Tags

Type your tag names separated by a space and hit enter

Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis.

Abstract

OBJECTIVES

Despite aggressive antifungal prophylaxis, the increased risk for systemic fungal infection in recipients of hematopoietic cell transplants (HCT) continues to be a significant concern because Candida infection can cause morbidity and mortality in these patients. The objectives of this study were to examine the relationship of oral colonization by Candida species to systemic infection, mortality, and the impact of antifungal treatment on a population of recipients of HCT.

STUDY DESIGN

One hundred and fifteen consecutive patients undergoing hematopoietic cell transplantation were evaluated. Oral examinations and cultures for Candida were completed before transplantation and on a weekly basis until discharge. The oral complications were assessed, and the level of mucositis was scored by using the National Cancer Institute grade. Systemic antifungal prophylaxis was provided to all patients. Chlorhexidine oral rinses were also routinely provided.

RESULTS

Colonization by Candida species was identified in 31% of patients. Fifty-six percent of patients with colonization had clinical evidence of oral candidiasis. Significantly decreased Candida colonization was seen in patients using chlorhexidine alone compared with those using chlorhexidine and nystatin together (P <.046). Twenty-five patients died in the immediate posttransplantation period, 17 of whom were Candida-positive. The length of hospital stay ranged from 15 to 153 days; increased stay was also associated with Candida colonization (P =.04). Seventy-four percent of all patients developed ulcerative mucositis. More severe mucositis was seen in patients undergoing chemotherapy and radiation therapy. There was no significant difference between Candida colonization and the presence or severity of mucositis.

CONCLUSIONS

Despite systemic and topical antifungal prophylaxis, oropharyngeal colonization by Candida species was common in patients who had received HCT. Candidiasis was commonly present in those who did not survive the early transplant period. Of the 25 patients who died early after the transplantation, 92% had ulcerative mucositis in comparison with 70% of those who survived, reflecting the association of oral mucositis with the toxicity of HCT. There was a significant relationship among allogeneic and autologous HCT, length of stay, and colonization of Candida. In patients undergoing systemic antifungal prophylaxis, chlorhexidine rinse was statistically more effective in reducing colonization by Candida than chlorhexidine and nystatin combined (P =.046).

Authors+Show Affiliations

Department of Oral Medicine and Diagnostic Sciences, University of Illinois, Chicago, USA. jepstein@uic.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12931087

Citation

Epstein, Joel B., et al. "Oral Candidiasis in Hematopoietic Cell Transplantation Patients: an Outcome-based Analysis." Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, vol. 96, no. 2, 2003, pp. 154-63.
Epstein JB, Hancock PJ, Nantel S. Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(2):154-63.
Epstein, J. B., Hancock, P. J., & Nantel, S. (2003). Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 96(2), pp. 154-63.
Epstein JB, Hancock PJ, Nantel S. Oral Candidiasis in Hematopoietic Cell Transplantation Patients: an Outcome-based Analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(2):154-63. PubMed PMID: 12931087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oral candidiasis in hematopoietic cell transplantation patients: an outcome-based analysis. AU - Epstein,Joel B, AU - Hancock,Pamela J, AU - Nantel,Stephen, PY - 2003/8/22/pubmed PY - 2003/10/28/medline PY - 2003/8/22/entrez SP - 154 EP - 63 JF - Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics JO - Oral Surg Oral Med Oral Pathol Oral Radiol Endod VL - 96 IS - 2 N2 - OBJECTIVES: Despite aggressive antifungal prophylaxis, the increased risk for systemic fungal infection in recipients of hematopoietic cell transplants (HCT) continues to be a significant concern because Candida infection can cause morbidity and mortality in these patients. The objectives of this study were to examine the relationship of oral colonization by Candida species to systemic infection, mortality, and the impact of antifungal treatment on a population of recipients of HCT. STUDY DESIGN: One hundred and fifteen consecutive patients undergoing hematopoietic cell transplantation were evaluated. Oral examinations and cultures for Candida were completed before transplantation and on a weekly basis until discharge. The oral complications were assessed, and the level of mucositis was scored by using the National Cancer Institute grade. Systemic antifungal prophylaxis was provided to all patients. Chlorhexidine oral rinses were also routinely provided. RESULTS: Colonization by Candida species was identified in 31% of patients. Fifty-six percent of patients with colonization had clinical evidence of oral candidiasis. Significantly decreased Candida colonization was seen in patients using chlorhexidine alone compared with those using chlorhexidine and nystatin together (P <.046). Twenty-five patients died in the immediate posttransplantation period, 17 of whom were Candida-positive. The length of hospital stay ranged from 15 to 153 days; increased stay was also associated with Candida colonization (P =.04). Seventy-four percent of all patients developed ulcerative mucositis. More severe mucositis was seen in patients undergoing chemotherapy and radiation therapy. There was no significant difference between Candida colonization and the presence or severity of mucositis. CONCLUSIONS: Despite systemic and topical antifungal prophylaxis, oropharyngeal colonization by Candida species was common in patients who had received HCT. Candidiasis was commonly present in those who did not survive the early transplant period. Of the 25 patients who died early after the transplantation, 92% had ulcerative mucositis in comparison with 70% of those who survived, reflecting the association of oral mucositis with the toxicity of HCT. There was a significant relationship among allogeneic and autologous HCT, length of stay, and colonization of Candida. In patients undergoing systemic antifungal prophylaxis, chlorhexidine rinse was statistically more effective in reducing colonization by Candida than chlorhexidine and nystatin combined (P =.046). SN - 1079-2104 UR - https://www.unboundmedicine.com/medline/citation/12931087/Oral_candidiasis_in_hematopoietic_cell_transplantation_patients:_an_outcome_based_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1079210403002968 DB - PRIME DP - Unbound Medicine ER -