Oral Oncology Reports (Jun 2023)
Spectrum of chemo-radiotherapy induced fungal infection in head and neck cancer patients at tertiary care centre of Eastern India
Abstract
Background: Cancer management is a dynamically developing field. Chemotherapy and radiation affect the level and duration of immunosuppression in the already immunocompromised cancer hosts, leaving them vulnerable to various opportunistic infections such as fungi, bacteria, viruses and parasites. Mucosal damage to the oral cavity induced by cytotoxic radiotherapy causes hypersecretion of saliva, which in turn can contribute to local invasion by colonizing microorganisms and subsequently lead to systemic infections. The aim of this study to identify the fungal isolates as well as their antifungal susceptibility in patients from undergoing chemo-radiotherapy. Materials and methods: The study was conducted on 188 patients with loco-regionally advanced head and neck cancer, undergoing chemoradiotherapy. Urine, throat swabs and blood were collected from the cancer patients at week 0, week 2 and week 6. These samples were inoculated on duplicate set of Saboraud's Dextrose Agar and incubated at 37 °C and 25 °C for 21 days. Candida species and other yeasts were identified using Germ tube test, Hichrome Agar, Corn Meal Agar and Carbon and Nitrogen assimilation tests. Antifungal susceptibility was done by disc diffusion method. Results: Out of 188 patient specimens, 83 throat swabs and 7 urines were positive for Candida species. In this study candida species didn't isolate in blood cultures specimens. Non-albicans Candida species (28.19%) predominate over Candida albicans (15.95%). Approximately 75.90% of isolates were susceptible to fluconazole and all isolates were susceptible to voriconazole and amphotericin-B. Maximum isolation of yeast occurred during the 6th week of radiotherapy. Conclusion: Oral candidiasis is a common fungal infection in patients with cancer on treatment with chemotherapy and radiotherapy. Candida albicans and non-Candida albicans differ significantly in their antifungal susceptibility pattern. Hence, species level identification in vitro antifungal susceptibility pattern is essential to choose the appropriate antifungal drug and to predict the outcome of therapy.
