title: High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer.
abstract: Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non-C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.
authors.affiliation: Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK. j.bagg@dental.gla.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Bagg
authors.forename: M P
authors.initials: MP
authors.lastname: Sweeney
authors.forename: M A O
authors.initials: MA
authors.lastname: Lewis
authors.forename: M S
authors.initials: MS
authors.lastname: Jackson
authors.forename: D
authors.initials: D
authors.lastname: Coleman
authors.forename: Mosaid A
authors.initials: MA
authors.lastname: Al
authors.forename: W
authors.initials: W
authors.lastname: Baxter
authors.forename: S
authors.initials: S
authors.lastname: McEndrick
authors.forename: S
authors.initials: S
authors.lastname: McHugh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009059:Mouth Diseases / Q000188:drug therapy* / Q000382:microbiology; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D009369:Neoplasms / Q000150:complications / Q000382:microbiology*; D009894:Opportunistic Infections / Q000150:complications / Q000382:microbiology*; D010166:Palliative Care; D015003:Yeasts / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole