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Objective: Candida constitutes the main yeast flora in the oral cavity. Different species are known with C. albicans being the principal one. In healthy individuals, the balance among the oral microbial flora is maintained. However, this equilibrium might be altered in certain diseases resulting in the predominance of yeast flora over other microorganisms and behave as pathogens. Thalassemias constitute a large group of immunocompromised patients in our country with multiple hematological, immunological and endocrine disorders making them susceptible to local and systemic opportunistic yeast infections. Fluconazole is a globally used antifungal antibiotic especially in treating recurrent infections in immunocompromised patients. Little is known about the oral yeast carriage in the healthy individuals and thalassemic patients in our population, and their susceptibility pattern to fluconazole. This study has been done to assess the frequency of oral Candida carriage in a group of β-thalassemia major patients and sex and age-matched healthy controls, and to evaluate the susceptibility pattern of the isolates to fluconazole. Place of study: Microbiology Laboratory at College of dentistry/Hawler Medical University, Erbil, Iraq. Methodology: Two hundred subjects were included in the present study, 100 patients with β-thalassemia major (38 females &62 males) aged 4-26 years and 100 apparently healthy subjects age and sex-matched with thalassemic patients. Oral swab specimens were collected from each individual subject, cultured on sabouraud dextrose agar plates and incubated at 37oC for 48-72 hours. Identification of Candida species was based on colony morphology, germ tube test, biochemical reaction using API Candida system and growth characteristics on CHROMagar Candida. The disc diffusion method was applied to test sensitivity of the isolated strains to various concentrations of fluconazole. Results: All the subjects included in this study harbored only C. albicans in their oral cavities, with higher carriage rate observed among thalassemic patients (20%) than healthy controls (7%). Candida albicans was recovered much frequently from healthy children (57%) and adolescent thalassemias (65%) than other age groups within each study group. However the statistical analysis showed no significant correlation between age and oral C. albicans carriage rate (χ2 p-value > 0.05). Healthy females showed higher carrier rate than males, meanwhile C. albicans was equally distributed between male and female thalassemic patients. Susceptibility of C. albicans isolates to a 25 μg/ml fluconazole showed that out of the 27 C. albicans isolates, 23 were resistant to fluconazole. The resistant albicans strains showed high resistance rate (>128 μg/ml) within both groups. Whereas the response of sensitive strains to fluconazole was variable ranged from >16 μg/ml in healthy subjects to 4 - >16 μg/ml in thalasemias. Conclusion: C. albicans was the only isolated species from the oral cavity of thalassemic patients and healthy subjects. However the carrier rate was higher among thalassemias than healthy controls. Most of the isolated strains were resistant to fluconazole. Further studies are required to assess the sensitivity of oral Candida isolates to other antifungal drugs. |
