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 Table of Contents  
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 293-295

Estimating the frequency of candida in oral squamous cell carcinoma patients

Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Date of Submission04-Mar-2019
Date of Decision22-Aug-2019
Date of Acceptance18-Sep-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Radhika Gadge
20, Jeevan Chhaya Layout Deendayal Nagar, Nagpur - 440 022, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_49_19

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Background : Oral squamous cell carcinoma (OSCC) is one of the most common cancers affecting the oral cavity. Worldwide, the occurrence of OSCC is estimated to be 26,000 cases annually. Material and Method: It consists of a variety of normal human flora but in an elevated form. In this study, the association between OSCC and Candida was investigated. Twenty samples from patients suffering from OSCC and 20 healthy samples were taken. Results: Both the samples were tested for the presence of Candida. Sabouraud's Dextrose Agar plates were used for a culture which was then incubated to detect the growth of Candida. Colony identification was done using Gram stain. When the growth of Candida on both the groups of samples was compared, the frequency of Candida was found to be significantly higher in patients with OSCC than the healthy individuals. Conclusion: Our results authenticated with the other studies related to OSCC and yeast carriage. More amount of yeast carriage was associated with OSCC patients.

Keywords: Candida, candidiasis, neoplasms of oral cavity, oral squamous cell carcinoma

How to cite this article:
Gadge R, Jidewar N, Hande A. Estimating the frequency of candida in oral squamous cell carcinoma patients. J Datta Meghe Inst Med Sci Univ 2019;14:293-5

How to cite this URL:
Gadge R, Jidewar N, Hande A. Estimating the frequency of candida in oral squamous cell carcinoma patients. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2021 Jul 28];14:293-5. Available from: http://www.journaldmims.com/text.asp?2019/14/4/293/289860

  Introduction Top

Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm affecting the oral cavity. Its incidence in India is about 45%, although its percentage varies in different parts of the world. It constitutes about 80%–90% of all the malignancies.[1] OSCC mostly affects the elderly but it can be found in young adults too. Various etiological factors are responsible for OSCC; the most common being the tobacco in its various forms. Other predisposing factors include excess alcohol, genetic disturbances, diet with low levels of vitamins and minerals, high exposure to ultraviolet radiation, and patients with Human Papilloma Virus (HPV) infections. Patients with immunocompromised states such as renal homograft patients or HIV patients are found to have a higher risk of developing cancer.[2] Trauma and dental irritation are not found significant but along with the other factors such as infections, they can act as aggravating factors for OSCC. Commonly affected sites are buccal mucosa, alveolar mucosa, tongue, floor of the mouth, and lips.[2] Initially, it is a painless mass but may become painful later. Bleeding on touch may also be found in advanced stages.

Candida is a fungal species that is a part of normal human flora. It is found in varying quantities in the skin, genital, respiratory, and the gastrointestinal tracts, however, a larger quantity of this species is found in the mucous membranes.[2] It is an opportunistic pathogen that is capable of producing infections in the immunocompromised hosts. Overgrowth of Candida can cause infections at these sites which is known as candidiasis. Candida species have been attributed to various epithelial malignancies. Several studies have reported about the chronic mucocutaneous lesions undergoing malignant transformation. This is because Candida has the ability to produce carcinogens by metabolizing the procarcinogens.[3] This study is aimed to clinically evaluate the relationship of Candida species with OSCC.

  Materials and Methods Top

Sources of data

Twenty samples from patients with OSCC and 20 random samples from healthy individuals were collected. The patients were selected from the outpatient department of oral medicine and radiology. They were well informed about the procedure in the local language, and verbal consent was obtained before starting the procedure. Data such as name, age, sex, and the current status of treatment were recorded. Ethical approval was obtained from the Institutional Committee of Datta Meghe Institute of Medical Sciences.

Method of collection

Only the preoperative patients or the patients undergoing chemotherapy were included in the study. Patients were asked to open the mouth wide enough to expose the lesion. Samples were collected under aseptic conditions to avoid false-positive results. Swab stick was used to collect the salivary samples. It was rolled in the area surrounding the lesion with gentle pressure until it was completely wet by saliva. Only unstimulated saliva was collected. Samples collected from healthy individuals were referred to as “control.” Procedure for collection was similar to that mentioned above, only difference being that the sample was collected from the areas rich in unstimulated saliva [Chart 1] and [Chart 2].

Method of culture

Sabouraud's Dextrose Agar is a growth medium containing peptones. It is used to cultivate dermatophytes, fungi, and filamentous bacteria like Nocardia. The collected salivary sample was immediately inoculated on the agar plate containing Sabouraud's Dextrose Agar. The inoculated plate was then incubated in an incubator for 5–7 days. Plate, if showing positive culture was then subjected to Gram staining to confirm the growth. The stained slide was observed under the microscope using × 100 magnification. Colony identification was done based on the microscopic morphology of Candida. Same procedure was repeated for each sample.

Inclusion criteria

I. For OSCC samples:

  • Preoperative patients
  • Patients undergoing chemotherapy.

  • II. For control samples:

  • Patients without the presence of any immunocompromised states.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of JNMC, Sawangi (Meghe), Wardha, on 22nd April 2019. With ethical clearance no DMIMS(DU)/IEC/2019-20/344.

  Results Top

Twenty samples from OSCC patients and 20 healthy samples were taken. Each sample was cultured on the agar plates for the detection of Candida species. Candida was detected in 14 out of the 20 samples of OSCC patients. This indicated that the frequency of Candida was about 70% in the OSCC samples. In contrast to this, among the 20 healthy samples, only five detected the presence of Candida. Here, the prevalence of Candida was only 25%. When the two samples were compared, samples from OSCC patients showed a significantly higher frequency of Candida than the healthy controls. The presence of Candida has a significant association with OSCC which can further deteriorate the oral health. This suggests an increased risk of infection among the OSCC patients. Moreover, this showed that the presence of Candida can influence the pathogenesis of the disease [Table 1].
Table 1: Frequency of Candida detected in both the samples when cultured on Sabouraud's Dextrose Agar

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  Discussion Top

OSCC is the most common epithelial neoplasm of oral cavity. Lesions of OSCC are painless but may become painful if associated with infection or in advanced stages. Variety of organisms is found associated with the lesions of OSCC. These organisms are the normal inhabitants of the oral cavity but their elevated forms are harmful for oral as well as systemic health. Candida is one such organism.

Candida is an opportunistic pathogen that is capable of producing genital, oral, and cutaneous lesions in immunocompromised hosts. About 30%–50% of the skin and mucosa are inhabited by Candida.[4] Hence, lesions of candidiasis are predominantly found on the mucous membranes and the skin. Candida has the ability to produce inflammation depending on the local oral environment and the host defense mechanisms by transforming from a commensal to a harmful organism. There is also an evidence of this species having a role in carcinogenesis. Candida has special attributes that can produce carcinogens such as nitrosamines which cause mutations in the DNA and thus initiate oral cancer development. In addition, it also has the ability to metabolize the procarcinogens, converting them into carcinogens.[4] Several studies have reported the association of Candida with leukoplakias and various epithelial malignancies.[3] This is because of the immunocompromised states of the patients that favor the growth of Candida.

In this study, when the salivary samples were cultured on Sabouraud's Dextrose Agar, the growth of Candida was seen as smooth, white, and mucoid colonies. Gram staining was performed to confirm the results obtained on culture. The colonies showed the presence of Gram-positive budding yeast cells. Of the 20 samples of OSCC patients, 14 showed the presence of the growth of Candida. While only five out of 20 healthy samples detected the growth of Candida. This showed that the frequency of Candida in healthy samples was 25% which had significantly increased to 70%. This suggests that though OSCC is a multifactorial disease, Candida may play a role in the etiopathogenesis of the disease, as the neoplastic conditions representing immunosuppressive states promote the growth of Candida, which further deteriorates the oral and systemic health.[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]

  Conclusion Top

In conclusion, our study suggests that Candida can play a vital role in the etiopathogenesis of the disease.

Higher prevalence of Candida in OSCC patients plays a significant role in the prognosis of OSCC.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Neville BW, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin 2002;52:195-215.  Back to cited text no. 1
Sanjaya PR, Gokul S, Gururaj Patil B, Raju R. Candida in oral pre-cancer and oral cancer. Med Hypotheses 2011;77:1125-8.  Back to cited text no. 2
Berkovits C, Tóth A, Szenzenstein J, Deák T, Urbán E, Gácser A, et al. Analysis of oral yeast microflora in patients with oral squamous cell carcinoma. Springerplus 2016;5:1257.  Back to cited text no. 3
Mohd Bakri M, Mohd Hussaini H, Rachel Holmes A, David Cannon R, Mary Rich A. Revisiting the association between candidal infection and carcinoma, particularly oral squamous cell carcinoma. J Oral Microbiol 2010;2. doi: 10.3402/jom.v2i0.5780.  Back to cited text no. 4
Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer 2006;118:3030-44.  Back to cited text no. 5
de Martel C, Franceschi S. Infections and cancer: Established associations and new hypotheses. Crit Rev Oncol Hematol 2009;70:183-94.  Back to cited text no. 6
Nagy KN, Sonkodi I, Szöke I, Nagy E, Newman HN. The microflora associated with human oral carcinomas. Oral Oncol 1998;34:304-8.  Back to cited text no. 7
Cannon RD, Chaffin WL. Oral colonization by Candida albicans. Crit Rev Oral Biol Med 1999;10:359-83.  Back to cited text no. 8
d'Enfert C. Hidden killers: Persistence of opportunistic fungal pathogens in the human host. Curr Opin Microbiol 2009;12:358-64.  Back to cited text no. 9
Rosa DD, Pasqualotto AC, Denning DW. Chronic mucocutaneous candidiasis and oesophageal cancer. Med Mycol 2008;46:85-91.  Back to cited text no. 10
Gupta B, Gupta S, Chaudhary M, Raj AT, Awan KH, Patil SG. Oral Candida Prevalence and Species Specificity in Leprosy. Disease-a-Month, 2019;66:66-73. Available from: https://doi.org/10.1016/j.disamonth.2019.100920. [Last accessed on 2019 Aug 30].  Back to cited text no. 11
Hande A, Chaudhary M, Gawande M, Gadbail A, Zade P, Bajaj S, et al. “Oral Submucous Fibrosis: An Enigmatic Morpho-Insight.”J Cancer Res The 2019:15:463-69. Available from: https://doi.org/10.4103/jcrt.JCRT_522_17. [Last accessed on 2019 Aug 30].  Back to cited text no. 12
Panchbhai A. Effect of Oral Submucous Fibrosis on Jaw Dimensions. Turkish Journal of Orthodontics 2019;32:105-9. Available from: https://doi.org/10.5152/TurkJOrthod.2019.18061. [Last accessed on 2019 Aug 30].  Back to cited text no. 13
Alka HH, Prajakta ZR, Minal CS, Madhuri GN, Swati P, Aakruti A. Immunohistochemical Analysis of Tumor-Associated Stroma in Oral Squamous Cell Carcinoma with and without Preexisting Oral Submucous Fibrosis. J Datta Meghe Inst Med Sci Univ 2017;12:170-6. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_8_17. [Last accessed on 2019 Aug 30].  Back to cited text no. 14
Gadbail AR, Chaudhary M, Gawande M, Hande A, Sarode S, Tekade SA, et al. Oral Squamous Cell Carcinoma in the Background of Oral Submucous Fibrosis Is a Distinct Clinicopathological Entity with Better Prognosis. J Oral Pathol Med 2017;46:448-53. Available from: https://doi.org/10.1111/jop.12553. [Last accessed on 2019 Aug 30].  Back to cited text no. 15
Tekade SA, Chaudhary MS, Tekade SS, Sarode SC, Wanjari SP, Gadbail AR, et al. Early Stage Oral Submucous Fibrosis Is Characterized by Increased Vascularity as Opposed to Advanced Stages. J Clin Diagn Res 2017;11:ZC92-6. Available from: https://doi.org/10.7860/JCDR/2017/25800.9948. [Last accessed on 2019 Aug 30].  Back to cited text no. 16
Gadbail AR, Chaudhary M, Sarode SC, Gondivkar S, Tekade SA, Zade P, et al. Ki67, CD105, and α-SMA Expression Supports the Transformation Relevant Dysplastic Features in the Atrophic Epithelium of Oral Submucous Fibrosis. PLoS ONE 2018;13. Available from: https://doi.org/10.1371/journal.pone.0200171. [Last accessed on 2019 Aug 30].  Back to cited text no. 17
Gondivkar SM, Bhowate RR, Gadbail AR, Gaikwad RN, Gondivkar RS, Sarode SC, et al. Sarode. Development and Validation of Oral Health-Related Quality of Life Measure in Oral Submucous Fibrosis. Oral Dis 2018;24:1020-8. Available from: https://doi.org/10.1111/odi.12857. [Last accessed on 2019 Aug 30].  Back to cited text no. 18
Gondivkar SM, Bhowate RR, Gadbail AR, Gondivkar RS, Sarode SC, Sarode GS, et al. Impact of Oral Submucous Fibrosis on Oral Health-Related Quality of Life: A Condition-Specific OHRQoL-OSF Instrument Analysis. Oral Dis 2018;24:1442-8. Available from: https://doi.org/10.1111/odi.12921. [Last accessed on 2019 Aug 30].  Back to cited text no. 19
Gondivkar SM, Bhowate RR, Gadbail AR, Sarode SC, Gondivkar RS, Yuwanati M, et al. Quality of Life-Related 'Patient-Reported Outcome Measures' in Oral Submucous Fibrosis Patients.J Contemp Dent Pract 2018;19:331-8. Available from: https://doi.org/10.5005/JP-JOURNALS-10024-2262.  Back to cited text no. 20


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