Anticandida and antibiofilm activities of extract from Schinopsis brasiliensis Engl. against Candida spp

Abstract The pathogenic nature of infections caused by Candida spp. underscores the necessity for novel therapeutic agents. Extracts of Schinopsis brasilienses Engl are / a promising source of agents with antifungal effects. This study aimed to assess the antifungal potential of the leaf extract of S. brasilienses. The antifungal activity was evaluated by determining the minimum inhibitory concentrations and fungicide concentrations (MIC and MFC). The antibiofilm potential was assessed by counting colony-forming units/mL. The study examined the inhibition kinetics of fungal growth and potential synergism between gallic acid or the extract and nystatin using the Checkerboard method. Cytotoxicity was evaluated through the MTT assay. The extract exhibited antifungal effect against all tested strains, with MIC and MFC ranging from 31.25-250 μg/mL. Gallic acid, the main isolated compound, displayed a MIC of 2000 μg/mL. The extract of S. brasilienses at 31.25 μg/mL inhibited the formation of biofilm by C. albicans and significantly reduced the mass of mature biofilm after 24 and 48 h (p < 0. 05). At a concentration of 125 μg/mL, the extract demonstrated significant inhibition of fungal growth after 6 hours. The combination of gallic acid or extract with nystatin did not exhibit synergistic or antagonistic effect. Furthermore, the extract did not induce cytotoxicity to a human cell line. The extract of S. brasiliensis demonstrates antifungal activity against Candida, generally exhibiting fungicidal action and capacity to inhibit biofilm formation as well as reduce mature biofilms. Additionally, the extract showed low cytotoxicity to human cells.

Antifungal activity and physical characterization of an experimental dentifrice containing carvacrol

Introduction: The successful treatment of oral candidiasis depends on three essential principles, namely: early and accurate diagnosis, correlation with predisposing factors or underlying diseases that compromise immunity, and appropriate use of antifungal drugs. Objectives: To determine the minimum inhibitory concentration of carvacrol against Candida albicans and to develop and evaluate the in vitro antifungal activity (diameter of inhibition zone) and physical properties (foaming capacity, spreadability and cleaning capacity) of an experimental dentifrice containing carvacrol. Methods: The carvacrol was incorporated into a dentifrice base at different concentrations and tested for its minimum inhibitory concentration and agar diffusion against Candida albicans and the physical properties. Data were analysed by ANOVA. Results: The minimum inhibitory concentration of carvacrol was 1041.67 ± 360.84 µg/mL. The dentifrice containing carvacrol C1 e C2 produced an inhibition zone of 27.50 ± 2.12 mm and 36.66 ± 2.08 mm, respectively (p<0.05). As for the physical properties, the dentifrices showed no foaming capacity, while their cleaning capacity and spreadability remained unaltered. Conclusions: The experimental dentifrices containing carvacrol showed antifungal activity. The incorporation of carvacrol significantly altered the foaming capacity of the formulations, without any significant effects on their cleaning capacity and spreadability.

Introducción: El tratamiento exitoso de la candidiasis oral depende de tres principios esenciales, a saber: diagnóstico temprano y preciso, correlación con factores predisponentes o enfermedades subyacentes que comprometan la inmunidad y uso apropiado de medicamentos antimicóticos. Objetivos: Determinar la concentración inhibitoria mínima de carvacrol contra Candida albicans y desarrollar y evaluar la actividad antifúngica in vitro (diámetro de la zona de inhibición) y las propiedades físicas (capacidad espumante, esparcibilidad y capacidad de limpieza) de un dentífrico experimental que contiene carvacrol. Métodos: El carvacrol se incorporó a una base dentífrica a diferentes concentraciones y se probó su concentración mínima inhibitoria y difusión en agar contra Candida albicans y las propiedades físicas. Los datos fueron analizados por ANOVA. Resultados: La concentración mínima inhibitoria de carvacrol fue 1041,67 ± 360,84 µg/mL. El dentífrico con carvacrol C1 y C2 produjo un halo de inhibición de 27,50 ± 2,12 mm y 36,66 ± 2,08 mm, respectivamente (p < 0,05). En cuanto a las propiedades físicas, los dentífricos no mostraron capacidad espumante, mientras que su capacidad de limpieza y esparcibilidad permanecieron inalteradas. Conclusiones: Los dentífricos experimentales que contenían carvacrol mostraron actividad antifúngica. La incorporación de carvacrol alteró significativamente la capacidad espumante de las formulaciones, sin efectos significativos sobre su capacidad de limpieza y esparcibilidad.

Diversidad de especies de Candida recuperadas de la cavidad bucal de pacientes oncológicos en Barranquilla, Colombia Candida spp bucal y cáncer / Species diversity of the genus Candida in the oral cavity of cancer patients in Barranquilla, Colombia

Resumen Se caracterizaron especies de Candida recuperadas de la cavidad bucal de pacientes oncológicos en una institución prestadora de salud de Barranquilla, Colombia. La investigación tuvo un diseño de corte transversal, mediante un muestreo a conveniencia se seleccionaron 60 pacientes oncológicos con candidiasis oral. Las muestras obtenidas se cultivaron en agar Sabouraud cloranfenicol, CHROMagar® Candida y agar Sabouraud dextrosa. Los microorganismos aislados se identificaron y se estableció el perfil de sensibilidad a los antifúngicos. Se aplicó estadística descriptiva, prueba de X 2 y análisis bivariado utilizando el programa Statgraphics Centurión XVII, con razón de momios (OR) para probabilidad de ocurrencia. Se identificaron un total de 107 cepas de Candida correspondientes a 15 especies, distribuidas del siguiente modo: C. albicans 23%, C. glabrata 18%, C. tropicalis 13%, C. krusei 10%, C. intermedia y C. lipolytica con 1,5%. En 77% de los casos estuvieron implicadas especies diferentes de C. albicans. Se identificó la existencia de relación entre cáncer del sistema reproductor y C. guilliermondii (p = 0,0001, < 0,05; OR 17) y entre C. colliculosa y cánceres respiratorios (p = 0,0003 < 0,05; OR 19,5). El 99% de las especies de Candida identificadas fueron sensibles a los antifúngicos: fluconazol, voriconazol, caspofungina y micafungina. Solo una cepa de C. krusei fue resistente. Se concluye que existió diversidad de especies de Candida en la cavidad bucal de pacientes oncológicos, ya sea como colonizantes únicos o en combinación, de modo que más de una especie de Candida podría ser responsable de la infección micótica en la cavidad bucal de estos enfermos.

Abstract Candida spp. was characterized in the oral cavity of cancer patients in a health care center in Barranquilla, Colombia. This is a cross-sectional investigation including 60 oncological patients with oral candidiasis, selected by convenience sampling, from whom samples were subjected to culture in Sabouraud chloramphenicol agar, CHROMagar® Candida and Sabouraud dextrose agar were taken. The antifungal susceptibility profile was then identified and established. Descriptive statistics, Chi square test, and bivariate analysis were conducted using the Statgraphics Centurion XVII software with odds ratio (OR) for the probability of occurrence. A total of 107 Candida strains were identified belonging to 15 species, C. albicans with 23%, C. glabrata with 18%, C. tropicalis 13%, C. krusei 10%, C intermedia, and C. lipolytica with 1.5%. Species other than C. albicans were identified in 77% of the cases. A relationship between reproductive system cancer and C. guilliermondii was identified (p = 0.0001, <0.05) OR: 17.0. Between C. colliculosa and respiratory cancer (p = 0.0003, <0.05) OR 19.5. With regard to antifungal susceptibility, 99% of the identified Candida species were susceptible to the following antifungals: fluconazole, voriconazole, caspofungin, and micafungin. Only one strain of C. krusei was resistant. It is concluded that there was a diversity of Candida species, either single or mixed in cancer patients, which could determine that only one species is not responsible for fungal infection in the oral cavity.

Research progress in animal models of oral squamous cell carcinoma and common oral mucosal diseases / 中国基层医药

The pathogeneses of oral squamous cell carcinoma and most oral mucosal diseases are unclear. Therefore, establishing animal models with similar pathogeneses is significant for clinical prevention, diagnosis, and treatment of related diseases. At present, scholars have established animal models for different focuses. This paper aims to introduce the methods for establishing animal models of oral squamous cell carcinoma and common oral mucosal diseases, compare their advantages and disadvantages, and provide evidence for related basic research.

Analysis of pathogens of mucosal candidiasis and their resistance to drugs in a third-grade class-A hospital in Taiyuan, Shanxi / 中华皮肤科杂志

Objective:To analyze types of mucosal candidiasis and drug resistance of relevant pathogens in a dermatology outpatient clinic in Taiyuan.Methods:Clinical data were collected from 172 patients with mucosal candidiasis, who had positive fungal culture results, in the dermatology outpatient clinic of Shanxi Bethune Hospital from 2019 to 2020. Pathogens were identified by a molecular biological approach, and in vitro drug sensitivity test was performed. Results:Among the 172 patients with mucosal candidiasis, 142 (82.6%) had vulvovaginal candidiasis, 24 (14.0%) had candidal balanoposthitis, and 6 (3.5%) had oral candidiasis; 3 patients were aged ≤ 18 years, 155 were aged 19 - 59 years, and 14 were aged ≥ 60 years, and the proportion of patients with vulvovaginal candidiasis significantly differed among the above 3 age groups (2/3, 134/155[86.45%], 6/14, respectively; χ2 = 14.29, P < 0.05) . Molecular biological identification showed that all the 172 isolated strains belonged to the genus Candida, including 165 strains of Candida albicans (95.9%) , 5 strains of Candida glabrata (2.9%) , and 2 strains of Candida parapsilosis (1.2%) ; the sensitivity to common antifungal agents including flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole was 95.9%, 100.0%, 62.2%, 47.1% and 56.4%, respectively. Conclusion:In the dermatology outpatient clinic of Shanxi Bethune Hospital, vulvovaginal candidiasis was the most common type of mucosal candidiasis, and the main pathogen was Candida albicans; the Candida isolates showed high sensitivity to flucytosine and amphotericin B.

Terapia fotodinámica antimicrobiana sobre Candida albicans en superficies acrílicas de prótesis dentales. Estudio in vitro / Antimicrobial photodynamic therapy on Candida albicans on acrylic surfaces of dental prostheses. In vitro study

Frecuentemente, se hayan especies del género Candida en la microbiota oral de los humanos. Objetivo: comparar la efectividad antimicrobiana de la terapia fotodinámica sobre las cepas de Candida albicans en superficies acrílicas para prótesis dentales, empleando láser con 660nm de longitud de onda y azul de metileno como agente fotosensibilizador, con respecto a otros métodos terapéuticos. Metodología: estudio in vitro, empleando 60 discos de acrílico de termocurado sumergidos en una suspensión de C. albicans, generando una simulación de biofilm sobre la superficie de una prótesis dental. Luego se conformaron cinco grupos al azar de 12 unidades a los que se aplicó diferentes procedimientos terapéuticos: G1 (suero fisiológico), G2 (clorhexidi-na al 0,12%), G3 (nistatina en solución tópica en 0,001ml/ul), G4 (azul de metileno al 0,005% + láser diodo con λ=660nm, 100mW, 32J/cm2) y G5 (azul de metileno 0,01% + láser diodo con λ=660nm, 100mW, 321J/cm2). Resultados: Se observó una diferencia estadísticamente significativa al comparar los grupos G4 y G5 con respecto a los G1 y G3 (p<0,05). Conclusión: la eficacia en la reducción del número de UFC viables de C. albicans resultó superior en los grupos donde se empleó radiación láser con una longitud de onda de 660nm con diferentes concentraciones de azul de metileno. El uso de nistatina y de suero fisiológico tuvieron los menores valores de eficacia.

Species of the genus Candida are frequently found in the oral microbiota of humans. Objective: to compare the antimicrobial effectiveness of photodynamic therapy on Candida albicansstrains on acrylic surfaces for dental prostheses by using a 660nm wavelength laser and methyle-ne blue as a photosensitizing agent, with respect to other therapeutic methods. Methodology: in vitro study, using 60 thermosetting acrylic discs immersed in a suspension of C. albicans, gene-rating a biofilm simulation on the surface of a dental prosthesis. After that, five random groups of 12 units were formed to apply them different therapeutic procedures: G1 (saline solution), G2 (chlorhexidine 0.12%), G3 (nystatin in topical solution at 0.001ml/ul), G4 (0.005% methylene blue + diode laser with λ=660nm, 100mW, 32J/cm2) and G5 (0.01% methylene blue + diode laser with λ=660nm, 100mW, 321J/cm2). Results: a statistically significant difference was observed when comparing groups G4 and G5 with respect to G1 and G3 (p<0.05). Conclusion: the efficacy in reducing the number of viable C. albicans CFU was higher in the groups where laser radiation with a wavelength of 660nm was used with different concentrations of methylene blue. The use of nystatin and physiological saline had the lowest efficacy values

Manifestaciones orales y recuento de linfocitos T CD4+ en pacientes adultos con infección por VIH atendidos en el Hospital San Juan de Dios. Santiago, Chile

Resumen Introducción: Las lesiones orales clasificadas como fuertemente asociadas a infección por VIH se presentan en casos de inmunosupresión profunda (recuento de linfocitos T CD4+ ≤ a 200 céls/mm3 de sangre). Objetivo: Asociar la presencia de lesiones orales fuertemente asociadas a infección por VIH con el recuento sérico de linfocitos T (LT) CD4+ al momento del diagnóstico. Métodos: Se realizó un estudio transversal en PVVIH atendidas en el Hospital San Juan de Dios entre 2013 y 2019. Las lesiones orales se diagnosticaron por el criterio de EC-Clearinghouse - OHARA, y la inmunosupresión fue determinada según el recuento de LT CD4+. Resultados: De los 240 pacientes reclutados, 35 pacientes presentaron lesiones fuertemente asociadas a infección por VIH y 26 de ellos presentaron inmunosupresión profunda. La probabilidad de ocurrencia de una lesión fuertemente asociada a infección por VIH fue 12,3 veces mayor en pacientes con inmunosupresión profunda. Conclusión: Existe una asociación estadísticamente significativa entre un estado de inmunosupresión profunda y la presencia de manifestaciones orales fuertemente asociadas a infección por VIH/SIDA, lo cual posee relevancia clínica pues se presenta como una herramienta clínica de diagnóstico inicial, progresión de la enfermedad y monitorización de la terapia antiretroviral.

Abstract Background: Oral lesions classified as strongly associated with HIV infection occur in cases of severe immunosuppression (CD4+ T lymphocyte count ≤ 200 cells/mm3 of blood). Aim: To associate the presence of oral lesions strongly associated with HIV infection with CD4+ T lymphocytes count at the time of diagnosis. Methods: A cross-sectional study was carried out in PLHIV treated at the San Juan de Dios Hospital between 2013 and 2019. Oral lesions were diagnosed by the EC-Clearinghouse - OHARA criteria and immunosuppression was determined according to the CD4+ T lymphocyte count. Results: Of the 240 recruited patients, 35 had lesions strongly associated with HIV infection and 26 of them had severe immunosuppression. The probability of occurrence of a lesion strongly associated with HIV infection is 12.3 times higher in patients with severe immunosuppression. Conclusion: There is a statistically significant association between a severe immunosuppression and the presence of oral manifestations strongly associated with HIV/ AIDS infection, which has clinical relevance since it is presented as a clinical tool for initial diagnosis, disease progression and monitoring of antiretroviral therapy.

Atividade antifúngica e potencial antibiofiome do extrato hidroetanólico de Spondias mombin L. e de suas frações frente a leveduras do gênero Candida / Antifungal activity and antibiofiome potential of the hydroethanolic extract of Spondias mombin L. and its fractions against yeasts of the genus Candida

A Candidose é uma patologia que pode ter manifestações locais e também sistêmicas e acontece pela proliferação de fungos do gênero Candida. O tratamento desta patologia é realizado com antifúngicos mas, devido a resistência dos fungos causadores desta enfermidade se faz necessário conhecer outros antifúngicos. A ação antimicrobiana do extrato hidroetanólico de Spondias mombin L. já é conhecida e é fundamental que seja pesquisado a atividade antibiofilme das substâncias, uma vez que estes fungos causam adoecimento quando se acumulam e proliferam. Sabendo disso é que o presente estudo teve por objetivo principal investigar a ação antifúngica e antibiofilme do extrato hidroetanólico (EH) de Spondias mombin L. e das frações de taninos, flavonoides e ácidos fenólicos, frente a fungos do gênero Candida, de importância clínica. Para isto, determinou-se a concentração inibitória mínima por meio do uso de discos e pela técnica da microdiluição em caldo, concentração inibitória mínima de aderência, determinação da curva de morte dos fungos e atividade antibiofilme das frações de ácidos fenólicos, flavonoides e tanino, frente aos fungos Candida albicans, Candida tropicalis, Candida Krusei e Candida Glabrata, utilizando como controle positivo a Nistatina (100.000 UI), em triplicata. Foi visto que, a atividade antifúngica e antibiofilme do EH e de suas frações analisadas existe, porém, quando comparamos as frações com o EH este último apresentou melhor atividade em suas maiores concentrações (500 µg/mL e 250 µg/mL) e quando traçamos o comparativo entre a ação antifúngica e antibiofilme das substâncias testadas e do grupo controle, tivemos melhores resultados do grupo controle frente aos fungos testados. Desta forma foi possível concluir que o extrato hidroetanólico apresentam resultados superiores de atividade antifúngica frente a todos os microrganismos testados, exceto C. krusei e antibiofilme frente a, pelo menos, uma das espécies de Candida e que este extrato teve resultados muito semelhantes e, por vezes, superior ao grupo controle (AU).

Candidosis is a pathology that can have local as well as systemic manifestations and happens due to the proliferation of fungi of the Candida genus. The treatment of this pathology is carried out with antifungal agents, but due to the resistance of the fungi that cause this disease, it is necessary to know other antifungal agents. The antimicrobial action of the hydroethanolic extract of Spondias mombin L. is already known and it is essential that the antibiofilm activity of the substances be researched, since these fungi cause illness when they accumulate and proliferate. Knowing that, this study aimed to investigate the antifungal and antibiofilm action of the hydroethanolic extract (EH) of Spondias mombin L. and its fractions, against fungi of the genus Candida, of clinical importance. For this, the minimum inhibitory concentration was determined through the use of disks and the technique of microdilution in broth, minimum inhibitory concentration of adhesion, determination of the fungal death curve and antibiofilm activity of the fractions of phenolic acids, flavonoids and tannin, against the fungi Candida albicans, Candida tropicalis, Candida Krusei and Candida Glabrata, using nystatin (100,000 IU) as a positive control, in triplicate. It was seen that the antifungal and antibiofilm activity of EH and its analyzed fractions exists, however, when we compare the fractions with EH, the latter showed better activity at its highest concentrations (500 µg/mL e 250 µg/mL) and when we draw the comparison between the antifungal and antibiofilm action of the tested substances and the control group, we had better results than the control group against the tested fungi. Thus, it was possible to conclude that the hydroethanolic extract presented superior results of antifungal activity against all tested microorganisms, except C. krusei and antibiofilm against at least one of the Candida species and that this extract had very similar results and, for times higher than the control group (AU).

A retrospective study on the oral health of patients in the intesive care unit / Um estudo retrospectivo sobre a condição bucal de pacientes em unidade de terapia intensiva

Introduction: the oral condition of patients in the Intensive Care Unit (ICU) is extremely important for clinical status monitoring, as lesions in the oral mucosa may imply complications and worsening of the health status of these patients. A higher probability of adherence, colonization, and bacterial infection in the oral cavity of patients in the ICU has also been reported. The poor oral hygiene conditions of these patients may be related to the reduction of salivary flow and difficulties in maintaining oral hygiene in a hospital environment, which rarely employs dentists on staff. Objective: to analyze the dental condition of patients admitted to the ICU of Roberto Santos General Hospital, Salvador, Bahia, Brazil. Methodology: a total of 73 patients were evaluated through an oral examination performed with a wooden spatula and sterile gauze under natural light, and data were collected and analyzed. Results: The most commom oral lesions were tongue-coating (41%) and ulcerations in the oral mucosa caused by trauma or dehydration (19.1%). The occurrence of pseudomembranous candidiasis (8.2%), dehydration of the lips and mucosa (26%), and angular cheilitis (9.5%) was additionally recorded. It was observed that 31.5% patients had more than 10 days of hospitalization and of these, 26% presented pseudomembranous candidiasis. This clinical condition was not seen in patients with a shorter hospital stay. Conclusions: this study suggest a possible association between the length of stay of these patients and the clinical conditions presented. Thus, the results of this study may guide preventive and curative measures implemented by dental surgeons who may, in the future, be part of the multidisciplinary team of professionals working in the hospital environment, especially in ICUs.

Introdução: a condição oral de pacientes internados em Unidade de Terapia Intensiva (UTI) é de extrema importância na evolução do quadro clínico desta população, já que lesões na mucosa oral podem implicar em complicações e agravo do estado de saúde destes indivíduos. Tem sido relatado também maior probabilidade de aderência, colonização e infecção bacteriana na cavidade oral de pacientes que se encontram em leitos de UTI. As condições precárias de higiene oral que estes pacientes normalmente apresentam podem estar relacionadas à redução do fluxo salivar e às dificuldades de higienização oral inerentes ao ambiente hospitalar, o qual geralmente não conta com cirurgiões-dentistas integrando a equipe de profissionais da instituição. Objetivo: a presente pesquisa visou analisar a condição odontológica de pacientes internados na Unidade de Terapia Intensiva do Hospital Geral Roberto Santos. Metodologia: setenta e três foram avaliados através de um exame bucal, realizado com espátula de madeira e gaze estéril sob a iluminação de luz natural e seus dados foram coletados e analisados. Resultados: as lesões orais mais comuns foram saburra lingual (41%) e ulcerações na mucosa oral provocadas por trauma ou ressecamento (19,1%). A ocorrência de candidíase pseudomembranosa (8,2%), lábios e mucosas desidratados (26%) e queilite angular foi adicionalmente registrada. Foi observado que dos 31,5% dos pacientes com mais de 10 dias de internação, 26% apresentaram candidíase pseudomembranosa. Essa condição clínica não foi observada em pacientes com menor tempo de internação. Conclusão: o presente estudo sugere uma possível associação entre o tempo de internação destes pacientes e as condições clínicas apresentadas. Desta forma, a descrição dos resultados desta investigação pode contribuir para nortear os cuidados preventivos e curativos a serem adotados por cirurgiões-dentistas que futuramente integrem a equipe multidisciplinar de profissionais que atuam no ambiente hospitalar, em especial, nas unidades de terapia intensiva.

Oral candidiasis and denture stomatitis in diabetic patients: Systematic review and meta-analysis

Abstract Here, the prevalence of oral candidiasis and denture stomatitis among diabetic patients compared to healthy ones was summarized through a systematic review with meta-analysis. Medline, Scopus, Web of Science, Lilacs, Cochrane Library, Embase, and the grey literature were searched without restriction, until May 2020. Eligibility criteria were established, data were extracted, and quality assessment was conducted by two trained examiners. Qualitative synthesis was based on the recommendations of Fowkes and Fulton. Two meta-analyses were performed on studies investigating patients with: a) oral candidiasis and b) denture stomatitis. Out of 6034 screened studies, seven were eligible for qualitative and quantitative synthesis; of these, three evaluated oral candidiasis and four evaluated denture stomatitis. Qualitative synthesis showed that the main methodological problems of the studies included sample size, source of controls, matching, and randomization. Diabetic patients had a similar chance of developing oral candidiasis to non-diabetic patients (OR1.40 [0.96; 2.04], p = 0.08, I2 = 94%). However, diabetic patients had a higher chance to present denture stomatitis compared to non-diabetic patients (OR 1.92 [1.42, 2.59] p < 0.0001, I2 = 0%). Therefore, diabetic patients have a higher chance of developing denture stomatitis compared to non-diabetic patients. However, for all analyses, the certainty of the evidence was considered to be very low.

Clinical characteristics analysis of 1 808 rheumatism in-patients with oral candidiasis / 中华口腔医学杂志

Objective@#To analyze the clinical characteristics of oral candidiasis (OC) in in-patients with rheumatism, in order to provide theoretical basis for the prevention and treatment of OC in rheumatism patients.@*Methods@#One thousand eight hundred and eight in-patients were recruited in the Department of Rheumatology, the Second Hospital of Shanxi Medical University from January 2017 to December 2017. The patients included 607 males and 1 201 females. Their average age was (49.5±15.5) years old with a ranging from 14 to 81 years. According to occurrence of OC or not, the patients were divided into OC group and non-OC group. The differences of general data, primary diseases, laboratory examinations, usage of glucocorticoid and immunosuppressant therapy were compared between the two groups, and the risk factors of OC occurrence were analyzed.@*Results@#Two hundred and sixty-nine patients had OC and 1 539 patients had no OC. Age [(54.9±14.7) years], duration of illness [(9.4±4.4) years] and hospital stay [(15.3±5.7) d] in OC group were significantly longer than those in non-OC group. OC incidence in patients with connective tissue disease (CTD) [17.40% (193/1 109)] was higher than that in non-CTD patients [10.87% (75/699)] (P<0.001). OC most likely occurred in patients with such CTD as Sjögren syndrome (SS) and Behcet syndrome. OC incidence in non-CTD patients with osteoarthritis (OA) was highest. The salivary flow rate in OC group [(0.65±0.45) ml/min] was significantly lower than that in non-OC group [(0.78± 0.39) ml/min] (t=2.394, P=0.017). There was no statistical differences in other laboratory examinations between the two groups, including white blood cells (WBC), lymphocyte, platelet count, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, immunoglobulin G, immunoglobulin M, immunoglobulin A, C3, C4 and so on. OC incidence in patients using prednisone≥15 mg/d [17.16% (133/775)] was higher than that in patients using prednisone<15 mg/d [12.53% (94/750)] and patients not using prednisone [14.84% (42/283)] (P<0.05). The incidence of OC in patients with immunosuppressant therapy [16.11% (226/1 403)] was statistically higher than that in non-immunosuppressant patients [10.62% (43/405)] (P<0.01). Logistic regression analysis showed that the risk factors of OC occurrence included primary diseases (P<0.001), age (P<0.001), duration of illness (P=0.001) and duration of hospitalization (P=0.002).@*Conclusions@#OC occurred commonly in rheumatism in-patients, especially in elder patients, patients with long duration of illness and hospital stay. OC incidence in CTD patients is significantly higher than that in non-CTD patients. Glucocorticoid and immunosuppressant therapy might significantly reduce the anti-fungal immunity of the patients.

Factores relacionados a candidiasis oral en niños y adolescentes con VIH, caracterización de especies y susceptibilidad antifúngica / Factors related to oral candidiasis in HIV children and adolescents, species characterization and antifungal susceptibility

Resumen Introducción: Se desconocen los factores asociados a la candidiasis oral en población pediátrica con infección por VIH de los países en desarrollo. Objetivo: Identificar los factores asociados a la colonización por Candida, candidiasis oral y la susceptibilidad in vitro a antifúngicos, en niños y adolescentes con infección por VIH institucionalizados en la ciudad de Tijuana, México. Materiales y Métodos: Se examinó la cavidad oral de 30 niños y adolescentes con infección por VIH, se obtuvo una muestra de la mucosa oral para identificar las especies de Candida mediante cultivo y auxonograma. La susceptibilidad a los antifúngicos se determinó de acuerdo al CLSI. Los indicadores del estado inmunológico y falla virológica se clasificaron conforme a la OMS. Resultados: Se identificaron seis especies de Candida, 53% colonizantes y 47% causantes de candidiasis. Los factores asociados a candidiasis fueron alta carga viral (p = 0,001), menor recuento de LTCD4+ (p = 0,002) y esquema TARAA (p ≤ 0,014). La especie prevalente fue C. glabrata (33%); sin embargo, C. albicans (27%) fue más resistente a fluconazol (p = 0,001). Las especies resistentes a itraconazol se identificaron en esquemas que incluyen un INNTR (p = 0,041). Conclusiones: Los niños y adolescentes con infección por VIH institucionalizados mostraron una prevalencia elevada de Candida spp. colonizante y resistencia a los antifúngicos relacionada con los INNTR .

Background: Factors associated with candidiasis and colonization in HIV-positive children and adolescents in developing countries are not well understood. Aim: To identify the factors associated with oral Candida colonization and candidiasis in institutionalized HIV-positive children and adolescents in Tijuana, México, as well as the response of the isolates to antifungals. Materials and Methods: Sample of the oral mucosa of 30 HIV positive children and adolescents were obtained to isolate and identify Candida species by culture and metabolic profile. Antifungal drugs susceptibility was determined according to CLSI. Indicators of immunological and virologic failure were classified in accordance to WHO criteria. Results: Six Candida species were identified from oral mucosa, 53% colonizers and 47% in candidiasis. Factors associated with candidiasis and oral colonization were viral load (p = 0,001), CD4+ counts (p = 0,002) and HAART regimen (p ≤ 0,014). The most prevalent species was C. glabrata (33%), but C. albicans (27%) was more resistant to fluconazole (p = 0,001). Itraconazol resistant species were identified in regimens that include an NNRTI (p = 0,041). Conclusion: HIV-positive children and adolescents living in an orphanage showed high prevalence of colonizing Candida spp. and resistance to antifungals, related to NNRTI.

Presence of Candida spp. and candidiasis in liver transplant patients

Abstract: BACKGROUND: Candidiasis is the most common opportunistic fungal infection of the oral cavity caused by fungi of the genus Candida and usually associated with immunosuppressed individuals. OBJECTIVES: To evaluate the presence of oral candidiasis and identify the presence of Candida spp. in liver transplant recipients and assess the association between the presence of the fungus and sociodemographic variables, dietary habits and environmental exposure. METHODS: A cross-sectional study was performed with 49 patients who had undergone liver transplants at Hospital São Vicente de Paulo in Passo Fundo - RS. Patient information was collected to obtain sociodemographic data, eating habits and environmental exposure. Fungal infections were screened by oral clinical examination and the presence of Candida spp by the collection of oral samples with a sterile swab, seeded in Sabouraud Dextrose Agar, incubated at 25°C and observed at 48 hours. To identify Candida albicans, the germ tube test was performed. RESULTS: In 49 patient samples, 39% had the yeast of the genus Candida isolated and, of these patients, 12% had candidiasis, 66% of atrophic type and 34% pseudomembranous. Eleven yeast species were (58%) Candida non-albicans and eight (42%) Candida albicans. STUDY LIMITATIONS: The present study presents as a limitation the inclusion of patients in different stages of immunosuppression. CONCLUSION: The high incidence of Candida non-albicans in the oral cavity of transplant patients with a long period of transplantation is warning to a more effective control of the health of these individuals, especially those with older age.

Presentación inusual de infección por HTLV-1: una caja de pandora de infecciones oportunistas / An unusual presentation of HTLV-1 infection: a pandora box of opportunist infections

HTLV-1 es un retrovirus endémico en Perú, relacionado ocasionalmente con algunas infecciones oportunistas aisladas. Presentamos el caso de un varón de 41 años, avicultor, con antecedente de TBC pulmonar tratado hace 6 meses. Ingresó a emergencia por presentar alteración de conciencia, disartria y diarrea acuosa. Al examen físico se evidenciaron placas confluentes en cavidad oral, lesiones máculo-papulares violáceas y placas costrosas; por biopsia de piel se confirmó sarcoma de Kaposi y sarna costrosa, además adenopatías cervicales que al estudio microscópico con test de Auramina mostró BAAR (++) y en el examen de heces con tinción Zielh Nielsen modificado, se evidenció ooquiste de Cystoisospora belli. Recibió trimetropin / sulfametozaxol, tratamiento antituberculoso. Se confirmó HTLV-1 por inmunofluorescencia. En el fondo de ojo se observó retinitis por citomegalovirus, recibió ganciclovir. A las tres semanas del ingreso hospitalario, falleció por insuficiencia respiratoria severa. Se discute la presencia de múltiples co-infecciones oportunistas en un paciente con inmunosupresión por HTLV-1.

HTLV-1 is an endemic retrovirus in Peru , occasionally associated with some isolated opportunistic infections. We present the case of a 41-year-old male poultry farmer with a history of pulmonary tuberculosis treated 6 months ago. He was admitted to emergency due to alteration of conscience, dysarthria and watery diarrhea; the examination revealed confluent plaques in the oral cavity, violaceous maculopapular lesions and crusted plaques. Skin biopsy confirmed Kaposi's sarcoma and crusted scabies; in addition, cervical lymphadenopathies showed evidence of BAAR (++) in the microscopic study with Auramine test, and in the examination of feces with modified Zielh Nielsen's stain, Cystoisospora belli oocyst was observed, and trimetropin / sulfametozaxol received antituberculous treatment. HTLV-1 was confirmed by immunofluorescence. In the fundus of the eye cytomegalovirus retinitis was evidenced, he received ganciclovir. At three weeks of hospital admission he died due to severe respiratory failure. We discuss the presence of multiple opportunistic co-infections in a patient with immunosuppression by HTLV-1.

A single-center 18-year experience with oral candidiasis in Brazil: a retrospective study of 1, 534 cases

Abstract Despite the large number of published studies about oral candidiasis and associated risk factors, reports of large single-center retrospective studies on the prevalence of oral candidiasis, risk factors, and the oral candidiasis types diagnosed more frequently in oral diagnostic reference centers are scarce. The objective of the present study was to retrospectively survey the demographic and clinical profiles of 1,534 patients diagnosed with candidiasis and treated at the Center for Diagnosis of Oral Diseases (CDOD), Pelotas Dental School, Federal University of Pelotas between 1997 and 2014. Using a retrospective, cross-sectional, epidemiological design, data on race, gender, age, systemic diseases, oral candidiasis type and location, symptoms, and harmful habits such as smoking and alcohol consumption were collected. The statistical analysis was performed using STATA version 13.1. Risk factors for chronic atrophic candidiasis (CAC) were evaluated using Poisson regression with robust variance (p ≤ 0.05). The majority of patients with oral candidiasis seen at the CDOD over the 18-year period of analysis were Caucasian women, aged 51-60 years, nonsmokers, and nondrinkers, with no systemic disease, and who wore some form of dental prostheses. CAC was the single most common clinical type of candidiasis detected, and the most frequently affected oral site was the palate. These data from a large single-center in Brazil agree with previous evidence about the clinical and demographic profiles of patients with oral candidiasis.

Oral colonization by Candida species in HIV-positive patients: association and antifungal susceptibility study / Colonização oral por espécies de Candida em pacientes HIV positivo: estudo de associação e suscetibilidade antifúngica

ABSTRACT Objective To investigate antifungal susceptibility and factors associated with oral colonization by Candida species in HIV-positive patients. Methods A prospective study based on convenience sampling of subjects recruited from a pool of confirmed HIV-positive individuals seen at a specialty outpatient service in Rondonópolis, Mato Grosso, Brazil). Oral swabs were collected from 197 patients. Candida species were identified by standard microbiological techniques (phenotypic and molecular methods). Antifungal susceptibility was investigated using the broth microdilution method. Results A total of 101 (51.3%) patients were Candida spp carriers. Candida albicans was the most prevalent species (80%). Patients aged 45 to 59 years (Prevalence ratios: 1.90; 95%CI: 1.57-6.31) and 60 years or older (Prevalence ratios: 4.43; 95%CI: 1.57-34.18) were at higher risk of oral colonization by Candida species. Resistance to fluconazole and ketoconazole, or to itraconazole, corresponded to 1% and 4%, respectively. Conclusion Age (45 years or older) was the only factor associated with oral colonization by Candida . Low rates of antifungal resistance to azoles were detected in yeast isolates obtained from HIV-positive patients. Findings of this study may contribute to proper therapeutic selection for oral candidiasis in HIV-positive patients.

RESUMO Objetivo Investigar a suscetibilidade a antifúngicos e os fatores associados à colonização oral por espécies de Candida isoladas de pacientes HIV positivo. Métodos Estudo prospectivo realizado com amostragem por conveniência de indivíduos HIV positivo, acompanhados por um serviço de atendimento especializado da cidade de Rondonópolis, Mato Grosso, Brasil. Foram coletados swabs orais de 197 pacientes. As espécies de Candida foram identificadas por técnicas microbiológicas fenotípicas padrão e por método molecular. A suscetibilidade antifúngica foi determinada pelo método de microdiluição em caldo. Resultados Cento e um (51,3%) pacientes foram colonizados por Candida spp. Candida albicans foi a espécie mais prevalente (80%). Identificou-se um maior risco de colonização oral por espécies de Candida em pacientes com idade entre 45 e 59 anos (razão de prevalência: 1,90; IC95%: 1,57-6,31) e 60 anos ou mais (razão de prevalência: 4,43; IC95%: 1,57-34,18). A resistência ao fluconazol e ao cetoconazol foi de 1% cada e de 4% ao itraconazol. Conclusão O único fator associado à colonização oral por espécies de Candida foi ter 45 anos ou mais. Identificamos baixa taxa de resistência antifúngica aos azóis entre as leveduras isoladas de pacientes HIV positivo. Estes achados podem contribuir para selecionar o tratamento da candidíase oral em pacientes HIV positivos.

Relationship between oral candidiasis and users of dental prostheses

Aim: To investigate the relationship between oral candidiasis and users of dental prostheses. Methods: A cross-sectional study was carried out which the inclusion of adults and elderly people of both genders using dental prostheses. Lectures were given with guidelines on oral hygiene techniques and dental prostheses, preventive measures of candidiasis, highlighting their influence on the oral and general health of the individual for the 240 users of dental prostheses. Of this number, 153 did not want to participate in the clinical examination. Signals and symptoms were analyzed in 87 patients, and lesions were present in only 21, and a cytological complement of the lesions was performed. Data were analyzed using SPSS version 15.0 with Chi-square (χ2 ) test at p < 0.05. Results: The 21 patients presented oral candidiasis, with erythematous (prosthetic) stomatitis being the most prevalent. There was a correlation between the presence of Candida and the use of prostheses (p- value 0.00*). Candidiasis was associated with poorly adapted prostheses, poor oral hygiene, inadequate prostheses and prolonged use of them. Conclusion: There was a correlation between oral candidiasis and users of dental prostheses. The most prevalent type of candidiasis was erythematous stomatitis (prosthetic), and nystatin was used to treat all cases. The preventive activities carried out were extremely important, since patients were not aware of oral candidiasis and the factors that trigger it, such as poor oral hygiene and dental prostheses

Alteraciones en la cavidad bucal en pacientes tratados con radioterapia de cabeza y cuello. Medellín, Colombia / Alterations found in the mouth of patients treated with head and neck radiotherapy. Medellin, Colombia

El objetivo del estudio fue determinar las alteraciones bucales en pacientes con cáncer de cabeza y cuello tratados con radioterapia y explorar la participación del Odontólogo en la atención de estos pacientes. Se realizó un estudio exploratorio en 52 pacientes que habían recibido más de 1,000 cGy de radiación. Se encuestó y realizó examen bucal a cada participante, tasa de flujo salivar estimulado y prueba de sabores. Los resultados muestran alta prevalencia de alteraciones bucales en pacientes con radiación acumulada entre 3,001 y 5,000 cGy. La boca seca (xerostomía) fue la alteración más sentida (78.8%). La tasa de secreción salivar total estimulada confirmó hiposalivación en el 82.7% de los pacientes. Se encontró una asociación estadísticamente significativa entre el lugar del cáncer (p < 0.01) y el tipo de tumor con la presencia de trismus (p < 0.05). La hiposialia se presentó más en los pacientes con tumores en estadio IV (50%) y en aquellos sometidos a tratamientos combinados (p < 0.05). Fue posible realizar la valoración periodontal al 50% de los pacientes, el 92% de ellos presentó periodontitis con pérdida de inserción principalmente severa y moderada. El 84.6% de los participantes manifestaron no haber sido remitidos a odontólogo antes o durante el tratamiento. Los hallazgos ratifican una alta frecuencia de alteraciones bucales en pacientes sometidos a tratamiento de radioterapia e inoportunidad de atención odontológica para prevenir o tratar estos efectos. Se alerta sobre la obligatoriedad de seguir protocolos de manejo del paciente oncológico, incluyendo valoración odontológica antes, durante y después del tratamiento respectivo.

The aim of the present study was to determine which oral alterations can be found in patients with head and neck cancer treated with radiotherapy as well as to explore dentist's involvement in treatment of these patients. An exploratory study was conducted in 52 patients who had previously received over 1,000 cGy radiation. A survey was undertaken as well as oral examination of each participant, in order to assess stimulated salivary flow and flavor tests. Results revealed high prevalence of oral alterations in patients with accumulated radiation of 3,001-5,000 cGy. Dry mouth (xerostomia) was the most frequently reported alteration (78.8%). Estimated total salivary secretion rate confirmed a state of hyposalivation in 82.7% of all patients. A statistically significant association was found between cancer location (p < 0.01) and type of tumor with presence of trismus (p < 0.05). Hyposialia was more frequently present in patients with stage IV tumors (50%) in those subjected to combined treatments (p < 0.05). Periodontal assessment was possible in 50% of all patients, Of this proportion, 92% exhibited periodontitis with mainly moderate to severe insertion loss; 84.6% of all participants reported not to have been remitted to dentists either before or after treatment. Findings support high frequency of oral alterations in patients subjected to radiotherapy treatment and dental care inappropriateness to prevent or treat these effects. An alert is raised with respect to the compulsiveness to follow treatment protocols for cancer patients, which should include dental evaluation before, during and after respective treatment.

Irradiação a Laser de baixa intensidade sobre cepas de Candida in vitro: In vitro / Irradiación Láser de baja intensidad en cepas de Candida: an in vitro study / Low-level laser irradiation on Candida strains

Objetivo: avaliar o efeito de parâmetros específicos da irradiação com laser de baixa intensidade sobre cepas de Candida albicans (ATCC 18804), Candida krusei (ATCC 34135) e Candida tropicalis (ATCC 13803). Metodologia: inóculos das três especies de cândida (1.5 x 106 microorganismos/ml ) foram irradiadas com um dispositivo laser infra-vermelho de Arsenato de Gálio -AsGa (TwinFlex Evolution, MMO Equipamentos Eletrônicos 660 nm, 0,5 nW), nas doses (J/cm2): 1,2 (10 seg), 3,7 (30 seg), 7,5 (1min) e 15(2 min). Após aplicação, os inóculos foram semeados em placas petri com meio de cultura Sabouraud-Dextrose e incubadas em estufa bacteriológica a 37ºC. Depois de 48 horas, realizou-se a quantificação das Unidades Formadoras de Colônias ­ UFC e analisou-se os dados estatisticamente, através dos Testes de Friedman e Wilcoxon (a =0,05). Todos os testes foram realizados em duplicata. Resultados: os valores da mediana (Q25 - Q75) obtidos na quantificação das cepas após irradiação do laser nas doses ( J/cm2) 1,2, 3,7, 7,5 e 15 foram respectivamente: 35,23 (9,15-47,64); 6,79 (1,45-6,87); 5,32 (1,39-8,15); 6,10 (1,18-11,86) e 5,13 (0,99-6,25). Estes resultados mostraram diferença significativa estatisticamente de acordo com a dose aplicada (p<0,05), no entanto, não se identificou o(s) grupo (s) que apresenta diferença significativa dentre os demais, no pós-hoc. Conclusão: alaserterapia de baixa intensidade apresentou efeito inibitório sobre cepas de Candida, sendo esta atividade alterada de acordo com a dose irradiada(AU)

Objetivo: evaluar el efecto de los parámetros específicos de la irradiación con láser de baja intensidad en cepas de Candida albicans (ATCC 18804), Candida krusei (ATCC 34135) y Candida tropicalis (ATCC 13803). Métodos: los inóculos de las tres especies de Candida (1,5 x 106 microorganismos / ml) se irradiaron con un dispositivo láser de infra-roj de GaAs-arseniato de galio (TwinFlex Evolution, MMO Electronic Equipment 660 nm, 0,5 nW) en la dosis (J/cm2) 1,2 (10 seg), 3,7 (30 seg), 7,5 (1 min) y 15 (2 min). Después de la aplicación, los inóculos se sembraron en placas de Petri con medio de cultivo de Dextrosa Sabouraud y se incubaron en incubadora bacteriológica a 37 ° C. Después de 48 horas, se produjo la cuantificación de unidades formadoras de colonias - UFC y los datos fueron analizados estadísticamente mediante la prueba de Wilcoxon y Friedman (a= 0,05). Todos los ensayos se realizaron por duplicado. Resultados: los valores medios (Q25 - Q75) obtenidos en la cuantificación de las cepas después de la irradiación con láser en la dosis (J/cm2) 1,2, 3,7, 7,5 y 15, fueron respectivamente: 35,23 (9,15-47,64) 6,79 (1,45-6,87) 5,32 (1,39 a 8,15) 6,10 (1,18-11,86) y 5.13 (0,99-6,25). Estos mostraron una diferencia estadísticamente significativa de acuerdo con la dosis aplicada (p <.05), sin embargo, no se identificaron (s) grupo (s) que presenta una diferencia significativa entre otros en lo post-hoc. Conclusiones: el tratamiento con láser de baja intensidad mostró efecto inhibitorio sobre cepas de Candida, siendo esta actividad alterada de acuerdo con la dosis irradiada(AU)

Objective: to evaluate the effect of specific parameters of low-level laser irradiation on strains of Candida albicans (ATCC 18804), Candida krusei (ATCC 34135) and Candida tropicalis (ATCC 13803). Methods: the inocula of the three Candida species (1.5 x 106 microorganisms/ml) were irradiated with a gallium-arsenide (GaAs) infrared laser device (Twinflex Evolution, MMO Electronic Equipment, 660 nm, 0.5 nW) at doses (J/cm2): 1.2 (10 sec), 3.7 (30 sec), 7.5 (1min) and 15 (2 min). Following irradiation, the inocula were grown on Petri dishes containing Sabouraud Dextrose culture medium and then incubated in bacteriological incubator at 37 °C. After 48 hours, it was quantified the number of colony-forming units (CFU) and data were statistically analyzed using Friedman's and Wilcoxon's tests (α=0.05). All tests were performed in duplicate. Results: the median values (Q25 - Q75) gathered in the quantification of the strains after laser irradiation at doses (J/cm2) 1.2, 3.7, 7.5 and 15 were, respectively: 35.23 (9,15-47,64); 6,79 (1,45-6,87); 5,32 (1,39-8,15); 6.10 (1,18-11,86) and 5.13 (0,99-6,25). These results were found to show statistically significant differences according to the dose administered (p<0.05). Nevertheless, it was not possible to identify in the post-hoc tests which group(s) showed significant difference. Conclusion: low-intensity laser therapy showed inhibitory effect on Candida strains, and such activity was altered according to the irradiated dose(AU)

Lesiones bucales en pacientes con VIH/SIDA asociadas a tratamiento antirretroviral y carga viral / Oral lesions associated with antiretroviral treatment and viral load in HIV/AIDS patients

Objetivo: determinar la asociación entre las manifestaciones bucales de pacientes VIH/SIDA con la terapia antirretroviral y carga viral. Métodos: estudio de corte transversal, en una población de 166 pacientes en Cartagena, Colombia, para la recolección de la información se tuvo en cuenta los conceptos del Centro de intercambio de criterios sobre problemas bucales relacionados con la infección por el VIH y los parámetros para el diagnóstico clínico de las manifestaciones bucales asociadas a VIH establecidos por el Centro Colaborador de la Organización Mundial de la Salud (OMS) para la realización del examen estomatológico, los niveles de carga viral y terapia antirretroviral se obtuvieron de la historia clínica médica. Resultados: el 66,7 % de afectados fueron hombres, mientras que el 33,3 % fueron mujeres. La edad promedio fue de 36,1 años, la prevalencia de manifestaciones bucales asociadas al VIH fue del 59,5 %, la candidiasis fue la más frecuente 35,5 %, los pacientes tratados con monoterapia presentaron menos manifestaciones bucales, OR: 0,20; IC: 0,00-0,96 (P<0,02). Conclusión: los pacientes tratados con monoterapia farmacológica antirretroviral presentaron menos lesiones bucales que aquellos tratados con biterapia.

Objective: determine the association between oral manifestations and antiretroviral therapy and viral load in HIV/AIDS patients. Methods: a cross-sectional study was conducted of a population of 166 patients in Cartagena, Colombia. Data collection followed the recommendations of the Center for the exchange of criteria on oral conditions related to HIV infection, and the parameters for the clinical diagnosis of oral manifestations associated with HIV infection established by the WHO (World Health Organization) Collaborating Center for oral checkups. Viral load and antiretroviral therapy data were obtained from medical records. Results: 66.7% of the patients affected were men and 33.3% were women. Mean age was 36.1 years. Prevalence of oral manifestations associated with HIV was 59.5%, and candidiasis was the most common with 35.5%. Patients under monotherapy presented fewer oral manifestations (OR: 0.20; CI: 0.00-0.96 (P<0.02)). Conclusion: Patients under antiretroviral drug monotherapy presented fewer oral lesions than those under bitherapy.