RESEARCH ARTICLE


Effect of Denture-Related Stomatitis Fluconazole Treatment on Oral Candida albicans Susceptibility Profile and Genotypic Variability



Maria Helena Figueiral *, 1, Patrícia Fonseca 1, Maria Manuel Lopes 2, Eugénia Pinto 3, Teresa Pereira-Leite 4, Benedita Sampaio-Maia 1, 5
1 Faculty of Dentistry, Universidade do Porto, Portugal
2 Department of Microbiology, Faculty of Pharmacy, Lisbon University, Portugal
3 CEQUIMED/CIIMAR, Microbiology Service, Biological Sciences Department, Faculty of Pharmacy, Universidade do Porto, Portugal
4 USF-Alcaides, Portugal
5 INEB/I3S - Instituto de Engenharia Biomédica, Instituto de Investigação e Inovação em Saúde, Universidade do Por-to, Portugal


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Creative Commons License
© Figueiral et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Rua Dr. Manuel Pereira da Silva, 4200-393 Porto Portugal; Tel: +351 220 901 100; Fax: +351 220 901 101; E-mails: mhsilva@fmd.up.pt and hfigueiral@gmail.com


Abstract

Denture-related stomatitis (DRS) is the most common condition affecting removable-denture wearers, and Candida albicans the most frequent pathogenic agent. Systemic antifungal treatment is indicated but recurrences are frequent. The aim of this study was to characterize the oral load, fluconazole susceptibility profile and genotypic variability of oral C. albicans isolates from patients with DRS before (T0), immediately after fluconazole treatment (Tat) and after 6-months follow-up (T6m). Eighteen patients presenting DRS and treated with fluconazole were followed at the Faculty of Dentistry of Oporto University. Seventy C. albicans isolates were obtained and identified using standard cultural and biochemical multi-testing. Fluconazole susceptibility was tested by E-test®. Microsatellite-primed PCR was performed to assess the genotypic variability of C. albicans isolates. The patients’ mean age was 58.0±3.2 years, and 55.6%/44.4% had total/partial dentures. Before treatment, 22.2%, 44.4% and 33.3% of the patients presented DRS type I, II or III, respectively. Fluconazole treatment healed or improved DRS in 77.8% of the patients, accompanied by an 83.5% reduction in oral C. albicans load. However, after 6-months, oral C. albicans load increased significantly and DRS severity was similar to the one observed before treatment. Moreover, the prevalence of patients presenting fluconazole resistant isolates of C. albicans increased significantly throughout the study: T0-5.6%, Tat-10.0% and T6m-42.9%. A change in the genotypic variability of C. albicans isolates was also verified, being mostly associated to fluconazole susceptibility profile change. In conclusion, fluconazole presents a good short-term DRS treatment efficiency, but may be associated to a long-term emergence of C. albicans fluconazole resistance.

Keywords: Candida albicans, denture, denture wearers, denture-related stomatitis, fluconazole resistance, genotypic variability.