IS THERE ANY CHANGE IN THE SPECTRUM OF CANDIDIASIS DUE TO
THE RISE AND EPIDEMIOLOGICAL SHIFTS OF NON-ALBICANS
CANDIDA spp?
drg. Erni Marlina, Sp.PM*, drg. Ali Yusran, M.Kes, drg. Zohra Nazaruddin
Abstract
Background : angular cheilitis most commonly caused by secondary
infection of candida mainly candida albicans, bacteria ie s.aureus, or mixed
infection of both microorganism. Recently some reports suggest that a shift
has rise in the distribution of infection with non-albicans candida spp. Aim :
to identify candida spp in isolate obtained from angular cheilitis. Material and
method : 30 angular cheilitis patients age range 6-12 years. Lesion occur 2 –
14 days before. Angular cheilitis swab with cotton roll then put in Stuart
Transport Medium. After 48 hours incubation isolate carried to sabouroud
dextores agar and nutrient agar for next 48 hours incubation. Then isolate
carried to Manitol Salt Agar (MSA) for next incubation. If there were not any
growth,it suggested as candida spp, and if there were, it suggested as
staphylococcus. For species identification biochemical test was performed for
bacteria and microscopic examination for candida morphology. Result and
conclusion : s.aureus was isolated from 10 (33,3%), s.epidermidis 8
(26,6%), s.saproficus 5 (16,6%), streptococcus spp 3 (10%) , negative basil 3
(10%), and candida tropicalis 1 (3,3%) This interesting result show that there
was a shift in pathogens of non-albicans candida which must be considered
in therapeutic for candidiasis.
Key words : candida albians, non-albicans candida, sabouroud broth.
Background
Angular cheilitis most commonly caused by secondary infection of
candida mainly candida albicans, bacteria ie s.aureus, or mixed infection of
both microorganism. Ohman and partner, in 1986 performed clinical
microbiology research for angular cheilitis that show result 20% of
candidiasis, 20% bacteria infection and 60% mixed infection. 1 Bacteria
identified was streptococcus aureus, and Candida albicans being the most
prevalent.2
Recently some reports suggest that a shift has rise in the distribution of
infection with non-albicans candida spp.2-7 This has been rise interest
because some non candida albicans species infection is highly mortality and
resistance with antifungi.2,8 Based on our clinical therapy that use miconazole
as gold standart for angular cheilitis therapy than it is advisable to determine
the distribution and the pattern of epidemiological shift in angular cheilitis.
Therefore, we try to performed a research which purpose to examine the
distribution and to draw epidemiological shift of candida species in angular
cheilitis lesion to provide some insight into the management of this lesion.
Material and method
This study performed on 30 angular cheilitis patients age range 6-12
years. This patients selected from all individual attended to Hasanuddin
University Dental Hospital at department Oral Medicine from February to
October 2011. All this patient unremarkable health histories from anamnesis,
and clinical sign and excluded angular cheilitis because of denture wearing.
The patient were enrolled after providing informed verbal and written concent.
For microbiology
examination, the modification of Kleinegger et al
was used. Briefly angular cheilitis swab with cotton roll then put in Stuart
Transport Medium. After 48 hours incubation isolate carried to sabouroud
dextores agar and nutrient agar for next 48 hours incubation. Then isolate
carried to Manitol Salt Agar (MSA) for next incubation. If there were not any
growth,it suggested as candida spp, and if there were, it suggested as
staphylococcus. For species identification biochemical test was performed for
bacteria and microscopic examination for candida morphology.
Statistical method used manual tabulation to draw distribution and
epidemiological pattern of microorganism isolated from the lesion.
Result
Table 1 lists the frequency of microorganism include Candida species which
were isolated from 30 angular cheilitis patients. S.aureus was isolated from
10 (33,3%) samples, s.epidermidis 8 (26,6%), s.saproficus 5 (16,6%),
streptococcus spp 3 (10%) , negative basil 3 (10%), and candida tropicalis 1
(3,3%).
Discussion
Angular cheilitis most commonly caused by secondary infection of
candida. In a research by Ohman and partner reported the microorganism
found in angular cheilitis was 20% infected by candidiasis, 20% infected by
bacteria, and 60% mixed infection from both microorganism. 1 Streptococcus
aureus dominated the bacteria species, and candida albicans prevalent for
Candida infection.
The result of the present study is not accordance with the above
reports which showed that 96% angular cheilitis infected by bacteria even that
this research concordance for bacteria species isolated that is s.aureu. But it
show a shift in epidemiological pattern which only 10 sampel (33,3%)
s.aureus found.
For candidiasis, Candida albicans was the prevalent fungi infected to
human. Even some reports suggest that a shift has rise in the distribution of
infection wit non-albicans candida spp.2-7 As in report of Li et al, that
C.glabrata is increasingly implicated in human infection and should got an
attention because of the mortality rate is high.2
This research accordance with review by Capoor et al in 2005 in fungi
infected human which report C.tropicalis (48%) as the prominence Candida
spp in his research. This report only found 22,5% C.albicans which rank as a
third Candida Spp, after C. Tropicalis and C. Parapsilopsis. This report is ini
agreement with several published reports
from India and abroad. 7
In our small but prosective study, interesting result has found where
angular cheilitis isolated microorganisme predominance by bacteria Spp.
mainly s.aureus and only one Candida Spp. that is C.tropicalis which by some
report emerging as a pathogen Candida. The differences between the
presenter sult and thoe of other tudies may be due to the variation in the
clinical observations, number and age ranges of subjects, geographic
locations, the eesign studies and sampling techniques. But, it is still a very
worth result that have to considering in evidence based therapeutic, since in
our dental hospital angular cheilitis still manage by using anti-fungi.
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