title: Candida infection in oral leukoplakia: an unperceived public health problem.
abstract: OBJECTIVE
  The study aimed to determine the proportion, known risk factors and etiology for Candida infection in leukoplakia lesions among patients with oral leukoplakia attending the Oral and Maxillofacial Clinic at a Tertiary Care Hospital in Sri Lanka.
  
  
  METHODS
  Eighty clinically suspected oral leukoplakia patients were included. Two oral swabs each, from leukoplakia patients: one swab from the lesion and the other one from the contralateral unaffected corresponding area (as a control) were collected. Direct microscopy and culture followed by colony count and phenotypic identification were performed to identify pathogenic Candida species.
  
  
  RESULTS
  Candida infection was seen in 47% of patients with oral leukoplakia. Candida albicans (94.7%) was the most common Candida species followed by Candida tropicalis (5.3%). Majority of Candida-infected lesions were seen in the buccal mucosa region. Alteration of taste (p = 0.021), having other oral lesions (p = 0.008), angular cheilitis (p = 0.024) and periodontitis (p = 0.041) showed a significant association with Candida-associated leukoplakia. Increasing age showed a significant tendency for Candida infection (p = 0.020). Smoking (p = 0.026) and betel-quid chewing (p = 0.006) were also found to be significantly associated, although alcohol consumption alone did not show a significant association. Oral leukoplakia patients who had all three habits: alcohol consumption, smoking and betel-quid chewing had a significant association with Candida infection (p = 0.004).
  
  
  CONCLUSIONS
  Patients who had a combination of risk factors: smoking, betel-quid chewing and alcohol consumption were seen to have a significant association with Candida infection. Further betel-quid chewing alone and smoking singly was also significantly associated with Candida infection in oral leukoplakia.
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Ayomi
authors.initials: A
authors.lastname: Dilhari
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Manjula M
authors.initials: MM
authors.lastname: Weerasekera
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Anusha
authors.initials: A
authors.lastname: Siriwardhana
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Oshanthi
authors.initials: O
authors.lastname: Maheshika
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Chinthika
authors.initials: C
authors.lastname: Gunasekara
authors.affiliation: b Oral and Maxillofacial Unit , Colombo South Teaching Hospital , Kalubowila , Dehiwala , Sri Lanka.
authors.forename: Sunil
authors.initials: S
authors.lastname: Karunathilaka
authors.affiliation: c Department of Microbiology, Faculty of Medicine , University of Ruhuna , Galle , Sri Lanka.
authors.forename: Ajith
authors.initials: A
authors.lastname: Nagahawatte
authors.affiliation: a Department of Microbiology, Faculty of Medical Sciences , University of Sri Jayewardenepura, Gangodawila , Nugegoda , Sri Lanka.
authors.forename: Neluka
authors.initials: N
authors.lastname: Fernando
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D001114:Areca; D002175:Candida / Q000145:classification; D002176:Candida albicans / Q000302:isolation & purification; D041022:Candida tropicalis / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000150:complications*; D002613:Cheilitis / Q000382:microbiology; D015169:Colony Count, Microbial; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007972:Leukoplakia, Oral / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000382:microbiology; D009172:Mycology / Q000379:methods; D010518:Periodontitis / Q000382:microbiology; D010641:Phenotype; D011634:Public Health; D012307:Risk Factors; D012907:Smoking; D013651:Taste Disorders / Q000382:microbiology
keywords: Candida; Sri Lanka; oral leukoplakia; risk factors