Investigating the Prevalence and Virulence Factors of Oral Candidiasis in Neonates
DOI:
https://doi.org/10.36320/ajb/v17.i1.18640Keywords:
oral infants, candida species, virulence factorsAbstract
Abstract
Background: A thrush is an oral yeast infection caused by the fungal pathogen Candida albicans. Oral thrush predominantly occurs in newborns and is typically not a dangerous problem on its own. Fifty percent of the population harbours candida in their oral cavities. Under typical conditions, Candida albicans is regulated by microorganisms.
Objective: The objective is to ascertain the epidemiological agents of newborn oral candidiasis and to isolate and identify Candida spp. from the oral cavities of infants at Raparin Teaching Hospital in Erbil Province using standard laboratory procedures. Additionally, to identify the virulence factors of Candida spp., including protease and hemolysis, which play a significant role of the pathophysiology of disorders of the mouth.
Patients and methods: The study comprised 65 newborns exhibiting oral lesions who were enrolled in the Medical Care and Consulting Clinic of Raparin Teaching Hospitals, as well as the Neonatal Care Unit of Erbil Maternity Teaching Hospital. Samples gathered between February 2024 and April 2024. The control group consisted of 30 ostensibly children in good health who provided mouth swabs for collection. Biochemical assay, culture, and direct inspection were used to identify the isolated yeasts. API – 20 C system and the Vitek II, subsequently assessing protease activity and hemolysis in Candida species obtained from oral lesions.
Results: The results of the present study indicated that over 62.07% of participants were male, and more than half of the instances occurred within the first three months of age. Approximately 59% of cases involve mothers with a low level of education, specifically at the primary level. It has been demonstrated that 46.55% of infants are delivered via cesarean section. About 58.62% of the mothers had a history of birth canal infections. 43.10% of neonatal patients were artificially fed. The fungal isolates in the current study exhibited a range of virulence factors. Hemolysin and protease production were observed in C. albicans at rates of 12 (100%) and 9 (75%), respectively, while C. glabrata exhibited hemolysin production at 1 (50%) and protease production at 1 (50%). Additionally, C. parapsilosis isolates generated both protease and hemolysin. C. krusei produced just hemolysin 1 (100%).
Conclusions: The oral lesions revealed the presence of Candida albicans and other yeasts. and additional causes, demonstrating the infection was spread to and from the afflicted children. Proteinase and hemolysin, two crucial virulence factors, are produced by the isolates in Candida albicans much more frequently than in other yeasts.
Downloads
References
References
1. Wilkins E.G.L.. HIV infection and Aids. In : Colledge N R , Walker BR, Ralston SH. Davidsons Practice of Medicine , London, Churchill Living Stone; 2010 : p 384-407.
2. Frobes BA, Sahm DF, weissfeld A.S. Baily & Scotts Diagnostic Microbiology (12 ed.), China, MOSBY ELSEVIER 2007;629-716
3. Kumar M. Thrush. 2017. Available in: http://emedicine.medscape.com/article/969147-overview#a4
4. Kraft S. Oral Thrush In Babies: Causes, Symptoms and Treatments.2016, available in :http://www.medicalnewstoday.com/articles/179069. php?page=2.
5. Weiss M., Arnoff S.C. Mycotic Infection. In : Behrman R.E.,Kliegman R.M.,Jenson H.B. Nelson Textbook of Pediatrics, London, W.B.Saunders Company;2000; p 932-937.
6. Borges RM, Soares LR, de Brito CS, de Brito DV, Abdallah VO, Filho PP: Risk factors associated with colonization by Candida spp in neonates hospitalized in a Neonatal Intensive Care Unit in Brazil. Rev Soc Bras Med Trop. 2009, 42 (4): 431-5.
7. Singhi S, Rao R, Chakrabarti A: Candida colonization and candedemia in a pediatric intensive care unit, Pediatric. Crit Care Med. 2008, 9 (1): 91-95.
8. Kaufman DA, Manzoni P. Perinatal fungal and protozoal infections. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine Diseases of the Fetus and Infant. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 56.
9. Lee GE, Kaufman DA, Zaoutis TE. Candidiasis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 199.
10. Melkoumov A, Goupil M, Louhichi F, Raymond M, de Repentigny L, Leclair G. Nystatin nanosizing enhances in vitro and in vivo antifungal activity against Candida albicans. J .Antimicrob Chemother. 2013;68(9):2099–2105
11. Baley J. E. Neonatal candidiasis: The current challenge. Clinics in Perinatology, (1991)18(2):, 263–280
12. Ben Abdeljelil J, Saghrouni S, Nouri S, Geith I, Khammari A, Fathallah H, et al. Neonatal invasive candidiasis in Tunisian hospital: incidence, risk factors, distribution of species and antifungal susceptibility. Mycoses. 2012;55(6):493–500.
13. Koneman, E.W.; and Roberts, G.D.; 1985. Practical Mycology, 3rd ed Baltimore, MD Williams and Wilkins.
14. Bensadoun R-J. Patton LL, Lalla RV, et al. Oropharyngeal Candidiasis in head and neck cancer patients treated with radiation. Support Care Cancer 2011;19:737-44.
15. Scully C, el- Kabir M, Samaranayaka LP . Candida and oral candidosis: a review. Crit Rev oral Boil Med 1994;5:125-27.
16. Koneman, E.W.; and Roberts, G.D.; 1985. Practical Mycology, 3rd ed Baltimore, MD Williams and Wilkins
17. Ellis, D.H. 1994.Clinical microbiology. The human opportunistic mycosis. Gillingham. Printters pty. Ltd, Australia. P:166.
18. Marsh, P. D. and Martin, M. 2009. Oral fungal infections in Or Microbial. Churchill Livingstone, Edinburgh, U. K. pp.166- 179.
19. Manns JM, Mosser DM, Buckley HR. (1994) Production of a Hemolytic Factor by Candida albicans. Infect Immun. 62;5154-6.
20. Ellis, D.; Stephan, D.; Helen, A.; Rosemary, H. and Roben, B .2007. Description of Medical Fungi. 2nd ed. Ltd. Australia, PP: 147 –15.
21. Aoki S, Ito-Kuwa S, Nakamura Y, Masuhara T. (1990) Comparative pathogenicity of wild-type strains and respiratory mutants of Candida albicans in mice. Bio Sci. 273: 332-343.
22. Seebacher, C.; Bouchara, J. P., and Mignon, B. (2008). Updates on the epidemiology of dermatophyte infections. Mycopathologia, 166(5-6), 335352.
23. Nneka UC and Ebele OM . The occurrence of oral thrush yeasts among school children in Onitsha Urban, Anambra State, Nigeria. J Med Sci 2005;5(3):177-80.
24. Samaranayake LP, Lamey PJ (1988) Oral candidosis: Clinicopathological aspects. Dent Update 15: 227-228, 230-1.
25. Gupta P., Faridi M.M.A., Rawal S., Sharma P. Clinical profile and risk factors for oral candidiasis in sick newborns. Indian ped.(33)-1996-p299-303
26. Issa SY, Badran EF,Aki KF, Shehabi AA. Epidemiological characteristics of Candida species colonization oral and rectal sites of Jordanian infants, BMC pediatrics 2011:77
27. Kumar M. Thrush. 2017. Available in : http://emedicine.medscape.com/article/969147-overview#a4
28. Seebacher, C.; Bouchara, J. P., and Mignon, B.. Updates on the epidemiology of dermatophyte infections. Mycopathologia.(2008); 253533,(5-6);661.
29. Sardi, J. C.; Duque, C.; Höfling, J. F., and Gonçalves, R. B. Genetic and phenotypic evaluation of Candida albicans strains isolated from subgingival biofilm of diabetic patients with chronic periodontitis. Sabouraudia, (2012). 50(5): 467-475.
30. Yehia MM, Ali HYM, Al– Jammas MA. Oral candidiasis (Thrush) in debilitated children in north Iraq. J Bah Med Society 2004;16(1):28-31.
31. Kaufman DA, Manzoni P. Perinatal fungal and protozoal infections. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine Diseases of the Fetus and Infant. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 56.
32. Lee GE, Kaufman DA, Zaoutis TE. Candidiasis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 199.
33. Gupta P., Faridi M.M.A., Rawal S., Sharma P. Clinical profile and risk factors for oral candidiasis in sick newborns. Indian ped.(33)-1996-p299-303
34. Nneka UC and Ebele OM . The occurrence of oral thrush yeasts among school children in Onitsha Urban, Anambra State, Nigeria. J Med Sci 2005;5(3):177-80.
35. Yehia MM, Ali HYM, Al– Jammas MA. Oral candidiasis (Thrush) in debilitated children in north Iraq. J Bah Med Society 2004;16(1):28-31.
36. Gupta P , Faridi MMA , Rawat S, et al. Clinical profile and risk factors for oral candidiasis in sick newborns. Ind Ped 1996; 33:299- 03.
37. Johnstone HA, Marcinak JF. Candidiasis in breast feeding mother and infant. J Obstet Gynecol Neonatal Nurs 1990;19:171-73.
38. Chetty GN, Selvi GS, Kamalan A, et al. Candidiasis in mother and child. Mykosen 1980;23:580-82.
39. Brent NB. Thrush in the breast feeding dyad : results of a survey on diagnosis and treatment. Clin Pediatr 2001;40:503-06.
40. Grimm III SE, Lawrence L, Bailey J, et al. Oral thrush in a one – month – old infant: etiology and treatment. Academy of General Dentistry 2011;114(1):1-5.
41. Mohandas V, Ballal M. Distribution of Candida species in different clinical samples and their virulence: Biofilm formation, proteinase and phospholipase production: a study on hospitalized patients in Southern India. J of Global Infectious Diseases 2011;3(1):4-8.
42. Castilho SD, Rocha MA. Pacifier habit: history and multidisciplinary view. J Pediatr 2009;85(6): 480-89.
43. Belazi M, Velegraki A, Koussidou- Eremondi T, et al. Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azoles susceptibility profiles and response to antifungal treatment. Oral Microbiol Immunol 2004; 19:347.
44. Li L, Redding S, Dongari– Bagtzoglou A. Candida glabrata, an emerging oral opportunistic pathogen. J Dent Res 2007; 86:204.
45. Tomee JFC and Kauffman HF. Putative virulence factors of Aspergillus fumigates. Clin Exp Allergy 2000; 30: 476-84.
46. Ge YP, Lu GX, Shen YN, et al. In vitro evaluation of phospholipase, proteinase, and esterase activities of Candida parapsilosis and Candida metapsilosis. Mycopathologia 2011; 172: 429- 38.
47. Kantarcioglu AS and Yucel A. Phospholipase and protease activities in clinical candida isolates with reference to the sources of strains. Mycoses 2002; 45: 160-5.
48. De Bernardis F, Mondello F, San Milan R, Ponton J, Cassone A. (1999) Biotyping and virulence properties of skin isolates of Candida parapsilosis. J Clin Microbiol, 37:3481-86.
49. Yamamoto T, Nohara K, Uchida K, Yamaguchi K.Purification (1992). characterization of secretory proteinase of Candida albicans. Microbiol Immuno, 36: 637- 41.
50. Ramesh N, Priyadharsini M, Sumathi CS, Balasubramanian V, Hemapriya J, Kannan R. (2011) Virulence factors and anti-fungal sensitivity pattern of Candida sp. isolated from HIV and TB patients. Indian J Microbiol. 51(3):273-8.
51. Rossoni RD, Barbosa JO, Vilela SFG, Jorge AOC, Junqueira JC . (2013) Comparison of the hemolytic activity between C. albicans and non-albicans Candida species, J Clin Microbiol, 27(6):484-9 485.
52. Luo, G., Samaranayake, L. P. & Yau, J. Y. Y. (2001). Candida species exhibit differential in vitro hemolytic activities. J Clin Microbiol 39, 2971–2974.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 sheylan abdullah
This work is licensed under a Creative Commons Attribution 4.0 International License.
which allows users to copy, create extracts, abstracts, and new works from the Article, alter and revise the Article, and make commercial use of the Article (including reuse and/or resale of the Article by commercial entities), provided the user gives appropriate credit (with a link to the formal publication through the relevant DOI), provides a link to the license, indicates if changes were made and the licensor is not represented as endorsing the use made of the work.
