High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer

Abstract

Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non-C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.

Oral <i>Candidiasis</i> amongst cancer patients at Qods Hospital

“…Our findings were consistent with that noted by other investigators [15][16]. Bagg et al [17] showed that patients with advanced cancer have demonstrated a high incidence (51%) of oral colonization with non-C. albicans yeasts [18]. Antifungal drug resistance of Candida spp continues to increase in response to the widespread of application of antifungal agents in treatment of cancer patients.…”

Voriconazole susceptibility of yeasts isolated from the mouths of patients with advanced cancer

“…Previous studies have reported a diverse oral mycological flora in hospice patients, with a significant proportion of non-C. albicans yeasts (Sweeney et al, 1998;Jobbins et al, 1992b), a result confirmed in a recent study of oral yeast carriage among 120 patients with advanced cancer (Davies et al, 2002). In a recently completed multi-centre study (Bagg et al, 2003), the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease was examined. In total, 194 yeasts were isolated, of which 95 (49 %) were C. albicans.…”

“…Yeast isolates were available from the mouths of 199 patients who were receiving palliative care for advanced cancer. These isolates had been collected and characterized during two previous studies of fungal carriage among randomly selected patients receiving palliative care in the UK (Bagg et al, 2003;Davies et al, 2002).…”

“…In total, 194 yeasts were isolated, of which 95 (49 %) were C. albicans. There was a high prevalence of C. glabrata isolates (47) of which 72 % were resistant to both fluconazole and itraconazole by standard National Committee for Clinical Laboratory Standards (NCCLS) susceptibility testing (Bagg et al, 2003).…”

Characteristics of Oropharyngeal Candida and Bacterial Colonization in Cancer Patients

“…Best examples for this situation are methicillin resistant Staphylocooccus aureus (MRSA), C. difficile, candida species and vancomycin-resistant enterococcus which are the most frequent nosocomial pathogens of infection. [9][10][11] In addition undiscovered colonized patients are like a reservoir in the hospital and they easily contaminate the other patients. The two most important factors increasing the colonization rate are the duration of hospitalization and the severity of disease.…”