Clinical Characteristics and Relevance of Oral Candida Biofilm in Tongue Smears

Abstract

Dimorphic Candida exist as commensal yeast carriages or infiltrate hyphae in the oral cavity. Here, we investigated the clinical relevance of Candida hyphae in non-pseudomembranous oral candidiasis (OC) by smears of tongue biofilms. We conducted a retrospective study of 2829 patients who had had tongue smears regardless of OC suspicion. Clinical characteristics were evaluated using a novel method of assessing hyphae. Clinical factors (moderate/severe stimulated pain, pain aggravated by stimulation, tongue dorsum appearance and initial topical antifungal use) were highly significant in the high-grade hyphae group but were statistically similar in the low-grade hyphae and non-observed hyphae group, suggesting low-grade hyphae infection as a subclinical OC state. In addition to erythematous candidiasis (EC), a new subtype named “morphologically normal symptomatic candidiasis” (MNSC) with specific pain patterns and normal tongue morphology was identified. MNSC had a significantly higher proportion of moderate and severe stimulated pain cases than EC. Low unstimulated salivary flow rate (<0.1 mL/min) was found to be a common risk factor in MNSC and EC. In non-pseudomembranous OC, pain patterns were dependent on Candida hyphae degree regardless of tongue dorsum morphology. Morphologic differences seen in high-grade hyphae infection were not associated with systemic diseases or nutritional deficiencies.

Oral candidiasis in patients with haematological diseases: Diagnosis through clinical and cytopathological examinations

“…An imbalance in this mechanism makes the relationship between Candida and host pathogenic. Candida colonisation is related to many local (use of dentures, oral lesions, hyposalivation, topical and inhaled corticosteroids, and smoking habits) and systemic (malnutrition, host immune status, long‐term treatment with systemic corticosteroids and antibiotics, diabetes, history of radiotherapy, chemotherapy, immunosuppression, human immunodeficiency virus, endocrine diseases) factors 3,25,26 …”

“…Candidiasis is an opportunistic yeast infection, and studies suggest that about 40%‐60% of the overall population carry oral Candida species, 1 among which Candida albicans is the most prevalent 2 . Although fungus may comprise part of the human microbiota, certain local and systemic factors may promote their growth and lead to candidiasis 3 …”

“…In hospitalised patients, such as individuals with haematological diseases, oral candidiasis represents a serious problem that may interfere with their prognosis 4 . Yeast infection may cause mild, acute, or chronic manifestations, and superficial or deep infection, and in oral mucosa several clinical and subclinical presentations are seen 3,5,6 …”

Oral Candidiasis in Patients with Hematological Diseases: Diagnosis Through Clinical and Cytopathological Exams

“…9 These factors include the use of denture, inhaled or systemic corticosteroids, xerostomia, endocrine diseases, human immunode ciency virus (HIV), leukemia, malnutrition, immunosuppression, radiotherapy, chemotherapy, and long-term use of antibiotics. 9 Oral candidiasis has a variety of clinical presentations and the diagnosis is often based only in the clinical aspects. 7 Although pseudomembranous oral candidiasis is readily recognized, the same does not happen for other clinical forms, and it is necessary to perform additional methods to con rm the diagnosis.…”

“…5,8 Although fungus may comprise part of the human microbiota, certain local and systemic factors may promote their growth and lead to diseases. 9 These factors include the use of denture, inhaled or systemic corticosteroids, xerostomia, endocrine diseases, human immunode ciency virus (HIV), leukemia, malnutrition, immunosuppression, radiotherapy, chemotherapy, and long-term use of antibiotics. 9 Oral candidiasis has a variety of clinical presentations and the diagnosis is often based only in the clinical aspects.…”