Speciation of Candida using CHROMagar in cases with oral epithelial dysplasia and squamous cell carcinoma

Evaluation of Candidiasis in Upper-Aerodigestive Squamous Cell Carcinoma Patients—A Clinico-Mycological Aspect

Candida is a commensal yeast. It can be infective when the host’s defense mechanism is weakened, as in the case of squamous cell carcinoma patients. We aimed to evaluate the prevalence and clinical mycological manifestation of candidiasis in 150 cancer cases comprised of preoperative and post-operative (with or without radiotherapy) upper aerodigestive squamous cell carcinoma. A total of 150 patients suffering from squamous cell carcinoma of the Upper Aero-Digestive Tract (UADT) were divided into preoperative (n = 48), post-operative without radiotherapy (n = 29) and post-operative with radiotherapy (n = 73). Samples were collected using cotton swabs and cultured. Candida species were identified according to color pigmentation on Candida Differential Agar (CDA) plate. The clinico-mycological association of patients was evaluated by the chi-square test, and 98 out of 150 patients showed the presence of various Candida species. The major species isolated was Candida albicans (53%), followed by Candida tropicalis (16%). There was a significant statistical difference between patients who showed mycological associations and patients who did not have any such association (p = 0.0008). The prevalence of oral candidiasis was found to be 65.33% among total cases of upper aero-digestive squamous cell carcinoma. Chronic erythematous cases of candidiasis were mainly seen in preoperative squamous cell carcinoma cases, whereas the acute erythematous type of candidiasis was mainly seen in post-operative cases who received radiotherapy. The clinicomycological assessment can help to correlate the signs and symptoms with the presence of candidiasis in upper aerodigestive squamous cell carcinoma patients. Meticulous testing and examination can help in the early detection of candidiasis. Future studies are needed to develop advance scientific preventive strategies for high-risk cases.

Investigation of Candidal Species among People Who Suffer from Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

AIM AND OBJECTIVE

The aim of the present study was to evaluate the candidal species among masses with oral potentially malignant disorders and oral squamous cell carcinoma.

MATERIALS AND METHODS

This prospective and observational study was conducted by the Department of Oral Pathology and Microbiology, S. B. Patil Dental College, Bidar, Karnataka, India, from February 2018 to January 2019. The study composed of total of 150 individuals, of which 50 individuals did not had any visible manifestations, 50 were analyzed with potentially malignant disorders (PMDs) in particular oral leukoplakia, oral lichen planus, and oral submucous fibrosis and last group of 50 individuals were suffering from oral squamous cell carcinoma (OSCC). First, the swab samples were elicited from culture technique after that incisional biopsy of the discernible investigated lesion was done for the purpose of justopathological verification. The swab samples were streak on Sabouraud dextrose agar (SDA) and HiCrome Candida Differential HiVeg agar/CHROMagar medium and incubation at 37°C for 24-48 h. Biopsy was done for all the samples.

RESULTS

The proportion of candidates as men and women in control was 45 (90%) and 5 (10%), in PMD was 30 (60%) and 20 (40%), and in OSCC was 45 (90%) and 5 (10%), correspondingly. On evaluation on SDA medium in controls, PMD and OSCC groups, Candida was founded in 14 (28%), 20 (40%), and 42 (84%) and not founded in 36 (72%), 30 (60%), and 8 (16%) folks, subsequently. Intragroup contrast illustrated exceedingly necessary distinction with P = 0.000 between both controls versus OSCC and PMD in comparison to OSCC. Nevertheless, controls versus PMD manifested insignificant, P = 0.119. Investigation on CHROM AGAR media among controls, PMD and OSCC groups, Candida species was seen in 11 (22%), 19 (38%), and 40 (80%) and absent in 39 (78%), 31 (62%), and 10 (20%) individuals, respectively. On statistical inspection, the variations noted were enormous, (P = 0.000). On speciation of Candida in CHROM agar among the controls, PMD and OSCC groups, Candida albicans species was present in 9 (18%), 16 (32%), and 6 (12%), Candida krusei in 3 (6%), 6 (12%), and 13 (26%), Candida glabrata in 0, 0, and 8 (16%), and Candida tropicalis in 0, 0, and 3 (6%) cases, respectively. Nonetheless, only OSCC group reveal amalgamation of species such as C. glabrata and C. krusei was present in 2 (4%) case, C. tropicalis and C. krusei in was present 3 (6%) cases, C. tropicalis and C. glabrata was present in 2 (4%) case, C. albicans and C. tropicalis was present in 2 (4%) cases, and C. krusei, C. glabrata with C. albicans was present in 1 (2%) case, respectively. All other types of fungi were regarded as infectious excluding Candida, on analysis on SDA medium, infestation in the form of fungal molds was seen in 18 (36%) in controls, 12 (24%) in PMD and 8 (16%) in OSCC groups.

CONCLUSION

We interpreted that the chief carrier of candidal species in PMDs and OSCC, yet more light is to be thrown on the topic that Candida has particular establishment in PMDs or in malignancy.

The A756T Mutation of the ERG11 Gene Associated With Resistance to Itraconazole in Candida Krusei Isolated From Mycotic Mastitis of Cows

Candida krusei (C. krusei) has been recently recognized as an important pathogen involved in mycotic mastitis of cows. The phenotypic and molecular characteristics of 15 C. krusei clinical isolates collected from cows with clinical mastitis in three herds of Yinchuan, Ningxia, were identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry. In addition to sequencing analysis, the ERG11 gene that encodes 14α-demethylases, the expression of the ERG11 gene, and efflux transporters ABC1 and ABC2 in itraconazole-susceptible (S), itraconazole-susceptible dose dependent (SDD), and itraconazole-resistant (R) C. krusei isolates was also quantified by a quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) assay. Sequencing analysis revealed three synonymous codon substitutions of the ERG11 gene including T939C, A756T, and T642C in these C. krusei clinical isolates. Among them, T642C and T939C mutations were detected in itraconazole-resistant and -susceptible C. krusei isolates, but the A756T substitution was found only in itraconazole-resistant isolates. Importantly, the expression of the ERG11 gene in itraconazole-resistant isolates was significantly higher compared with itraconazole-SDD and itraconazole-susceptible isolates (p = 0.052 and p = 0.012, respectively), as determined by the qRT-PCR assay. Interestingly, the expression of the ABC2 gene was also significantly higher in itraconazole-resistant isolates relative to the itraconazole-SDD and itraconazole-susceptible strains. Notably, the expression of ERG11 was positively associated with resistance to itraconazole (p = 0.4177 in SDD compared with S, p = 0.0107 in SDD with R, and p = 0.0035 in S with R, respectively). These data demonstrated that mutations of the ERG11 gene were involved in drug resistance in C. krusei. The A756T synonymous codon substitution of the ERG11 gene was correlated with an increased expression of drug-resistant genes including ERG11 and ABC2 in itraconazole-resistant C. krusei isolates examined in this study.

Analyzing the Association between Candida Prevalence, Species Specificity, and Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis— Candida and OSCC

The present review is a qualitative and quantitative analysis of the overall prevalence of Candida, and its species specificity in oral squamous cell carcinoma (OSCC). PubMed, Scopus, and Web of Science databases were searched using the keywords ‘Candida and oral squamous cell carcinoma’. Only case-control observational studies in the English language evaluating the prevalence and species specificity of Candida in OSCC were included. 297 articles were identified (PubMed-106, Scopus-148, Web of Science-43) using the keywords. After screening the titles and abstracts, 206 articles were removed as they were duplicates (118) or irrelevant to the topic (88). Full text of the remaining 91 articles was assessed using the inclusion criteria, based on which only seven articles were included in the systematic review. For the quantitative analysis, the odds ratio and confidence interval were assessed and a forest plot was generated. Based on the meta-analysis, there is an association between the total Candida, Candida albicans (CA) and OSCC, while the association with non-Candida albicans (NCA) is relatively weak. The number of studies included in the meta-analysis was relatively low (four to five). Further, at least one of the studies included in the meta-analysis for the association of CA., NCA and total Candida with OSCC had a Newcastle–Ottawa score below 7. Thus, although the results showed an association, the quality and quantity of the evidence may not be sufficient for conclusive inference.

Candida spp. Determination and Th1/Th2 Mixed Cytokine Profile in Oral Samples From HIV+ Patients With Chronic Periodontitis

Background: Chronic periodontitis (CP), caused by bacteria and fungi, appears in up to 66% of HIV-patients. The impact and association of HIV-treatment (HAART) and Candida itself has not been properly evaluated in the development and progression of CP. The immunopathogenesis is characterized by CD4+ T-cells activation and the balance between the T-helper 1 (Th1) and T-helper 2 (Th2) or a mixed cytokine profile. Currently, the associated causes of an immune response in HIV-patients with CP is controversial. Our aims were the determination of Candida spp. and cytokine profile in oral samples from HIV-positive patients with CP, considering the CD4+ T cells levels and HAART use. Methods: From 500 HIV-positive patients evaluated, 228 patients were enrolled. Patients were separated in groups: (A) n = 53 (≤200 CD4+ T-cells on HAART); (B) n = 57 (≤200 CD4+ T-cells without HAART); (C) n = 50 (>200 CD4+ T-cells without HAART); (D) n = 68 (>200 CD4+ T-cells on HAART). Candida spp. were isolated from the oral biofilm and crevicular fluid in CHROMagar and confirmed by endpoint PCR. Cytokine levels were measured by beads-based immunoassay in saliva by flow cytometry. Results: 147 patients (64.5%) were positive to Candida spp. and 204 strains were isolated; 138 (67.6%) were C. albicans and the remaining C. non-albicans species (C. glabrata>C. tropicalis>C. krusei>C. dubliniensis). In this study, CHROMagar showed good sensitivity (95%) but poor specificity (68%); since of the 152 samples identified as C. albicans, only 131 were confirmed by PCR; from the 10 samples identified as C. glabrata, only six were confirmed. Finally, of the 42 samples detected as C. tropicalis, only five were confirmed. When evaluating Candida spp. presence, group A and D had higher isolation, while group B had the highest species diversity. Whereas, group C had a significant reduction of Candida spp. Despite the presence of Candida and HAART, we found a Th1/Th2 hybrid profile in the saliva of patients with low CD4+ T-cell count (group A). Conclusion: Abundance and diversity of the Candida spp. detected in HIV-patients with CP could be related to HAART and low CD4+ T-cells levels. Also, the immunosuppression might promote a local Th1/Th2 hybrid cytokine profile.