title: Candida albicans Carriage in Children with Severe Early Childhood Caries (S-ECC) and Maternal Relatedness.
abstract: BACKGROUND
  Candida albicans has been detected together with Streptococcus mutans in high numbers in plaque-biofilm from children with early childhood caries (ECC). The goal of this study was to examine the C. albicans carriage in children with severe early childhood caries (S-ECC) and the maternal relatedness.
  
  
  METHODS
  Subjects in this pilot cross-sectional study were recruited based on a convenient sample. DMFT(S)/dmft(s) caries and plaque scores were assessed during a comprehensive oral exam. Social-demographic and related background information was collected through a questionnaire. Saliva and plaque sample from all children and mother subjects were collected. C. albicans were isolated by BBL™ CHROMagar™ and also identified using germ tube test. S. mutans was isolated using Mitis Salivarius with Bacitracin selective medium and identified by colony morphology. Genetic relatedness was examined using restriction endonuclease analysis of the C. albicans genome using BssHII (REAG-B). Multilocus sequence typing was used to examine the clustering information of isolated C. albicans. Spot assay was performed to examine the C. albicans Caspofungin susceptibility between S-ECC children and their mothers. All statistical analyses (power analysis for sample size, Spearman's correlation coefficient and multiple regression analyses) were implemented with SAS 9.4.
  
  
  RESULTS
  A total of 18 S-ECC child-mother pairs and 17 caries free child-mother pairs were enrolled in the study. Results indicated high C. albicans carriage rate in the oral cavity (saliva and plaque) of both S-ECC children and their mothers (>80%). Spearman's correlation coefficient also indicated a significant correlation between salivary and plaque C. albicans and S. mutans carriage (p<0.01) and caries severity (p<0.05). The levels of C. albicans in the prepared saliva and plaque sample (1ml resuspension) of S-ECC children were 1.3 ± 4.5 x104 cfu/ml and 1.2 ± 3.5 x104 cfu/ml (~3-log higher vs. caries-free children). Among 18 child-mother pairs, >60% of them demonstrated identical C. albicans REAG-B pattern. C. albicans isolated from >65% of child-mother pairs demonstrated similar susceptibility to caspofungin in spot assay, while no caspofungin resistant strains were seen when compared with C. albicans wild-type strain SC5314. Interestingly, the regression analysis showed that factors such as antibiotic usage, birth weight, inhaler use, brushing frequency, and daycare attendance had no significant effect on the oral carriage of C. albicans in the S-ECC children.
  
  
  CONCLUSIONS
  Our results reveal that both the child with S-ECC and the mother were highly infected with C. albicans, while most of the strains were genetically related, suggesting that the mother might be a source for C. albicans acquisition in the oral cavity of children affected by the disease.
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Jin
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Yonghwi
authors.initials: Y
authors.lastname: Moon
authors.affiliation: Department of Dentistry, North Sichuan Medical University, Sichuan, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Biochemistry and Biophysics, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Elena
authors.initials: E
authors.lastname: Rustchenko
authors.affiliation: Department of Biochemistry and Biophysics, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Hironao
authors.initials: H
authors.lastname: Wakabayashi
authors.affiliation: School of Dentistry, Peking University, Beijing, China.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Changyong
authors.initials: C
authors.lastname: Feng
authors.affiliation: Genomics Research Center, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Gill
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Sean
authors.initials: S
authors.lastname: McLaren
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Hans
authors.initials: H
authors.lastname: Malmstrom
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Yanfang
authors.initials: Y
authors.lastname: Ren
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Quivey
authors.affiliation: Department of Orthodontics and Pediatric Dentistry & Community Oral Health Divisions, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
authors.forename: Hyun
authors.initials: H
authors.lastname: Koo
authors.affiliation: Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Dorota T
authors.initials: DT
authors.lastname: Kopycka-Kedzierawski
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology; D002176:Candida albicans / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003710:Demography; D003731:Dental Caries / Q000175:diagnosis* / Q000382:microbiology; D003773:Dental Plaque / Q000382:microbiology; D005260:Female; D056426:Genetic Loci; D006801:Humans; D007223:Infant; D008297:Male; D058885:Multilocus Sequence Typing; D012463:Saliva / Q000382:microbiology; D013295:Streptococcus mutans / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents