Vol 5, No 1 (2017) ISSN 2167-8677 (online) DOI 10.5195/d3000.2017.74 Oral candidiasis: relation to systemic diseases and medications Xiaozhu Chu1 1University of Pi.sburgh, School of Dental Medicine Cita%on: Chu, X. (2017) Oral candidiasis: rela,on Abstract to systemic diseases and medica-ons. Den$stry 3000. 1:a001 doi:10.5195/d3000.2017.74 Background: Oral candidiasis is by far the most common oral fungal infecon in humans. It is caused by the fungal or- Received: May 5, 2017 ganism Candida albicans. When the host is debilitated by other diseases and condions, C. albicans, which is usually a Accepted: May 26, 2017 part of the normal oral flora, can turn pathogenic and invade the host ssue to cause the infecon. The purpose of Published: June 19, 2017 this paper is to inves-gate the role of systemic diseases and medica-ons in the development of oral candidiasis. Copyright: ©2017 Chu, X. This is an open access Methods: A total of 12 cases with code indicang oral candidiasis were collected from the University of Pi.sburgh arcle licensed under a Creave Commons School of Dental Medicine Dental Registry and DNA Repository. The systemic diseases and medicaons were descrip- A!ribu%on Work 4.0 United States License. vely analyzed. Results: 50% of the subjects had more than two systemic diseases. The most prevalent diseases were Email: xic81@pi(.edu mental illnesses (50%), cardiovascular diseases (41.7%), and respiratory system diseases (33.3%). 50% of subjects were on polypharmacy therapies and 75% of subjects were taking medicaons that may contribute to oral candidiasis. Among the medicaons, andepressants and inhala#onal corcosteroids may have strong poten#als to cause oral candidiasis. Conclusion: Oral candidiasis is associated with having systemic diseases and intake of medica.on, espe- cially with those medicaons can cause xerostomia. As the number of systemic diseases and medicaons increases, the risk of developing oral candidiasis may increase too. Introduction result of complex host and organ- γT (RORγT), produce interleukin ism interaction, a large percentage (IL)-17, which has an essential role Candidiasis is by far the of patients with candidal infection in defensing against candidal in- most common oral fungal infec- are still individuals who are debili- fections in humans. Four genetic tion in humans and has a variety tated by another diseases and etiologies, AR IL-17 receptor A, IL- of clinical manifestations. It is the conditions. Many risk factors can 17 receptor C and ACT1 deficien- infection caused by the yeast-like modify an individual’s susceptibil- cies, and AD IL-17F deficiency, are fungal organism Candida albicans. ity to oral candidiasis, including identified as underlying risk fac- As many other pathogenic fungi, compromised autoimmunity, to- tors for chronic mucocutaneous C. albicans can exist in two bacco consumption, hyposaliva- candidiasis. Each of these gene forms—the yeast form and the tion, denture wearing, systemic defects has a direct negative effect hyphal form. The hyphal form is disease, and medication. on IL-17 signaling. Patients with believed to be able to invade the these gene defects may have se- host tissue and cause the infec- Compromised autoimmunity verely reduced frequencies of cir- tion. [1] C. albicans is considered culating IL-17-producing T cells. Or as part of the normal oral flora T-cell immunity has a criti- cal role in host defense against they may produce neutralizing au- and the prevalence of oral Can- toantibodies against IL-17. As a dida carriage in the healthy popu- candidal infection. Chronic muco- cutaneous candidiasis (including result, the ability of neutrophil lation has been estimated to range cells to kill C. albicans is impaired from 23% to 68%. [2] Candidiasis oral candidiasis) is an infectious phenotype in patients with inher- and chronic mucocutaneous can- used to be considered as only an didiasis may develop. [3] opportunistic infection but it has ited or acquired T-cell deficiency. been recognized that people who Studies have shown that Th17 cell, Tobacco consumption are otherwise healthy can develop as well as other cell expressing ret- oral candidiasis too. However, as a inoic acid-related orphan receptor New articles in this journal are licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by the University Library System, University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponored by the University of Pittsburgh Press. http://dentistry3000.pitt.edu E!ology and familial inheritance of pleomorphic adenomas Vol 5, No 1 (2017) DOI 10.5195/d3000.2017.73 Denture wearing Denture stomatitis is con- sidered to be a form of erythema- tous candidiasis and it’s a common inflammatory lesion of the oral mucosa covered by denture. Epi- demiological studies show a prevalence of denture stomatitis among denture wearers from 15% to over 70%. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumula- tion of denture plaque, and bacte- Tobacco smoking has been Adequate salivation is es- rial and yeast contamination of considered as one of the many sential for oral health, since it pro- denture surface. All together, the- factors that can predispose indi- vides support for the microbial se factors may increase the ability viduals to oral candidiasis. Litera- population of the mouth, while at of C. albicans to colonize both tures revealed that the rate of oral the same time containing antimi- denture and oral mucosal surfac- candidal carriage in tobacco crobial products that control these es, exerting its pathogenic effort. smokers is significantly higher microbial populations. Histatin 5 [6] than in non-smokers. Besides C. (Hst 5) is an important salivary an- Systemic diseases Many systemic albicans, the oral carriage of other timicrobial protein. It has been diseases have been associated species such as C. glabrata, C. shown that Hst 5 has potent and with oral candidiasis. The primary dubliniensis and C. tropicalis are selective antifungal activity. After cause is attributed to the de- also associated with smoking. The coupling with the carrier molecule creased salivary secretion, leading observation is even more striking spermidine, Hst 5 significantly en- to the reduced concentration of in HIV-infected individuals. It has hances the killing of C. albicans. immunoglobulin in the saliva and been reported that HIV-positive [5] Reduced salivary secretion, as less efficient humoral-mediated smokers are 50 times more likely occurred in patients with Sjögren's host defense against C. albicans. to be oral candidal infection posi- syndrome, can re- tive compared to HIV-infected sult in a significant non-smokers. It has not been increase in oral cleared yet that why tobacco con- candidal carriage. sumption can increase candidal The prevalence of carriage. However, there are stud- oral candidal car- ies suggesting that smoking may riage among lead to localized epithelial altera- Sjögren's syndrome tions, which facilitate candidal patients is estimat- colonization. Another hypothesis ed to range from is that cigarette smoke may con- 68% to 100%, com- tain nutritional factors for C. albi- pared to the range cans. [4] from 23% to 68% in normal population Hyposalivation [2]. http://dentistry3000.pitt.edu E!ology and familial inheritance of pleomorphic adenomas Vol 5, No 1 (2017) DOI 10.5195/d3000.2017.73 used for academic research pur- pose. 12 cases with codes indicat- ing oral candidiasis were collected from the 5,869 subjects. Com- pared to the estimated prevalence of oral candidal carriage, which ranges from 23% to 68% in the normal population [2], the number 12 in 5,869 subjects (0.2%) seems to be unreasonably small. This can be a result of the inconsistent re- port of the oral lesions by clinical faculty members and student den- tists. For the 12 cases with oral candidiasis, the data on current (i.e. time of examination) systemic For patients with diabetes melli- oral candidiasis by directly reduc- diseases/medical conditions, daily tus, besides the reduced salivary ing the salivary flow. [8] intake of prescribed or OTC medi- flow, the high level of blood glu- cations were obtained from the cose also plays a significant role. It It appears that the associa- registry. The total number of sys- is associated with reduced salivary tion between oral candidiasis and temic diseases and medical condi- pH and facilitates oral candidal systemic diseases, intake of medi- tions were counted. All medica- overgrowth and colonization. [7] cations has been well established. tions were categorized by using As an opportunistic infection, oral The purpose of this study is to the internationally approved Ana- candidiasis is also associated with analyze the 12 cases collected tomical Therapeutic Chemical a wide spectrum of systemic dis- from the University of Pittsburgh (ATC) classification system. And eases that suppress the host auto- School of Dental Medicine Dental their impacts on oral hygiene and immunity [8]. Registry and DNA Repository, and dental treatment were obtained further investigate which systemic from the website Lexicomp Online Medication diseases and medications may be for Dentistry potent and contribute to the de- (http://www.wolterskluwercdi.co Several drugs may cause velopment of oral candidiasis. the development of oral candidia- m/online-for-dentistry/). All data sis by many mechanisms. The Methods then were descriptively analyzed. pharmacological action of the Results broad-spectrum group of antibiot- By the time of the study started, ics may break the balance within 5,869 subjects from the University Characteristics of the 12 study the normal oral flora, resulting in of Pittsburgh School of Dental samples are presented in Table 1. the overgrowth of C. albicans. Medicine Dental Registry and DNA Among the 12 cases, only one par- Drugs such as corticosteroids may Repository were available for ticipant (8.3%) did not report any suppress either the nonspecific analysis.