title: Spectrum of fungal infection in head and neck cancer patients on chemoradiotherapy.
abstract: BACKGROUND
  Radiotherapy for head and neck cancers (HNC) causes alteration of oral mucosal barrier predisposing it to colonization and infection. Such infections often result in pain and burning sensation thus contributing to major morbidity.
  
  
  OBJECTIVE
  MATERIALS AND METHODS: Study was done on 50 patients of HNC treated with concurrent chemoradiotherapy. Three samples (throat, urine, blood) were collected for fungal culture and sensitivity. These samples were collected before the start of radiotherapy, during radiotherapy (2nd and 6th week) and post radiotherapy (10th week).
  
  
  RESULTS
  Only 49 patients were available for analysis. Fungal infection was found in 27/49 patients (55.10%) out of which Non-albicans Candida was isolated in 18/49 (36.73%) and Candida albicans in 9/49 (18.36%) cases. About 66.66% (18/27) isolates were sensitive to fluconazole. Maximum isolation of yeast was during 6th week of radiotherapy. All grade 4 and 71.42% of grade 3 oral mucositis were found in patients who were positive for fungal infection.
  
  
  CONCLUSIONS
  The spectrum of fungal species in throat swab was: Non-albicans Candida and Candida albicans observed in 36.73% and 18.36% of patients respectively. Higher rate of fungal colonization and infection was found in patients with grade 3/4 oral mucositis. Prophylactic fluconazole in HNC patients on concurrent chemoradiotherapy has the potential to reduce emerging invasive fungal infection and its associated morbidity.
authors.affiliation: Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India. Electronic address: gunjeshsingh00764@gmail.com.
authors.forename: Gunjesh Kumar
authors.initials: GK
authors.lastname: Singh
authors.affiliation: Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi 110029, India. Electronic address: rajeevmalini@rediffmail.com.
authors.forename: Malini R
authors.initials: MR
authors.lastname: Capoor
authors.affiliation: Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi 110029, India. Electronic address: deepthinair2@gmail.com.
authors.forename: Deepthi
authors.initials: D
authors.lastname: Nair
authors.affiliation: Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India. Electronic address: bhowkt@gmail.com.
authors.forename: K T
authors.initials: KT
authors.lastname: Bhowmik
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects*; D025141:Drug Resistance, Fungal; D005260:Female; D005658:Fungi / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D013280:Stomatitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Chemoradiotherapy; Fungal infection; Head and neck malignancies