Exploring oral candidiasis among cancer patients undergoing chemotherapy in eastern Iran
-
Abdol Sattar Pagheh
,
Fatemeh Kardan
,
Aynaz Ghojoghi
,
Ahmad Reza Sebzari
,
Maryam Erfaninejad
,
Parvin Askari
,
Seyed Reza Aghili
,
Eisa Nazar
,
Masood Ziaee
Abstract
Background and Objectives: Understanding the epidemiology of Candida species among cancer patients is crucial for preventing invasive infections. This study aimed to identify Candida species and assess risk factors among cancer patients receiving chemotherapy in Birjand, eastern Iran.
Materials and Methods: The samples were obtained from the oral cavity of 140 patients and the initial identification of Candida species was carried out through fungal cultures. Subsequently, Candida isolates were molecularly identified using the PCR-RFLP method with the restriction enzyme Msp1. Furthermore, the demographic characteristics, risk factors, and clinical history of the patients were extracted and scrutinized using a multiple logistic regression model.
Results: Among the 140 patients examined, 55 individuals (39.3%) tested positive for oral candidiasis (OC). Notably, Hemorrhagic cancer emerged as the most common type of cancer associated with OC (46.7%). The predominant species isolated was the Candida albicans complex (64.8%), followed by the Candida glabrata complex (26.8%). A noteworthy finding was the significant association between the occurrence of OC and the number of chemotherapy sessions (P<0.05). Conversely, no significant correlations were detected between OC and variables such as sex, age, type of cancer, occupation, residence, underlying disease, and drug use (P>0.05).
Conclusion: The prevalence of Candida spp. and its correlation with the number of chemotherapy sessions underscored the importance of preventive measures. These findings provided valuable insights for designing targeted interventions to mitigate the burden of oral candidiasis in this vulnerable population.
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25. Nasri E, Vaezi A, Falahatinejad M, Rizi MH, Sharifi M, Sadeghi S, et al. Species distribution and susceptibility profiles of oral candidiasis in hematological malignancy and solid tumor patients. Braz J Microbiol 2023; 54: 143-149.
26. Lanier OL, Pérez-Herrero E, Andrea APD', Bahrami K, Lee E, Ward DM, et al. Immunotherapy approaches for hematological cancers. iScience 2022; 25: 105326.
27. Hamzehee S, Kalantar-Neyestanaki D, Mohammadi MA, Nasibi S, Mousavi SAA. Identification of Candida spp. isolated from oral mucosa in patients with leukemias and lymphomas in Iran. Iran J Microbiol 2019; 11: 114-119.
28. Souza E Silva VC, Oliveira VC, Sousa ÁFL, Bim FL, Macedo AP, Andrade D, et al. Prevalence and susceptibility profile of Candida spp. isolated from patients in cancer therapy. Arch Oral Biol 2020; 119: 104906.
29. Crawford J, Dale DC, Lyman GH. Chemotherapy‐induced neutropenia: risks, consequences, and new directions for its management. Cancer 2004; 100: 228-237.
30. Ghojoghi A, Khodavaisy S, Mahmoudabadi AZ, Nazar E, Fatahinia M. Exploring the diversity of uncommon oral yeast species and associated risk factors among substance abusers in southwestern Iran. Sci Rep 2024; 14: 1906.
31. Mousavi SAA, Salari S, Rezaie S, Nejad NS, Hadizadeh S, Kamyabi H, et al. Identification of Candida species isolated from oral colonization in Iranian HIV-positive patients, by PCR-RFLP method. Jundishapur J Microbiol 2011; 5: 336-340.
32. Ghojoghi A, Erfaninejad M, Ahmadpour E, Nazar E, Barac A, Fatahinia M. Non-albicans candidemia in cancer patients as an increasing health problem: A comprehensive review and meta-analysis. Asian Pac J Trop Med 2022; 15: 387-399.
2. Demaria S, Golden EB, Formenti SC. Role of local radiation therapy in cancer Immunotherapy. JAMA Oncol 2015; 1: 1325-1332.
3. Chaveli-López B. Oral toxicity produced by chemotherapy: A systematic review. J Clin Exp Dent 2014; 6(1): e81-e90.
4. Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis 2015; 15: 1429-1437.
5. Bunetel L, Tamanai-Shacoori Z, Martin B, Autier B, Guiller A, Bonnaure-Mallet M. Interactions between oral commensal Candida and oral bacterial communities in immunocompromised and healthy children. J Mycol Med 2019; 29: 223-232.
6. Lalla RV, Latortue MC, Hong CH, Ariyawardana A, D’Amato-Palumbo S, Fischer DJ, et al. A systematic review of oral fungal infections in patients receiving cancer therapy. Support Care Cancer 2010; 18: 985-992.
7. Charsizadeh A, Nikmanesh B, Ahmadi B, Jalalizand N, Jafari Z, Rahmani M, et al. Frequency of Candida species isolated from patients in children’s Medical Center, Tehran, Iran. Arch Pediatr Infect Dis 2017; 6(1): e62410.
8. Puri S, Edgerton M. How does it kill?: understanding the candidacidal mechanism of salivary histatin 5. Eukaryot Cell 2014; 13: 958-964.
9. Mendonça MA, Cunha FQ, Murta EF, Tavares-Murta BM. Failure of neutrophil chemotactic function in breast cancer patients treated with chemotherapy. Cancer Chemother Pharmacol 2006; 57: 663-670.
10. Saloustros E, Tryfonidis K, Georgoulias V. Prophylactic and therapeutic strategies in chemotherapy-induced neutropenia. Expert Opin Pharmacother 2011; 12: 851-863.
11. Westbrook SD, Kirkpatrick WR, Wiederhold NP, Freytes CO, Toro JJ, Patterson TF, et al. Microbiology and epidemiology of oral yeast colonization in hemopoietic progenitor cell transplant recipients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115: 354-358.
12. Abastabar M, Shokohi T, Kord RR, Badali H, Hashemi SJ, Ghasemi Z, et al. In vitro activity of econazole in comparison with three common antifungal agents against clinical Candida strains isolated from superficial infections. Curr Med Mycol 2015; 1: 7-12.
13. Zaoutis TE, Prasad PA, Localio AR, Coffin SE, Bell LM, Walsh TJ, et al. Risk factors and predictors for candidemia in pediatric intensive care unit patients: implications for prevention. Clin Infect Dis 2010; 51(5): e38-e45.
14. Rafat Z, Sasani E, Salimi Y, Hajimohammadi S, Shenagari M, Roostaei D. The prevalence, etiological agents, clinical features, treatment, and diagnosis of HIV-associated oral Candidiasis in pediatrics across the world: A systematic review and meta-analysis. Front Pediatr 2021; 9: 805527.
15. Gadducci A, Cosio S. Neoadjuvant chemotherapy in locally advanced cervical cancer: review of the literature and perspectives of clinical research. Anticancer Res 2020; 40: 4819-4828.
16. Kord M, Salehi M, Khodavaisy S, Hashemi SJ, Daie Ghazvini R, Rezaei S, et al. Epidemiology of yeast species causing bloodstream infection in Tehran, Iran (2015–2017); superiority of 21-plex PCR over the Vitek 2 system for yeast identification. J Med Microbiol 2020; 69: 712-720.
17. Mirhendi H, Makimura K, Khoramizadeh M, Yamaguchi H. A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nihon Ishinkin Gakkai Zasshi 2006; 47: 225-229.
18. Maheronnaghsh M, Fatahinia M, Dehghan P, Teimoori A. Identification of Candida species and antifungal susceptibility in cancer patients with oral lesions in Ahvaz, Southern West of Iran. Adv Biomed Res 2020; 9: 50.
19. Sabar KA, Abdulbaqi NJ. Isolation of Candida spp. from cancer patients who suffered oral candidiasis due to immunodeficiency. Plant Arch 2020; 20: 1222-1224.
20. Alnuaimi AD, Wiesenfeld D, O’Brien-Simpson NM, Reynolds EC, McCullough MJ. Oral Candida colonization in oral cancer patients and its relationship with traditional risk factors of oral cancer: a matched case-control study. Oral Oncol 2015; 51: 139-145.
21. Armstrong-James D, Meintjes G, Brown GD. A neglected epidemic: fungal infections in HIV/AIDS. Trends Microbiol 2014; 22: 120-127.
22. Rawashdeh MA, Ayesh JA, Darwazeh AM. Oral candidal colonization in cleft patients as a function of age, gender, surgery, type of cleft, and oral health. J Oral Maxillofac Surg 2011; 69: 1207-1213.
23. Khedri S, Santos ALS, Roudbary M, Hadighi R, Falahati M, Farahyar S, et al. Iranian HIV/AIDS patients with oropharyngeal candidiasis: identification, prevalence and antifungal susceptibility of Candida species. Lett Appl Microbiol 2018; 67: 392-399.
24. Ye P, Chen W, Huang F, Liu Q, Zhu Y-N, Wang X, et al. Smoking increases oral mucosa susceptibility to Candida albicans infection via the Nrf2 pathway: In vitro and animal studies. J Cell Mol Med 2021; 25: 7948-7960.
25. Nasri E, Vaezi A, Falahatinejad M, Rizi MH, Sharifi M, Sadeghi S, et al. Species distribution and susceptibility profiles of oral candidiasis in hematological malignancy and solid tumor patients. Braz J Microbiol 2023; 54: 143-149.
26. Lanier OL, Pérez-Herrero E, Andrea APD', Bahrami K, Lee E, Ward DM, et al. Immunotherapy approaches for hematological cancers. iScience 2022; 25: 105326.
27. Hamzehee S, Kalantar-Neyestanaki D, Mohammadi MA, Nasibi S, Mousavi SAA. Identification of Candida spp. isolated from oral mucosa in patients with leukemias and lymphomas in Iran. Iran J Microbiol 2019; 11: 114-119.
28. Souza E Silva VC, Oliveira VC, Sousa ÁFL, Bim FL, Macedo AP, Andrade D, et al. Prevalence and susceptibility profile of Candida spp. isolated from patients in cancer therapy. Arch Oral Biol 2020; 119: 104906.
29. Crawford J, Dale DC, Lyman GH. Chemotherapy‐induced neutropenia: risks, consequences, and new directions for its management. Cancer 2004; 100: 228-237.
30. Ghojoghi A, Khodavaisy S, Mahmoudabadi AZ, Nazar E, Fatahinia M. Exploring the diversity of uncommon oral yeast species and associated risk factors among substance abusers in southwestern Iran. Sci Rep 2024; 14: 1906.
31. Mousavi SAA, Salari S, Rezaie S, Nejad NS, Hadizadeh S, Kamyabi H, et al. Identification of Candida species isolated from oral colonization in Iranian HIV-positive patients, by PCR-RFLP method. Jundishapur J Microbiol 2011; 5: 336-340.
32. Ghojoghi A, Erfaninejad M, Ahmadpour E, Nazar E, Barac A, Fatahinia M. Non-albicans candidemia in cancer patients as an increasing health problem: A comprehensive review and meta-analysis. Asian Pac J Trop Med 2022; 15: 387-399.
| Files | ||
| Issue | Vol 16 No 6 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i6.17259 | |
| Keywords | ||
| Candidiasis; Neoplasms; Chemotherapy adjuvant; Candida; Risk factors; Epidemiology | ||
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How to Cite
1.
Pagheh AS, Kardan F, Ghojoghi A, Sebzari AR, Erfaninejad M, Askari P, Aghili SR, Nazar E, Ziaee M. Exploring oral candidiasis among cancer patients undergoing chemotherapy in eastern Iran. Iran J Microbiol. 2024;16(6):803-811.
