title: The Oral Carriage of Candida in Oral Cancer Patients of Indian Origin Undergoing Radiotherapy and/or Chemotherapy.
abstract: BACKGROUND
  Oral cancer is a challenging disease in Indian subcontinent because of increased use of tobacco and associated products. Although surgery is the main treatment modality, radiotherapy (RT) and chemotherapy (CT) are employed in inaccessible cases. Both RT & CT will result in painful and debilitating adverse effects in oral cavity e.g., mucositis, ulceration, dysgeusia, xerostomia and opportunistic infections. One of the most common opportunistic infection is caused by fungus Candida.
  
  
  OBJECTIVE
  Our aim was to investigate the incidence of oral colonization of Candida species with differentiation between carrier and infective state of the organism. We also investigate the effect of treatment modality (RT and CT) on the incidence of Candida, in oral cancer patients, undergoing RT and/or CT, in order to prevent and treat the Candida infection in a better way.
  
  
  METHODS
  It was a cross-sectional case-control study; done in Gujarat, India. Fifty patients of oral cancer undergoing RT, CT alone or combined were investigated and compared with the healthy controls. The samples were collected from mid-dorsum of tongue by using imprint culture technique. The samples were inoculated on Sabouraud's dextrose agar medium and the organisms were identified by wet mount, germ tube test, chlamydospore formation and sugar fermentation tests.
  
  
  RESULTS
  There was significant increase in oral Candida colonization from 20% in healthy controls to 70% in oral cancer patients undergoing RT and/or CT (p = 0.001, < 0.05). A significant increase in infective state of Candida (71.4%) was noted (p = 0.001, < 0.05) with predominance of non-albicans species of Candida, chiefly C. tropicalis (42.8%).
  
  
  CONCLUSIONS
  RT and CT leads to increased oral colonization and infection by Candida with a shift towards growth of non-albicans species. As the pattern of candidal species infection is changing, such studies are important for better diagnosis and treatment planning to gain good control over the disease.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Pathology, NIMS Dental College , Jaipur, India .
authors.forename: Manish
authors.initials: M
authors.lastname: Jain
authors.affiliation: Professor and Ex HOD, Department of Oral and Maxillofacial Pathology, Government Dental College and Hospital , Ahmadabad, India .
authors.forename: Raksha
authors.initials: R
authors.lastname: Shah
authors.affiliation: Senior Lecturer, Department of Oral and Maxillofacial Pathology, NIMS Dental College , Jaipur, India .
authors.forename: Betina
authors.initials: B
authors.lastname: Chandolia
authors.affiliation: Senior Lecturer, Department of Orthodontics, NIMS Dental College , Jaipur, India .
authors.forename: Ayush
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Senior Lecturer, Department of Pedodontics, NIMS Dental College , Jaipur, India .
authors.forename: Yashwant
authors.initials: Y
authors.lastname: Chauhan
authors.affiliation: Professor and HOD, Department of Oral and Maxillofacial Pathology, Government Dental College and Hospital , Ahmadabad, India .
authors.forename: Jyoti
authors.initials: J
authors.lastname: Chawda
authors.affiliation: Professor and Ex HOD, Department of Oral and Maxillofacial Pathology, NIMS Dental College , Jaipur, India .
authors.forename: Siddarth
authors.initials: S
authors.lastname: Mosby
authors.affiliation: Professor and Ex HOD, Department of Oral and Maxillofacial Pathology, NIMS Dental College , Jaipur, India .
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhagalia
keywords: Adverse effects of radiotherapy and Chemotherapy; Candida albicans; Opportunistic pathogen; Oral candidiasis