Esther Goldenberg Birman

Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of Candida species.

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.

Oral yeasts in patients with cancer of the mouth, before and during radiotherapy

The yeasts of patients with oral cancer has been studied before and during Xr-therapy. Gram and PAS smears revealed an increase of yeast-like structures, during treatment, from 56% to 66% of the cases. Before radiotherapy oral yeasts were isolated from 56% of the patients with cancer represented by Candida albicans (30%); C. tropicalis (12%); C. glabrata and C. krusei (4%), besides six other different species (2%). During radiotherapy yeasts were isolated in 72% of the cases, as follow: C. albicans (36%); C. tropicalis (16%); Rhodotorula rubra (6%); C. kefyr; C. krusei and Pichia farinosa (4%), besides other nine species (2%). C. albicans serotype A represented 93% of the isolated samples, before treatment and 88,8% during Xr-therapy.

Yeasts from the oral cavity of children with AIDS: exoenzyme production and antifungal resistance

The oral fungal microbiota of 30 children with AIDS, of both genders, aged from two to six years, receiving outpatient treatment, was evaluated and compared with that of a control group composed of 30 healthy subjects with matching ages and genders. Virulence factors, such as exoenzyme production, and susceptibility to five antifungal agents using an E-Test kit were evaluated. C. albicans predominated over other species in the AIDS group, showing a higher production of proteinase and phospholipase when compared with that observed in the control group. In this study few clinical manifestations of and low selectivity for C. albicans (23.3%) were observed in the AIDS group. The enzymatic studies showed that 53.8% of the AIDS strains were strongly positive whereas only 33.3% of the non-AIDS strains were positive. Amphotericin B was the most effective drug among the antifungal agents tested against C. albicans. The frequency, selectivity and level of exoenzyme production by C. albicans suggest a higher pathogenicity in the AIDS children than in the control children.

Suscetibilidade a antifungicos de cepas de Candida albicans isoladas de pacientes com estomatite protetica

Users of total prosthesis present in general a high frequency of the so called denture stomatitis, associated to erythematous candidiasis. So, we evaluated the susceptibility of oral yeast to three antifungal agents. Strains of Candida albicans isolated from patients with denture stomatitis were evaluated in relation to the susceptibility of the antifungal drugs as amphotericin B (polyenic derivatives), and azole agents as ketoconazole and miconazole. The antifungal activity was evaluated, and the minimal inhibitory concentration (MIC) and minimal fungicide concentration (MFC) were determined utilizing the agar dilution method. The results demonstrated low values for MICs and MFCs (0.15 mg/ml) for AmB in face of all yeast present. For miconazole and ketoconazole, MICs were invariably £ 4.00 mg/ml, while values of the MFC were ³ 16.00 mg/ml for the majority of the strains. We could conclude that AmB presented a major fungicidal action in vitro, while azoles demonstrated a fungistatic but not fungicidal profile. So, we can consider that new drugs, mainly topical ones, are needed to treat lesions related to denture stomatitis, so commonly observed in wearers of dental prostheses.

Oral manifestations in children with AIDS and in controls

Thirty children with AIDS, aging 2 to 6 years, of both genders, treated as outpatients at the hospital Santa Casa de Misericórdia, São Paulo, were evaluated for oral manifestations and compared to a control group of age- and sex-matched healthy subjects. The correlation between oral lesions and the degree of immunosuppression was analyzed. The most prevalent oral manifestations--lymphadenopathy, followed by gingival alterations--were observed in the children with the highest levels of immunosuppression. Other manifestations observed in the AIDS group were: pseudomembranous and erythematous candidosis, enlargement of the parotids and ulcers. The results did not indicate a higher frequency of lesions. However, the observed oral manifestations had an early occurrence, which indicates that the early diagnosis is an important component in the management of those patients.

Avaliação da estomatite protética em portadores de próteses totais

As proteses muco-suportadas sao consideradas facilitadoras em potencial da estomatite protetica (EP), lesao comumente observada sob a base das proteses, caracterizada por aspectos eritematosos difusos ou pontilhados na mucosa de suporte. Sua etiologia e controversa, podendo estar relacionada principalmente a fatores locais. Diversos aspectos funcionais associam-se a estes fatores representados pela oclusao, dimensao vertical, retencao, estabilidade dinâmica e estatica alem de aspectos qualitativos relacionados as condicoes encontradas no desdentado. Foram levados em consideracao o periodo de edentulismo, numero e tempo de uso das proteses, uso continuo, conservacao, presenca de placa e higiene bucal. Os fatores foram avaliados, visando esclarecer a possivel relacao dos aspectos funcionais e proteticos com a EP. Exame clinico foi realizado em 116 pacientes de ambos os sexos, desdentados bimaxilares, que utilizavam as duas proteses muco-suportadas, portadores ou nao de estomatite protetica (EP). Os resultados indicaram que a maioria dos pacientes examinados tinha EP frente ao menor numero de pacientes sem EP, havendo nos dois grupos equivalencia nos resultados da avaliacao clinica e protetica. Os fatores funcionais e qualitativos das proteses, avaliados isoladamente, nao puderam ser considerados responsaveis pela ocorrencia dessa patologia, constatando-se que um unico fator protetico nao demonstrou, de per si, ser responsavel pela presenca da EP, embora possa ser um facilitador para o seu desenvolvimento.

Freqüência e atividade enzimática (proteinase e fosfolipase) de Candida albicans de pacientes desdentados totais, com e sem estomatite protética

A Estomatite Protetica (EP) e frequentemente observada em pacientes portadores de protese total, sendo a presenca de fungos considerada um importante fator para o seu aparecimento. Baseado neste fato, avaliamos pacientes edentulos com e sem estomatite protetica, identificando os fungos presentes, e os niveis de proteinase e fosfolipase produzidos por Candida albicans. Os resultados mostraram que C. albicans foi a especie mais frequente, prevalecendo em pacientes com EP. Todas as cepas de C. albicans isoladas foram fortemente positivas para proteinase, diferentemente da atividade de fosfolipase.

Candida isolated from vaginal mucosa of mothers and oral mucosa of neonates : Occurrence and biotypes concordance

Background: The common occurrence of Candida spp. on the vaginal mucosa of pregnant women suggests this as the source of neonatal candidiasis. Methods: This study investigated the occurrence of yeasts on the vaginal mucosa of 100 mothers at the time of birth, and on the oral mucosa of their respective neonates, all full-term, on the 1st, 3rd, and 9th days after birth by vaginal (72 cases) and cesarean (28 cases) routes. In each case where concordance at the level of species was found between the isolate from the mother and that from the neonate, tests were made to check for concordance between the genotypic and phenotypic profiles (susceptibility to killer toxins, serotyping, proteinase and phospholipase production, and susceptibility to antifungal agents). Results: For the vaginal-route group, yeasts were recovered from the vaginal mucosa of 47.2% of the mothers and from 25% of the neonates. For the cesarean-route group, these rates were 46.4% and 3.6%, respectively. Species found most frequently in the samples from the mothers and the neonates were, respectively C. albicans and C. guilliermondii. For the vaginal-route group, the rate of mother/neonate concordance at the level of species was 23.5% and no cases of concordance for the cesarean births. Of these cases with species concordance, there was concordance between the genotypic and phenotypic profiles in 6% (2 cases). Conclusion: The vaginal mucosa was not the main route of transmission of the Candida species to the neonate, because there was concordance between the genotypic and phenotypic profiles in only 6% (2 cases).

Experimental paracoccidioidomycosis in high and low antibody-producer mice: I.—Evolution of the disease, its correlation with the humoral immune response and the patterns of tissue lesions

High (H) and low (L) responder mice selected for their capacity to produce antibody against flagellar antigens of Salmonellae sp. were infected i.p. with 10(6) L forms of Paracoccidioides brasiliensis, strain 18. In H mice, the mortality ratio was 50%; the splenic index was high at the onset of infection (1.0), decreasing to normal levels after 30 days (0.45), with antibody titres such as 4-5 log2. In L mice, the mortality was 87.5%, the splenic index was above 0.6 and the antibody titres after 30 days were below 2 log2. In L mice, granulomas containing a high number of fungi, epithelioid cells, macrophages and a few polymorphonuclear cells were found. In H mice, focal or diffuse infiltrate of mononuclear cells with few or even the absence of fungi was seen. The passive transfer of immune ascitic fluid to L mice induced a reduction in the number of granulomas and fungi in the lesions.

Erythematous candidosis in patients with complete dentures and HIV+/AIDS.

This investigation was designed to evaluate the frequency of erythematous candidosis (EC) and Candida species, proteinase and phospholipase exoenzyme production, and to compare clinical features in patients with complete dentures and HIV+/Acquired Immunodeficiency Disease Syndrome (AIDS). Fifty‐one patients were selected from a total of 285 with EC: denture wearers (n = 30) and HIV+/AIDS (n = 21). The yeast prevalence and the production of exoenzymes, such as proteinase and phospholipase by Candida species were evaluated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS–PAGE) electrophoresis. The frequency of Candida albicans was significantly higher (P < 0.05) in both groups although other yeast species (Candida glabrata, Candida krusei, Candida parapsilosis, Candida guilliermondi and Candida tropicalis) were also found. Candida albicans showed greater levels of proteinase production in the denture wearers, when compared with the HIV+/AIDS group. There was no difference between groups with regard to phospholipase production. The protein bands presented similar molecular weights, showing the presence of proteinases in both groups. It could be concluded that the clinical manifestation of EC may be related to its proteinase production capacity. Combination therapies using proteinase inhibitors play an important role in inhibiting exoenzyme production by Candida species, mainly C. albicans.