The influence of antifungal drugs on virulence properties of Candida albicans in patients with diabetes mellitus.
OBJECTIVE
This study investigated the influence of nystatin and fluconazole on virulence properties of Candida albicans.


METHODS
A total of 108 diabetic patients participated in the study. Eighty-eight patients had clinical oral candidosis. Drug therapy was given at 6 hourly intervals for nystatin or daily with fluconazole for a maximum of 2 weeks. Adhesion of C albicans to buccal epithelial cells was determined by using an autologous adhesion assay prospectively over 6 months. Phospholipase production was estimated by using an agar plate method. The data analysis included a paired Student t test and calculation of correlation coefficients.


RESULTS
Unlike nystatin, treatment with fluconazole reduced the ability of C albicans to colonize the buccal mucosa for up to 8 weeks after the treatment. Patients without clinical signs of oral candidosis had significantly fewer C albicans isolates producing phospholipase than did patients with oral candidosis. Treatment with fluconazole, but not nystatin, reduced the production of phospholipase from C albicans oral isolates in patients with diabetes mellitus.


CONCLUSIONS
In addition to being antifungal, fluconazole alters phospholipase production, modifies buccal epithelial cells, and reduces adhesion of C albicans to human buccal epithelial cells for up to 8 weeks posttreatment in diabetic patients with oral candidosis.
Department of Oral Medicine, School of Dentistry, The Queen's University of Belfast, Ireland. a.willis@qub.ac.uk
A M
AM
Willis
W A
WA
Coulter
C R
CR
Fulton
J R
JR
Hayes
P M
PM
Bell
P J
PJ
Lamey
D000704:Analysis of Variance; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001422:Bacterial Adhesion / Q000187:drug effects; D002176:Candida albicans / Q000187:drug effects* / Q000201:enzymology / Q000502:physiology; D002180:Candidiasis, Oral / Q000150:complications / Q000188:drug therapy*; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D004847:Epithelial Cells / Q000187:drug effects; D005260:Female; D015725:Fluconazole / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009761:Nystatin / Q000494:pharmacology* / Q000627:therapeutic use; D010740:Phospholipases / Q000096:biosynthesis; D011446:Prospective Studies; D014774:Virulence / Q000187:drug effects
D000935:Antifungal Agents; D009761:Nystatin; D015725:Fluconazole; D010740:Phospholipases