CLINICAL AND MICROBIOLOGICAL PROFILE OF CANDIDA ISOLATES FROM ORAL CANDIDIASIS IN PATIENTS UNDERGOING RADIOTHERAPY FOR HEAD AND NECK MALIGNANCY.

摘要

Objective: To study the clinico-microbiological profile of oral candidiasis in Head and Neck Squamous Cancer (HNSCC) patients undergoing curative Radiotherapy (cRT). Methods: Patients undergoing cRT and developing oral candidiasis were enrolled. Clinical features such as pain, xerostomia, etc. were recorded. Candida isolates from lesions were then speciated using CHROMagar (Himedia Inc), and their antifungal-susceptibility was determined using microbroth dilution (MBD). Patients were followed up to study the clinical course of infection. Results: Of 100 patients undergoing cRT, 79 developed oral candidiasis. Median duration to development of infection was four weeks (range: 1-6.5 weeks). Mucositis was observed in 76 (96.2%) and xerostomia in 53 (67.1%) patients; 61 patients (77.2%) had symptoms attributable to candidiasis. However, there was no correlation between severity of infection and mucositis (p=0.84) or xerostomia (p=0.51). C.albicans was the most frequent (47 patients, 59.4%) isolate, followed by C.tropicalis (23 patients; 29.1%), C.glabrata (4), C.krusei (2), C.parapsilosis (2) and C.famata (1). All isolates were sensitive to Nystatin by MBD, but fluconazole resistance/dose-dependent susceptibility was noted in 26 (32.9%) isolates. Both C.krusei and two of four C.glabrata isolates exhibited fluconazole resistance. All patients received treatment for Candidiasis. On follow up, one month after cRT, oral candidiasis resolved with gradual recovery of mucositis in all patients. Conclusion: C.albicans was the commonest cause of oral Candidiasis in HNSCC cRT and all isolates were susceptible to Nystatin in-vitro. All lesions resolved with recovery from mucositis. Additionally, as no patient developed systemic candidiasis, it appears that oral candidiasis though troublesome is curable with treatment.