Candidiasis bucal en pacientes con cáncer sometidos a quimioterapia / Oral candidiasis in patients undergoing cancer chemotherapy

RESUMEN Introducción: Algunos tipos de cáncer suelen ser tratados con fármacos quimioterapéuticos que afectan de forma indirecta la cavidad bucal, los cuales susceptibilizan al paciente a contraer infecciones bucales como candidiasis bucal. Se ha evidenciado que una condición oncológica facilita una infección bucal por Candida albicans, sin embargo, otras especies de Candida se les relaciona poco. Objetivo: Identificar especies de Candida spp. en cavidad bucal de pacientes sometidos a quimioterapia. Métodos: Estudio descriptivo de corte transversal. Se tomaron 60 muestras de igual número de pacientes por conveniencia de un Instituto Oncológico en Barranquilla, Colombia. Previo a un examen clínico de diagnóstico de candidiasis bucal. Se tomaron hisopados en las superficies infectadas para realizar un examen directo -tinción de Gram y cultivo en agar dextrosa Sabouraud con cloranfenicol incubadas a 37 ºC durante 48 h y posteriormente cultivadas en medio CHROMagar® Candida- para identificación de diferentes especies. Se aplicó estadística descriptiva y de correlación. Resultados. El 55 por ciento de los pacientes correspondió al sexo femenino, con edades mayores a 60 años. El cáncer de mama fue el más frecuente en el 30 por ciento. La quimioterapia aplicada a todos fue el 5-fluorouracilo combinado con ciclofosfamida. El tipo clínico de candidiasis atrófica en lengua fue más frecuente en el 37 por ciento, seguida de candidiasis pseudomembranosa en lengua en el 33 por ciento. El 90 por ciento de muestras presentó algún tipo de Candida, crecimiento de una única especie y cultivos mixtos con más de una especie de Candida. Se evidenció el 13,3 por ciento de C. albicans y otro 13,3 por ciento de Candida spp. no albicans. Ninguno de los diagnósticos oncológicos tuvo una asociación estadísticamente significativa con las especies de Candida. Conclusiones: Se evidencia que la especie de C. albicans en candidiasis bucal en pacientes con cáncer, fue la más frecuente, con predominio en mayor proporción cultivos mixtos de Candida no albicans (C. glabrata, C. tropicalis) poco relacionados con este tipo de enfermedad(AU)

ABSTRACT Introduction: Some types of cancer are often treated with chemotherapeutic drugs which indirectly affect the oral cavity, thus making the patient vulnerable to infections such as oral candidiasis. Oral infection by Candida albicans has been found to be fostered by oncological conditions, but other Candida species have not been sufficiently analyzed in such a context. Objective: Identify Candida spp. in the oral cavity of patients undergoing cancer chemotherapy. Methods: A descriptive cross-sectional study was conducted of 60 samples of an equal number of patients selected by convenience sampling at an Oncological Institute in Barranquilla, Colombia, following diagnostic clinical examination for oral candidiasis. Swab samples were taken from the infected surfaces to perform direct examination - Gram staining and Sabouraud dextrose agar culture with chloramphenicol incubated at 37ºC for 48 h and then cultured in CHROMagar® Candida medium - for identification of various species. Analysis was based on correlation and descriptive statistics. Results: Of the total patients evaluated 55 percent were female and aged over 60 years. Breast cancer prevailed with 30%. The chemotherapy applied in all cases was 5-fluorouracil combined with cyclophosphamide. Atrophic candidiasis of the tongue was the most common clinical type with 37 percent, followed by pseudomembranous candidiasis of the tongue with 33 percent. Of the samples examined, 90 percent contained some sort of Candida, growth of a single species and mixed cultures with more than one Candida species. C. albicans represented 13.3 percent and non-albicans spp. another 13.3 percent. None of the oncological diagnostic analyses had a statistically significant association to Candida species. Conclusions: The species C. albicans was the most commonly found in oral candidiasis among cancer patients, with a predominance of non-albicans Candida spp. (C. glabrata, C. tropicalis) mixed cultures, a fact not generally related to this condition(AU)

Concordance analysis between different methodologies used for identification of oral isolates of Candida species / Análisis de concordancia de diferentes metodologías para la identificación de aislamientos orales de especies de Candida

Abstract Background: The yeasts species determination is fundamental not only for an accurate diagnosis but also for establishing a suitable patient treatment. We performed a concordance study of five methodologies for the species identification of oral isolates of Candida in Colombia. Methods: Sixty-seven Candida isolates were tested by; API® 20C-AUX, Vitek®2 Compact, Vitek®MS, Microflex® and a molecular test (panfungal PCR and sequencing). The commercial cost and processing time of the samples was done by graphical analysis. Results: Panfungal PCR differentiated 12 species of Candida, Vitek®MS and Microflex® methods identified 9 species, and API® 20C-AUX and Vitek®2 Compact methods identified 8 species each. Weighted Kappa (wK) showed a high agreement between Panfungal PCR, Vitek®MS, Microflex® and API® 20C-AUX (wK 0.62-0.93). The wK that involved the Vitek®2 Compact method presented moderate or good concordances compared with the other methods (wK 0.56-0.73). Methodologies based on MALDI TOF MS required 4 minutes to generate results and the Microflex® method had the lowest selling price. Conclusion: The methods evaluated showed high concordance in their results, being higher for the molecular methods and the methodologies based on MALDI TOF. The latter are faster and cheaper, presenting as promising alternatives for the routine identification of yeast species of the genus Candida.

Resumen Introducción: La clasificación a nivel de especies de las levaduras del género Candida de origen clínico es fundamental para el diagnóstico y la instauración de un adecuado tratamiento para el paciente. Se realizó un estudio de concordancia de cinco metodologías usadas para la identificación de aislamientos orales de Candida spp en Colombia. Métodos: Sesenta y siete aislamientos de Candida spp fueron identificados a nivel de especie utilizando; API® 20 C AUX‚ Vitek® 2 Compact, MALDI TOF (Vitek® MS y Microflex®) y una prueba molecular, PCR Panfungal y secuenciación. Un análisis del costo comercial y tiempo de procesamiento de las muestras por cada método fue realizado mediante el análisis gráfico de ambas variables. Resultados: La PCR Panfungal y secuenciación diferenció 12 especies de Candida‚ los métodos Vitek® MS y Microflex® identificaron 9 especies y los métodos API® 20 C AUX y Vitek® 2 Compact identificaron 8 especies. El análisis de Kappa ponderado (wK) demostró una concordancia alta entre los métodos PCR Panfungal y secuenciación‚ Vitek® MS‚ Microflex® y API® 20 C AUX‚ concordancias agrupadas en las categorías buena y muy buena (wK 0.62 - 0.93); los Kp que involucraron el método Vitek® 2 Compact presentaron concordancias moderadas o buenas frente a los otros métodos (wK 0.56 - 0.73). Las metodologías basadas en MALDI TOF MS requirieron 4 minutos para generar un resultado y el método Microflex® fue el método que en nuestro medio presentó el menor precio de venta del servicio. Conclusión: Los métodos evaluados presentaron una alta concordancia en sus resultados‚ siendo más alta para los métodos moleculares y las metodologías basadas en MALDI TOF MS; estas últimas son metodologías más rápidas, económicas y precisas, las cuales se presentan como alternativas prometedoras para la identificación rutinaria de especies de levaduras del género Candida.

Clinical and laboratorial features of oral candidiasis in HIV-positive patients

Abstract INTRODUCTION We describe the clinical and laboratorial features of oral candidiasis in 66 HIV-positive patients. METHODS: Polymerase chain reaction-based techniques were performed for differentiation of Candida spp. isolated from patients at a public teaching hospital in Midwest Brazil. RESULTS: Oral lesions, mainly pseudomembranous, were significantly related to higher levels of immunosuppression. Of 45 Candida isolates, 66.7% were C. albicans. Most of the isolates were susceptible to the antifungal drugs tested. CONCLUSIONS: Oral lesions were associated with higher immunosuppression levels. Lower susceptibility to antifungals by non-albicans isolates supports the importance of surveillance studies using susceptibility tests to aid in the treatment.

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.

Fungal and Viral Oral Infections in individuals with Onco-Hematologic Neoplasms in a University Hospital

Introduction: Individuals undergoing onco-hematologic treatment present higher risk for developing oral and/or systemic infections, due to the intense immunosuppression and compromise of the mucosal barriers during treatment. The aim of this study was to identify the fungal and viral oral infections that most frequently affected patients undergoing onco-hematologic treatment in a University Hospital, and relate them to the biopsychosocial data, underlying disease and treatment. Methods: This was a crosssectional study in which descriptive analysis of the data was performed, and the Exact Fisher test was applied to verify the association between the infections and the variables: sex, age group, educational level, underlying disease and treatment, considering a 5% probability of error. Results and Discussion: The clinical exam revealed that oral candidiasis was present in 8.92% of the individuals, and herpes simplex, in 4.5%. No significant associations were found between the variables and infections. The fungal and viral oral infections were little prevalente in individuals with hematologic neoplasms in the present study, suggesting that the action of dental surgeons in caring for the onco-hematologic patients at the Institution evaluated and the protocols use were efficient (AU)

Prevalência de candidose bucal em pacientes hospitalizados e avaliação dos fatores de risco / Oral candidiasis prevalence in hospitalized patients and evaluation of risk factors

Introdução: Candida albicans é um fungo que se destaca pela alta frequência de colonização e infecção no hospedeiro humano. É comumente encontrado na cavidade bucal e pode causar infecção em indivíduos que se encontram com deficiência do sistema imunológico ou em portadores de próteses removíveis. Objetivo: realização de um estudo epidemiológico referente à prevalência de candidose bucal em pacientes hospitalizados, avaliando possíveis fatores de risco, como: diabetes, presença de neoplasias malignas e utilização ou não de algum tipo de prótese dentária removível. Metodologia: foram analisados 141 pacientes internados no Hospital da Cidade (HC) no município de Passo Fundo/RS, a fim de avaliar a presença ou ausência de candidose bucal, bem como alguns fatores de risco relacionados a tal enfermidade. Foi feito o exame clínico e, quando possível, realizada a documentação fotográfica dos casos. Os dados coletados foram tabulados em planilha eletrônica e analisados por meio de estatística descritiva de frequência e teste Qui-quadrado ao nível de significância de 5%. Resultados: observou-se que os fatores sistêmicos não apresentaram significância com a presença de candidose (p = 0,726), porém o uso de próteses removíveis (p = 0,042) e o gênero (p = 0,05) apresentaram significância estatística. Conclusão: Na amostra estudada independente de alguns pacientes internados apresentarem doenças sistêmicas (diabetes e/ou neoplasia maligna), não foi notada relação destas com a presença de candidose bucal. Contudo, notou-se que a utilização de próteses dentárias removíveis e o gênero feminino constituem-se como fatores preditivos para a ocorrência de candidose bucal.

Introduction: Candida albicans is a fungus that stands out for the high frequency of colonization and infection in the human host. It is commonly found in the oral cavity and can cause infection in individuals who are disabled or the immune system in patients with removable dentures. Objective: to conduct an epidemiological study regarding the prevalence of oral candidiasis in hospitalized patients, assessing possible risk factors such as diabetes, presence of malignant neoplasms and use or not some kind of removable dental prosthesis. Methods: we analyzed 141 patients admitted to City Hospital (HC) in the city of Passo Fundo/RS, to assess the presence or absence of oral candidiasis, as well as some risk factors related to this disease. Clinical examination was made and, where possible, carried out photographic documentation of cases. Data were tabulated in a spreadsheet and analyzed using descriptive statistics and frequency chi-square test at the 5% significance level. Results: it was observed that the systemic factors were not significant with the presence of candidiasis (p = 0.726), but the use of removable dentures (p = 0.042) and gender (p = 0.05) were considered significant. Conclusion: in the sample studied independent of some hospitalized patients had systemic diseases (diabetes and/or malignancy), was noted their relation with the presence of oral candidiasis. However, it was noted that the use of removable dentures and females constitute as predictors for the occurrence of oral candidiasis (AU)

Isolamento de leveduras do gênero Candida em amostras da cavidade bucal de crianças com paralisia cerebral / Isolation of Candida yeast in samples obtained from the oral cavity of children with cerebral palsy

Este trabalho teve como objetivo isolar e identificar leveduras do gêneroCandida isoladas de amostras bucais de crianças na faixa etária de 2 a 8 anos com paralisia cerebral, atendidas na associação de pais e amigos dos excepcionais (APAE) em um município do interior da Bahia e atendidas em unidade de saúde da família do mesmo município. Amostras de saliva de 20 crianças (2-8 anos) foram coletadas com auxílio de swabe encaminhadas para processamento no laboratório de Microbiologia onde foram semeadas em Agar Sabouraud Dextrose com cloranfenicol em duplicata e, em seguida, foram incubadas a 35°C±2/ 24h e mais 5 dias à temperatura ambiente para verificação de crescimento de unidades formadoras de colônia por mililitro (UFC.mL-1). Os dados obtidos em UFC.mL-1 foram transformados em logaritmo (Log) e submetidos tanto à análise descritiva quanto ao teste estatístico ANOVA (5%) para observação de diferenças de relevância estatística. Todos os isolados de amostra bucal de crianças do grupo com paralisia cerebral apresentaram positividade para espécies de leveduras do gênero Candida. No grupo de crianças com paralisia cerebral houve um maior isolamento de leveduras de gênero Candida (médialog = 1,8 UFC.mL-1) nas amostras bucais em relação ao grupo de crianças controle (médialog = 0,6 UFC.mL-1). Crianças portadoras de paralisia cerebral apresentam um índice aumentado de espécies de Candida na cavidade bucal que, juntamente com outras condições odontológicas peculiares, predispõem ao aparecimento de candidíases e requerem preparo da equipe de saúde bucal para obtenção de melhores resultados no tratamento direcionado a essa população...

This study aimed to isolate and identify Candida species from oral samples of 2-8 years children with cerebral palsy from the Association of Parents and Friends of Exceptional (APAE) and assisted at the family health unit at a town in the interior of Bahia. Saliva samples from 19 children were collected with a swab and sent for processing in the microbiology laboratory where they were plated on Sabouraud Dextrose Agar with chloramphenicol in duplicate and then incubated at 35°C±2 for 24h and then 5 days at room temperature to check the growth of colony-forming units per milliliter (UFC.mL-1). Data from UFC.mL-1 were transformed into logarithm (Log) and submitted to descriptive analysis and ANOVA (5%) to observe statistic differences. All oral isolates of children with cerebral palsy were positive for Candida yeast species. Greater isolation of Candida yeasts (medialog = 1.8 UFC.mL-1) was observed in the group of children with cerebral palsy when compared to control group (medialog = 0.6 UFC. mL-1). Children with cerebral palsy have an increased rate of Candida species in the oral cavity, along with other peculiar dental conditions that predispose to candidiasis. Thus proper training of the oral health team is required in order to achieve better results in the treatment of this population...

Candidiasis bucal en pacientes con diabetes mellitus / Oral Candidiasis in patients with diabetes mellitus

Se realizó un estudio descriptivo y transversal de 75 pacientes con diabetes mellitus, quienes presentaron candidiasis bucal, tratados en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde marzo de 2013 hasta igual mes de 2015, a fin de evaluar los resultados del diagnóstico clínico e histopatológico de la citada afección. Las muestras para biopsias se fijaron y procesaron con la técnica clásica de inclusión en parafina; se colorearon con una tinción especial de ácido peryódico de Schiff, lo cual confirmó la existencia de cambios celulares. Predominaron el sexo masculino, el grupo etario de 60 años y más; la ausencia de manifestaciones clínicas, el paladar duro y la comisura labial como los sitios de mayor prevalencia y la candidiasis eritematosa como la forma clínica más común. La presencia de hifas patógenas y células levaduriformes fueron los hallazgos histopatológicos más sobresalientes.

A descriptive and cross-sectional study of 75 patients with diabetes mellitus who presented oral candidiasis, treated in the stomatological service of the Specialties Polyclinic of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out, from March, 2013 to the same month in 2015, in order to evaluate the results of the clinical and histopathologic diagnosis of the mentioned affection. The samples for biopsies were fixed and processed with the classic technique of inclusion in paraffin; they were colored with a special stain of Schiff periodic acid, which confirmed the existence of cellular changes. There was a prevalence of male sex, the 60 years and over age group; the absence of clinical symptoms, the hard palate and the corner of the mouth as the sites of greater prevalence and the erythematous candidiasis as the most common clinical form. The presence of pathogen hyphae and yeast-like cells were the most outstanding histopathologic findings.

Terapia fotodinâmica antimicrobiana no tratamento de candidíase em paciente com prótese total mucossuportada superior - relato de caso / Candidiasis treatment with antimicrobial photodynamic therapy in patient with upper complete denture - case report

As próteses totais mucossuportada têm por objetivo reabilitar o sistema estomatognótico de pacientes desdentados totais, restabelecendo a saúde das estruturas de suporte bucais. Apesar da constante busca pela perfeição na confecção de próteses totais, lesões como a Candidíase podem estar associadas ao seu uso. O objetivo deste trabalho foi apresentar um caso clínico de estomatite protética tratada por meio da Terapia Fotodinâmica Antimicrobiana (aPDT), associada ao tratamento protético. O presente estudo mostrou que a luz emitida pelo laser associada ao CHIMIOLUX© foi eficiente em reduzir o número de células de C. albicans e regredir as manifestações clínicas da candidíase atrófica crônica. Assim, aPDT pode ser considerada uma alternativa viável ao tratamento coadjuvante para as lesões fúngicas intraorais e alternativa terapêutica para desinfecção de PTM. Apesar da eficiência da aPDT, a necessidade de orientar o paciente quanto … mudança de hábitos de higiene bucal e utilização de próteses adaptadas são de grande importância na manutenção da saúde dos tecidos orais

Complete mucous membrane-supported dentures aim to rehabilitate the stomatognathic system of edentulous patients, restoring oral health. Even with a constant search to improve complete dentures’ manufacturing process some adverse effects such as candidiasis may still occur. The aim of this study was to present a clinical case of denture stomatitis treated by Antimicrobial Photodynamic Therapy (aPDT), associated with prosthetic treatment. This study showed that the laser light associated with CHIMIOLUX© is effective in reducing the number of cells of C. albicans and to reverse clinical manifestations of chronic atrophic candidiasis. Thus, the aPDT can be considered a viable alternative to adjuvant treatment for denture stomatitis caused by C. albicans and to reverse clinical manifestations of chronic atrophic candidiasis. The aPDT can also be used for disinfection of complete dentures. Despite the efficiency of the aPDT, counseling the patients about oral hygiene and the use of adapted prostheses has great importance in preserving the health of oral tissues

Oral lesions frequency in HIV-positive patients at a tertiary hospital, Southern Brazil

AIM: To report the frequency of oral lesions in HIV-positive patients on Highly Active Antiretroviral Therapy (HAART), comparing with a non-HIV infected control group, and to correlate the presence of lesions with demographic and clinical features of HIV-seropositive patients. METHODS: A quantitative case-control study was conducted by a dental professional, using a questionnaire, analysis of medical records of patients and clinical examinations. RESULTS: According to the results, oral lesions were found in 23% of HIV-positive patients versus 5% in controls. Candidiasis (29%) and periodontal changes (25%) were the most frequent oral lesions found in these patients. Gender and viral load values were statistically significant when HIV-positive patients with and without oral lesions were compared. CONCLUSIONS: The results showed a change in lesion pattern of HIV patients on HAART, highlighting a high frequency of these new lesions and reinforcing the need for periodic dental evaluation of HIV-positive patients.

Candidíase invasiva e alterações bucais em recém-nascidos prematuros / Invasive candidiasis and oral manifestations in premature newborns

OBJETIVO: Investigar a prevalência de candidíase invasiva em Unidade de Terapia Intensiva Neonatal e avaliar alterações bucais e colonização bucal por Candida spp. em recém-nascidos prematuros com baixo peso. MÉTODOS: Estudo epidemiológico descritivo em duas etapas. Na primeira, analisou-se prevalência de candidíase invasiva em base de dados de 295 prematuros com tempo de internação superior a 10 dias e peso ao nascer inferior a 2.000g. Na segunda etapa, avaliaram-se alterações bucais e colonização por Candida spp. em 65 pacientes com peso inferior a 2.000g, com até 4 semanas de idade, internados há mais de 10 dias e apresentando alterações bucais compatíveis com lesões fúngicas. Coletaram-se amostras com swab bucal e identificou-se a colonização fúngica. RESULTADOS: Na análise da base de dados, constatou-se que a prevalência de candidíase foi de 5,4%. Houve correlação com o tempo prolongado de internação (p<0,001), que foi, em média, de 31 dias, com risco de desenvolver infecção de 85% nos primeiros 25 dias. Houve correlação com o baixo peso ao nascer (p<0,001), com média de 1.410g. No exame dos pacientes, constatou-se que as alterações bucais mais frequentes foram placas brancas, moles, destacáveis localizadas na mucosa jugal e língua. Houve colonização bucal expressiva por Candida spp. (80%). CONCLUSÃO: A frequência de candidíase invasiva foi baixa e teve correlação com baixo peso ao nascer e tempo de internação prolongado. As alterações bucais mais frequentes foram placas brancas compatíveis com candidíase pseudomembranosa e a colonização por Candida spp. foi acima da média.

OBJECTIVE: To investigate prevalence of invasive candidiasis in a Neonatal Intensive Care Unit and to evaluate oral diseases and Candida spp. colonization in low birth weight preterm newborns. METHODS: A descriptive epidemiological study performed in two stages. First, prevalence of candidiasis was analyzed in a database of 295 preterm patients admitted to hospital for over 10 days and birth weight less than 2,000g. In the second stage, oral changes and Candida spp. colonization were assessed in 65 patients weighing less than 2,000g, up to 4 week-old, hospitalized for over 10 days and presenting oral abnormalities compatible with fungal lesions. Swab samples were collected in the mouth to identify fungi. RESULTS: Prevalence of candidiasis was 5.4% in the database analyzed. It correlated with prolonged hospital length of stay (p<0.001), in average, 31 days, and 85% risk of developing infection in the first 25 days. It correlated with low birth weight (p<0.001), with mean of 1,140g. The most frequent alterations were white soft plaques, detachable, in oral mucosa and tongue. Intense oral colonization by Candida spp was observed (80%). CONCLUSIONS: The frequency of invasive candidiasis was low and correlated with low birth weight and prolonged hospital stay. The most common oral changes were white plaques compatible with pseudomembranous candidiasis and colonization by Candida spp. was above average.

Identificação de espécies de Candida na cavidade bucal e susceptibilidade antifúngica em pacientes irradiados em região de cabeça e pescoço e portadores de prótese removível / Identification of candida species in oral cavity and antifungal susceptibility in patients receiving radiation for head and neck cancer and in patients with removable prosthesis

A candidose é a doença de origem fúngica oral mais comum em seres humanos e apresenta uma variedade de características clínicas. Sendo causada principalmente pelo fungo Candida albicans, ela é considerada uma infecção oportunista, afetando principalmente indivíduos que são debilitados por outras doenças. Os avanços da medicina levaram ao prolongamento da sobrevida de pacientes imunocomprometidos, como aqueles pacientes irradiados de cabeça e pescoço que apresentam neoplasias...

Screening da Atividade Antifúngica de Óleos Essenciais sobre Cepas de Candida / Screening of Essential Oils Antifungal Activity on Candida Strains

Objetivo: O propósito desse estudo foi identificar a atividade antifúngica de óleos essenciais sobre cepas de Candida envolvidas com infecções da cavidade bucal. Método: Foram avaliados óleos essenciais obtidos a partir das seguintes espécies vegetais: Citrus reticulata (Tangerina Cravo); Citrus aurantifolia (Limão Tahiti); Cinnamomum zeylanicum (Canela); Matricaria chamomilla (Camomila Azul); Mentha piperita (Menta); Eugenia uniflora (Pitanga) e Zingiber officinale (Gengibre). A determinação da atividade antifúngica foi realizada utilizando a técnica de difusão em meio de cultura sólido, onde discos de papel de filtro foram embebidos nos óleos e colocados em placas de Petri contendo agar Sabouraud Dextrose inoculado com cepas de Candida albicans e C. tropicalis. Também foi observada a concentração inibitória mínima a partir do método da microdiluição. Os ensaios foram realizados em duplicata. Resultados: Foi observada expressiva atividade antifúngica dos óleos essenciais de C. zeylanicum, C. aurantifolia e M. piperita, que apresentaram diâmetros de halos de inibição de crescimento microbiano de até, respectivamente, 48 mm, 30 mm e 19 mm. Ainda foi possível identificar que 66,7% das cepas ensaiadas mostraram-se resistentes aos óleos essenciais de C. reticulata, M. chamomilla, E. uniflora e Z. officinale. O C. zeylanicum e nistatina apresentaram, respectivamente, CIMs de 312 µg mL-1 e 32 µg mL-1. Conclusão: Os óleos essenciais avaliados apresentam atividade antifúngica, sendo os melhores resultados encontrados para C. zeylanicum. Sugere-se a realização de outros ensaios para avaliação de atividade anti-Candida desse óleo essencial, que pode representar possível agente terapêutico no tratamento de infecções fúngicas da cavidade bucal

Objective: The purpose of this study was to identify the antifungal activity of essential oils on Candida strains involved in oral cavity infections. Methods: essential oils obtained from the following species were evaluated: Citrus reticulata (Cravo Tangerine) Citrus aurantifolia (Tahiti Lime), Cinnamomum zeylanicum (Cinnamon), Matricaria chamomilla (Blue Chamomile), Mentha piperita (Mint), Eugenia uniflora (Pitanga) and Zingiber officinale (Ginger). The determination of antifungal activity was performed using the diffusion technique on solid medium, where filter paper discs were soaked in oils and placed in Petri dishes containing Sabouraud dextrose agar inoculated with strains of Candida albicans and C. tropicalis. It was also observed the minimum inhibitory concentration from the microdilution method. Tests were performed in duplicate. Results: We observed significant antifungal activity of essential oils ofC. zeylanicum, C. aurantifolia and M. piperita, which had halos of microbial growth inhibition with diameters up to 48 mm, 30 mm and 19 mm, respectively. Still, it was possible to identify that 66.7% of strains tested were resistant to essential oils of C. reticulata, M. chamomilla, E. uniflora and Z. officinale. C. zeylanicum and nystatin showed µg mL-1 and 32 µg mL-1 MIC, respectively. Conclusion: The essential oils tested have antifungal activity, with best results for C. zeylanicum. It is suggested to conduct other tests for evaluation of anti-Candida activity of this essential oil, which could represent possible therapeutic agent in the treatment of fungal infections of the oral cavity

Avalia ao da susceptibilidade a antifungicos de diferentes espécies de leveduras candida isoladas de mucosa bucal e pele / Evaluation of antifungal susceptibility of different species of candida yeast isolated from buccal mucosa and skin

A variabilidade das diferentes especies de Candida sp, juntamente com as distintas respostas as formas de tratamento, desenvolveram a necessidade da utiliza tao de diferentes metodos diagn6sticos e esquemas terapeuticos. Entre as leveduras deste grupo, a Candida albicans e urn dos pat6genos mais comuns envolvidos nas candidiases mucocutaneas e da orofaringe, porem as especies nao albicans tern aumentado em numero e em importancia devido ao acrescimo do perfil de resistencia aos antifUngicos. A resistencia da Candida albicans e das especies nao albicans ao fluconazole outros derivados az61icos e descrito na literatura com freqOencia, o que torna importante a realiza tao de testes de susceptibilidade. Neste contexte esta pesquisa tern como objetivo determinar o perfil de susceptibilidade das leveduras Candida em diferentes sftios anatomicos. As leveduras isoladas da mucosa bucal e de pele foram semeadas em CHROMagar Candida, incubadas por 48 horas, a 35°C sendo posteriormente identificadas e avaliado in vitro o perfil de susceptibilidade utilizando o metodo da macrodilui tao. Entre as 25 amostras analisadas, verificou-se urn perfil de resistencia maior ao fluconazol em compara tao ao cetoconazol, sendo que 44% dos isolados de boca e 50% de pele mostraram-se resistentes ao fluconazol.

The variability of the different species of Candida sp, together with the distinct responses to treatment, elicited the need of using different diagnostic methods and therapeutic programs. Among the yeast of this group, Candida albicans is one of the most common pathogens involved in muco-cutaneous and oropharingeal candidiases, but the non-albicans species have increased in number and importance due to antifungal resistance. The resistance of Candida albicans and the non-albicans species to fluconazole and other azolic derivatives is frequently reported, which makes susceptibility tests important. Within this scope, this research has the purpose of determining the susceptibility profile of Candida yeast from different anatomical sites. The yeast cells isolated from buccal mucosa and skin were seeded in CHROMagar Candida, incubated for 48 hours at 35°C; later, they were identified and the susceptibility profile was assessed in vitro using themacrodilution method. Of the 25 samples analyzed, a higher profile of resistance to fluconazole compared to ketoconazole was noticed, where 44% ofthe buccal and 50% ofthe skin isolates were resistant to fluconazole.

Avaliação Clínica e Microbiológica do Tratamento da EstomatiteProtética com Tintura de Schinus terebinthifolius Raddi (Aroeira) / Clinical and Microbiological Evaluation of the Treatment of Denture Stomatitis withSchinus terebinthifolius Raddi (Aroeira) Tincture

Objeti vo: Avaliar a efi cácia clínica da ti ntura da aroeira notratamento da estomati te protéti ca.Método: Foram selecionados 18 pacientes usuários de prótesesremovíveis com diagnósti co clínico para estomati te protéti cati po II e presença de candidose associada à prótese, constatadosa parti r de um exame clínico e micológico. Os pacientes foramdistribuídos em dois grupos: GT (grupo teste) - tratamentocom a ti ntura da aroeira; GC (grupo controle), tratamento comnistati na. Todos os pacientes foram orientados a higienizara prótese com escova e denti frício e, em seguida, aplicar oproduto na mucosa palati na e na superfí cie da prótese 3 vezesao dia, durante 15 dias consecuti vos, remover a prótese à noitee armazená-la em um recipiente com água. No 15º dia de uso,foi realizado um novo exame clínico e micológico para avaliara efi cácia do tratamento. Os dados foram analisados com ostestes Wilcoxon e Mann-Whitney com nível de signfi cância de5%.Resultados: Observou-se eliminação do processo infl amatórioe da infecção por Candida spp. em 66,7% e 77,8% dos casos,respecti vamente, para GT. Já para GC, a eliminação doprocesso infl amatório e da infecção fúngica ocorreu em 77,8%e 88,9% dos casos, respecti vamente. Estes resultados foramestati sti camente signifi cantes (Wilcoxon p=0,01). Não foiobservada diferença estatí sti camente signifi cante entre os doistratamentos (Mann-Whitney p>0,05). A infecção fúngica foidiagnosti cada apenas na prótese em todos os casos, sendo a C.albicans o microorganismo mais prevalente, estando presenteem 94,4% dos casos.Conclusão: O tratamento com a ti ntura da aroeira foi efi caz notratamento da estomati te protéti ca, promovendo remissão doprocesso infl amatório e da infecção por Candida spp...

Objecti ve: To evaluate the clinical effi cacy of Schinusterebinthifolius Raddi (aroeira) ti ncture in the treatment ofdenture stomati ti s.Method: Eighteen removable denture wearers with clinicaldiagnosis of type II denture stomati ti s and presence ofcandidosis associated to the denture use, as confi rmed byclinical and mycological examinati ons, were selected forthe study. The pati ents were allocated to two groups: TG(test group) - treatment with Schinus terebinthifolius Raddi(aroeira) ti ncture; CG (control group), treatment with nystati n.All pati ents were instructed to clean the dentures withtoothbrush and denti frice, and then apply the product on thepalatal mucosa and on denture surface 3 ti mes a day, during15 consecuti ve days, removing the denture at bedti me andkeeping it in a receptacle with water. At the 15th day of use, theclinical and mycological examinati ons were redone to evaluatetreatment effi cacy. Data were analyzed stati sti cally by Wilcoxonand Mann-Whitney tests at 5% signifi cance level.Results: The infl ammatory process and Candida spp. infecti onwere eliminated in 66.7% and 77.8% of the cases, respecti vely,in TG. In CG, eliminati on of the infl ammatory process andfungal infecti on occurred in 77.8% and 88.9% of the cases,respecti vely. These results were stati sti cally signifi cant (p=0.01).There was no stati sti cally signifi cant diff erence between thetreatments (p>0.05). In all cases, fungal infecti on was detectedonly on the denture, and C. albicans was the most prevalentmicroorganism, being present in 94.4% of the cases.Conclusion: The treatment with Schinus terebinthifolius Raddi(aroeira) ti ncture was eff ecti ve in the treatment of denturestomati ti s, promoti ng remission of the infl ammatory processand Candida spp infecti on...

Unusual palatal foreign body: Case presentation

A two- year old Yemeni boy was referred to the Oral and Maxillofacial Clinic of the Aden University because his father had noticed a white lesion on the palate three days before; the child was examined by many dentists and a pediatrician prescribing medical treatment without improvement of the lesion. Questions to the father had not provided any interesting data about previous traumatism, ingestion of caustic substance or history of general disease. A rigorous oral and maxillofacial examination showed a white smooth lesion around 1.5 cm on the middle of the hard palate. According to previous experiences, the final diagnosis was a foreign body adhered to mucosa of the hard palate, the internal cover of a cap from drug bottle, which was removed by the use of a dental probe and college tweezers, leaving a concavity in the involved area that was healed without problems after a few days

Tratamento de candidíase oral em pacientes com câncer de cabeça e pescoço: uma revisão sistemática / Treatment of oral candidiasis in patients with head and neck cancer: a systematic review

Introdução: A candidíase constitui uma das infecções oportunistas mais frequentes em pacientes oncológicos, sendo resultado do desequilíbrio da ecologia do ambiente, em virtude dos tratamentos antineoplásicos. Objetivo: Investigar através de uma revisão sistemática as intervenções para o tratamento de candidíase orofaríngea em pacientes com câncer de cabeça e pescoço. Metodologia: Consulta em bases de dados eletrônicos MEDLINE, LILACS e BBO, cuja coleta de dados incluiu estudos de intervenção (ensaio clínico), apresentando desfechos relacionados à avaliação clínica e microbiológica da candidíase através dos antifúngicos. As estratégias de buscas utilizadas incluíram como palavras: cancer and (oral or bucal or neck or head) and (treatment or therapy), nos idiomas português, inglês e espanhol, no período de 1966 a 2007. Resultados: Foram selecionados três estudos, todos no idioma inglês, sendo que apenas um objetivou avaliar a resposta dos indivíduos ao fluconazol e os demais compararam a resposta do fluconazol a outras drogas (voriconazol, itraconazol e anfotericina B). Conclusão: O fluconazol apresentou melhores resultados, sendo eficaz em debelar a candidíase orofaríngea. No entanto, deve-se atentar para a resistência de determinadas linhagens de cândida ao fluconazol, devendo o profissional ser capaz de escolher o medicamento de melhor efeito para cada caso.

Introduction: Candidiasis (thrush) is one of the most common opportunistic infections among cancer patients, being a result of an imbalance in the environmental ecology because of the antineoplastic therapies. Aim: To investigate through a systematic review the available interventions for treatment of oral candidiasis in patients with head and neck cancer. Methods: A review was made of electronic databases MEDLINE, LILACS and BBO, in which data collection included intervention studies (clinical trials) presenting outcomes related to clinical and microbiological evaluation of candidiasis through antifungal drugs. The search strategies included words like cancer and (oral or buccal or neck or head) and (treatment or therapy), in Portuguese, English and Spanish, from 1966 to 2007. Results: Three studies were selected, all written in English, one of which evaluating patient response to fluconazole and the other two comparing response to fluconazole with other drugs (voriconazole, itraconazole and amphotericin B). Conclusion: Fluconazole presented the best results, being effective to suppress oral candidiasis. However, the resistance of certain candida strains to fluconazole must be considered, so as to be able to select the drug that is most likely to succeed in each particular case.