title: Posterior pharyngeal candidiasis in the absence of clinically overt oral involvement: a cross-sectional study.
abstract: OBJECTIVE
  Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy.
  
  
  METHODS
  We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy.
  
  
  RESULTS
  Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage.
  
  
  CONCLUSIONS
  This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.
authors.affiliation: Department of Respiratory Medicine, Galway University Hospital, National University of Ireland Galway, Galway, Ireland, siobhan.glavey@nuigalway.ie.
authors.forename: Siobhan V
authors.initials: SV
authors.lastname: Glavey
authors.forename: Niamh
authors.initials: N
authors.lastname: Keane
authors.forename: Maria
authors.initials: M
authors.lastname: Power
authors.forename: Anthony W
authors.initials: AW
authors.lastname: O'Regan
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000730:Androstadienes / Q000009:adverse effects; D001999:Bronchoscopy; D002177:Candidiasis / Q000139:chemically induced / Q000382:microbiology* / Q000473:pathology; D002180:Candidiasis, Oral / Q000139:chemically induced / Q000382:microbiology* / Q000473:pathology; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D055154:Dysphonia / Q000139:chemically induced; D005260:Female; D000068298:Fluticasone; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010608:Pharyngeal Diseases / Q000139:chemically induced / Q000382:microbiology* / Q000473:pathology; D010614:Pharynx / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D000068298:Fluticasone
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