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.     

HIV感染者口腔念珠菌负荷及生物型研究

目的调查人类免疫缺陷病毒（human immunodeficiency virus，HIV）感染者口腔中念珠菌负荷状况、生物分型及与口腔念珠菌病临床表现的关系。方法采取漱口法对64例HIV感染者和42名健康对照者进行口腔念珠菌的定量分离培养，并综合利用革兰染色、厚壁孢子生成实验、CHROMagar显色培养和API 20C AUX酵母菌鉴定系统对分离株进行生物型鉴定。结果64例HIV感染者中，52例中可分离出念珠菌74株，阳性分离率为81．3％，而42名健康对照者口腔念珠菌阳性分离率仅为16．7％（P〈0．001）。通过对74株念珠菌的生物型进行鉴定，发现有39株白色念珠菌，15株热带念珠菌及其他6个生物型20株。健康对照组中，分离出5株白色念珠菌和其他裂2株。结论HIV感染者口腔念珠菌感染率明显增加，其口腔念珠菌的检出率和负荷量亦明显增加，白色念珠菌和热带念珠菌为其主要分离菌；与健康对照组相比，HIV感染者的口腔念珠菌分离株生物类型旱现多样化。     

Mycological and cytological examination of oral candidal carriage in diabetic patients and non-diabetic control subjects: thorough analysis of local aetiologic and systemic factors

In this study, 55 diabetic patients and 45 non-diabetic control subjects were examined to determine oral candidal carriage state. The influence of some local aetiologic and systemic factors such as: salivary flow rate and pH, heredity, alcohol drinking, smoking habits, antimicrobial therapy, wearing of denture, burning sensation, dry mouth, taste alteration and tooth brushing habit on candidal carriage rate were investigated. Imprint culture, cytological smears and biochemical tests were used. Oral carrier rate and density of Candida species were non-significantly higher in the diabetic patients than in the non-diabetic control subjects. This increase was confirmed cytologically too. In both groups, Candida albicans was found to be a predominant species on tongue dorsum. Cigarette and alcohol habits of men were higher while tooth brushing habit was less than in women in diabetic and control groups. Salivary flow rate and pH values of diabetic patients were significantly lower while serum glucose values were significantly higher than of non-diabetic controls. The rate of diabetic patients suffering from dry mouth and having diabetic heredity in the family were significantly higher than control subjects. The candidal colonization was higher and keratinization was lower while diabetic treatment tended from diet and oral antidiabetic towards insulin. The decrease in salivary pH, the increase in serum glucose and wearing denture were correlated with the increased rate and density of C. albicans in both groups. Keratinization was also accompanied with the increase in leucocytes. In diabetic group, positive correlations were found between antimicrobial therapy and C. glabrata carriage; the increase in leucocytes and C. albicans carriage; the increase in keratinization and alcohol habit; serum glucose and smoking habit; dry mouth complaint and antimicrobial therapy. There was a negative correlation between salivary flow rate and C. albicans carriage. In control group a positive correlation was found between antimicrobial therapy and keratinization.     

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.     

The relationship between oral Candida carriage and the secretor status of blood group antigens in saliva

OBJECTIVE: The aim of the study was to investigate the relationship between oral Candida carriage and the secretor status of blood group antigens. STUDY DESIGN: Unstimulated whole saliva and oral rinse samples were obtained from 180 healthy subjects. These samples were plated on Sabouraud's dextrose agar media to determine oral Candida carriage. Sodium dodecylsulfate polyacrylamide gel electrophoresis and immunoblotting were performed on whole saliva samples to determine the secretor status of blood group antigens. RESULTS: The oral Candida carriage rate was found to be 45.0%. The sensitivity of the concentrated rinse culture proved to be superior. Oral Candida carriage was not significantly related to the blood group or secretor status of ABH or Lewis antigens. No significant relationship was found between oral Candida carriage and salivary flow rate. However, smoking affected oral Candida carriage. CONCLUSION: Oral Candida carriage in healthy individuals is not significantly related to blood group or secretor status.     

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.     

Effect of cannabis use on oral candidal carriage

The effects of cigarette smoking on oral candidal carriage and candidosis have been well documented but few similar studies on cannabis smoking have appeared, therefore it was felt that such a study needed to be undertaken. In this investigation, the effect of cannabis smoking combined with methaqualone and tobacco on candidal prevalence, density and candidosis was examined in 55 users. Age and sex matched tobacco-smoking (n = 58) and non-smoking controls (n = 50) were examined similarly. The imprint culture technique was used for harvesting Candida. Results showed an increased prevalence and density of C. albicans in cannabis users while there was no apparent difference in the prevalence of candidiasis. However, two subjects presented with oral multifocal candidiasis.     

The effects of orthodontic appliances on Candida in the human mouth

Background.  Candida is an opportunistic pathogen present in about 50–60% of the healthy human population, and becomes pathogenic when the host immune defence is undermined such as in HIV infection. Adhesion and colonization of the oral cavity by Candida albicans is an initial step in candidosis, and the presence of orthodontic and other oral appliances seems to alter the oral ecological environment, hence may tip the balance to favour the candidal presence.
Objective.  The purpose of this paper was to review the literature with specific attention to prevalence; intra-oral density of the candidal organisms; and Candida carriage status in orthodontic patients before, during, and after treatment.
Conclusions.  The limited amount of literature demonstrated that the density of Candida increases; the most common Candida species isolated in the orthodontic patients was C. albicans ; and that there seems to be a direct relationship between the presence of a removable appliance, Candida , and low salivary pH levels. No healthy patients developed Candida infection from the orthodontic appliances. However, there seems to be a trend that some non- Candida carriers converted to Candida carriers following the insertion of the appliances by unknown mechanism. This may indicate a more cautious approach when providing orthodontic treatments to immunocompromised children concerning the possible increased risk of candidal infection.     

Isolation of Candida species from the oral cavity and fingertips of complete denture wearers.

STATEMENT OF PROBLEM: Candida species usually colonize in the oral cavity of denture wearers and may also colonize on their fingers because of frequent manual manipulation of the dentures. PURPOSE: This study investigated the association between oral and fingertip candidal isolation in a group of denture wearers. MATERIAL AND METHODS: Oral rinse and fingerprints obtained from 25 healthy male complete denture wearers were microbiologically investigated for candidal growth, and isolated Candida species were identified with a germ tube test and a commercially available yeast identification system. Denture cleanliness, hand washing, and denture wearing and handling habits were recorded for each subject. RESULTS: Candida species were isolated from the oral cavity of 15 (60%) and fingertips of 11 (44%) subjects. Ten (66.7%) subjects had concomitant oral and fingertip candidal isolation, whereas 5 (33.3%) subjects had only oral Candida (P=.005). CONCLUSION: The hands of denture wearers who had oral Candida were significantly more colonized with Candida species than oral Candida-free subjects. Further studies identifying Candida species to the strain level and the significance of hand Candida as a source for mouth reinfection are needed.     

Alteration of humoral responses to Candida in HIV infection

The objectives of this preliminary study were to determine the prevalence of oral candidal carriage and infection in a group of HIV-positive individuals and compare the humoral immune responses in serum and saliva in this group with a control group of HIV-negative subjects. Patients were examined clinically with particular reference to the presence of candidal lesions and oral swabs taken to identify carriers. Venous blood and whole saliva were obtained for estimation of total and anti-Candida antibody levels. Pseudomembranous candidiasis was the commonest clinical variant in HIV-positive individuals. Candida albicans was the commonest species isolated in both groups. Increased levels of anti-Candida IgG were found in both serum and saliva of HIV-negative individuals who were either carriers of Candida species or had clinical candidiasis. This was associated with a reciprocal fall in anti-Candida IgA. Similar trends were seen in HIV-positive individuals in association with candidal carriage and infection, although the changes were more marked.     

Carriage of Candida species in the oral cavity in diabetic patients: relationship to glycaemic control

To study the possible relationship between the quality of glycaemic control in diabetes mellitus and the carriage of Candida species, the candidal carrier status of 412 diabetic patients was examined using an oral rinse technique and correlated with measurements of random blood glucose and total glycosylated haemoglobin. Candida was isolated in 210 diabetics (51%) with 13 patients (6%) carrying more than one species. The positive isolates were: Candida albicans (89%), Candida krusei (2.8%), Candida glabrata (2.8%), Candida tropicalis (6.2%), Candida stellatoidea (2.8%) and Candida parapsilosis (0.5%). No association was identified between carriage rates and the type of treatment of diabetes, or with the quality of glycaemic control. As in non-diabetic subjects, the carriage rates were higher in diabetic patients wearing dentures. Thus, the oral carriage of Candida in diabetic patients was independent of glycaemic control but in certain sub-groups the carriage rates were higher, and involved uncommon candidal species.     

Oral Candida infection and colonization in solid organ transplant recipients

Introduction:  Oral Candida carriage and infection have been reported to be associated with a greater risk for systemic infection in transplant recipients; however, a systematic analysis of the oral Candida titers and species has not been previously conducted. The objectives of this study were to determine the prevalence of oropharyngeal candidiasis, the oral carrier status, Candida titers and species in this population.
Methods:  Ninety kidney and heart transplant subjects and 72 age-matched healthy controls were included. Swabs from the oral mucosa and a standardized amount of unstimulated saliva were plated on Chromagar™ Candida , and colony-forming units per millilitre were calculated. Initial speciation was based on colony color and was confirmed by standard germ tube, biotyping, or polymerase chain reaction assays.
Results:  Infection with C. albicans was detected in seven transplant subjects and none of the controls. The transplant group had significantly higher oral Candida titers than the control group. There were no statistically significant relationships between the dose or type of immunosuppressants and oral Candida titers or infection. A significantly higher percentage of transplant subjects were colonized by more than one species, compared with control subjects. The most frequent species combination in transplant subjects was C. albicans and C. glabrata . C. glabrata was isolated from 13.5% of transplant carriers and none of the controls.
Conclusions:  Increased oral Candida infection and carriage titers were found in the transplant population. Although the majority of transplant patients were colonized by C. albicans , C. glabrata appears to emerge as the second most prevalent species.     

Oral yeast carriage in patients with advanced cancer

The aim of this study was to investigate oral yeast carriage amongst patients with advanced cancer. Oral rinse samples were obtained from 120 subjects. Yeasts were isolated using Sabouraud's dextrose agar and CHROMagar Candida, and were identified using a combination of the API 20 C AUX yeast identification system, species-specific PCR and 26S rDNA gene sequencing. Oral yeast carriage was present in 66% of subjects. The frequency of isolation of individual species was: Candida albicans, 46%; Candida glabrata, 18%; Candida dubliniensis, 5%; others, < 5%. The increasing isolation of non-Candida albicans species is clinically important, since these species are often more resistant to antifungal drugs. Oral yeast carriage was associated with denture wearing (P = 0.006), and low stimulated whole salivary flow rate (P = 0.009). Identification of these risk factors offers new strategies for the prevention of oral candidosis in this group of patients.     

Study of the oral carriage of Candida sp. in dental students and staff—Identification of Candida sp. and background survey

PurposeThe purpose of this study is to investigate the relationship between oral candidal carriage in able-bodied persons (dental students and staff) and health condition using a epidemiological method with questionnaire, and use the results for an educational campaign for the promotion of health.MethodsThe candidal carriage was examined by culture method using swabs from tongue surfaces. The identification of Candida spp. of the culture positive specimens was performed by a multiplex polymerase chain reaction method. Questionnaire items included age, gender, body mass index, pedometer use, oral conditions, regularity of hospital visits, medication, dental visits, oral care, exercise habits, alcohol habits, and smoking habits.ResultsA total 482 participants were surveyed over a period of two years, males: 269 (mean, 36 years); females: 213 (33 years). Oral candidal carriage was 18.3%. Candida albicans accounted for 80.7% of isolated Candida spp. After analysis using a stepwise method, three items (age, smoking habits, and exercise habits) were selected as the variables in the model. The adjusted odds ratios (95% confidence intervals) for the three model variables were 1.84 (1.10–3.08) for exercise habits, 1.93 (1.00–3.69) for smoking, and 0.96 (0.94–0.98) for age. Logistic regression analysis suggested an association between candidal carriage, exercise habits, and smoking.ConclusionsBecause lack of exercise, as well as smoking are well-known to be detrimental factors to the maintenance of good health, candidal carriers do not appear to be in a condition of good health. In other words, candidal carriage may be a health warning.     

Betel quid-associated oral lesions and oral Candida species in a female Cambodian cohort

BACKGROUND: Betel quid chewing (BQC) is still prevalent among elderly Cambodian women and is associated with a wide variety of oral mucosal lesions. BQC has also been associated with a reduced rate of dental caries and changes in the oral microbiological flora. METHODS: Since no studies were available on the impact of BQC on the oral carriage of Candida species, in this study oral swabs (Fungiquick, Hain Diagnostika, Germany) were taken from the tongue and palate of 48 Cambodian women with BQC habit (study group) and 13 control subjects without BQC habit (control group) to determine the spectrum of Candida species in these two groups. In addition, we investigated lesions of the oral mucosa likely to be associated with BQC habit in both study and control groups. RESULTS: The median duration of BQC was 10 years (range 10 months-30 years). The following oral lesions were found in the study group: betel chewer's mucosa (85.4%), oral leukoplakia (8.3%), leukoedema (37.5%) and oral lichen planus (4.2%). Oral candidiasis was seen neither in BQ-chewers nor in controls. Candida spp. were found in 70.8% of the cases (controls 69.2%). Whilst C. albicans was isolated from 27.1% of the study cohort, C. tropicalis was the second most common isolate. One control case was colonised by C. dubliniensis--the first report of this organism from a Cambodian population. There was no significant difference in the candidal carriage rate or the Candida species isolated between the study and the control group. CONCLUSIONS: Mycological findings from the present study do not indicate that BQC has a significant effect on oral colonisation by Candida species.     

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.     

Oral candidal flora in healthy infants

Asymptomatic oral candidal carriage has been extensively studied in adults, but only rarely in infants. The present investigation aimed to determine the asymptomatic oral carriage of candidal species in healthy infants and its relationship to age, sex, feeding pattern and use of a pacifier. The swab technique was used for oral candidal isolation. Candidal species were isolated from 48% of the infants without a significant relationship to age, gender or between breast-fed or bottle-fed infants. Similarly, a history of maternal vaginal candidosis, or presence of nappy rash, had no significant relationship to oral candidal carriage. Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.     

Carriage of Candida species in the oral cavity in diabetic patients: relationship to glycaemic control

To study the possible relationship between the quality of glycaemic control in diabetes mellitus and the carriage of Candida species, the Candidal carrier status of 412 diabetic patients was examined using an oral rinse technique and correlated with measurements of random blood glucose and total glycosylated haemoglobin. Candida was isolated in 210 diabetics (51%) with 13 patients (6%) carrying more than one species. The positive isolates were: Candida albicans (89%), Candida krusei (2.8%), Candida glabrata (2.8%), Candida tropicalis (6.2%), Candida stellatoidea (2.8%) and Candida parapsilosis (0.5%). No association was identified between carriage rates and the type of treatment of diabetes, or with the quality of glycaemic control. As in non-diabetic subjects, the carriage rates were higher in diabetic patients wearing dentures. Thus, the oral carriage of Candida in diabetic patients was independent of glycaemic control but in certain sub-groups the carriage rates were higher, and involved uncommon candidal species.     

2型糖尿病患者罹患口腔假丝酵母菌感染危险因素的Logistic回归分析

目的通过多因素分析,筛选出与2型糖尿病患者伴发口腔假丝酵母菌感染密切相关的指标,建立预测方程,分析2型糖尿病患者口腔假丝酵母菌感染的危险因素。方法选择140例2型糖尿病患者,记录性别,年龄,病程,吸烟史,空腹血糖值及系统并发症（包括肾病、神经病变和高血压）;并对患者进行口腔检查,记录口腔卫生状况、口腔黏膜情况及义齿修复情况。运用标准含漱浓缩法检测患者口腔假丝酵母菌的检出率和负载量,并采用CHROM agar显色培养基进行初步生物分型。应用Logistic回归分析方法研究2型糖尿病患者口腔假丝酵母菌感染与上述11项临床指标之间的关系。结果140例2型糖尿病患者中有69例检出口腔假丝酵母菌,检出率为49.3%,检出的假丝酵母菌菌种以白假丝酵母菌为主。以上述11项临床指标作为自变量,口腔假丝酵母菌感染发生与否作为因变量,进行Logistic回归分析,建立Logistic回归方程,方程的总判断率为82.1%。经回归分析,空腹血糖值、口腔卫生状况和黏膜干燥是2型糖尿病患者伴发口腔假丝酵母菌感染的危险因素。结论空腹血糖值、口腔卫生状况、黏膜干燥是2型糖尿病患者伴发口腔假丝酵母菌感染的危险因素;通过回归方程得出的概率值可为2型糖尿病患者口腔假丝酵母菌感染的预测及口腔护理保健提供参考。