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Evaluation of the recurrence of denture stomatitis and Candida colonization in a small group of patients who received itraconazole

Cross, L., Williams, David Wynne ORCID:, Sweeney, C., Jackson, M., Lewis, Michael Alexander Oxenham ORCID: and Bagg, J. 2004. Evaluation of the recurrence of denture stomatitis and Candida colonization in a small group of patients who received itraconazole. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 97 (3) , pp. 351-358. 10.1016/j.tripleo.2003.10.006

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Objectives The aim of the study was to determine the recurrence rate of denture stomatitis and persistence of Candida in 22 patients (5 male and 17 female, mean age 71 years) over a 3-year period. Study design Denture hygiene practice, denture cleanliness, and the presence of palatal erythema were assessed for each patient at the start of the study (baseline). The oral cavity was sampled for yeasts by imprint culture and denture discs. Ten patients received a capsular form of itraconazole (100 mg twice daily for 15 days) and 12 patients were provided with 100 mg of itraconazole in the form of a mouthwash (10 mL twice daily), which was then swallowed. No further antifungal treatment was administered to any of the patients. Clinical and microbiological assessments were repeated for each patient at 6 months and 3 years after the original appointment. Yeasts were identified by colony color on CHROMagar Candida, germ-tube formation, and API-32C profiling. Selected isolates were then typed by inter-repeat polymerase chain reaction (IR PCR). Results Candida albicans was isolated at baseline from all patients either alone (12 patients) or in combination with another species (10 patients). Other yeast species recovered were C glabrata (5 patients), C tropicalis (1 patient), C guilliermondii (1 patient), C krusei (1 patient), C parapsilosis (1 patient), C kefyr (1 patient), and Saccharomyces cerevisiae (2 patients). Candida albicans and/or C glabrata were recovered from 11 of the 22 patients after 6 months or 3 years. A complete and consistent change of yeast species from baseline was observed in 6 patients after 6 months and at 3 years. The remaining 5 patients were yeast-free at the follow-up assessments. PCR fingerprinting of C albicans and C glabrata indicated strain persistence over 6 months in 10 patients and in 4 patients after 3 years. A switch in strain type occurred for 1 patient after 6 months and for 3 patients after 3 years. Conclusions The recurrence of denture stomatitis in patients who maintained a high standard of denture cleanliness was low. Although itraconazole was beneficial in reducing the fungal load, there may be strain persistence or subsequent recolonization of the oral cavity by a broader range of potentially less sensitive yeast species. Numerous studies over many years have reported an association between Candida albicans and denture stomatitis. [1.], [2.], [3.], [4.] and [5.] Although bacteria as well as yeasts may be involved in the etiology of denture stomatitis,6 antifungal preparations have been used to treat denture stomatitis. [5.], [7.], [8.] and [9.] Topical antifungal drugs, such as nystatin, amphotericin B, and miconazole have been shown to be effective in producing a marked improvement in denture stomatitis.5 However, recurrence rates are high and treatment regimens tend to be prolonged. [10.], [11.] and [12.] The systemic triazoles fluconazole and itraconazole have provided potentially important additional agents for treatment of this infection. [7.] and [8.] Fluconazole was found to be efficacious in the treatment of denture stomatitis, [13.] and [14.] although a high rate of clinical relapse and recurrence after therapy has also been reported. [14.] and [15.] Itraconazole can be used as a lactose bead-encapsulated preparation or as a liquid formulation (hydroxy-b-cyclodextrin).16 A single blind clinical trial of itraconazole formulations in the management of Candida-associated denture stomatitis was performed between 1996 and 1997 at the University of Glasgow Dental School.9 Twenty patients received a capsular form of itraconazole (100 mg twice daily for 15 days) and 20 patients were provided with 100 mg of itraconazole in the form of a mouthwash (10 mL twice daily), which was then swallowed. This previous study revealed that over a 6-month period, the capsule and the liquid formulation of itraconazole were equally effective adjuncts in the treatment of denture stomatitis. However, high incidences of gastrointestinal side effects were observed in patients who received the liquid formulation. Progressive recolonization of the mucosa and the fitting surface of the denture by yeast together with the recurrence of denture stomatitis after antifungal treatment has been reported. [7.], [15.], [17.], [18.] and [19.] Molecular typing of C albicans isolates has been useful in determining whether commensal strains within the oral flora provide a reservoir of infective organisms, whether strains are adapted to specific body niches, and whether new episodes of infection are due to reinfection with new or previous strains.19 Mathaba et al20 concluded that denture stomatitis resulted from the overgrowth of commensal strains in the oral cavity and that no single strain of C albicans was associated with the infection. Cross et al21 have previously reported that C albicans strains from denture stomatitis patients prior to itraconazole therapy and 6 months later were identical in 17 of 18 patients examined and concluded that recurrence of denture stomatitis was due to recolonization by the original strain. However, despite the high recurrence rate of denture stomatitis, [5.] and [15.] there have been few detailed long-term clinical and mycological follow-up studies.10 As a result, the aim of the study was to assess the relapse rates of denture stomatitis 3 years after initial management with denture hygiene instruction and itraconazole therapy. In addition, isolates of C albicans and C glabrata were genetically typed in an attempt to assess and relate strain persistence to clinical recurrence.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Dentistry
Subjects: R Medicine > RK Dentistry
R Medicine > RM Therapeutics. Pharmacology
Publisher: Elsevier
ISSN: 1079-2104
Last Modified: 08 Dec 2022 10:00

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