title: Effect of Denture-Related Stomatitis Fluconazole Treatment on Oral Candida albicans Susceptibility Profile and Genotypic Variability.
abstract: Denture-related stomatitis (DRS) is the most common condition affecting removable-denture wearers, and Candida albicans the most frequent pathogenic agent. Systemic antifungal treatment is indicated but recurrences are frequent. The aim of this study was to characterize the oral load, fluconazole susceptibility profile and genotypic variability of oral C. albicans isolates from patients with DRS before (T0), immediately after fluconazole treatment (Tat) and after 6-months follow-up (T6m). Eighteen patients presenting DRS and treated with fluconazole were followed at the Faculty of Dentistry of Oporto University. Seventy C. albicans isolates were obtained and identified using standard cultural and biochemical multi-testing. Fluconazole susceptibility was tested by E-test(®). Microsatellite-primed PCR was performed to assess the genotypic variability of C. albicans isolates. The patients' mean age was 58.0±3.2 years, and 55.6%/44.4% had total/partial dentures. Before treatment, 22.2%, 44.4% and 33.3% of the patients presented DRS type I, II or III, respectively. Fluconazole treatment healed or improved DRS in 77.8% of the patients, accompanied by an 83.5% reduction in oral C. albicans load. However, after 6-months, oral C. albicans load increased significantly and DRS severity was similar to the one observed before treatment. Moreover, the prevalence of patients presenting fluconazole resistant isolates of C. albicans increased significantly throughout the study: T0-5.6%, Tat-10.0% and T6m-42.9%. A change in the genotypic variability of C. albicans isolates was also verified, being mostly associated to fluconazole susceptibility profile change. In conclusion, fluconazole presents a good short-term DRS treatment efficiency, but may be associated to a long-term emergence of C. albicans fluconazole resistance.
authors: Faculty of Dentistry, Universidade do Porto, Portugal.
authors: Maria Helena
authors: MH
authors: Figueiral
authors: Faculty of Dentistry, Universidade do Porto, Portugal.
authors: Patrícia
authors: P
authors: Fonseca
authors: Department of Microbiology, Faculty of Pharmacy, Lisbon University, Portugal.
authors: Maria Manuel
authors: MM
authors: Lopes
authors: CEQUIMED/CIIMAR, Microbiology Service, Biological Sciences Department, Faculty of Pharmacy, Universidade do Porto, Portugal.
authors: Eugénia
authors: E
authors: Pinto
authors: USF-Alcaides, Portugal.
authors: Teresa
authors: T
authors: Pereira-Leite
authors: Faculty of Dentistry, Universidade do Porto, Portugal ; INEB/I3S - Instituto de Engenharia Biomédica, Instituto de Investigação e Inovação em Saúde, Universidade do Por-to, Portugal.
authors: Benedita
authors: B
authors: Sampaio-Maia
keywords: Candida albicans; denture; denture wearers; denture-related stomatitis; fluconazole resistance; genotypic variability.