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Journal of Clinical Microbiology, December 1999, p. 3896-3900, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Epidemiology of Oropharyngeal Candida Colonization and Infection in Patients Receiving Radiation for Head and Neck Cancer

Spencer W. Redding,1,* Richard C. Zellars,2 William R. Kirkpatrick,3 Robert K. McAtee,3 Marta A. Caceres,3 Annette W. Fothergill,4 Jose L. Lopez-Ribot,3 Cliff W. Bailey,1 Michael G. Rinaldi,4 and Thomas F. Patterson3

Department of General Dentistry,1 Department of Radiology, Division of Radiation Oncology,2 Department of Medicine, Division of Infectious Diseases,3 and Department of Pathology,4 The University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7881

Received 2 July 1999/Returned for modification 5 August 1999/Accepted 21 August 1999

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.

* Corresponding author. Mailing address: Department of General Dentistry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78284-7881. Phone: (210) 567-3798. Fax: (210) 567-6721. E-mail: redding{at}uthscsa.edu.

Journal of Clinical Microbiology, December 1999, p. 3896-3900, Vol. 37, No. 12
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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