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

Abstract

Objective: This study is the first to analyse the prevalence of oral candidiasis in oncohaematological patients by physical and oral cytopathological examinations.Methods: This is a cross-sectional and observational study with a retrospective sample composed of participants hospitalised in the haematology clinic, who were diagnosed with haematological diseases. All participants received an oral mucosal examination and scraping from oral mucosa.Results: Of the 62 participants, 56.5% were male and 82.3% were white, with mean age of 57 years. Lymphoma was the most common haematological disease (24.2%). In total, 48.4% of the sample was diagnosed with oral candidiasis. Of the participants with oral candidiasis, 13 (21.0%) had a clinical diagnosis. Cytopathological analysis revealed 17 more (27.4%) cases without oral lesions indicative of candidiasis. Erythematous candidiasis (P = 0.02), pseudomembranous candidiasis (P < 0.001), clinical candidiasis (P < 0.001), fibrous hyperplasia (P = 0.032), and coated tongue (P = 0.012) showed a correlation with a candidiasis cytopathological diagnosis. Conclusions:Oral candidiasis is common among patients with haematological disease, and the cytopathological examination proved to be a useful tool, confirming clinical diagnosis of candidiasis and identifying subclinical cases. These data are of great relevance considering the possible complications that these patients may develop, such as longer hospitalisations, worsening of the general condition or even death due to candidemia.

Oral candidiasis in patients hospitalised in the intensive care unit: Diagnosis through clinical and cytopathological examinations

“…After collection, the material obtained was smeared on an identified glass slide and immediately placed in a container with alcohol at 96° for fixation. The smears were stained with Papanicolaou (PAP) and periodic acid‐Schiff (PAS) on the same glass slide, with one staining superimposed on the other 19,21 . This methodology allowed the identification and morphological analysis of the fungus as well as the cytopathic alterations on the same glass slide.…”

“…The cytopathological diagnosis was performed by an experienced cytopathologist (AM). The cytopathological diagnosis of candidiasis was based on the presence of hyphae/pseudohyphae associated with keratinised cells and inflammatory alterations, ie, nuclear hyperchromatism, leukocytes, and a perinuclear halo 19,21 …”

“…The smears were stained with Papanicolaou (PAP) and periodic acid-Schiff (PAS) on the same glass slide, with one staining superimposed on the other. 19,21 This methodology allowed the identification and morphological analysis of the fungus as well as the cytopathic alterations on the same glass slide. The cytopathological diagnosis was performed by an experienced cytopathologist (AM).…”

“…The cytopathological diagnosis of candidiasis was based on the presence of hyphae/pseudohyphae associated with keratinised cells and inflammatory alterations, ie, nuclear hyperchromatism, leukocytes, and a perinuclear halo. 19,21 The diagnosis of clinical candidiasis was based on the presence of clinical alterations suggestive of candidiasis together with a positive cytopathological examination for candidiasis. The diagnosis of subclinical candidiasis was based on the absence of clinical lesions suggestive of candidiasis but with a positive cytopathological examination for candidiasis.…”

“…Therefore, in these cases, clinical inspection and microscopic aspects are relevant 18 . The cytopathology examination is a non‐invasive, safe, inexpensive, easy to perform, and effective method employed for candidiasis diagnosis 19 . The aim of this study was to evaluate the prevalence and clinical aspects of oral candidiasis in patients in ICUs, through clinical and cytopathological examinations.…”