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ASSESSEMENT OF THE PREDISPOSING FACTORS ASSOCIATED WITH ORAL CAVITY COLONIZATION BY CANDIDA SPECIES

CHAPTER ONE

 INTRODUCTION 

1.1 Background of the Study
 Oral infections caused by fungi have been recognized throughout recorded history. Hippocrates described oral candidiasis in the fourth century BC. Rosen Von Rosenstein and Underwood made the first description of oral candidiasis in modern medicine (Gurjeet et al., 2013). In 1844, Bennett first isolated Candida species in sputum of a patient with tuberculosis (Gurjeet et al., 2013). However, since the 1980s a clear surge of interest and associated research into these infections have occurred. This is because of increase in the number of the population with candida infections. The abuse of antibiotics as self-medications and the starting of antibiotics as the first line treatment in most diseases have led to increased colonization of Candida species because of the suppression of the commensal bacterial flora (Deorukhkar et al., 2014).Candida is a fungus and the single most common cause of opportunistic mycoses worldwide (Eggiman et al., 2005). They can cause disease in both immunocompetent and immunocompromised hosts, but the incidence of infections is more in the immunocompromised individuals (Deorukhkar et al., 2014). They are in the family of Deuteromycetes, indicating a lack of sexual reproduction. However, several pathogenic and non-pathogenic Candida species have been identified to have a sexual stage (Calderone et al., 2001).They are normal inhabitants of oral cavity, vagina and skin (Coronado-Castellote and Jimenez, 2013). They are kept under control by specific and non-specific defense mechanisms, and also, by the competition of the normal flora microbes. In that normal state, they are present as yeast but switches to hyphal form when the conditions are not favorable because of their great adaptability to different host niches. Oral candidiasis occurs when there is overgrowth of this endogenous Candida species. The pathogenicity of Candida species is attributed to their various virulence factors and host factors (Silva et al., 2011). This over growth can be caused by deficiencies of the local and systemic host defenses. Oral candidiasis can manifest in various clinical forms involving one or more oral sites, up to affecting the whole cavity and disseminate into invasive forms. Some people can also have more than one species at the same time, and this is commonly observed among hospitalized patients (Klotz et al., 2007: Thompson et al., 2010). In many epidemiology studies of oral candidiasis, the most commonly isolated Candida species is Candida albicans (Coronado-Castellote and Jimenez 2013; Zahir and Himratul-Aznita 2013). They constitute the fifth pathogen among hospital acquired pathogens except in intensive care unit, where they are reported as the fourth among bloodstream infection pathogens (Kullberg et al., 2015). However, in recent years, as a consequences of extensive use of azole drugs, severe immunosuppression or illness, prematurity and exposure to broad spectrum antibiotics, species of non- Candida albicans are replacing Candida albicans in infections (Deorukhkar et al., 2012; Gurjeet et al., 2013; Deorukhkar et al., 2014). The clinical manifestations of different members of non- Candida species are indistinguishable. The non- Candida species responsible for oral infections include Candida glabrata, Candida krusei, Candida dubliniensis, Candida tropicalis, Candida parapsilosis and Candida gulliermondii (Lar et al., 2012).Candida dubliniensis is phenotypically similar to Candida albicans and mainly isolated from HIV patients (Binolfi, 2005). The oral mucosa is considered to be a unique environment because it provides a variety of adhesion sites for colonization of Candida species (McCullough, 2000). These adhesion sites includes the epithelial cells of buccal mucosa, the tongue, tooth surfaces, various oral prostheses such as dentures, and other oral microorganisms that have already colonized these surfaces (Eggiman et al.,2005). In colonized individuals with no clinical symptoms of candidiasis, Candida species are most frequently found on the dorsum of tongue, (Richardson et al., 2003), followed by the palate and the buccal mucosa (Muzyka, 2005). The tongue provides the humidity, temperature and also existence of hidden niches between the papillae of the tongue creates a good environment for candida organisms (Zadik et al., 2010). Presence of oral candidiasis has a significant impact on health. Oral lesions contribute to patient’s morbidity, affecting the psychological and economic functioning of the individual and community. It is progressive and increases in severity over time. It spreads down to esophagus causing dysphagia, which will also result to rapid clinical deterioration of these people. They can cause invasive candidiasis that carries a mortality rate of more than 60% (Leroy et al., 2009). It can also lead to intestinal hyper permeability called leaky gut syndrome that can cause food and environmental allergies. World Health Organization global review of oral health states that, oral candidiasis is one of the oral diseases that represent a major public health problem worldwide (Petersen, 2008). Oral candidiasis has been recognized centuries ago as indicators of much larger underlying diseases and that is why the infection is called the “disease of the diseased” (Deorukhkar et al., 2014). It can also be used in monitoring prognosis of these underlying diseases (Williams et al., 2011). A form of candida infection called hyperplastic candidiasis has been associated with malignant transformation (Rautenaa et al., 20011; Williams et al., 2011). Also Candida species can metabolise ethanol to carcinogenic acetaldehyde and can thus, induce oral and upper gastrointestinal tract cancers (Lalla et al., 2013). The challenge of candida infection in the tropics, in a third world and a developing country like Nigeria can best be imagined. Oral colonization precedes invasive candidiasis, hence identification of risk factors for oral colonization would be of great interest to the clinicians because of the following reasons. Firstly, they will use it as a marker for systemic diseases and monitor prognosis of these diseases. Secondly, its presence will help in selection of patients at risk of colonization for early interventions. Thirdly, the clinicians will use it to implement preventive strategies and formulate anti mycotic policies to help prevent fungal resistance to drugs and improve the general well-being of the population. More so, there is no documented research done in this part of Nigeria in the best of the researcher’s knowledge. Different risk factors to oral candidiasis vary with geographical locations, hence there is also need for comparative and complementary information on this from the South Eastern part of Nigeria

Project detailsContents
 
Number of Pages89 pages
Chapter one Introduction
Chapter two Literature review
Chapter three  methodology
Chapter  four  Data analysis
Chapter  five Summary,discussion & recommendations
ReferenceReference
QuestionnaireQuestionnaire
AppendixAppendix
Chapter summary1 to 5 chapters
Available documentPDF and MS-word format


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