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. 1999 Dec;37(12):3896-900.
doi: 10.1128/JCM.37.12.3896-3900.1999.

Epidemiology of oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer

S W Redding  1 , R C Zellars, W R Kirkpatrick, R K McAtee, M A Caceres, A W Fothergill, J L Lopez-Ribot, C W Bailey, M G Rinaldi, T F Patterson
Affiliations

Epidemiology of oropharyngeal Candida colonization and infection in patients receiving radiation for head and neck cancer

S W Redding et al. J Clin Microbiol. 1999 Dec.

Abstract

Oral mucosal colonization and infection with Candida are common in patients receiving radiation therapy for head and neck cancer. Infection is marked by oral pain and/or burning and can lead to significant patient morbidity. The purpose of this study was to identify Candida strain diversity in this population by using a chromogenic medium, subculturing, molecular typing, and antifungal susceptibility testing of clinical isolates. These results were then correlated with clinical outcome in patients treated with fluconazole for infection. Specimens from 30 patients receiving radiation therapy for head and neck cancer were cultured weekly for Candida. Patients exhibiting clinical infection were treated with oral fluconazole. All isolates were plated on CHROMagar Candida and RPMI medium, subcultured, and submitted for antifungal susceptibility testing and molecular typing. Infections occurred in 27% of the patients and were predominantly due to Candida albicans (78%). Candida carriage occurred in 73% of patients and at 51% of patient visits. Yeasts other than C. albicans predominated in carriage, as they were isolated from 59% of patients and at 52% of patient visits. All infections responded clinically, and all isolates were susceptible to fluconazole. Molecular typing showed that most patients had similar strains throughout their radiation treatment. One patient, however, did show the acquisition of a new strain. With this high rate of infection (27%), prophylaxis to prevent infection should be evaluated for these patients.

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Figures

FIG. 1
FIG. 1
Isolates from patient 20. Each lane represents a separate subisolate collected over six visits when cultures were positive. (A) Karyotype; (B) RFLP analysis with SfiI digestion of genomic DNA; (C) fingerprinting analysis with the Ca 3 probe. All isolates appear to be similar.
FIG. 2
FIG. 2
Isolates from patient 24. Each lane represents the karyotype analysis of a separate subisolate collected over seven visits when cultures were positive. Lanes 5 and 7 show the emergence of a new strain at visit 3. All other isolates appear to be similar, including that in lane 6, which was also from visit 3.
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