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Journal of Clinical Microbiology, May 2002, p. 1879-1881, Vol. 40, No. 5
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.5.1879-1881.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Candida glabrata Oropharyngeal Candidiasis in Patients Receiving Radiation Treatment for Head and Neck Cancer

Spencer W. Redding,1* William R. Kirkpatrick,2 Brent J. Coco,2 Lee Sadkowski,3 Annette W. Fothergill,3 Michael G. Rinaldi,3 Tony Y. Eng,4 and Thomas F. Patterson2

Department of General Dentistry,1 Division of Infectious Diseases, Department of Medicine,2 Department of Pathology,3 Department of Radiation Oncology, The University of Texas Health Science Center and The South Texas Veterans Healthcare System, San Antonio, Texas 78229-39004

Received 15 October 2001/ Returned for modification 7 December 2001/ Accepted 31 January 2002

Candida glabrata colonization is common in patients receiving radiation treatment for head and neck cancer, but to our knowledge has never been described as the infecting organism with oropharyngeal candidiasis (OPC). This study presents the first three patients described with C. glabrata OPC in this patient population. Patient 1 developed C. glabrata OPC and required fluconazole, 800 mg/day, for clinical resolution. Antifungal susceptibility testing revealed a MIC of fluconazole of >64 µg/ml. Elapsed time from initial culturing to treatment decision was 7 days. Patients 2 and 3 developed C. glabrata OPC. They were patients in a study evaluating OPC infections, and cultures were taken immediately. CHROMagar Candida plates with 0, 8, and 16 µg of fluconazole/ml were employed for these cultures. Lavender colonies, consistent with C. glabrata, grew on the 0- and 8-µg plates but not on the 16-µg plate from patient 2 and grew on all three plates from patient 3. Based on these data, a fluconazole dose of 200 mg/day was chosen for patient 2 and a dose of 400 mg/day was chosen for patient 3, with clinical resolution in both. Elapsed time from initial culturing to treatment decision was 2 days. C. glabrata does cause OPC in head and neck radiation treatment patients, and the use of fluconazole-impregnated chromogenic agar may significantly reduce treatment decision time compared to that with conventional culturing and antifungal susceptibility testing.

* 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 78229-3900. Phone: (210) 567-3656. Fax: (210) 567-3662. E-mail: redding{at}uthscsa.edu.

Journal of Clinical Microbiology, May 2002, p. 1879-1881, Vol. 40, No. 5
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.5.1879-1881.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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