Oral Colonization and Virulence Factors of Candida spp. in Babies With Cleft Palate

Abstract

Objective: To examine oral colonization and virulence factors of Candida spp. in patients aged from 0 to 18 months with cleft palate (CP). Materials and Methods: Sixty babies were allocated into 3 groups: CP, CP with orthodontic plate (CPwP), and control group (Ctrl) without CP. Information on feeding habits, hygiene, and history of candidosis was collected. The presence of Candida spp. was investigated in samples of saliva. Fungal hydrophobicity, protease, esterase, phospholipase, and hemolysin were evaluated in a semiquantitative manner. Results: Positive oral isolations of Candida spp. were detected in CP (89.5%), CPwP (100%), and Ctrl (44%) groups. Candidosis was more reported in the cleft groups than in the Ctrl group ( P ≤ .023). There was a higher prevalence of Candida albicans, followed by Candida krusei, Candida tropicalis, and Candida parapsilosis in all groups. There was no uniformity of expression of virulence factors, either among different species or among different groups. Conclusion: Candida spp. colonization occurred in all groups, being superior in CPwP group. Candidosis episodes were more reported in patients from CPwP than in other groups, although candidosis was also registered in other groups. Candida albicans was the predominant species and virulence factors did not exhibit any pattern for species or groups of patients.

Candida species biotypes and polyclonality of potentially virulent Candida albicans isolated from oral cavity of patients with orofacial clefts

“…Candida albicans was highly prevalent, followed by C. krusei, C. tropicalis, and C. parapsilosis regardless of the patient groups (CP, CPwP, and control group). Patterns of oral colonization by single or multiple (30.5%) species of the genus, mainly involving the C. albicans, were also detected [13]. Patterns of colonization (single or multiple species) by Candida species should be considered clinically relevant to the patients with CLP throughout their surgical rehabilitation treatments due to high incidence of colonization and, consequently, greater risk of clinical manifestations of oral candidiasis and antifungal therapy [12][13][14] [28].…”

“…These results suggest that the anatomical conditions of the oral cavity of patients with CLP contribute to the high incidence of Candida species, especially C. albicans, with patterns of oral colonization by multiple species of the genus (heterogeneous colonization or multicolonization), or by a single species (homogeneous colonization or monocolonization) in greater or lesser frequency dependent on age groups and types of orofacial clefts. In part, these variations in oral Candida colonization profiles in patients with CLP could be explained by the sampling number and other factors such as decreased salivary flow, reduced defense, increased formation of dental plaque [27], reduced oral colonization by Candida due to surgical corrections [12], and patients bearing orthodontic acrylic plates [13]. Compared to children with CLP (7.2 ± 3.2 years of age) previously to surgical rehabilitation procedures, the frequencies of oral colonization by Candida species were related significantly higher for the group of infants (11.2 ± 6.6 months of age) with CLP (28.3%) and male gender (30.4%), but regardless of the surgical clinical histories [12].…”

“…Recently, the oral colonization of Candida spp. and their virulence manifestation were evaluated in babies with cleft palate, clinically classified as uni or bilateral transforamen, users (CPwP) or not users (CP) of orthodontic acrylic plates [13]. The frequencies of oral colonization by Candida species (CP 89.5% and CPwP 100% ) and clinical manifestations of candidoses (CP >30% and CPwP >40% ) were significantly higher in patients with CP than in healthy babies without CP (control group 44%; >10% ).…”

“…Bacterial infections after primary CLP surgery increase the risk of wound breakdown, palatal fistulas, poor growth, and speech [9]. The pathogens implicated in such clinical wound infections are often Staphylococcus aureus or β-hemolytic Streptococcus, although other microorganisms are also important [5,[9][10][11], such as yeasts of the genus Candida that colonize patients with CLP [12][13][14].…”

“…Currently, there is a limited literature on prevalence and/or incidence of colonization and/or infection caused by Candida species in patients with CLP [12][13][14]. The initial objective of this study was to evaluate the oral colonization of Candida species in patients with CLP undergoing treatment at the Dental Center for Patients with Orofacial Cleft.…”