Oropharyngeal candidiasis and resistance to antifungal drugs in patients receiving radiation for head and neck cancer

Document Type: Original Article(s)

Authors

1 Specialist of Oral Medicine, Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor, Department of Medical Mycology and Parasitology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Assistant Professor, Kerman Oral and Dental Diseases Research Center, Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

4 Radiotherapy, Oncology Unit, Shafa Hospital, Kerman, Iran

5 Dentist, Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran

Abstract

BACKGROUND: Oropharyngeal candidiasis is a common infection in patient receiving radiotherapy for head and neck cancer. Accurate and rapid identification of candida species is very important in clinical laboratory, because the incidence of candidiasis continues to rise after radiotherapy. The genus Candida has about 154 species that show different level of resistance to antifungal drugs and have high degree of phenotypic similarity. The aim of this study was to investigate oral yeast colonization and infection and resistance to antifungal drugs in these patients.METHODS: Thirty patients receiving a 6-week course of radiation therapy for treatment of head and neck cancer at the Oncology Unit in Shafa Hospital, in 2008, were enrolled in the study. Specimens from patients were cultured weekly for Candida. All isolates were plated on CHROM agar and RPMI-based medium. They were subcultured and submitted for antifungal susceptibility testing (nystatin, fluconazole, clotrimazole and ketoconazole) and molecular typing.RESULTS: Infection (clinical and microbiological evidence) occurred in 50% of the patients and Candida colonization (only microbiological evidence) occurred in 70% of subjects in the first week. Candida albicans alone was isolated in 94.9% of patient visits with positive cultures. Candida tropicalis was isolated from 5.1% of patient visits with positive cultures. All isolates were susceptible to nystatin, but did not respond to the other antifungal drugsCONCLUSIONS: The irradiation-induced changes of the intraoral environment such as xerostomia lead to increased intraoral colonization by Candida species. All yeast isolates were susceptible to nystatin. Thus prophylactic therapy with nystatin should be considered for these patients.

Keywords


  1. Redding SW, Zellars RC, Kirkpatrick WR, McAtee RK, Caceres MA, Fothergill AW, et al. Epidemiology of
  2. oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer. J Clin
  3. Microbiol 1999; 37(12): 3896-900.
  4. Fotos PG, Hellstein JW. Candida and candidosis. Epidemiology, diagnosis and therapeutic management. Dent Clin
  5. North Am 1992; 36(4): 857-78.
  6. Ramirez-Amador V, Silverman S Jr, Mayer P, Tyler M, Quivey J. Candidal colonization and oral candidiasis in patients
  7. undergoing oral and pharyngeal radiation therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;
  8. (2): 149-53.
  9. Haveman CW, Redding SW. Dental management and treatment of xerostomic patients. Tex Dent J 1998; 115(6):
  10. -56.
  11. Scully C, Ettinger RL. The influence of systemic diseases on oral health care in older adults. J Am Dent Assoc
  12. ; 138(Suppl): 7S-14S.
  13. Leung WK, Dassanayake RS, Yau JY, Jin LJ, Yam WC, Samaranayake LP. Oral colonization, phenotypic, and genotypic
  14. profiles of Candida species in irradiated, dentate, xerostomic nasopharyngeal carcinoma survivors. J Clin
  15. Microbiol 2000; 38(6): 2219-26.
  16. Pons V, Greenspan D, Debruin M. Therapy for oropharyngeal candidiasis in HIV-infected patients: a randomized,
  17. prospective multicenter study of oral fluconazole versus clotrimazole troches. The Multicenter Study Group.
  18. J Acquir Immune Defic Syndr 1993; 6(12): 1311-6.
  19. Lopez-Ribot JL, McAtee RK, Lee LN, Kirkpatrick WR, White TC, Sanglard D, et al. Distinct patterns of gene expression
  20. associated with development of fluconazole resistance in serial candida albicans isolates from human immunodeficiency
  21. virus-infected patients with oropharyngeal candidiasis. Antimicrob Agents Chemother 1998;
  22. (11): 2932-7.
  23. Lopez-Ribot JL, McAtee RK, Perea S, Kirkpatrick WR, Rinaldi MG, Patterson TF. Multiple resistant phenotypes of
  24. Candida albicans coexist during episodes of oropharyngeal candidiasis in human immunodeficiency virus-infected
  25. patients. Antimicrob Agents Chemother 1999; 43(7): 1621-30.
  26. Patterson TF, Revankar SG, Kirkpatrick WR, Dib O, Fothergill AW, Redding SW, et al. Simple method for detecting
  27. fluconazole-resistant yeasts with chromogenic agar. J Clin Microbiol 1996; 34(7): 1794-7.
  28. Mahmoudabadi AZ, Boote V, Verran J, Johnson E, Drucker DB. Phospholipid molecular species distributions of
  29. Candida isolates from the UK and Iran. J Appl Microbiol 2003; 95(4): 883-9.
  30. Ayatollahi Mousavi SA, Khalesi E, Shahidi Bonjar GH, Aghighi S, Sharifi F, Aram F. Rapid Molecular Diagnosis
  31. for Candida species Using PCR-RFLP. Biotechnology 2007; 6(4): 583-7.
  32. Suryawanshi H, Ganvir SM, Hazarey VK, Wanjare VS. Oropharyngeal candidosis relative frequency in
  33. radiotherapy patient for head and neck cancer. J Oral Maxillofac Pathol 2012; 16(1): 31-7.
  34. Nicolatou-Galitis O, Sotiropoulou-Lontou A, Velegraki A, Pissakas G, Kolitsi G, Kyprianou K, et al. Oral candidiasis
  35. in head and neck cancer patients receiving radiotherapy with amifostine cytoprotection. Oral Oncol 2003; 39(4):
  36. -401.
  37. Nicolatou-Galitis O, Dardoufas K, Markoulatos P, Sotiropoulou-Lontou A, Kyprianou K, Kolitsi G, et al. Oral
  38. pseudomembranous candidiasis, herpes simplex virus-1 infection, and oral mucositis in head and neck cancer
  39. patients receiving radiotherapy and granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash.
  40. J Oral Pathol Med 2001; 30(8): 471-80.
  41. Makkonen TA, Minn H, Jekunen A, Vilja P, Tuominen J, Joensuu H. Granulocyte macrophage-colony stimulating
  42. factor (GM-CSF) and sucralfate in prevention of radiation-induced mucositis: a prospective randomized study.
  43. Int J Radiat Oncol Biol Phys 2000; 46(3): 525-34.