Candidal colonization, strain diversity, and antifungal susceptibility among adult diabetic patients.
OBJECTIVE
Candidal colonization in diabetics is a matter of debate. The aim of this study is to investigate oral candidal colonization, strain diversity, antifungal susceptibility, and the influence of local and systemic host factors on candidal colonization in adult diabetics.


METHODS
We conducted a case-control study that compared 150 diabetics (49 type 1, 101 type 2) with 50 healthy controls. Two salivary samples were collected, using the oral rinse sampling method: one for salivary flow rate and pH determination, and the other for candidal colonization assessment. The candidal isolates were identified and tested in vitro for antifungal susceptibility using the commercial kit, Candifast. The relationship between specific host factors and candidal colonization was also investigated.


RESULTS
Diabetics had a higher candidal carriage rate compared to controls, but not density. Candida albicans was the most frequently isolated species, but diabetics had a variety of other candidal species present. None of the control samples were resistant to any tested antifungal, while the diabetic samples had differing resistances to azole antifungals. Although there was a significant positive correlation between glycemic control and candidal colonization in type 2 diabetics, there was a negative correlation between salivary pH and candidal carriage in the controls versus density in type 2 diabetics.


CONCLUSIONS
Diabetic patients not only had a higher candidal carriage rate, but also a variety of candidal species that were resistant to azole antifungals. Oral candidal colonization was significantly associated with glycemic control, type of diabetes, and salivary pH.
Al-Attas
Safia A
SA
Department of Oral Basic and Clinical Sciences, King Abdul Aziz University Faculty of Dentistry, Jeddah, Saudi Arabia. safia_attas@hotmail.com
Amro
Soliman O
SO
D000328:Adult; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000254:growth & development; D002180:Candidiasis, Oral / Q000188:drug therapy / Q000382:microbiology*; D002353:Carrier State / Q000188:drug therapy / Q000382:microbiology*; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000382:microbiology; D004198:Disease Susceptibility; D005260:Female; D006442:Glycated Hemoglobin; D038321:Glycemic Index; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry / Q000382:microbiology; D012529:Saudi Arabia; D013223:Statistics as Topic; D011795:Surveys and Questionnaires
D000935:Antifungal Agents; D006442:Glycated Hemoglobin