Oral Candida and nasal Aspergillus flora in a group of Saudi healthy dentate subjects

The prevalence of oral candidal carriage is widely variable in different populations but has never been studied previously in a Saudi population. Nasal mycological flora has never been investigated previously in a healthy population. OBJECTIVES: To assess the oral and nasal candidal and Aspergillus flora in a group of Saudi healthy adult dentate subjects. DESIGN: The concentrated oral rinse technique and nasal swab technique were used to sample the oral and nasal cavity respectively. RESULTS: Candida species were isolated from the oral cavity of 52 (52%) subjects. Candida albicans constituted 80.8% of the isolates, followed by C. krusei (5.8%). Aspergillus species were isolated from the nose of 21 (21%) subjects. A. flavus constituted 42.3% of the isolates followed by A. niger (31.8%) and A. fumigatus (26.9%). Subjects who did not brush their teeth had a significantly higher rate of oral Candida and nasal Aspergillus compared with those who brushed regularly (P = 0.02). CONCLUSION: Oral mycological flora in the Saudi population is not different than reported for other populations. Lack of oral hygiene increases oral candidal colonisation. Larger scale studies are encouraged to determine the prevalence of oral candidal carriage in the population generally, and the significance of nasal Aspergillus carriage should be determined.     

Influence of oral conditions on colonization by highly toxigenic Staphylococcus aureus strains

Oral Diseases (2012) 18 , 402–409 Objectives: As the oral cavity is regarded as a relevant site for Staphylococcus aureus colonization and interhuman transmission, this study aimed to investigate whether different oral conditions influence the rates of S. aureus oral carriage and genetic characters of S. aureus isolates. Subjects and methods: Staphylococcus aureus was searched in samples collected from cheek, gingival margin, and anterior nares of 45 healthy subjects, 27 periodontitis affected subjects, and 29 subjects with fixed prosthetic restorations. Isolates were screened for 17 genetic determinants, and Partial Least Square Discriminant Analysis was performed to evaluate whether specific characters correlated with oral condition or site of isolation. Results: The three subject groups showed comparable nasal carriage rates but, both the periodontitis and prosthetic restoration groups showed significantly higher oral carriage rates, as compared to healthy subjects (P = 0.01 and 0.02, respectively). Moreover, periodontitis affected subjects hosted strains possessing a distinct genotypic and phenotypic background, characterized by the presence of a larger number of exotoxins encoding genes. Conclusions: These data confirm that the oral cavity is an important site of S. aureus colonization and demonstrate that conditions modifying the oral environment, as the presence of periodontitis and of fixed prosthetic restorations, promote S. aureus carriage and may favor the spread of more pathogenic strains.     

中老年患者口腔念珠菌携带情况的研究

目的研究口腔修复门诊戴用和不戴可摘义齿中老年患者口腔念珠菌携带情况及常见的念珠菌菌种,并分析相关因素。方法选择不戴可摘义齿患者54人(A组),戴上颌可摘义齿患者84人(B组),年轻学生51人作为对照组(C组)。采集唾液培养并初步鉴定菌种,分析相关因素。结果 A组念珠菌检出率为51.9%,白念珠菌占82.1%。B组念珠菌检出率为82.1%,白念珠菌占73.9%。C组念珠菌检出率为17.6%,白念珠菌占55.6%。A、B、C 3组间及每两组间的念珠菌检出率差异均有统计学意义(P≤0.01)。结论戴用可摘义齿的中老年患者口腔念珠菌检出率显著高于不戴义齿中老年患者;中老年患者口腔念珠菌检出率明显高于年轻对照组。白念珠菌仍是口腔中主要念珠菌种。     

Fungal load and candidiasis in Sjögren's syndrome

OBJECTIVE: We sought to investigate the prevalence of Candida carriage and the relationships between salivary flow rates and oral Candida load in patients with Sj?gren's syndrome (SS). METHODS: The oral Candida load of patients with SS was evaluated by culturing oral rinse (swish and spit) samples. Culture, Gram stain, and wet-mount test results were reported. RESULTS: One hundred three patients (96 women) met European criteria for SS (91 with primary SS and 12 with secondary SS). The mean age (95% confidence interval) was 55 years (range, 51-57 years). Oral rinse cultures were positive in 77% of subjects. The total stimulated salivary flow rate was inversely correlated with oral Candida load (r = -0.47; P 相似文献   

Respiration characteristics in subjects diagnosed as having nasal obstruction

The purpose of this study was to determine the respective oral and nasal contributions to total respiration in patients scheduled for surgical corrections of nasal obstruction. The effect of anterior nares expansion and/or nasal decongestant administration on the nasal component of breathing was also examined in these patients. Although variability among subjects was demonstrated in the ratio of nasal respiration to total respiration, 25% of the "nasally-obstructed" patients were 100% nasal breathers and no patient had a nasal component less than 18% of total respiration. Great variability existed among the patients in their response to nares expansion and/or decongestant administration. Collectively, they demonstrated no significant mean increase in nasal respiration with nares expansion alone. The patients demonstrated an increase with administration of the decongestant and with decongestant combined with nares expansion. The latter condition resulted in an increase that was greater than with decongestant alone. The implication of this study is that the traditional diagnostic terms "mouth breathing" or "nasal obstruction" are not useful. They do not describe the type, location, or severity of an obstruction or the relative contribution of the nose and mouth to respiration. Many patients who experience symptoms or have signs of nasal obstruction can functionally compensate to maintain 100% nasal breathing.     

Asymptomatic oral Candida albicans carriage in HIV-infection: frequency and predisposing factors

Many studies have focused on the epidemiology and pathogenesis of oral candidiasis in HIV infection. Little is known on the incidence and predisposing factors of asymptomatic oral Candida carriage in this setting, obviously an important issue in view of prophylaxis. To address this question. 261 consecutive HIV-infected individuals without clinical evidence of candidiasis were investigated. C. albicans was isolated from cultured oral cavity swabs of 63 subjects (24%). Colonization was significantly more frequent in IV drug users. CDC groups IV. and in subjects with lymphocytopenia. CD4+ cell depletion, or elevated beta-2 microglobulin. These data further suggest that oral candidiasis occurs in HIV infection as a result of C. albicans overgrowth and raise the question of primary antifungal prophylaxis in subjects with low CD4 counts and asymptomatic oral Candida carriage.     

Methicillin-resistant Staphylococcus aureus and infection control for restorative dental treatment in nursing homes

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in nursing home residents now averages 20–35%. This includes both numerous asymptomatic mostly unidentified carriers, and the occasional patient with an active infection. Among the most common sites for positive MRSA colonization are the nares and mouth (saliva). Ohio State University (OSU) dental students perform routine restorative dental care onsite in local nursing homes using portable equipment including handpieces that can generate aerosols. Using a series of cultured test swabs and plates, this pilot study suggests that protection for both dental health care personnel and patients are provided by the following: I. universal barrier precautions (for example, gloves, gowns, masks, hats, facial shields, glasses), 2. surface disinfectants, 3. pre-op 0.12% chlorhexidene mouth rinses, 4. high volume evacuation, 5. perioral skin scrubs. Additional infection control methods, techniques and equipment were evaluated and compared including rubber dam isolation, hand excavation and bond technique, high-speed air turbine and electric "high" speed handpiece. There was no indication of a special tendency or heightened ability of MRSA to aerosolize.     

Persistence of oral Candida albicans carriage in healthy Portuguese schoolchildren followed for 3 years

Little is known about carriage of Candida albicans, the predominant pathogenic yeast in oral infection, in children. We cultured buccal mucosal and gingival swabs from 150 Portuguese children to investigate the prevalence of C. albicans at baseline (before dental treatment), post-treatment, and 12, 24, and 36 months post-baseline. The children, aged 8 to 11 years at baseline, had no systemic disease or clinical symptoms of oral candidiasis. At each successive visit, respectively, 47, 32, 21, 27, and 28% of children were C. albicans positive, resulting in an almost 50% reduction in prevalence from baseline to post-treatment (P < 0.0005). Children who carried C. albicans at one visit had 3 to 20 times greater odds of carrying C. albicans at another visit. C. albicans was cultured from 12 children at all time-points and from 10 children at four time-points. Children with oral C. albicans frequently maintained carriage over time, even with regular dental care.     

Antibiotic susceptibility of Staphylococcus aureus isolates in oral mucosa and pockets of patients with gingivitis-periodontitis

Both oral cavity and subgingival pocket are ecological niches conducive to hosting microorganisms that may act as opportunistic pathogens, such as Staphylococcus aureus and especially methicillin-resistant Staphylococcus aureus (MRSA). Early detection of MRSA is a matter of concern to Public Health. The aim of our study was to determine phenotypic and genotypic detection of methicillin resistance of S. aureus in oral mucosa and subgingival pocket in 102 patients with gingivitis-periodontitis. The prevalence of S. aureus was 10.8% (n = 11) in subgingival pocket and 19.6% (n = 20) in oral mucosa. We obtained 31 isolates of S. aureus of which 13 were mecA positive and 18 were mecA negative. Detection of mecA gene by PCR was used as the reference method to compare the results of phenotypic methods to determine methicillin resistance. Early, accurate detection of S. aureus through phenotyping and genotyping methods is crucial for assessing the colonization and preventing the spread of MRSA.     

Association of asymptomatic oral candidal carriage, oral candidiasis and CD4 lymphocyte count in HIV-positive patients in China

OBJECTIVES: To compare the prevalence of asymptomatic oral candidal carriage in healthy volunteers with human immunodeficiency virus (HIV)-positive patients in China, as well as to investigate the relationship between CD4+ lymphocyte count and oral candidal colonization or oral candidiasis. METHODS: Oral candidal carriage and oral candidiasis were investigated in 101 patients with HIV-infection seen at Youan Hospital, Beijing, China. Two hundred and seventeen healthy volunteers were involved as a control. Culture from saliva was used to test for the presence of oral Candida. CD4+ lymphocyte count was measured by flow cytometry. All data were analyzed statistically by SAS. RESULTS: Asymptomatic oral candidal carriage rate (28.6%) in HIV-positive group was similar to that in the healthy group (18.0%; P = 0.07). No significant difference in CD4+ lymphocyte count was found between oral Candida carriers and non-carriers among HIV-positive subjects (P = 0.89). However, the frequency of oral candidiasis increased with the decrease in CD4+ lymphocyte count (P < 0.0001), and pseudomembranous candidiasis was predominant in HIV-positive patients with CD4+ <200 cells microl(-1) (66.7%). CONCLUSIONS: In HIV-positive subjects, asymptomatic oral candidal colonization is not related to CD4+ lymphocyte count of blood, and the carriage rate is similar to that in the healthy population. Oral candidiasis is more likely to be observed in HIV-positive patients who have a low CD4+ lymphocyte count.     

Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data

OBJECTIVE: A retrospective analysis of laboratory data to investigate the isolation of Staphylococcus aureus from the oral cavity and facial area in specimens submitted to a regional diagnostic oral microbiology laboratory. METHODS: A hand search of laboratory records for a three-year period (1998-2000) was performed for specimens submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital and School. Data were collected from forms where S. aureus was isolated. These data included demographics, referral source, specimen type, methicillin susceptibility and clinical details. RESULTS: For the period 1998-2000, there were 5,005 specimens submitted to the laboratory. S. aureus was isolated from 1,017 specimens, of which 967 (95%) were sensitive to methicillin (MSSA) and 50 (5%) were resistant to methicillin (MRSA). The 1,017 specimens were provided from 615 patients. MRSA was isolated from 37 (6%) of patients. There was an increasing incidence of S. aureus with age, particularly in the >70 years age group. The most common specimen from which MSSA was isolated was an oral rinse (38%) whilst for MRSA isolates this was a tongue swab (28%). The clinical condition most commonly reported for MSSA isolates was angular cheilitis (22%). Erythema, swelling, pain or burning of the oral mucosa was the clinical condition most commonly reported for MRSA isolates (16%). Patients from whom the MSSA isolates were recovered were most commonly (55%) seen in the oral medicine clinic at the dental hospital, whilst patients with MRSA were more commonly seen in primary care settings such as nursing homes, hospices and general dental practice (51%). CONCLUSION: In line with more recent surveys, this retrospective study suggests that S. aureus may be a more frequent isolate from the oral cavity than hitherto suspected. A small proportion of the S. aureus isolates were MRSA. There were insufficient data available to determine whether the S. aureus isolates were colonising or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.     

Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry?

We assessed the frequency of carriers of methicillin-resistant Staphylococcus aureus (MRSA) among 500 dental patients of a university clinic. From each participant, two specimens were taken from the anterior nares and the pharynx and analysed by culture. The participants completed a questionnaire on possible risk factors of MRSA infection. Two hundred ten individuals carried S. aureus, 90 in the nares only, 51 in the throat only and 69 in nares and throat. Isolates of 208 patients were methicillin-sensitive; two isolates were methicillin-resistant, both carried in the throat exclusively. In conclusion, the frequency of nasal and/or throat carriers of MRSA among dental patients was low and suggests few opportunities of exposure in the dental clinic assessed.     

Prevalence of Candida species in Turkish children: relationship between dietary intake and carriage

In this study, the prevalence and intensity of Candida species were evaluated in 300 healthy Turkish children aged between 0 and 12 years. The candidal carriage in 26 children who were fed only with breast milk and 38 children who were fed with both breast milk and bottle milk or other fluids was also examined. Oral samples cultured for fungal growth and Candida species were identified using germ tube test, chlamydospore formation test and API 20C AUX system. The results demonstrated that the prevalence of oral candidal carriage in 300 healthy children was 26.3%. Candida albicans was the most frequently isolated yeast (84.8% of the isolates). The other yeasts were identified as Candida parapsilosis, Candida krusei, Candida kefyr, Candida famata, and Candida tropicalis. It was also observed that the frequency of carriage varied as a function of age. The prevalence of carriage in children who were fed with both breast milk and bottle milk or other fluids was 18.5%, while in children fed only with breast milk was 0%. This finding supports previously reported observations that there may be intrinsic differences in oral carriage of Candida species between different ages and populations and type of dietary intake may affect frequency of carriage.     

The relationship between oral hygiene and oral colonization with Candida species in healthy adult subjects*

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00371.x
Darwazeh AM‐G, Hammad MM, Al‐Jamaei AA. The relationship between oral hygiene and oral colonization with Candida species in healthy adult subjects. Abstract: Poor oral hygiene has been frequently suggested as a predisposing factor for oral candidal colonization, but the convincing evidence is lacking. Objective: To assess and compare oral candidal colonization, both quantitatively and qualitatively, in groups of healthy dentate subjects with different levels of oral hygiene as determined by the plaque index (PI) and gingival index (GI) scores. Methods: The concentrated oral rinse technique was used to isolate Candida species from 149 healthy dentate subjects. Candida species were cultured on Sabouraud’s dextrose agar plates and identified by germ‐tube test and the automated Vitek® system biochemical yeast card. According to the PI and GI scores, subjects were divided into different groups of oral hygiene level. Results: Candida species were isolated from 86 (57.7%) subjects. The prevalence of candidal carriage increased significantly as a function of age (P = 0.023), but was comparable between males and females (58.7% and 56.7% respectively; P = 0.87). Oral candidal carriage rate and density were not affected by the levels of dental plaque or gingival condition. The prevalence of oral candididal carriage was significantly higher in the subjects who were not using dental floss compared with those who were using dental floss (P = 0.032). Conclusion: Oral hygiene status, as determined by the PI and the GI scores per se, does not affect oral candidal colonization in healthy dentate subjects.     

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) and Use of a Nasal Mupirocin Ointment in Oral Cancer Inpatients.

PURPOSE: Elimination of methicillin-resistant Staphylococcus aureus (MRSA) is of critical importance in oral and maxillofacial surgery because control is very difficult once infection of an oral tumor or oral wound with MRSA is established. PATIENTS AND METHODS: We retrospectively investigated the risk factors for acquiring MRSA in 518 patients with oral cancer among 1,877 inpatients in our department between 1984 and 2005. RESULTS: The patients with oral cancer demonstrated a high rate of MRSA colonization and infection (77.8%) relative to the population as a whole with MRSA isolated percentage in our department after 1991. The risk factors for MRSA in oral cancer patients are also related to systemic diseases and physiological and iatrogenic conditions, including cerebrovascular diseases (77.8%), peripheral arterial catheterization (69.2%), diabetes (50.0%), tracheotomy (50.0%), renal failure (50.0%), long-term broad-spectrum antibiotic use (45.7%), and malnutrition (43.3%). However, the highest risk of MRSA seems to be related to poor hygienic care. CONCLUSIONS: Beginning in 1999, we implemented a strategy for reducing infection by MRSA that included nasal mupirocin ointment for patients at high risk of MRSA; since then, the detection rate has decreased. We suggest that the administration of nasal mupirocin ointment and provision of scrupulous hygienic care for high-risk patients are useful and effective measures for decreasing the incidence of MRSA infection.     

Candidal carriage in the oral cavity of human immunodeficiency virus-infected subjects

OBJECTIVES. We sought to assess asymptomatic oral carriage of Candida species and relative density in human immunodeficiency virus-infected (HIV+) subjects, as well as to determine whether yeast carriage is associated with CD4+ cell count, HIV-1 RNA quantity, gender, route of HIV transmission, antiretroviral therapy, or smoking. STUDY DESIGN. A cross-sectional analysis of oral rinses from HIV+ and healthy subjects was undertaken. Oral candidal carriage and relative species were investigated in 42 HIV+ and 41 healthy individuals, all of whom were seen at the Palermo University Department of Oral Sciences, Italy. Data were managed and analyzed by means of the computer software package StatView 5.0.1. RESULTS. Carriage rate was 61.9% and 29.3% (P =.003) among HIV+ and healthy subjects, respectively. Similarly, density carriage in the HIV+ group was found to be significantly higher than in the control group (P = .0002). Among HIV+ subjects, Candida carriage was significantly associated with smoking, whereas density was not. Oral candidal carriage and relative density were not significantly associated with the other 4 parameters evaluated. Candida albicans was the most frequently recovered species. CONCLUSIONS. Asymptomatic candidal carriage and relative density were found to be significantly higher in the oral cavity of HIV+ subjects-but not associated with CD4+ counts or HIV-1 RNA quantities.     

Colonization of the cleft nasal floor by anaerobic oral flora in patients with oronasal fistulae.

OBJECTIVES: Aerobic oral bacteria only rarely colonize the cleft nasal floor in patients with patent oronasal fistula. There are no studies that have investigated whether anaerobic oral flora colonize this site and whether attempting to culture them is useful for assessing the patency of oronasal fistulae in the clinic. DESIGN: A prospective study of 13 patients with cleft with patent unilateral oronasal fistulae. Microbiological culture swabs were taken from the oral cavity and both nasal floors, with the unaffected side being used as a control. Following aerobic and anaerobic culture, bacterial isolates were identified and compared. MAIN OUTCOME MEASURE: A significant growth of anaerobic oral bacteria from the cleft nasal floor when compared with the unaffected side. RESULTS: Aerobic oral flora was cultured from the oral cavity in all 13 patients. A light growth of aerobic oral flora was found in the cleft nasal floor in two patients, and anaerobic oral flora was cultured from the cleft nasal floor in the same two patients. No statistical correlation was found between growth of anaerobic flora and the cleft nasal floor (p =.48). CONCLUSIONS: Like aerobic oral flora, anaerobic oral bacteria would appear to only rarely colonize the cleft nasal floor in patients with oronasal fistulae. This additional investigation does not appear to be helpful in the assessment of oronasal fistulae in the clinic.     

Natural defenses against Candida colonization breakdown in the oral cavities of the elderly.

Candida colonization of the oral cavity increases in the elderly. A major predisposing condition is denture use, which also increases in the elderly. To test whether the increase in colonization is age-related in a fashion independent of denture use, we analyzed the frequency (incidence) of carriage, the intensity of carriage, the multiplicity of species, and the genetic relatedness of strains in the oral cavities of 93 test subjects separated into the three age groups: 60 to 69 yr, 70 to 79 yr, and > or = 80 yr. Each age group was further subdivided into subjects with and without dentures, and into males and females. The results demonstrate that the frequency of carriage, the intensity of carriage, and multispecies carriage all increase as a function of age and differ according to gender, in both cases independent of denture use, suggesting that the natural suppression of yeast carriage in the oral cavity breaks down in the elderly. In addition, it is demonstrated that Candida glabrata colonizes the oral cavities of elderly individuals without dentures only after 80 yr of age, suggesting that there are age-related compromising conditions other than denture use in this most elderly age group.     

Persistence of oral Candida albicans carriage in healthy Portuguese schoolchildren followed for 3 years

Little is known about carriage of Candida albicans, the predominant pathogenic yeast in oral infection, in children. We cultured buccal mucosal and gingival swabs from 150 Portuguese children to investigate the prevalence of C. albicans at baseline (before dental treatment), post‐treatment, and 12, 24, and 36 months post‐baseline. The children, aged 8 to 11 years at baseline, had no systemic disease or clinical symptoms of oral candidiasis. At each successive visit, respectively, 47, 32, 21, 27, and 28% of children were C. albicans positive, resulting in an almost 50% reduction in prevalence from baseline to post‐treatment (P < 0.0005). Children who carried C. albicans at one visit had 3 to 20 times greater odds of carrying C. albicans at another visit. C. albicans was cultured from 12 children at all time‐points and from 10 children at four time‐points. Children with oral C. albicans frequently maintained carriage over time, even with regular dental care.     

Oral cavity infection: an adverse effect after the treatment of oral cancer in aged individuals

Objective

The immune compromised patients after treatment of oral cancer may have a chance of infection by drug-resistant opportunistic microbes. We investigated the occurrence of opportunistic microorganisms in aged individuals receiving follow-up examinations after treatment of oral cancer in China.

Material and Methods

These patients were used as test group and the respective age grouped healthy individuals as control group. In this study, the oral cavity microorganisms such as bacteria and yeast were taken for the analysis. After the screening of representative microorganisms, their aptitude of pervasiveness against drugs was studied. Here, we used antimicrobial agents which are common in clinical practice. We also performed studies to investigate the presence of toxin genes in methicillin-resistant S. aureus (MRSA).

Results

The results indicate that the prevalence of drug-resistant microbes was more pronounced in oral cancer patients after initial treatment above 70 years old. The oxacillin resistance of S. aureus isolate confirms that the prevalence of MRSA is increasing in accordance to age-factor and immune compromise in elderly patients.

Conclusions

This study reveals the occurrence of drug-resistant opportunistic microorganisms in oral cavity after treatment for oral cancer in aged individuals. Special attention should be directed to MRSA during the treatment of oral cancer, and to realize the fact of immune compromise in elderly patients.