Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases

Abstract

BackgroundOral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection.MethodsOf 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out.ResultsCultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94).ConclusionWe should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

Susceptibility to antifungal drugs of Candida albicans isolated from upper respiratory tract of patients with chronic hepatitis C

“…The data in the presented study are in agreement with this tendency, showing the decreased susceptibility to azole derivatives, in the case of itraconazole reaching even 56.67% and 48.39% of C. albicans isolates. Similar results have been obtained by other authors for C. albicans isolated from the oral cavity in patients with HIV/AIDS, from the upper respiratory tract of patients with lung cancer, from blood specimens or from neoplasmatic patients [12,15,17,18]. According to other literature data [5,19], the decreased sensitivity to fluconazole was found with a frequency amount of 6 -31.2%, while to itraconazole with a frequency of 14 -45.7%.…”

“…in the upper respiratory tract of patients with chronic hepatitis C from both groupswithout or with the standard antiviral therapy (peginterferon and ribavirin), ranging from 43.48 -44.44%, was similar to that found in healthy people [7,13,14]. Similarly, other authors [15] showed that cultures of Candida sp. from the tongue surfaces were positive in 50% patients with HCV infection at least once during therapy with interferon.…”

Oral candidiasis following steroid therapy for oral lichen planus

“…However, the addition of corticosteroids is known to enhance the growth of Candida spp. (Lundstrom et al, 1984;Nagao et al, 2012), evidenced by the presence of active budding spores and hyphae seen on cytologic smears (Jainkittivong et al, 2007). Corticosteroid application also lowers host resistance to Candida spp.…”

Salivary hypofunction: An update on aetiology, diagnosis and therapeutics

“…52 Xerostomia is one of the adverse events observed during interferon (IFN) therapy. 53 Aghemo et al 54 demonstrated that changes in salivary flow in patients receiving both interferon and ribavirin might result from an alteration of exocytosis and/or liquid transport of the exocrine glands. This effect promptly reverts to normal upon cessation of treatment.…”