Identificação de espécies de candida na cavidade bucal e susceptibilidade antifúngica em pacientes irradiados em região de cabeça e pescoço e portadores de prótese removível

• Ano de defesa: 2012
• Autor(a) principal: Mara Cristina Lopes Amorim
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Candida; Antifúngicos uso terapêutico; Antimicóticos Tratamento; Cândida; Antifúngicos/uso terapêutico; Neoplasias de cabeça e pescoço/radioterapia; Estomatologia; Candida Albicans; Prótese dentária parcial removível; Reação em cadeia da polimerase; Odontologia; Reação em cadeia de polimerase
• Link de acesso: http://hdl.handle.net/1843/ZMRO-8XKJ8R

Candidiasis is the most common oral fungal infection in humans and includes a variety of clinical features. Being mainly caused by the fungus Candida albicans, it is considered an opportunistic infection, affecting mainly people who are debilitated by other diseases. Advances in medicine have led to prolonged survival of immunocompromised patients, such as those patients irradiated for head and neck neoplasias. Thus, there was an increased importance of infectious diseases caused by fungi. The denture stomatitis and denture stomatitis is defined as an inflammation of a mucosa underlying a denture. The antifungal agents used for the treatment of candidiasis are particularly toxic to human cells and use of such drugs must comply with strict criteria, to minimize the possibility of resistance of the microorganisms. BiocheCIMal tests for the detection of candida species and to test the resistance of microorganismaos to antifungals such as Candifast®, have proven useful, practical and effective, as well as molecular techniques such as Polymerase Chain Reaction (PCR). The PCR technique has the ability to amplify a precise sequence of DNA in a simplified manner, with high sensitivity and specificity. our objectives were to identify the species of candida in patients irradiated in the head and neck malignancies that present (Group 1) and in patients who use removable dental prosthesis (Group 2), using the Candifast® kit, CHROMagar® Candida and PCR EI1, comparing these methods, to evaluate the susceptibility of Candida species collected from two groups of patients to antifungal agents present Candifast® kit, and compare this with the MIC (Minimal Inhibitory Concentration), a susceptibility microdilution method. 15 patients in Group 1 and 12 patients in Group 2 were studied. The pseudomembranous clinical candidosis was more prevalent in Group 1, while the denture stomatitis was the most frequent clinical form in Group 2. In Group 1, the Candifast® kit identified 38.8% of C. albicans, 38.8% C. tropicalis, 5.5% C. krusei, 5.5% C. lusitaniae, 5.5% C. parapsilosis and 5.5% C. glabrata. For Group 2, Candifast® identified 100% of samples with C. albicans. Considering the CHROMagar® Candida, in group 1, 9 samples (33.3%) were identified as C. albicans, 14 (51.9%) as C. tropicalis, and 2 (7.4%) as C. krusei. Two samples (7.4%) were not identified because they had other colors (white and beige), not described by the manufacturer. Compared to Group 2 of the 25 isolates CHROMagar® (60%) were identified as C. albicans, (16%) as C. tropicalis, (8%) as C. krusei; (12%) were not identified. PCR (EI1 and NLI/NL4) identified in Group 1 as C. albicans (37.1%), as C. tropicalis (55%), (7.4%) as C. krusei. In Group 2 PCR allowed the identification of 68% C. albicans, 20% as C. tropicalis, 8% as C. glabrata and 4% C. parapsilosis. Regarding the antifungal susceptibility profile, most isolates were sensitive to six antifungal agents tested in CIM technique (amphotericin B, ketoconazole, fluconazole, itraconazole, miconazole and nystatin). In Group 1 isolates C. tropicalis proved more resistant to fluconazole (33%), while C. albicans showed greater resistance to miconazole. 100% of the strains identified as C. krusei were resistant to fluconazole. In group 2, among the tested antifungals, fluconazole was the one that showed a higher degree of resistance of C. albicans and C. tropicalis. The antifungal drug nystatin was better with the susceptibility profile, at the time when all isolates were sensitive to it. The endurance Candifast® kit showed higher resistance rates of isolates compared to the MIC. Almost 100% of the isolates were resistant to miconazole in Group 1 and Group 2, 64.2% were resistant to miconazole and fluconazole. Thus, this kit was flawed in the identification of several Candida species, as compared with the method used for molecular identification (PCR). There was great divergence in theoutcome. CHROMagar® Candida was a good method for the presumptive identification of Candida species. The drug nystatin can be used as first choice for treatment of oral candidosis in patients irradiated in the head and neck in patients with prosthesis.