title: Candida glabrata is an emerging cause of oropharyngeal candidiasis in patients receiving radiation for head and neck cancer.
abstract: Oropharyngeal candidiasis (OPC) is relatively common in patients receiving radiation for head and neck cancer occurring in approximately 25% of patients. Candida albicans has been described as the primary infecting organism. Recently, other organisms, particularly Candida glabrata, have emerged as causative agents of OPC among immunocompromised patients. This study describes the characteristics of 6 patients with head and neck cancer treated with radiotherapy at our institution, who were found to have Candida glabrata-associated OPC and their responses to oral fluconazole. All 6 patients were successfully treated with oral fluconazole. However, most did not respond to the usual dose of 100 mg/day necessitating doses ranging from 200 to 800 mg/day to achieve clinical cure. All 3 patients receiving radiation only were successfully treated with up to 200 mg/day; 2 of 3 patients receiving concomitant chemoradiation required doses ranging from 400 to 800 mg/day. As with systemic infection, previous fluconazole use appears to be a risk factor for this infection, but not with all patients.
authors.affiliation: Department of General Dentistry, University of Texas Health Science Center at San Antonio, South Texas Veterans Healthcare System, TX 78229-3900, USA. redding@uthscsa.edu
authors.forename: Spencer W
authors.initials: SW
authors.lastname: Redding
authors.forename: Marta C
authors.initials: MC
authors.lastname: Dahiya
authors.forename: William R
authors.initials: WR
authors.lastname: Kirkpatrick
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Coco
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Patterson
authors.forename: Annette W
authors.initials: AW
authors.lastname: Fothergill
authors.forename: Michael G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D041221:Candida glabrata / Q000254:growth & development*; D002180:Candidiasis, Oral / Q000382:microbiology*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D025141:Drug Resistance, Fungal; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy*; D009894:Opportunistic Infections / Q000382:microbiology*; D009960:Oropharynx / Q000382:microbiology*; D010608:Pharyngeal Diseases / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole