Tuberculosis (TB) is a major public health problem worldwide, and particularly in South Africa. Micronutrient deficiency (malnutrition) is caused by insufficient supply of vitamins and minerals for normal cell function in the body. Nutritional deficiencies in minerals, vitamins and diets rich in carbohydrates have been implicated in the pathogenesis of oral candidal infections. Malnutrition and wasting are associated with TB, and HIV/TB co-infection may potentially worsen the wasting that occurs in TB or HIV infection alone. Aim of the study was to investigate the relationship between micronutrient deficiency and Oral Candidiasis (OC) in adult TB patients. The prevalence of OC and its association with malnutrition in terms of Zinc (Zn), Iron (Fe), Albumin, Selenium (Se),Vitamin A (Vit A) and Vitamin D (Vit D) deficiencies were evaluated in a cross sectional study among eighty eight (n=88) TB adult patients. Patients underwent a complete oral examination for presence and type of OC and blood collection was done for serum nutritional assessment for levels of the micronutrients (Zn, Fe, Albumin, Se, Vit A and Vit D). Results: The mean age was 36 years of age, with the majority being females (60%) and HIV positive (69.3%). The prevalence of OC was 60% with pseudomembranous OC (48%) being the most common. Serum concentrations for Zn deficiency (< 8.2 μmol/L) was 69.4%, Vit A deficiency (< 1.05 μmol/L) was 52.3%, Albumin deficiency (< 35 g/L) was 69%, Se deficiency (< 46 μg/L) was 93.2%, Fe deficiency (< 9 μmol/L) was 53.7% and Vit D deficiency (< 49 nmol/L) was 45.1%. OC was prevalent in 40% (Zn deficiency), 25% (Vit A deficiency), 32% (Albumin deficiency), 33% (Se deficiency), 31% (Fe deficiency) and 36% (Vit D deficiency). However, there was no significant association between micronutrient deficiency and OC (p > 0.05). Conclusion: These data demonstrate that OC in TB adult patients is not associated with micronutrient malnutrition. Longitudinal studies are required to investigate the relationship between micronutrient deficiency and OC in adult TB patients further.

Background Oral candidiasis is the most common infection of the oral mucosa of HIV-seropositive patients, although its frequency is rapidly decreasing with the advent of highly active antiretroviral therapy (HAART). Many questions regarding its complex pathogenesis remain unanswered. The diagnosis is usually established with non-invasive techniques such as mucosal smears. Oral lesions of HIV-associated Kaposi sarcoma (HIV-KS) are routinely biopsied and frequently show secondary infection with Candida albicans or other Candida species. Aims and objectives The aim of this investigation was to determine the frequency and histomorphology of secondary Candidal infection of the surface epithelium of oral HIV-associated KS lesions (HIV-KS), which are routinely biopsied in HIV infected patients. Materials and methods Haematoxylin and eosin (HE), and Periodic Acid-Schiff (PAS) stains of 133 cases of oral Kaposi sarcoma diagnosed between the period 2003 and 2007 within the Division of Oral Pathology were examined histologically for intensity and morphology of Candidal colonisation, depth of invasion, number of organisms, epithelial reactions and associated inflammatory response. The depth of Candidal invasion and severity of infection were correlated with the available CD4 T cell counts of HIV seropositive patients at the time of biopsy. Results Almost forty one percent (40.62%) of all oral HIV-KS cases were secondarily infected with Candida species. The intensity varied from an isolated single pseudohyphus to matted colonies of vegetative yeasts and psuedohyphae. Whilst in most cases the organisms did not invade beyond the parakeratin layer, pseudohyphae were noted extending into the stratum spinosum in 2 cases, and a single case showed a pseudohyphus within the lamina propria. A further 2 cases showed pseudohyphae growing in the pyogenic membrane. Neutrophilic permeation of the epithelium and Munro micro-abscess formation, features commonly associated with Candidal infection, were frequently present even in the absence of Candidal infection. Candidal organisms were often present in the absence of inflammation. Conclusion Oral lesions of HIV-KS are commonly secondarily infected with large numbers of Candidal organisms. The morphological characteristics of secondary Candidal infection within the surface epithelium of HIV-KS lesions suggest an altered pathogenetic pathway. Further studies are necessary in this regard.

Thesis (doctoral)--München, 1934.

Thesis (doctoral)--München, 1934.

Introduction The association between tuberculosis (TB) and malnutrition is well known. Malnutrition also weakens the immune system increasing the chance of latent TB progressing to active disease. Nutritional interventions can help improve overall quality of life and can reduce susceptibility to opportunistic infections including all forms of Oral Candidiasis (OC) which includes: (1) pseudomembranous candidiasis (oral thrush), (2) atrophic (erythematous) candidiasis, (3) hyperplastic candidiasis, and (4) angular cheilitis. This secondary data analysis of a longitudinal follow-up study evaluates the impact of a fortified supplementary food on OC among adult TB patients over a three month period. Results At baseline, an overall prevalence of 33% of OC (27 out of 83) was found in 83 adult TB patients; (pseudo-membranous 46% (16 out of 35), erythematous 26% (9 out 35), angular chelitis 20% (7 out 35) and hyperplastic 8% (3 out of 35). Thirty five different types of OC were found in 27 of the subjects some of whom manifested with more than one type of OC. Almost 89% of these TB patients had low levels of malnutrition (8% for selenium, 55% for iron, 62% for Vit-A, 42% for albumin, 47% for Vit-D and 34% for zinc). Their p values related to OC were (p=0.64 for selenium, p=0.74 for iron, p=0.19 for Vit-A, p=1 for albumin, p=1 for Vit-D and p=0.09 for zinc) showing no statistically significant difference for malnutrition in each different type of micronutrient related to OC at baseline. However, there was a statistically significant difference in HIV status (p=0.01) related to OC among factors such as sex (p=0.34), employment status (p=0.74), ARV status (p=0.46) and wellbeing (p=0.18) at baseline. OC was statistically significant at both 2nd and 3rd visits using univariate analysis p=0.04 (95%CI 0.22 to 0.97) and p=0.00 (95%CI 0.06 to 0.43) and also multivariate analysis p=0.01(95%CI 0.17 to 0.85) and p=0.00 (95%CI 0.04 to 0.34) with reference to the 1st visit (the prevalence of OC was significantly decreased in both 2nd and 3rd visits). For different types of clinical OC, pseudomembranous candidiasis was the only type of OC that showed statistically significant difference at the 3rd visit in both univariate analysis (p= 0.01, 95%CI 0.01 to 0.46) and multivariate analysis (p= 0.00, 95%CI 0.01 to 0.38) with reference to 1st visit. Discussion and Conclusions This study found no significant association between overall micronutrient level and the presence of OC at baseline. However, micronutrient interventions to the 83 adult TB patients receiving treatment at Johannesburg city clinics located in Alexandra showed a decrease in prevalence of different types of OC in both 2nd and 3rd visits. This analysis showed encouraging results which indicated a beneficial effect of e’Pap in adult TB patients.

Thesis (Ph. D.)--University of Washington, 2004. / Vita. Includes bibliographical references (leaves 121-133).

Orientador: Wander José da Silva / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-21T22:03:51Z (GMT). No. of bitstreams: 1 Vasconcellos_AndreaAraujode_M.pdf: 2510768 bytes, checksum: 3dde887465d6f0762c3b4b6771c9dd5f (MD5) Previous issue date: 2012 / Resumo: Na cavidade oral, a colonização por Candida albicans em nichos com valores distintos de pH contribui para o desenvolvimento de candidose associada ao uso de prótese. O tratamento dessa infecção tem sido facilitado utilizando-se o fluconazol (FLZ). Entretanto, não está claro se o pH dos biofilmes de C. albicans interfere na susceptibilidade destes ao FLZ. Dessa forma, neste trabalho foi avaliada a influência do pH de biofilmes de C. albicans na susceptibilidade ao FLZ. Testes de susceptibilidade ao FLZ foram realizados em células planctônicas e em biofilmes em três condições de pH (4,0, 5,5 ou 7,0). Testes de concentração inibitória mínima, concentração fungicida mínima e tempo de morte celular foram realizados para avaliar a susceptibilidade ao FLZ de células planctônicas. Para a susceptibilidade de biofilmes, Candida albicans ATCC 90028 foi desenvolvida na superfície de discos de resina a base de poli (metilmetacrilato) por um período de 48 horas. Em seguida, 2,56 ?g/mL de FLZ foram adicionados aos grupos experimentais por 24 horas, e os biofilmes foram analisados quanto à quantificação celular, bioatividade, secreção de proteinases e fosfolipases e parâmetros estruturais, como bio-volume, espessura média e coeficiente de rugosidade. A quantificação celular foi determinada por diluição decimal seriada, e a bioatividade foi avaliada pelo ensaio de XTT. A secreção de enzimas foi determinada por métodos colorimétricos. Microscopia confocal de varredura a laser foi usada para avaliar bio-volume, espessura média e coeficiente de rugosidade dos biofilmes. Todos os dados foram analisados estatisticamente por meio de análise de variância com dois fatores, seguido do teste de Tukey (? = 0,05). Para as células planctônicas, aumento na susceptibilidade ao FLZ foi observado com o valor mais alto de pH. Biofilmes desenvolvidos em pH 5,5 mostraram menor susceptibilidade ao FLZ em relação à quantificação celular (p < 0,05). Células de C. albicans expostas ao FLZ apresentaram menor bioatividade (p < 0,001). Quanto à atividade enzimática, maior produção de proteinase foi observada em biofilmes desenvolvidos em pH 4,0 (p < 0,001), enquanto houve valores aumentados de fosfolipase nos biofilmes desenvolvidos em pH 4,0 e 7,0 (p < 0,05). Considerando os parâmetros estruturais, os biofilmes desenvolvidos em pH 5,5, sem exposição ao FLZ, mostraram maior bio-volume e espessura média (p < 0,05), enquanto os biofilmes expostos ao FLZ mostraram coeficiente maior de rugosidade (p < 0,001). Dentro das condições estudadas, conclui-se que o pH dos biofilmes de C. albicans modula a susceptibilidade destes ao FLZ / Abstract: In the oral cavity, a successful colonization by Candida albicans in sites with different pH values contributes to the development of Candida-associated denture stomatitis. The treatment of this infection has been facilitated using fluconazole (FLZ). However, it is not clear how the pH of C. albicans biofilms can interfere in the susceptibility of FLZ. Therefore, this study evaluated the influence of pH of C. albicans biofilms in the susceptibility to FLZ. Susceptibility tests to FLZ were performed in planktonic cells and biofilms under three different pH values (4.0, 5.5 or 7.0). Minimal inhibitory concentration, minimal fungicidal concentration and time kill tests were used to evaluate the susceptibility in planktonic cells. For biofilms susceptibility, Candida albicans ATCC 90028 was allowed to be developed on poly (methlymethacrylate) resin discs surfaces for a period of 48 hours. Then, 2.56 ?g/mL of FLZ was added to the experimental groups for 24 hours and biofilms were analyzed by cell quantification, bioactivity, secretion of proteinases and phospholipases and structural parameters of bio-volume, average thickness and roughness coefficient. Cell quantification was determined by serial dilution, and bioactivity was evaluated by XTT assay. Secretion of enzymes was determined by colorimetric methods. Confocal microscopy was used to evaluate the bio-volume, average thickness and roughness coefficient of biofilms. All data were statistically analyzed by two?way ANOVA, followed by Tukey test (? = 0.05). For planktonic cells, an increase in susceptibility to FLZ was observed at the highest pH value. Biofilms developed at pH 5.5 showed less susceptibility to FLZ with respect to cell quantification (p < 0.05). C. albicans cells exposed to FLZ showed lower bioactivity (p < 0.001). In relation to enzymatic activity, higher production of proteinase was observed in biofilms developed at pH 4.0 (p < 0.001), whereas there were increased levels of phospholipase in biofilms developed at pH 4.0 and 7.0 (p < 0.05). Considering the structural parameters, the biofilms developed at pH 5.5, without exposure to FLZ, showed higher bio-volume and average thickness (p < 0.05), while the biofilms exposed to FLZ showed higher roughness coefficient (p < 0.001). Within the conditions studied, it can be concluded that pH of Candida albicans biofilms modulates the susceptibility to FLZ / Mestrado / Protese Dental / Mestra em Clínica Odontológica

A candidose bucal acomete grande número de pessoas mundialmente, sendo associada a condições como imunossupressão, radioterapia, tabagismo, higiene bucal, idade, xerostomia e uso de próteses removíveis. Uma importante abordagem terapêutica para essas infecções consiste nos medicamentos antifúngicos, que podem apresentar efeitos colaterais e resultar na resistência dos patógenos. Nesse contexto, a terapia fotodinâmica (PDT) faz-se interessante como alternativa capaz de minimizar essas limitações. Protocolos de PDT poderão ser mais facilmente assimilados à prática clínica se empregarem materiais já aprovados para uso odontológico. Sendo assim, este estudo propõe avaliar o uso de PDT com eritrosina como fotossensibilizador, irradiada por um LED azul, usando-se um modelo animal. Quarenta camundongos tiveram candidose induzida sobre o dorso da língua por meio de imunossupressão e inoculação com Candida albicans. Após estabelecimento da lesão durante cinco dias, os animais receberam um dentre quatro tratamentos possíveis: aplicação da eritrosina 5% seguida de irradiação pelo LED (E+L+); aplicação de eritrosina, somente (E+L-); salina seguida pela irradiação (EL+); e somente salina (E-L-). A fim de distinguir possíveis efeitos colaterais, os mesmos tratamentos foram aplicados em 12 camundongos sem a indução de candidose. O número de unidades formadoras de colônia de C. albicans foi contado após o tratamento, e a mucosa foi submetida à análise histológica para determinar o grau de inflamação. Os dados dos grupos foram comparados por meio de ANOVA e teste de Kruskal-Wallis, (&alpha;=0,05). Não foram detectadas diferenças significativas entre os grupos testados quanto à contagem de colônias de C. albicans e o grau de inflamação. O infiltrado inflamatório foi classificado como discreto na maioria dos casos. Os animais com candidose bucal induzida e os saudáveis que foram submetidos aplicação de eritrosina 5% e irradiação pelo LED apresentaram infiltrado inflamatório mais acentuado e lesões mais evidentes na camada epitelial, sugerindo que este protocolo ocasionou danos aos tecidos orais. / Oral candidosis affects many people worldwide and is associated with conditions such as immunosuppression, radiation, smoking, oral hygiene, age, xerostomia and use of removable prostheses. An important therapeutic approach for these infections consists of antifungal drugs, which have side effects and can result in the resistance of pathogens. In this context, photodynamic therapy (PDT) is an interesting alternative able to overcome those limitations. PDT protocols can be more easily assimilated in clinical practice if they employ materials already approved for use in dentistry. Thus, this study evaluate the PDT with the use of erythrosine as a photosensitizer, irradiated by a blue LED light, using an animal model. Forty mice had candidosis induced on the tongue by the immunosuppression and inoculation with Candida albicans. After five days that the lesion is established, the animals received one of four possible treatments: application of 5% erythrosine and irradiation by the LED (E+L+); erythrosine application, only (E+L- ); saline followed by irradiation (E-L+); and only saline (E-L-). In order to distinguish potential side effects, the same treatments were applied in 12 mice without induced candidosis. Colony-forming units (CFU) of C. albicans were counted after treatment, and the mucosa was subjected to histological analysis to determine the degree of inflammation. The data of the groups were compared using ANOVA and Kruskal-Wallis test (&alpha;=0.05). No significant difference was detected among the groups tested for the number of CFU of C. albicans and the degree of inflammation. The inflammatory infiltrate was classified as mild in most cases. Animals with induced oral candidosis and the healthy ones exhibited more pronounced inflammatory infiltrate and lesions in the epithelial layer following PDT by 5% erythrosine and irradiation by the LED light. Such findings suggest that this protocol resulted in damage to oral tissues.

A candidose bucal acomete grande número de pessoas mundialmente, sendo associada a condições como imunossupressão, radioterapia, tabagismo, higiene bucal, idade, xerostomia e uso de próteses removíveis. Uma importante abordagem terapêutica para essas infecções consiste nos medicamentos antifúngicos, que podem apresentar efeitos colaterais e resultar na resistência dos patógenos. Nesse contexto, a terapia fotodinâmica (PDT) faz-se interessante como alternativa capaz de minimizar essas limitações. Protocolos de PDT poderão ser mais facilmente assimilados à prática clínica se empregarem materiais já aprovados para uso odontológico. Sendo assim, este estudo propõe avaliar o uso de PDT com eritrosina como fotossensibilizador, irradiada por um LED azul, usando-se um modelo animal. Quarenta camundongos tiveram candidose induzida sobre o dorso da língua por meio de imunossupressão e inoculação com Candida albicans. Após estabelecimento da lesão durante cinco dias, os animais receberam um dentre quatro tratamentos possíveis: aplicação da eritrosina 5% seguida de irradiação pelo LED (E+L+); aplicação de eritrosina, somente (E+L-); salina seguida pela irradiação (EL+); e somente salina (E-L-). A fim de distinguir possíveis efeitos colaterais, os mesmos tratamentos foram aplicados em 12 camundongos sem a indução de candidose. O número de unidades formadoras de colônia de C. albicans foi contado após o tratamento, e a mucosa foi submetida à análise histológica para determinar o grau de inflamação. Os dados dos grupos foram comparados por meio de ANOVA e teste de Kruskal-Wallis, (&alpha;=0,05). Não foram detectadas diferenças significativas entre os grupos testados quanto à contagem de colônias de C. albicans e o grau de inflamação. O infiltrado inflamatório foi classificado como discreto na maioria dos casos. Os animais com candidose bucal induzida e os saudáveis que foram submetidos aplicação de eritrosina 5% e irradiação pelo LED apresentaram infiltrado inflamatório mais acentuado e lesões mais evidentes na camada epitelial, sugerindo que este protocolo ocasionou danos aos tecidos orais. / Oral candidosis affects many people worldwide and is associated with conditions such as immunosuppression, radiation, smoking, oral hygiene, age, xerostomia and use of removable prostheses. An important therapeutic approach for these infections consists of antifungal drugs, which have side effects and can result in the resistance of pathogens. In this context, photodynamic therapy (PDT) is an interesting alternative able to overcome those limitations. PDT protocols can be more easily assimilated in clinical practice if they employ materials already approved for use in dentistry. Thus, this study evaluate the PDT with the use of erythrosine as a photosensitizer, irradiated by a blue LED light, using an animal model. Forty mice had candidosis induced on the tongue by the immunosuppression and inoculation with Candida albicans. After five days that the lesion is established, the animals received one of four possible treatments: application of 5% erythrosine and irradiation by the LED (E+L+); erythrosine application, only (E+L- ); saline followed by irradiation (E-L+); and only saline (E-L-). In order to distinguish potential side effects, the same treatments were applied in 12 mice without induced candidosis. Colony-forming units (CFU) of C. albicans were counted after treatment, and the mucosa was subjected to histological analysis to determine the degree of inflammation. The data of the groups were compared using ANOVA and Kruskal-Wallis test (&alpha;=0.05). No significant difference was detected among the groups tested for the number of CFU of C. albicans and the degree of inflammation. The inflammatory infiltrate was classified as mild in most cases. Animals with induced oral candidosis and the healthy ones exhibited more pronounced inflammatory infiltrate and lesions in the epithelial layer following PDT by 5% erythrosine and irradiation by the LED light. Such findings suggest that this protocol resulted in damage to oral tissues.