Assessment of saliva and oral candidiasis levels 12, 24 and 36 months after radiotherapy in patients with head and neck cancer.

INTRODUCTION: Hyposalivation is a serious complication during radiotherapy (RT) and it is one of the major risk factors for the presence of candidiasis. The aim of this study was to evaluate the salivary hypofunction during the different stages of RT, analysing its connection with the presence of candidiasis. MATERIAL AND METHODS: A retrospective study was performed in 83 patients who had been diagnosed with head and neck tumours and who were undergoing RT treatment. Their salivary function was clinically analysed throughout the course of the RT treatment (before, during and after treatment) by means of the whole saliva test (WST), both unstimulated (WST-I) and stimulated (WST-II), and its relationship with candidiasis was evaluated using culture-based methods. RESULTS: The WST-I before RT was 37.24±17.36mm and the WST-II was 60.70±30.98mm, with 47% of patients testing positive for candidiasis. The prevalence of candidiasis increased up to 55.8% during RT and it returned to similar pre-RT levels at the end of treatment (45.2%). A statistical significant relationship was found between low WST-I and candidiasis in the 1st (13.58 vs 20.78mm), 3rd (18.06 vs 24.36mm), 6th (16.83 vs 24.5) and 12th (16 vs 28.74mm) months after RT; and this relationship was also detected for WST-II in the 1st (24.73 vs 41.26mm) and 3rd (27.71 vs 39.91mm) months after RT. Female sex was identified as an independent associated risk factor for mild hyposalivation before RT (OR=6.50, CI: 95% 1.77-23.93, p=0.005) and glandular hypofunction (OR=3.01, CI: 95% 1.12-8.10, p=0.029). DISCUSSION: There is a clear relation between hyposalivation and the presence of candidiasis during and after RT. Larger studies must be performed in order to further elucidate this effect.

Oral health and Candida carriage in socioeconomically disadvantaged US pregnant women.

BACKGROUND: Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oral Candida has recently been suggested as a potential culprit for children's dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oral Candida carriage in a cohort of underserved US pregnant women, and reveal factors associated with their oral Candida carriage. METHODS: Demographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identify Candida species and Streptococcus mutans by culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oral Candida carriage and caries severity. RESULTS: Eighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivary Candida albicans level. C. albicans was the most predominant/abundant Candida strain, with cheek and tonsil as the most common colonized sites. The detection of C. albicans was 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women's oral Candida carriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivary S. mutans level [p = 0.03, odds ratio = 4.80 (1.18-19.43)]. CONCLUSIONS: Socioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oral Candida. Due to the observed significant association between the decayed teeth number and oral Candida carriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women's oral health, but also present as a promising approach to reduce oral Candida carriage in women.

Management of oropharyngeal mycosis in head and neck cancer occurring during (chemo) radiotherapy: an Italian radio-oncologist survey.

AIMS AND BACKGROUND: Oropharyngeal candidiasis is a common disorder in head and neck cancer patients (HNCPs) who underwent (chemo)-radiotherapy. An Italian survey was conducted in order to investigate radiation oncologists' behavior in regard to diagnosis, prevention, and treatment of oral candidiasis. METHODS AND STUDY DESIGN: Between April and May 2013, a national online 18-question survey was sent to major Italian radiotherapy centers. RESULTS: All Italian regions were represented and 86 radiation oncologists were involved. Eighty-three percent of responders estimated that oropharyngeal candidiasis occurred in 30%-40% of their HNCPs. The majority of responders were able to recognize oral mycosis when it occurred in a localized pseudomembranous form and all responders agreed with the fact that oral candidiasis was always associated with mucositis. A prophylactic therapy was prescribed occasionally by 35% and routinely by 20% of responders. Forty percent prescribed an antifungal drug in the case of suspected mycotic infection and 20% waited for symptomatic clinical evidence before prescribing a therapy. In the presence of candidiasis, mainly topical fluconazole (59%) and itraconazole (36%) were prescribed. Concomitant chemo-radiotherapy was first identified as a risk factor for mycosis occurrence and development. Ninety-nine percent of responders believed that oral mycosis was associated with increased toxicity and 44% of them interrupted treatment due to candidiasis. CONCLUSIONS: A variety of approaches to oropharyngeal candidiasis emerges from this survey; further clinical trials are necessary to identify the best approach for oral mycosis prevention and treatment and to establish specific international guidelines for HNCPs.

Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database.

BACKGROUND: UK HIV guidelines identify 37 clinical indicator conditions for adult HIV infection that should prompt an HIV test. However, few data currently exist to show their predictive value in identifying undiagnosed HIV. AIM: To identify symptoms and clinical diagnoses associated with HIV infection and assess their relative importance in identifying HIV cases, using data from The Health Improvement Network (THIN) general practice database. DESIGN AND SETTING: A case-control study in primary care. METHOD: Cases (HIV-positive patients) were matched to controls (not known to have HIV). Data from 939 cases and 2576 controls were included (n = 3515). Statistical analysis assessed the incidence of the 37 clinical conditions in cases and controls, and their predictive value in indicating HIV infection, and derived odds ratios (ORs) for each indicator condition. RESULTS: Twelve indicator conditions were significantly associated with HIV infection; 74.2% of HIV cases (n = 697) presented with none of the HIV indicator conditions prior to diagnosis. The conditions most strongly associated with HIV infection were bacterial pneumonia (OR = 47.7; 95% confidence interval [CI] = 5.6 to 404.2) and oral candidiasis (OR = 29.4; 95% CI = 6.9 to 125.5). The signs and symptoms most associated with HIV were weight loss (OR = 13.4; 95% CI = 5.0 to 36.0), pyrexia of unknown origin (OR = 7.2; 95% CI = 2.8 to 18.7), and diarrhoea (one or two consultations). CONCLUSION: This is the first study to quantify the predictive value of clinical diagnoses related to HIV infection in primary care. In identifying the conditions most strongly associated with HIV, this study could aid GPs in offering targeted HIV testing to those at highest risk.

Hospital-based emergency department visits with oral candidiasis in the USA.

OBJECTIVES: The aim of this study was to determine the number of hospital Emergency Department (ED) visits with a diagnosis of oral candidiasis for the year 2007 in the USA and to identify the comorbid conditions associated with it. STUDY DESIGN: The Nationwide Emergency Department Sample (NEDS) for 2007 was employed in this study. Patients who visited the ED with a diagnosis of oral candidiasis were selected, and the estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also determined. RESULTS: A total of 249,092 ED visits had oral candidiasis. Most of the patients belonged to the lower socioeconomic strata. Patients presented with a wide range of comorbid conditions and a large percentage of the patients were subsequently hospitalized after ED visits. CONCLUSIONS: A significant number of patients in the US visited the ED with oral candidiasis in the year 2007.

Manifestaciones orales y caries dental en niños expuestos al virus de inmunodeficiencia humana / Oral manifestations and dental caries in children exposed to human immunodeficiency virus

Objetivo Determinar las manifestaciones orales y caries dental en niños expuestos al virus de inmunodeficiencia humana (VIH). Métodos Se estudiaron 37 niños que acuden a la consulta pediátrica del programa nacional de control de SIDA (PRONASIDA-Lara). Se informó a padres y representantes sobre los objetivos del estudio y su carácter confidencial. El examen de la cavidad oral lo realizó un odontólogo, quien además indagó sobre historia de manifestaciones bucales y corroboró la información con la historia clínica. Resultado La edad promedio fue 5,15±3,79 años, 62,2 % era del género masculino. Se infectaron por trasmisión vertical 91,8 %. La mayoría de los niños pertenecían a la categoría clínica A (35,1 %). El mayor porcentaje (37,8 %) de niños se encontró en la categoría 15-24 % de linfocitos CD4. Entre las manifestaciones orales más prevalentes se encontró la candidiasis oral, queilitis angular, eritema gingival lineal y parotiditis. Se observó diferencia estadísticamente significativa entre el porcentaje de linfocitos CD4 y queilitis angular (p<0,05). Cuarenta y cinco coma nueve (45,9 %) presentó caries dental y 29,7 % tenían necesidad de tratamiento dental "urgente". Por otra parte, el índice de necesidad de tratamiento calculado (INT) muestra que tres cuartos de los niños tenían necesidad de tratamiento dental. Conclusiones Los resultados del estudio permiten concluir que existe la necesidad de una estrategia basada en el manejo de las manifestaciones orales, frecuentes en la infección por VIH en niños, que permita un tratamiento desde un punto de vista integral, con un enfoque clínico y preventivo.

Objective Determining oral manifestations and dental caries amongst children exposed to the immunodeficiency virus (HIV). Methods Thirty-seven (n=37) children attending the Colombian AIDS Control Program (PRONASIDA-Lara) pediatric service were studied. Parents and guardians were informed about the purpose of the study and its confidentiality. An oral examination was conducted by a dentist; parents/guardians were asked about their children's history of oral manifestations and this was corroborated with their clinical charts. Results The mean age was 5.15±3.79; 62.2 % were males. Ninety-eight point eight percent had become vertically infected. Most of the children were classified in the A immune suppression category (35.1 %). The highest percentage (37.8 %) of children were in the 15 %-24 % total CD4+ lymphocyte category. The most prevalent oral manifestations were oral candidiasis, angular cheilitis, linear gingival erythema and parotid enlargement. There was a significant statistical difference between percentages of CD4 lymphocytes and angular qualities (p<0.05). Forty-five point nine percent had dental caries and 54.1 % were in "urgent" need of dental treatment. The Index of Orthodontic Treatment Need (IOTN) showed that ¾ of the children needed dental treatment. Conclusions The results of the study led to concluding that there was a need for an oral manifestation management-based strategy focusing on clinical and preventative treatment, as oral manifestations are frequent in children suffering from HIV infection.

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil.

OBJECTIVE: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. METHODS: This cross-sectional study selected 1586 subjects (719M/867F, age: 14-104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. RESULTS: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1-39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1-3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5-3.2 and OR = 1.7, 95% CI = 1.0-2.8), older age (OR=22, 95% CI = 8.0-60.8 and OR = 8.9, 95% CI = 3.4-23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0-3.5 and OR = 3.0, 95% CI = 1.2-7.2). CONCLUSIONS: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic-demographic disparities in this and similar populations.

Prevalence and treatment management of oropharyngeal candidiasis in cancer patients: results of the French CANDIDOSCOPE study.

PURPOSE: The aim of this pharmaco-epidemiological study was to evaluate the prevalence of oropharyngeal candidiasis (OPC) in cancer patients treated with chemotherapy and/or radiotherapy. METHODS AND MATERIALS: Signs and symptoms of OPC were noted for all patients. Antifungal therapeutic management was recorded in OPC patients. Patients receiving local antifungal treatments were monitored until the end of treatment. RESULTS: Enrolled in the study were 2,042 patients with solid tumor and/or lymphoma treated with chemotherapy and/or another systemic cancer treatment and/or radiotherapy. The overall prevalence of OPC was 9.6% (95% confidence interval, 8.4%-11.0%] in this population. It was most frequent in patients treated with combined chemoradiotherapy (22.0%) or with more than two cytotoxic agents (16.9%). Local antifungal treatments were prescribed in 75.0% of OPC patients as recommended by guidelines. The compliance to treatment was higher in patients receiving once-daily miconazole mucoadhesive buccal tablet (MBT; 88.2%) than in those treated with several daily mouthwashes of amphotericin B (40%) or nystatin (18.8%). CONCLUSION: OPC prevalence in treated cancer patients was high. Local treatments were usually prescribed as per guidelines. Compliance to local treatments was better with once-daily drugs.

[Oral manifestations and dental caries in children exposed to human immunodeficiency virus]. / Manifestaciones orales y caries dental en niños expuestos al virus de inmunodeficiencia humana.

OBJECTIVE: Determining oral manifestations and dental caries amongst children exposed to the immunodeficiency virus (HIV). METHODS: Thirty-seven (n=37) children attending the Colombian AIDS Control Program (PRONASIDA-Lara) pediatric service were studied. Parents and guardians were informed about the purpose of the study and its confidentiality. An oral examination was conducted by a dentist; parents/guardians were asked about their children's history of oral manifestations and this was corroborated with their clinical charts. RESULTS: The mean age was 5.15±3.79; 62.2 % were males. Ninety-eight point eight percent had become vertically infected. Most of the children were classified in the A immune suppression category (35.1 %). The highest percentage (37.8 %) of children were in the 15 %-24 % total CD4+ lymphocyte category. The most prevalent oral manifestations were oral candidiasis, angular cheilitis, linear gingival erythema and parotid enlargement. There was a significant statistical difference between percentages of CD4 lymphocytes and angular qualities (p<0.05). Forty-five point nine percent had dental caries and 54.1 % were in "urgent" need of dental treatment. The Index of Orthodontic Treatment Need (IOTN) showed that ¾ of the children needed dental treatment. CONCLUSIONS: The results of the study led to concluding that there was a need for an oral manifestation management-based strategy focusing on clinical and preventative treatment, as oral manifestations are frequent in children suffering from HIV infection.

A systematic review of oral fungal infections in patients receiving cancer therapy.

PURPOSE: The aims of this systematic review were to determine, in patients receiving cancer therapy, the prevalence of clinical oral fungal infection and fungal colonization, to determine the impact on quality of life and cost of care, and to review current management strategies for oral fungal infections. METHODS: Thirty-nine articles that met the inclusion/exclusion criteria were independently reviewed by two calibrated reviewers, each using a standard form. Information was extracted on a number of variables, including study design, study population, sample size, interventions, blinding, outcome measures, methods, results, and conclusions for each article. Areas of discrepancy between the two reviews were resolved by consensus. Studies were weighted as to the quality of the study design, and recommendations were based on the relative strength of each paper. Statistical analyses were performed to determine the weighted prevalence of clinical oral fungal infection and fungal colonization. RESULTS: For all cancer treatments, the weighted prevalence of clinical oral fungal infection was found to be 7.5% pre-treatment, 39.1% during treatment, and 32.6% after the end of cancer therapy. Head and neck radiotherapy and chemotherapy were each independently associated with a significantly increased risk for oral fungal infection. For all cancer treatments, the prevalence of oral colonization with fungal organisms was 48.2% before treatment, 72.2% during treatment, and 70.1% after treatment. The prophylactic use of fluconazole during cancer therapy resulted in a prevalence of clinical fungal infection of 1.9%. No information specific to oral fungal infections was found on quality of life or cost of care. CONCLUSIONS: There is an increased risk of clinically significant oral fungal infection during cancer therapy. Systemic antifungals are effective in the prevention of clinical oral fungal infection in patients receiving cancer therapy. Currently available topical antifungal agents are less efficacious, suggesting a need for better topical agents.

Clinical and microbiological assessment of patients with a long-term diagnosis of human immunodeficiency virus infection and Candida oral colonization.

The objective of this study was to evaluate Candida oral colonization in human immunodeficiency virus (HIV)-infected patients undergoing long-term highly active antiretroviral therapy (ARV). The cross-sectional study included 331 HIV patients, diagnosed from 1983 to 2003. Oral swabs were performed, and Candida species were determined using ID 32C. Isolates were tested for antifungal susceptibility. Clinical and laboratory data were collected to identify the association with Candida colonization. In total, 161 Candida isolates were detected among 147 of the 331 patients (44%), independently of the time when HIV infection was diagnosed. Candida albicans strains represented 137 (85%) of the isolates, and were susceptible to all of the tested antifungal drugs. Among the non-C. albicans strains, six isolates were dose-dependently susceptible to fluconazole, nine to itraconazole, and seven to ketoconazole. The isolation of Candida was significantly higher in patients with virological failure (83/147; p 0.0002) and CD4(+) T-lymphocyte counts <200 cells/mm(3) (30/83; p 0.0003). Recovery of Candida in the oral cavity was independent of protease inhibitor (PI) usage (p 0.60). Colonized patients typically underwent salvage therapy (p 0.003), and had more episodes of opportunistic fungal infections (p 0.046) and malignancies (p 0.004).Oral Candida colonization in patients under ARV therapy was associated with the immunosupressed status of HIV-infected patients, i.e. low number of CD4(+) T-cells per cubic millimetre, failure of ARV therapy (salvage therapy), and higher number of opportunistic infections and malignancies. Despite the fact that PIs have in vitro antifungal activity, the use of this class of antiretroviral agent did not influence the presence of Candida in the oral cavity of AIDS patients.

[Assessment of oral cavity mucosa and teeth state in patients with chronic obstructive pulmonary disease--part I]. / Ocena stanu blony sluzowej jamy ustnej i uzebienia u chorych na przewlekla obturacyjna chorobe pluc--czesc I.

UNLABELLED: The aim of the study was to assess the state of oral cavity mucosa and teeth in patients with chronic obturative pulmonary disease (COPD). MATERIAL AND METHODS: The study comprised 100 patients with COPD (68 men and 32 women), aged 30-83 years (mean 63.1 +/- 10.17 years). All patients demonstrated II grade COPD (moderate COPD). FEV1/FVC<70% and FEV1 was within 79% and 50% of the predicted value. Beta2-adrenomimetic inhalants or in nebulization, theophylline were applied in the therapy. The control group consisted of 101 subjects (38 men and 63 women), aged 42-88 years (mean 65.3-10.36 years), with no respiratory tract ailments. The rate of smoking was similar in both groups. The examination of oral cavity mucosa and teeth state was performed in artificial lightening with the use of probe and mouth mirror. The number of lacking teeth and the advancement of caries were determined. RESULTS: Thrush appeared to be the most frequent oral cavity mucosa ailment in COPD patients. Toothlessness and reduced teeth number were observed significantly more often in COPD patients than in the control group (p<0.05). The frequency and the type of caries did not differ significantly between the two groups (p>0.05).

Assessment of clinical case-definition for HIV/AIDS in Tanzania.

OBJECTIVE: To evaluate the usefulness of World Health Organisation (WHO's) clinical case-definition (CCD) for AIDS in a private hospital. DESIGN: A prospective study. SETTING: Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania. SUBJECTS: A total of 601 patients (> 14 years) were studied from January 1995 to December 1997. METHODS: Using HIV test results as a reference standard, sensitivity, specificity, positive predictive values (PPV) and negative predictive values of signs and symptoms were calculated. Multiple logistic regression was used to determine a set of predictive symptoms and signs. Stepwise logistic regression modelling was used to choose the final model. RESULTS: The frequently occurring signs and symptoms among the 473 sero-positive patients were fever (226), oral candidiasis (167), weight loss (161), chronic cough (157), diarrhoea (100) and pulmonary tuberculosis in 69 cases. The presence of anorectal lesions and the rarity of pneumocystis carinii pneumonia in this study are important findings. Seven clinical characteristics predicted HIV infection. These included pulmonary tuberculosis (p=0.009), lymphadenopathy (p=0.007), diarrhoea (p=0.000), chronic cough (p=0.001), dermatitis (p=0.003), herpes zoster (p=0.01) and oral candidiasis (p=0.000). CONCLUSIONS: A greater number of HIV positive patients presented with signs and symptoms different from those proposed by WHO's CCD were observed in this study. With environmental pathogens varying from one geographical region to another and new ones appearing, opportunistic disease cannot be constant in AIDS patients. Therefore, AIDS diagnosis based on clinical case definition alone without at least one positive HIV antibody test is inaccurate and no longer justified.

Candida and candidosis. Epidemiology, diagnosis and therapeutic management.

Infections caused by Candida species comprise one of the most common oral disease conditions encountered in the practice of dentistry. Gradual changes in population demographics have been accompanied by an increased incidence in candidal and related opportunistic infection rates. Candida albicans and other candidal species traditionally have been recognized as opportunistic pathogens. Recent advances in both the scientific basis for and the clinical significance of candidal organisms, however, have demonstrated these fungi to be distributed widely and to be important contributors to a broad range of mucosal and systemic disease conditions. These factors have allowed for a better understanding of fungal pathogenesis as it affects human oral disease through improvements in clinical and laboratory diagnosis and the therapeutic management of candidosis.