Oral Candidal Infections and Antimycotics

Abstract

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidoses. One form of the latter presents classically as a white lesion of "thrush" and is usually easily diagnosed and cured. Nonetheless, a minority of these lesions appears in new guises such as erythematous candidosis, thereby confounding the unwary clinician and complicating its management. Despite the availability of several effective antimycotics for the treatment of oral candidoses, failure of therapy is not uncommon due to the unique environment of the oral cavity, where the flushing effect of saliva and the cleansing action of the oral musculature tend to reduce the drug concentration to sub-therapeutic levels. This problem has been partly circumvented by the introduction of the triazole agents, which initially appeared to be highly effective. However, an alarming increase of organisms resistant to the triazoles has been reported recently. In this review, an overview of clinical manifestations of oral candidoses and recent advances in antimycotic therapy is given, together with newer concepts, such as the post-antifungal effect (PAFE) and its possible therapeutic implications.

Use of denaturing gradient gel electrophoresis for the identification of mixed oral yeasts in human saliva

“…Despite the small sample number, and the random convenience samples of apparently healthy adult donors, this overall yeast carriage rate in saliva, most commonly C. albicans, agrees with reported findings (Ellepola & Samaranayake, 2000;Samaranayake, 2009). …”

Anti-candidal activity of Piper betle (L.), Vitex negundo (L.) and Jasminum grandiflorum (L.)

“…Further studies are necessary to explain the high resistance of C. tropicalis to the ethanolic extract of leaves of P. betle. Non-albicans including C. tropicalis too are emerging human pathogens although to a lesser extent as compared to C. albicans (Ellepola and Samaranayake, 2000).…”

Investigation of the susceptibility of Candida species isolated from denture wearers to different antifungal antibiotics

“…Fluconazole also inhibit the adhesion of Candida to epithelial cells. Since fluconazole is secreted in high concentrations in saliva it may help reduce candidal colonization by interact with structure of Candida receptors on buccal epithelial cells (Ellepola and Samaranayake, 2000). Amphotericin B is the most commonly used polyene antifungal.…”

“…The former effects may be due to the mechanism of action of amphotericin B on the candidal cell wall, while the latter may be due to the blocking of the yeast attachment sites on the denture acrylic by the drug. Subminimal inhibitory concentrations (sub-MIC) of amphotericin B reduce proteinases activity of oral C. albicans isolates (Ellepola and Samaranayake, 2000).…”