title: Oral candidal speciation, virulence and antifungal susceptibility in type 2 diabetes mellitus.
abstract: OBJECTIVE
  To determine the oral candidal carriage (OCC), activity of virulent factors and fluconazole susceptibility in subjects with type 2 diabetes mellitus (T2DM) and investigate their association with HbA1c measurements.
  
  
  METHODS
  A cross sectional study was conducted on 100 diabetics and 100 healthy volunteers. The virulence was assessed by measuring the phospholipase activity and proteolysis index. Fluconazole susceptibility was performed using the gradient diffusion method. The OCC, virulence factors and antifungal susceptibility were correlated with patients' HbA1c measurements.
  
  
  RESULTS
  The OCC and candidal density carriage was significantly higher in diabetics. Candida albicans (C. albicans) was the most frequently isolated species followed by Candida tropicalis (C. tropicalis). Relatively uncommon species, Candida lusitaniae (C. lusitaniae) and Candida lipolytica (C. lipolytica) were isolated from the diabetics. Prevalence of virulence factor, proteinase, was greater in diabetic group (p<0.05). Reduced fluconazole susceptibility was noted among the isolates from diabetics; however it was not statistically significant (p=0.593). Except one, all the susceptible-dose dependent and resistant isolates were Candida no-albicans (C. non-albicans).
  
  
  CONCLUSIONS
  C. albicans remains the predominant pathogen in diabetics, although other species are on the rise. Compared to control group, the isolated species from T2DM group had higher proteinase activity. Resistance to fluconazole was considerably greater among the C. non-albicans isolates from T2DM group. These findings warrant effective treatment modalities to reduce the occurrence of oropharyngeal candidiasis.
authors.affiliation: Department of Oral Pathology and Microbiology, MCODS, Manipal, Manipal University, Karnataka, India.
authors.forename: Pratik N
authors.initials: PN
authors.lastname: Patel
authors.affiliation: Department of Oral Pathology and Microbiology, MCODS, Manipal, Manipal University, Karnataka, India.
authors.forename: Parul
authors.initials: P
authors.lastname: Sah
authors.affiliation: Department of Oral Pathology and Microbiology, MCODS, Manipal, Manipal University, Karnataka, India.
authors.forename: Chetana
authors.initials: C
authors.lastname: Chandrashekar
authors.affiliation: Department of Medicine, KMC, Manipal, Manipal University, Karnataka, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Vidyasagar
authors.affiliation: Department of Pharmaceutical Biotechnology and Microbiology, MCOPS, Manipal, Manipal University, Karnataka, India.
authors.forename: J
authors.initials: J
authors.lastname: Venkata Rao
authors.affiliation: Department of Pharmaceutical Biotechnology and Microbiology, MCOPS, Manipal, Manipal University, Karnataka, India.
authors.forename: Mradul
authors.initials: M
authors.lastname: Tiwari
authors.affiliation: Department of Oral Pathology and Microbiology, MCODS, Manipal, Manipal University, Karnataka, India. Electronic address: raghu.radhakrishnan@gmail.com.
authors.forename: Raghu
authors.initials: R
authors.lastname: Radhakrishnan
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy* / Q000473:pathology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D014774:Virulence
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: Candida; Fluconazole susceptibility; Oral candidal carriage; Type 2 diabetes mellitus (T2DM); Virulence