Epidemiology of OropharyngealCandidaColonization and Infection in Patients Receiving Radiation for Head and Neck Cancer

Abstract

Oral mucosal colonization and infection with Candidaare common in patients receiving radiation therapy for head and neck cancer. Infection is marked by oral pain and/or burning and can lead to significant patient morbidity. The purpose of this study was to identify Candida strain diversity in this population by using a chromogenic medium, subculturing, molecular typing, and antifungal susceptibility testing of clinical isolates. These results were then correlated with clinical outcome in patients treated with fluconazole for infection. Specimens from 30 patients receiving radiation therapy for head and neck cancer were cultured weekly forCandida. Patients exhibiting clinical infection were treated with oral fluconazole. All isolates were plated on CHROMagar Candida and RPMI medium, subcultured, and submitted for antifungal susceptibility testing and molecular typing. Infections occurred in 27% of the patients and were predominantly due to Candida albicans (78%). Candida carriage occurred in 73% of patients and at 51% of patient visits. Yeasts other than C. albicans predominated in carriage, as they were isolated from 59% of patients and at 52% of patient visits. All infections responded clinically, and all isolates were susceptible to fluconazole. Molecular typing showed that most patients had similar strains throughout their radiation treatment. One patient, however, did show the acquisition of a new strain. With this high rate of infection (27%), prophylaxis to prevent infection should be evaluated for these patients.

Microflora in oral ecosystems in subjects with radiation‐induced hyposalivation

“…An increased incidence of candidiasis before and during radiation therapy, as well as several years after completed radiation therapy has, been reported (Redding et al, 1999;Schwarz et al, 1999). In this study, 6-8 months after completed radiation therapy, we found no clinical signs of mucosal infections in the RT group.…”

Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy

“…fludarabine), in graft-versus-host disease (GvHD) or after radiation therapy. [4][5][6] Other predisposing factors include diabetes mellitus, therapy with antibacterial agents or local factors such as the use of a dental prosthesis. [7][8][9] Most infections are caused by yeast that colonise the skin or mucous membranes.…”

“…4 Status of licensing. 5 Not sufficiently validated in children below 13 years. 6 Potential for interactions, benefits compared with fluconazole undefined.…”

Role of the fungal Ras-protein kinase A pathway in governing epithelial cell interactions during oropharyngeal candidiasis

“…The conditions that place patients at risk for OPC are different from the risk factors for haematogenously disseminated candidiasis (HDC) (Wright and Wenzel, 1997), suggesting that the pathogenesis of OPC is different from HDC. Approximately 85% of episodes of OPC are caused by Candida albicans, either alone or in combination with other species of Candida (Sangeorzan et al ., 1994;Redding et al ., 1999) . The mechanisms by which C. albicans causes oropharyngeal disease are incompletely understood.…”