Identification and susceptibility testing of oral candidiasis in advanced cancer patients

Ragnhild Elisabeth Monsen; Anne Karin Kristoffersen; Caryl L Gay; Bente Brokstad Herlofson; Katrine Gahre Fjeld; Lene Hystad Hove; Hilde Nordgarden; Anita Tollisen; Anners Lerdal; Morten Enersen

doi:10.1186/s12903-023-02950-y

Identification and susceptibility testing of oral candidiasis in advanced cancer patients

BMC Oral Health. 2023 Apr 18;23(1):223. doi: 10.1186/s12903-023-02950-y.

Authors

Ragnhild Elisabeth Monsen^{1

2}, Anne Karin Kristoffersen³, Caryl L Gay^{4

5}, Bente Brokstad Herlofson^{6

7}, Katrine Gahre Fjeld⁸, Lene Hystad Hove⁸, Hilde Nordgarden⁹, Anita Tollisen¹⁰, Anners Lerdal^{11

4}, Morten Enersen³

Affiliations

¹ Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway. ragnhm@uio.no.
² Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. ragnhm@uio.no.
³ Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
⁴ Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.
⁵ Department of Family Health Care Nursing, University of California, San Francisco, USA.
⁶ Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
⁷ Unit of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway.
⁸ Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
⁹ National Resource Centre for Oral Health in Rare Disorders, Lovisenberg Diaconal Hospital, Oslo, Norway.
¹⁰ Unger-Vetlesens Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.
¹¹ Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1089 Blindern, 0317, Oslo, Norway.

Abstract

Background: Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity.

Methods: An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014-2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied.

Results: Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2-3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin.

Conclusion: C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer.

Trail registration: The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.

Keywords: Advanced cancer; Candida carriage; Candidiasis; Etest; Fungal; Oral; Polyfungal infection.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Amphotericin B / pharmacology
Amphotericin B / therapeutic use
Anidulafungin / pharmacology
Anidulafungin / therapeutic use
Antifungal Agents / pharmacology
Antifungal Agents / therapeutic use
Candida
Candida albicans
Candidiasis, Oral* / microbiology
Drug Resistance, Fungal
Fluconazole / pharmacology
Fluconazole / therapeutic use
Humans
Microbial Sensitivity Tests
Neoplasms* / drug therapy

Substances

Fluconazole
Amphotericin B
Anidulafungin
Antifungal Agents

Associated data

ClinicalTrials.gov/NCT02067572