that both species adhered to and formed biofilms on acrylic surfaces. A significantly ( P < 0.05) higher number of CFUs was evident in C. glabrata biofilms compared with those formed by C. albicans. Comparing single and dual species biofilms, equivalent CFU numbers were evident for the individual species. Both silver nanoparticles and nystatin reduced biofilm biomass and the CFUs of single and dual species biofilms ( P < 0.05). Silver nanoparticles had a significantly ( P < 0.05) greater effect on reducing C. glabrata biofilm biomass compared with C. albicans. Similarly, nystatin was more effective in reducing the number of CFUs of dual species biofilms compared with those of single species ( P < 0.05). In summary, C. glabrata and C. albicans can co-exist in biofilms without apparent antagonism, and both silver nanoparticles and nystatin exhibit inhibitory effects on biofilms of these species. [ABSTRACT FROM AUTHOR]

doi: 10.1111/j.1741-2358.2011.00476.x Salivary immunity in elderly individuals presented with Candida-related denture stomatitis Objectives: Elderly individuals with Candida-related denture stomatitis (DS) present with a reduced defence against Candida albicans. This study evaluated levels of antimicrobial mediators in the elderly DS saliva and salivary neutrophils' activation characteristics compared with elderly and young without DS. Methods: Salivary peroxidases (SPO) and elastase activities (ELA), nitric oxide (NO), transforming growth factor beta (TGF-β), IL-6 and CCL3 production were determined in saliva from elderly with or without DS, and young control individuals. TLR4, CXCR1, CD11b, CD16 and CD32 expression on salivary neutrophils were evaluated. Correlations between number and apoptosis rate of salivary neutrophils, enzymatic activities and cytokine levels were determined. Results: Elderly DS individuals exhibited the lowest SPO and ELA activities. Also, the activity of both enzymes was low in elderly without DS. Although both elderly groups showed higher salivary NO and TGF-β levels compared to young control groups, elderly DS presented the highest salivary NO, TGF-β, IL-6 and CCL3 levels. Decreased percentages of salivary TLR4+ and CD16+ neutrophils were detected in both elderly groups. Although these damages could influence the establishment and persistence of DS, the highest levels of salivary IL-6 and CCL3 in elderly DS could be preventing more serious complications. [ABSTRACT FROM AUTHOR]

Background: Radiation given during treatment of oral and pharyngeal malignancy frequently causes alteration of the oral environment predisposing to the colonization of the oral mucosa by yeast species most frequently Candida. Objective: Thus, this study was undertaken in 107 patients to find out association between radiation therapy and frequency of oropharyngeal candidosis, to quantitate colony forming units (CFUs) to identify Candida at species level and to check the incidence of serotype A and B in C. albicans. Materials and Methods: The study was done on patients suffering from oropharyngeal cancer who were advised radiotherapy. The oral rinse collection method was used to collect the sample. Sabourauds Dextrose Agar (SDA) was used as primary culture media and subsequently speciation was done using standard techniques. The strains of C. albicans were serotyped employing the method described by Hansclever and Mitchell (1961, J Bacteriol 1961;82:570-3). Results: 26.16% patients were mycologically positive for candida before radiotherapy with CFUs 100. 14 ± 59.11 that increased to 60.74% patients during radiotherapy with an increase in CFUs to 490.15 ± 207.97. Clinically, grading of mucositis was done and also individual signs and symptoms were noted in each patient. The occurrence of erythmatous lesions, ulceration, and xerostomia were found to be statistically significant (P<0.05). C. albicans was the most frequently encountered species with higher prevalence of serotype A suggesting higher virulent species. Conclusion: It is proposed that in such patients taking radiotherapy prophylactic antifungal treatment should be given specially in patients showing development of oral mucosal lesions such as erythmatous lesions, ulcerations, and complaining about dryness of mouth, that is, xerostomia irrespective of presence or absence of clinical oral candidosis. [ABSTRACT FROM AUTHOR]

Oral infections caused by yeast of the genus Candida and particularly Candida albicans (oral candidoses) have been recognised throughout recorded history. However, since the 1980s a clear surge of interest and associated research into these infections have occurred. This has largely been due to an increased incidence of oral candidosis over this period, primarily because of the escalation in HIV-infection and the AIDS epidemic. In addition, changes in medical practice leading to a greater use of invasive clinical procedures and a more widespread use of immunosuppressive therapies have also contributed to the problem. Whilst oral candidosis has previously been considered to be a disease mainly of the elderly and very young, its occurrence throughout the general population is now recognised. Candida are true 'opportunistic pathogens' and only instigate oral infection when there is an underlying predisposing condition in the host. Treatment of these infections has continued (and in some regards continues) to be problematic because of the potential toxicity of traditional antifungal agents against host cells. The problem has been compounded by the emergence of Candida species other than C. albicans that have inherent resistance against traditional antifungals. The aim of this review is to give the reader a contemporary overview of oral candidosis, the organisms involved, and the management strategies that are currently employed or could be utilised in the future. [ABSTRACT FROM AUTHOR]

Oral candidosis is the most common fungal infection encountered in general dental practice. It manifests in a variety of clinical presentations which may mimic more sinister diseases, and can occasionally be refractory to treatment requiring the attention of an oral medicine specialist. Management of oral candidosis should always include a thorough investigation of underlying predisposing conditions, as the disease often presents when the patient is systemically compromised. This update highlights the pathogenesis, clinical presentation, and management strategies of oral Candidal lesions commonly encountered in dental practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess a panel of risk factors associated to oral candidosis (OC) onset and its chronic maintenance by means of fuzzy logic (FL) approach and statistical traditional methodology (STM); to investigate their casual relationship within a multifactorial framework. Design: Case–control study. Setting: One hospital-based clinic. Patients: Eighty-nine patients with OC infection microbiologically diagnosed and 98 healthy subjects were consecutively recruited. Outcome measurements: Anamnestic and clinical evaluations for OC, microbiological assessment (i.e. culture, CFU/mL counting and identification) were performed. The commonest predisposing factors for OC onset and its chronic status were analysed by FL and STM. Results: By means of a twofold analysis (FL and STM) significant associations between OC onset and its chronic maintenance were found with respect to denture wearing and hyposalivation/xerostomia, as local risk factors, and to age and female gender, as socio-demographical variables. Tobacco smoking was found not to be a risk factor. Conclusions: The twofold (FL and STM) statistical approach for the identification of OC risk factors has been found useful and accurate in individuating a more selected target population for OC onset and chronic maintenance. The target patient appears to be an elderly person with multiple disease inducing, directly or by medications, hyposalivation/xerostomia. This data could provide to general and dental practitioners a decision-making model finalised to their preventative strategies for the geriatric population. [Copyright &y& Elsevier]

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidosis, which is by far the most common oral fungal infection in man. Broad-spectrum antibiotics used in the treatment of a wide range of disease conditions have also been attributed as a predisposing factor of oral candidosis. In this mini review we discuss the research findings on the relationship between antibiotics and oral candidosis and possible mechanisms of pathogenicity following such therapy. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the accuracy of HIV-related oral lesions to predict immune and virologic failure on HIV-infected children in use of highly active antiretroviral therapy (HAART). Study design: Data for this cross-sectional analysis come from a longitudinal study being conducted through the HIV-AIDS Outpatient Unit, ENT Division, Hospital das Clinicas, Sao Paulo University Medical School. The study began in January 1990 and is still ongoing. The cut-off point for analyses purposes was December 2004. Subjects were 471 HIV-infected consecutive children attending the outpatient unit during this period, who enrolled regardless of medical or immunological status. The children have undertaken oral cavity examination, serum CD4+ T-lymphocyte count, and, 271 of them, viral load measurement. Sensitivity, specificity, positive predictive value, negative predictive value and relative risk were calculated. Results: Oral lesions had moderate sensitivity, high specificity and positive predictive value to predict immune failure. It had low sensitivity and positive predictive value, and high specificity to predict virologic failure. Discussion and conclusions: Oral manifestations of HIV can be important markers for immune suppression and for virologic failure, in Brazilian children undergoing HAART. [ABSTRACT FROM AUTHOR]

Colonization of Candida albicans on oral surfaces can serve as a reservoir for disseminated infections, such as aspiration pneumonia and gastrointestinal infection, particularly in the immunocompromised host. Therefore, the aim of this study was to investigate the effects of salivary and serum pellicles on C. albicans, Streptococcus mutans, S. sanguis, Lactobacillus and Actinomyces colonization on type I collagen, a major organic component of periodontal ligaments. The colonization potential of two isolates each of C. albicans, S. mutans and S. sanguis, and a single isolate each of Lactobacillus and Actinomyces to uncoated (control), saliva-coated or serum-coated type I collagen plates (surface area 143 mm2, Cell Disk; Sumitomo, Tokyo, Japan) was examined using a bioluminescent adenosine triphosphate assay based on firefly luciferase–luciferin system. The results revealed that with mutans streptococci, a saliva pellicle was significantly more effective in promoting bacterial colonization compared with the pellicle-free collagen disc, and the serum-coated sample significantly inhibited the colonization of streptococci (anova; P < 0&bdot;01). In contrast, in the case of C. albicans, Lactobacillus and Actinomyces isolates, a serum pellicle was significantly more effective in promoting the colonization, followed by saliva pellicle and uncoated specimen (anova; P < 0&bdot;01). These results suggested that crevicular fluid rich in seruminous components would promote the colonization of Candida, Lactobacillus and Actinomyces on type I collagen as opposed to streptococci which showed greater avidity to saliva-coated collagen. [ABSTRACT FROM AUTHOR]

Introduction: Oral candidosis (OC) and hairy leukoplakia (OHL) are important markers of Human Immunodeficiency Virus (HIV) infection immune status. Objectives: to evaluate if OC and/or OHL should be considered clinical predictors of immune and virologic failure on HIV-infected Brazilian adults undergoing Highly Active Antiretroviral Therapy (HAART). Methods: 124 HIV-infected patients who used HAART for a minimum of six months were prospectively evaluated. All of them under-took oral examination and serum CD4+ count and viral load (VL), being divided in two groups, P and A, respectively according to the presence or absence of OC and/or OHL. During a six month period, patients belonging to group A were followed. They were re-examined for new oral lesions. New blood samples were collected and they were subdivided into groups P6 and A6. CD4+ count and VL were compared between groups at baseline and after the six months period. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and relative risk (RR) were obtained in order to assess the accuracy of using OC and OHL as predictors of immune and virologic failure, at baseline and after a six month period. Results: At baseline and after six months, patients with OC and OHL have mean CD4+ count lower and mean VL higher than patients of group A and A6 (p < 0.001). OC had high PPV for immune failure and a moderated PPV for virologic failure. OHL had low PPVs for both measures. Discussion and Conclusions: OC and OHL still indicate low serum CD4+ count and high VL, but OC seems to be a better predictor of immune and virologic failure in patients undergoing HAART than OHL. [ABSTRACT FROM AUTHOR]

The most common antifungal drugs in current clinical use for the treatment of oral candidosis are polyenes and azoles, mainly used topically. Poor glycaemic control in association with other local factors, such as the presence of oral dental prostheses, salivary pH, salivary flow rate and tobacco habits, may lead to the development of oral candidosis. Topical antifungal agents are frequently used to prevent the development of candidal infections in patients with poor metabolic control, particularly in the elderly wearing dentures. The aim of this study was to assess the antifungal susceptibility of Candida isolates to six antifungal agents using a commercially available kit, Fungitest®. The isolated were collected from patients affected by diabetes mellitus from two different geographic localities (London, UK, and Parma, Italy) and from a group of healthy non-diabetic subjects. No differences in antifungal susceptibility to the six agents tested were observed between Candida isolates from diabetic and non-diabetic subjects. However, differences were observed between the two geographically different diabetes mellitus populations. Oral yeast isolates from diabetes mellitus patients in the UK more often displayed resistance or intermediate resistance to fluconazole ( P = 0.02), miconazole ( P < 0.0001), and ketoconazole ( P = 0.01) than did isolates from diabetes mellitus patients in Italy. In addition, more C. albicans isolates were found in diabetic and non-diabetic subjects that were susceptible to fluconazole ( P = 0.0008 and P = 0.01, respectively) than non- albicans isolates. The difference in the antifungal resistance of isolates from the two populations of diabetes mellitus patients may be related to differences in the therapeutic management of candidal infections between the two centres. [ABSTRACT FROM AUTHOR]

It has been reported that poor glycaemic control predisposes to oral candidal infection in diabetic patients. For instance, the carriage of Candida species and the density of candidal growth in the oral cavity is frequently claimed to be increased in patients with diabetes mellitus. However, the validity of these observations remains controversial. Hence, we review and discuss here the clinical data in the literature on the relationship between diabetes and oral candidal carriage and infection, and possible mechanisms associated with its pathogenicity. [ABSTRACT FROM AUTHOR]

Smoking is associated with a variety of changes in the oral cavity. Cigarette smoke has effects on saliva, oral commensal bacteria and fungi, mainly Candida, which causes oral candidosis, the most common opportunistic fungal infection in man. How cigarette smoke affects oral Candida is still controversial. This brief overview is an attempt to address the clinical findings on the relationship between smoking and oral candidosis and possible mechanisms of pathogenicity. [ABSTRACT FROM AUTHOR]

Bartie KL, Williams DW, Wilson MJ, Potts AJC, Lewis MAO. Differential invasion of Candida albicans isolates in an in vitro model of oral candidosis. Oral Microbiol Immunol 2004: 19: 293–296© Blackwell Munksgaard, 2004. The study assessed the ability of Candida albicans isolates to invade an in vitro oral tissue model. The extent and pattern of isolate invasion was then correlated with the infection origin of the isolate to identify characteristics that may be restricted to specific forms of oral infection, particularly chronic hyperplastic candidosis (CHC). Reconstituted human oral epithelium was infected with C. albicans isolated from normal oral mucosa ( n = 4), CHC ( n = 7), non-CHC oral candidoses ( n = 4) and squamous cell carcinoma (SCC; n = 4). After infection for 24 h, histological analysis revealed yeast adhesion, hyphal extension, and invasion of the epithelium. Differential patterns of invasion were evident and, whilst consistent for a given isolate, did not relate to the infection origin of the isolate. Two principal patterns of invasion were evident and described as either a ‘localised’ or a ‘uniform’ distribution of invading hyphae. Several isolates also exhibited superficial infection with limited hyphal invasion. In conclusion, the use of the in vitro tissue model allowed the assessment of the invasive capabilities of isolates of C. albicans. However, the apparent differences in invasive characteristics did not appear to be related to the clinical origin of isolates. [ABSTRACT FROM AUTHOR]