Journal of Datta Meghe Institute of Medical Sciences University

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 14  |  Issue : 4  |  Page : 293--295

Estimating the frequency of candida in oral squamous cell carcinoma patients


Radhika Gadge, Namrata Jidewar, Alka Hande 
 Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

Correspondence Address:
Dr. Radhika Gadge
20, Jeevan Chhaya Layout Deendayal Nagar, Nagpur - 440 022, Maharashtra
India

Abstract

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.



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;14:293-295


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 2020 Aug 4 ];14:293-295
Available from: http://www.journaldmims.com/text.asp?2019/14/4/293/289860


Full Text



 Introduction



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



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].[INLINE:1][INLINE: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 patientsPatients 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



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}

 Discussion



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



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

Nil.

Conflicts of interest

There are no conflicts of interest.

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