Original article/Article original
Prevalence of Candida species in the buccal cavity of diabetic and non-diabetic individuals in and around PondicherryPrévalence des espèces de Candida dans la cavité buccale des sujets diabétiques et des sujets non diabétiques aux alentours et à Pondichéry

https://doi.org/10.1016/j.mycmed.2016.08.002Get rights and content

Summary

Objectives

The aim of the present study was to determine the prevalence of Candida in the buccal cavity of diabetic and non-diabetic individuals in and around Pondicherry, India and to analyse the antifungal susceptibility profile of the selected isolates.

Materials and methods

A total of 400 buccal samples, 200 each from diabetic and non-diabetic healthy individuals were included in the study. Sabouraud's dextrose agar was used for isolation of Candida species. Identification was performed through microscopy, germ tube test, sugar fermentation test, sugar assimilation test and by using Hichrome agar. Distinct and phenotypically representative colonies were selected and subjected to ITS analysis. In vitro antifungal susceptibility testing for the isolated Candida species was performed using E-test.

Results

Results revealed that the prevalence of Candida species in diabetic individuals was higher when compared with non-diabetic healthy individuals. The most predominantly isolated species in diabetic and non-diabetic individuals from buccal cavity was Candida albicans. Ctropicalis was predominant among the non-albicans Candida isolated from both diabetic and non-diabetic individuals. Among denture wearers Cglabrata was predominant. In vitro antifungal susceptibility testing shows that ketoconazole, fluconazole and itraconazole were effective against the isolated Candida species.

Conclusions

The rate of candidal carriage in diabetic individuals is higher. Different species of Candida are present in the oral cavity of diabetic individuals. There may be a positive correlation between glycemic control and candidal colonization. In vitro antifungal susceptibility testing of Candia species are required for proper management and treatment of candidal infections.

Résumé

Objectifs

L’objectif de la présente étude consiste à déterminer la prévalence de Candida dans la cavité buccale des personnes diabétiques et des personnes non diabétiques habitant à Pondichéry et aux alentours de Pondichéry en Inde et à analyser le profil de sensibilité antifongique des isolats sélectionnés.

Matériels et méthodes

Au total, 400 échantillons buccaux, 200 d’individus diabétiques et 200 d’individus non diabétiques ont été analysés. La gélose dextrose de Sabouraud a été utilisée pour isoler les espèces de Candida. L’identification a été réalisée par microscopie, par le test du tube germinatif, par le test de la fermentation des sucres, par le test de l’assimilation du sucre et en utilisant la gélose Hichrome. Des colonies distinctes et des colonies phénotypiquement représentatives ont été sélectionnées et soumises à l’analyse ITS. Analyse de sensibilité antifongique in vitro pour les espèces de Candida isolées a été réalisée en utilisant E-test.

Résultats

Les résultats ont révélé que la prévalence des espèces de Candida chez les personnes diabétiques était plus élevée par rapport aux sujets sains et non diabétiques. Les espèces les plus isolées principalement dans la cavité buccale chez les personnes diabétiques et des personnes non diabétiques étaient Candida albicans. Les espèces de Ctropicalis étaient prédominantes chez les espèces non-albicans isolées chez les individus diabétiques et les individus non diabétiques. Parmi les porteurs de prothèses dentaires, l’espèce Cglabrata était prédominante. Le test de sensibilité antifongique in vitro montre que le kétoconazole, le fluconazole et l’itraconazole étaient efficaces contre les espèces de Candida isolées.

Conclusion

Le taux de portage de Candida chez les personnes diabétiques est plus élevé. Différentes espèces de Candida sont présentes dans la cavité buccale des sujets diabétiques. Il peut y avoir une corrélation positive entre le contrôle glycémique et la colonisation par Candida. Les tests de sensibilité antifongique des espèces de Candida sont nécessaires pour la gestion et le traitement approprié des infections à Candida.

Introduction

Diabetes mellitus is a multisystemic disorder characterized by high blood sugar levels for a prolonged period. This is due to deficiency of insulin secretion or action. Researchers have reported that in the 21st century, diabetes mellitus is one of the largest emerging threats to health [1]. Although, there is an increase in the diabetes mellitus population in India, there are no clear-cut published studies to evaluate the oral fungal infection, which are prevalent in these diabetic individuals [22]. During the last 10 years, there is an increase in candidal infection and also changes have been noted in the species causing candidiasis [24]. In human beings, Candida albicans is one of the normal micro flora which is isolated from the oral cavity. The colonization of Candida species occurs on the mucosal surface immediately after birth and the risk of endogenous infection is persistent throughout the life of an individual [12]. Manifestations of oral candidiasis may occur in individuals infected with the HIV, with nutritional deficiencies, malignancies or with metabolic disorders, like diabetics mellitus [39]. Isolation of Candida species from the oral cavity of diabetes mellitus individual was frequent but the importance of Candida is a controversy [7]. In diabetes mellitus patients, the frequency of occurrence of these organisms varies from 18 to 80% [37]. The presence of dentures exerts a greater effect on the species of Candida isolated from the buccal cavity than the diabetic status [9], [17]. The differences in the Candida recovery are due to the methods followed in the laboratory, the number of subjects, the characteristics of the subjects, and also the techniques used in sampling [4], [13], [17]. The purpose of this study was to define the prevalence of Candida in the buccal cavity of type II diabetes mellitus individuals and healthy individuals, attending a diabetic clinic in Pondicherry. The in vitro antifungal susceptibility pattern of the isolated Candia species was also determined using the E-test method [3], [28].

Section snippets

Collection of buccal samples

The present study was approved by the Institutional Ethics Committee of Madras Diabetes Research Foundation. A part of the study was carried out at Dr. Mohan's Diabetes and Endocrine Specialties, Pondicherry.

Buccal swabs [20], [21] were obtained from 400 subjects of both sexes (200 diabetic individuals and 200 non-diabetic individuals). The diabetic group comprised 200 randomly chosen outpatients, 99 females and 101 males with the age group between 25 to 65 years, attending a diabetic clinic and

Results

A total of 400 buccal swabs were collected, of which 200 each was collected from diabetic and non-diabetic healthy individuals. The diabetic and non-diabetic healthy control groups in terms of age, sex, dental status and smoking habits are shown (Table 1). Out of the 200 samples screened from diabetic individuals and non-diabetic individuals, 64 and 17 samples were positive for Candida species, respectively.

Identification was based on the colony morphology on Sabouraud's dextrose agar as fast

Discussion

The comparison and correlation of candidal colonization in the buccal cavity of diabetic and non-diabetic individuals have been a subject of research in several parts of the world. The isolation of Candida on Sabouraud's dextrose agar medium may indicate infection and identification of the isolate is necessary. The colonies grown on the isolation plates show remarkable variation infringes characteristics and surface texture. Brown–Thomsen first observed such a colony variation and this was

Conclusion

Diabetic patients had higher candidal harbouring rates, when compared to healthy individuals. There may a positive correlation between glycemic control and candidal colonization. Improving blood glucose control may reduce the risk of candidal infection among diabetic individuals. Antifungal susceptibility testing must be done before treatment to candidosis caused by any species of Candida. This study shows that ketoconazole was the most effective followed by fluconazole, itraconazole, and

Disclosure of interest

The authors declare that they have no competing interest.

Acknowledgements

I am really thankful to Dr. Mohans Diabetes and Endocrine Specialities, Pondicherry for allowing me to collect samples. A whole hearted thanks to Dr. Vijay Baskar Reddy, for helping me during the process of sample collection. I would also like to thank Dr. V. S. Saravanan, Assistant Professor, who had helped me during my work.

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